This prospective study followed 87 children from birth to 14 months to examine the impact of maternal vitamin D status during pregnancy on the children's bone growth. The children were divided into two groups based on their mother's vitamin D status during pregnancy. While postnatal vitamin D supplementation improved status in both groups, it only partly eliminated differences in bone variables induced during fetal development. Children in the lower prenatal vitamin D group had lower bone mineral content at birth but greater gains, resulting in similar levels at 14 months. Those in the higher prenatal group had a larger bone area at birth, and this difference persisted. Maternal vitamin D status during pregnancy thus influenced long-term bone development in offspring.
Lecture held at the 4th Evidence-Based Neonatology conference, Nov 12 2017, in Hyderabad, India.
The lecture gives a short overview of the "fetal programming" theory, also referred to as the Developmental Origin of Health and Disease (DOHaD).
This document summarizes several studies on factors related to bronchopulmonary dysplasia (BPD) in preterm infants. One study found that maternal smoking during pregnancy doubled the odds of BPD in infants, and was also associated with prolonged ventilation and late respiratory disease. Another study found that endothelial cell dysfunction in umbilical vein cells was associated with BPD or death in extremely preterm infants. A third study found that infants treated with caffeine in the neonatal period had better lung function at 11 years of age compared to placebo, mediated by caffeine's ability to reduce rates of BPD.
Global Health Crises Caused By The Collision Of Biological And Cultural Evolu...Global Risk Forum GRFDavos
This document discusses global health crises caused by the collision of biological and cultural evolution. It notes that the human biological genome is becoming stressed by rapid changes in cultural evolution and modern diets. Currently, limited healthcare resources focus on "crisis medicine" to treat chronic diseases like diabetes and heart disease that result from poor nutrition. However, the document proposes that preventing harmful prenatal exposures during the pregnancies of the 3 billion babies expected by 2100 could reduce risks of diseases later in life, based on the Barker Hypothesis that prenatal environments can influence later health. It advocates shifting resources from crisis to preventive medicine by educating parents on healthy diets during pregnancy and development.
The document presents guidelines from the European Respiratory Society on diagnosing and managing obstructive sleep disordered breathing in children aged 1-23 months. It recommends a stepwise approach beginning with identifying symptoms and risk factors, followed by objective sleep studies to determine severity if indicated. Treatment may include adenotonsillectomy, continuous positive airway pressure, or interventions for specific conditions causing airway obstruction. Management requires a multidisciplinary approach and treatment of all contributing factors to reduce upper airway obstruction during sleep.
The document discusses the developmental origins of health and disease theory proposed by Barker, which links poor fetal and early life nutrition to increased risk of chronic diseases like heart disease and diabetes later in life. Barker observed correlations between low birth weights in the 1920s and higher heart disease rates decades later. His theory proposes that the fetus adapts to inadequate nutrition by diverting resources from organs like the heart to the brain, with health consequences appearing later. Subsequent studies found links between small fetal size and later health issues. The theory suggests these effects may be passed on to later generations through epigenetic changes and fetal programming of gene expression.
Oral presentation given at the jENS conference Nov 3, 2017, in Venice/Italy.
The presentation is a short summary of a project on maternal overweight and obesity and how that relates to offspring risk of cerebral palsy.
The study was published in in JAMA in 2017, where it is available as open access on https://jamanetwork.com/journals/jama/fullarticle/2608220
Infant Feeding And Feeding Transitions During The First Year Of LifeBiblioteca Virtual
This document summarizes infant feeding patterns during the first year of life based on data from the Infant Feeding Practices Study II. Key findings include:
1) While 83% of infants were breastfed in the hospital, 42% of these infants also received formula supplementation. By 3 months, 61% of infants received formula.
2) Solid foods were introduced earlier than recommended, with 40% of infants consuming cereal and 17% consuming fruits/vegetables by 4 months of age.
3) Early introduction of solids was associated with discontinuing breastfeeding earlier and consuming more fatty/sugary foods by 12 months.
Oral probiotics reduce the incidence and severity of necrotizingmarlonluisf
This study evaluated the effectiveness of probiotics in reducing necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. 367 VLBW infants were randomly assigned to receive breast milk with the probiotics Lactobacillus acidophilus and Bifidobacterium infantis or breast milk alone. The probiotic group had a significantly lower incidence of NEC and death compared to the control group. No adverse effects from the probiotics were observed. The probiotics were effective in reducing the incidence and severity of NEC in VLBW infants when administered with breast milk.
Lecture held at the 4th Evidence-Based Neonatology conference, Nov 12 2017, in Hyderabad, India.
The lecture gives a short overview of the "fetal programming" theory, also referred to as the Developmental Origin of Health and Disease (DOHaD).
This document summarizes several studies on factors related to bronchopulmonary dysplasia (BPD) in preterm infants. One study found that maternal smoking during pregnancy doubled the odds of BPD in infants, and was also associated with prolonged ventilation and late respiratory disease. Another study found that endothelial cell dysfunction in umbilical vein cells was associated with BPD or death in extremely preterm infants. A third study found that infants treated with caffeine in the neonatal period had better lung function at 11 years of age compared to placebo, mediated by caffeine's ability to reduce rates of BPD.
Global Health Crises Caused By The Collision Of Biological And Cultural Evolu...Global Risk Forum GRFDavos
This document discusses global health crises caused by the collision of biological and cultural evolution. It notes that the human biological genome is becoming stressed by rapid changes in cultural evolution and modern diets. Currently, limited healthcare resources focus on "crisis medicine" to treat chronic diseases like diabetes and heart disease that result from poor nutrition. However, the document proposes that preventing harmful prenatal exposures during the pregnancies of the 3 billion babies expected by 2100 could reduce risks of diseases later in life, based on the Barker Hypothesis that prenatal environments can influence later health. It advocates shifting resources from crisis to preventive medicine by educating parents on healthy diets during pregnancy and development.
The document presents guidelines from the European Respiratory Society on diagnosing and managing obstructive sleep disordered breathing in children aged 1-23 months. It recommends a stepwise approach beginning with identifying symptoms and risk factors, followed by objective sleep studies to determine severity if indicated. Treatment may include adenotonsillectomy, continuous positive airway pressure, or interventions for specific conditions causing airway obstruction. Management requires a multidisciplinary approach and treatment of all contributing factors to reduce upper airway obstruction during sleep.
The document discusses the developmental origins of health and disease theory proposed by Barker, which links poor fetal and early life nutrition to increased risk of chronic diseases like heart disease and diabetes later in life. Barker observed correlations between low birth weights in the 1920s and higher heart disease rates decades later. His theory proposes that the fetus adapts to inadequate nutrition by diverting resources from organs like the heart to the brain, with health consequences appearing later. Subsequent studies found links between small fetal size and later health issues. The theory suggests these effects may be passed on to later generations through epigenetic changes and fetal programming of gene expression.
Oral presentation given at the jENS conference Nov 3, 2017, in Venice/Italy.
The presentation is a short summary of a project on maternal overweight and obesity and how that relates to offspring risk of cerebral palsy.
The study was published in in JAMA in 2017, where it is available as open access on https://jamanetwork.com/journals/jama/fullarticle/2608220
Infant Feeding And Feeding Transitions During The First Year Of LifeBiblioteca Virtual
This document summarizes infant feeding patterns during the first year of life based on data from the Infant Feeding Practices Study II. Key findings include:
1) While 83% of infants were breastfed in the hospital, 42% of these infants also received formula supplementation. By 3 months, 61% of infants received formula.
2) Solid foods were introduced earlier than recommended, with 40% of infants consuming cereal and 17% consuming fruits/vegetables by 4 months of age.
3) Early introduction of solids was associated with discontinuing breastfeeding earlier and consuming more fatty/sugary foods by 12 months.
Oral probiotics reduce the incidence and severity of necrotizingmarlonluisf
This study evaluated the effectiveness of probiotics in reducing necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. 367 VLBW infants were randomly assigned to receive breast milk with the probiotics Lactobacillus acidophilus and Bifidobacterium infantis or breast milk alone. The probiotic group had a significantly lower incidence of NEC and death compared to the control group. No adverse effects from the probiotics were observed. The probiotics were effective in reducing the incidence and severity of NEC in VLBW infants when administered with breast milk.
Ibuprofen treatment reduces neuroinflammation and associated brain injury in growth restricted newborn piglets. The study found that giving ibuprofen to newborn piglets that experienced intrauterine growth restriction (IUGR) reduced markers of neuroinflammation including the number of activated microglia and astrocytes in the brain. Ibuprofen treatment also decreased proinflammatory cytokines. Additionally, ibuprofen prevented reductions in apoptosis, neuronal cell counts, and myelin index seen in untreated IUGR piglets. The results demonstrate that ibuprofen has neuroprotective effects by reducing neuroinflammation and concurrently protecting against neuronal and white matter impairment in the IUGR newborn brain.
Vita D Perrine Cg Ea At Adherence To Vit D Recommendations Among Us Infants P...alisonegypt
This study examined adherence to vitamin D recommendations among US infants using data from the Infant Feeding Practices Study II from 2005-2007. The researchers estimated the percentage of infants meeting the 2003 and 2008 vitamin D recommendations from the American Academy of Pediatrics at various ages from 1 to 10.5 months. They found that use of oral vitamin D supplements was low, ranging from 1% to 13% regardless of whether infants were breastfed, formula-fed, or mixed-fed. Most infants did not consume adequate amounts of vitamin D according to the 2008 recommendation, suggesting pediatricians should encourage vitamin D supplementation for breastfed and partially breastfed infants.
Exclusive Breastfeeding Reduces Acute Respiratory Infection And DiarrheaBiblioteca Virtual
This study examined the relationship between breastfeeding practices and infant mortality in Dhaka, Bangladesh. The researchers followed over 1600 infants from birth to 12 months. They found that exclusive breastfeeding declined from 53% at 1 month to 5% at 6 months. Partial or no breastfeeding was associated with a 2-3 times higher risk of infant death from all causes, acute respiratory infection (ARI), and diarrhea compared to exclusive breastfeeding. The study suggests that exclusive breastfeeding in early infancy reduces infant mortality, particularly from ARI and diarrhea.
This document summarizes research on small for gestational age (SGA) infants. The key points are:
1) Up to 10% of infants are born SGA, defined as weight and/or length below the 2nd percentile for gestational age. Most SGA infants catch up by age 2, but 10-15% do not.
2) Being born SGA increases the risk of metabolic diseases like obesity, insulin resistance, and cardiovascular disease later in life. Rapid weight gain in infancy, even within the first few weeks, can lead to these conditions by adulthood.
3) Ensuring appropriate catch-up growth may help mitigate some metabolic risks, but rapid weight gain should also
This document discusses nutrition from infancy to childhood. It covers important topics like the benefits of breastfeeding, introducing complementary foods, nutritional needs during pregnancy and lactation, and periods of peak malnutrition risk. Proper nutrition early in life is crucial for growth, development, and establishing healthy eating habits.
This article challenges the hypothesis that the modern genetic predisposition to obesity has arisen through random genetic drift following predation release. The authors present evidence to support the hypothesis that famines and seasonal food shortages in the post-agricultural era have exerted natural selection favoring fat storage, mediated through fertility selection. The authors conclude that genetic and bioinformatic methods will soon provide a definitive resolution to the long-standing debate over the "thrifty gene" theory of obesity.
Epigenetics describes how environmental factors can influence gene expression without changing the underlying DNA sequence. The document discusses several mechanisms of epigenetic gene regulation including DNA methylation and histone modification. It provides examples of how maternal diet, stress, and chemical exposure can influence epigenetic markers on genes in offspring and impact traits like obesity. Epigenetic changes also occur naturally over the female lifespan and identical twins studies have found epigenetics contributes to differences between twins.
Two Month Old Infant Tetralogy of Fallot Post ECMO- NICU_ CurranCara Curran
This case report describes a two-month-old infant named Evan Foster who was born prematurely at 32 weeks gestation and diagnosed with Tetralogy of Fallot and a diaphragmatic hernia. After birth, Evan underwent repair of the hernia and was placed on ECMO for seven days. He is currently in the NICU awaiting repair of the Tetralogy of Fallot. The physical therapist performed assessments of Evan and found that he had cramped movements consistent with a preterm infant and was hypotonic and scoring below average for motor skills compared to other infants at his adjusted age. The case report provides context on Evan's condition and the role of physical therapy in optimizing outcomes for infants in the N
1. Nutritional programming theories suggest that the prenatal and early life nutritional environment can influence long-term health by permanently programming physiological functions and disease risk.
2. Animal studies demonstrate a direct link between nutrient imbalance during fetal development and later diseases like hypertension, diabetes, and heart disease, independent of growth rates.
3. Exposure to glucocorticoids and alterations in gene expression from nutrient imbalance in early life are thought to be important mechanisms influencing tissue development and function long-term.
Genetics of Obesity: The thrifty gene hypothesisStephen Magness
Early humans faced regular cycles of feast and famine that promoted the evolution and selection of "thrifty genes" that increased the body's ability to efficiently store and utilize fuels like fat and glucose. While these genes provided an evolutionary advantage in the past by helping humans survive periods of starvation, they predispose modern humans to obesity and related diseases due to our current environment of abundant food and low physical activity levels. The "thrifty genotype" hypothesis has been expanded to include the concept of a "thrifty epigenome," where environmental factors like famine experienced by pregnant mothers can epigenetically influence gene expression and metabolic function in offspring in ways that increase disease risk in a modern context of plentiful food.
Clinician Support And Psychosocial Risk Factors Associated With BreastfeedingBiblioteca Virtual
This study examined factors associated with breastfeeding discontinuation at 2 and 12 weeks postpartum in a cohort of 1007 low-risk mothers who initiated breastfeeding. The study found that breastfeeding rates declined over time, with 13% discontinuing by 2 weeks and 45% discontinuing by 12 weeks. Factors associated with earlier discontinuation included lack of breastfeeding confidence, early breastfeeding problems, Asian race, lower education, and depressive symptoms. Receiving encouragement from clinicians was associated with lower risk of discontinuing by 12 weeks, as was not returning to work or school by 12 weeks. The results suggest clinician support and addressing maternal mental health could help promote longer breastfeeding duration.
This document summarizes several studies on the effects of different feeding formulas for preterm infants after hospital discharge. It discusses randomized controlled trials that compared nutrient-enriched formulas to standard formulas. The studies found that infants fed enriched formulas had greater weight gain, length growth, and head circumference increases during the study periods compared to those fed standard formulas. At longer-term follow up of 18 months, infants on enriched formulas continued to show small improvements in weight, length and neurodevelopmental outcomes.
The document provides guidance for health workers on managing childhood illnesses for children ages 2 months to 5 years, outlining how to assess for general danger signs, check main symptoms like cough, diarrhea and fever, evaluate nutritional status, and counsel caretakers on home care and follow-up. Key advice includes classifying diarrhea by severity and dehydration, treating respiratory infections based on breathing rate, and advising caretakers on oral rehydration and continued feeding.
This document discusses PDHPE (Personal Development, Health and Physical Education) and is divided into three parts. Part 1 describes the author's experiences with various physical activities like swimming, dancing, tennis, and netball through school sports. Part 2 examines the role of the PDHPE educator, outlining their physical characteristics, communication skills, teaching abilities, and knowledge. Part 3 addresses the author's views on PDHPE in different educational settings. The document concludes by thanking the reader and providing references.
This document discusses PDHPE (Personal Development, Health and Physical Education) and is divided into three parts. Part 1 describes the author's experiences with swimming, dancing, tennis, netball, and school sports. Part 2 outlines the characteristics, skills, knowledge, and teaching activities of a PDHPE educator. Part 3 indicates that the author will discuss their position on PDHPE in educational settings. The document concludes by thanking the reader and providing references.
This document discusses PDHPE (Personal Development, Health and Physical Education) and is divided into three parts. Part 1 describes the author's experiences with swimming, dancing, tennis, and netball in school sports. Part 2 outlines the characteristics, skills, knowledge, and teaching activities of a PDHPE educator. Part 3 indicates the author will discuss their position on PDHPE in different educational settings. The document concludes by thanking the reader and providing references.
This document summarizes a conference on maternal nutrition and infant feeding practices. The conference was organized to address gaps in understanding how maternal nutrition affects fetal growth, birth outcomes, and infant feeding practices. It covered 3 topics: 1) the effect of maternal nutrition and the placenta on fetal development and birth outcomes, 2) feeding preterm infants, and 3) feeding full-term infants. For topic 1, presentations showed the placenta's role in nutrient transport affects fetal growth and discussed the importance of nutrients like folate and calcium. Research priorities identified included studying nutrient interactions and their effects on different populations. Topic 2 noted a lack of evidence on best practices for preterm infant nutrition. Topic 3 discussed ensuring evidence on human milk
This presentation is adapted from the B.Ed course HUMAN DEVELOPMENT AND LEARNING (Code 8610) by TEACHER EDUCATION DEPARTMENT, FACULTY OF EDUCATION, ALLAMA IQBAL OPEN UNIVERSITY
Nuove strategie terapeutiche per il trattamento del cancro alla prostata refr...Merqurio
This review article discusses novel therapeutic strategies for castration-resistant prostate cancer that target persistent androgen production and androgen receptor signaling. It provides background on androgen deprivation therapy and secondary hormonal therapies. The article then focuses on selective CYP17 inhibitors like abiraterone acetate and second generation antiandrogens like MDV3100, which have shown promising results in clinical trials by further blocking androgen synthesis and receptor activity in castration-resistant prostate cancer. These novel targeted therapies may improve outcomes for patients with castration-resistant disease.
Cross-linking del collagene corneale per il trattamento del cheratocono e del...Merqurio
1) Corneal collagen crosslinking was performed on eyes with keratoconus or ectasia to evaluate 1-year outcomes.
2) Uncorrected and corrected distance visual acuity significantly improved from baseline to 12 months. Topographic measurements like maximum keratometry also significantly decreased.
3) Keratoconus patients had greater improvement in topographic measurements than patients with ectasia over 1 year. Both visual acuity and maximum keratometry initially worsened at 1 month but then improved from 1 to 6 months and stabilized thereafter.
Il trattamento chirurgico dei tumori del labbroMerqurio
This document summarizes a study on the surgical management of lip cancer. The study examined 32 patients treated for lip cancer over 5 years. Most cases involved squamous cell carcinoma of the lower lip. Surgical excision of the tumor was performed with oncologically appropriate margins. Reconstruction after surgery posed challenges, especially for advanced or extensive lesions. Local flaps from the lip or surrounding tissues were often used for reconstruction. Neck dissection was also performed in some cases to control lymph node metastases. While early stage tumors had good postoperative outcomes, advanced lesions resulted in greater functional impairments like drooling or chewing difficulties after surgery. The document discusses the surgical and reconstructive techniques used to treat lip cancers while aiming to preserve lip appearance and
Ibuprofen treatment reduces neuroinflammation and associated brain injury in growth restricted newborn piglets. The study found that giving ibuprofen to newborn piglets that experienced intrauterine growth restriction (IUGR) reduced markers of neuroinflammation including the number of activated microglia and astrocytes in the brain. Ibuprofen treatment also decreased proinflammatory cytokines. Additionally, ibuprofen prevented reductions in apoptosis, neuronal cell counts, and myelin index seen in untreated IUGR piglets. The results demonstrate that ibuprofen has neuroprotective effects by reducing neuroinflammation and concurrently protecting against neuronal and white matter impairment in the IUGR newborn brain.
Vita D Perrine Cg Ea At Adherence To Vit D Recommendations Among Us Infants P...alisonegypt
This study examined adherence to vitamin D recommendations among US infants using data from the Infant Feeding Practices Study II from 2005-2007. The researchers estimated the percentage of infants meeting the 2003 and 2008 vitamin D recommendations from the American Academy of Pediatrics at various ages from 1 to 10.5 months. They found that use of oral vitamin D supplements was low, ranging from 1% to 13% regardless of whether infants were breastfed, formula-fed, or mixed-fed. Most infants did not consume adequate amounts of vitamin D according to the 2008 recommendation, suggesting pediatricians should encourage vitamin D supplementation for breastfed and partially breastfed infants.
Exclusive Breastfeeding Reduces Acute Respiratory Infection And DiarrheaBiblioteca Virtual
This study examined the relationship between breastfeeding practices and infant mortality in Dhaka, Bangladesh. The researchers followed over 1600 infants from birth to 12 months. They found that exclusive breastfeeding declined from 53% at 1 month to 5% at 6 months. Partial or no breastfeeding was associated with a 2-3 times higher risk of infant death from all causes, acute respiratory infection (ARI), and diarrhea compared to exclusive breastfeeding. The study suggests that exclusive breastfeeding in early infancy reduces infant mortality, particularly from ARI and diarrhea.
This document summarizes research on small for gestational age (SGA) infants. The key points are:
1) Up to 10% of infants are born SGA, defined as weight and/or length below the 2nd percentile for gestational age. Most SGA infants catch up by age 2, but 10-15% do not.
2) Being born SGA increases the risk of metabolic diseases like obesity, insulin resistance, and cardiovascular disease later in life. Rapid weight gain in infancy, even within the first few weeks, can lead to these conditions by adulthood.
3) Ensuring appropriate catch-up growth may help mitigate some metabolic risks, but rapid weight gain should also
This document discusses nutrition from infancy to childhood. It covers important topics like the benefits of breastfeeding, introducing complementary foods, nutritional needs during pregnancy and lactation, and periods of peak malnutrition risk. Proper nutrition early in life is crucial for growth, development, and establishing healthy eating habits.
This article challenges the hypothesis that the modern genetic predisposition to obesity has arisen through random genetic drift following predation release. The authors present evidence to support the hypothesis that famines and seasonal food shortages in the post-agricultural era have exerted natural selection favoring fat storage, mediated through fertility selection. The authors conclude that genetic and bioinformatic methods will soon provide a definitive resolution to the long-standing debate over the "thrifty gene" theory of obesity.
Epigenetics describes how environmental factors can influence gene expression without changing the underlying DNA sequence. The document discusses several mechanisms of epigenetic gene regulation including DNA methylation and histone modification. It provides examples of how maternal diet, stress, and chemical exposure can influence epigenetic markers on genes in offspring and impact traits like obesity. Epigenetic changes also occur naturally over the female lifespan and identical twins studies have found epigenetics contributes to differences between twins.
Two Month Old Infant Tetralogy of Fallot Post ECMO- NICU_ CurranCara Curran
This case report describes a two-month-old infant named Evan Foster who was born prematurely at 32 weeks gestation and diagnosed with Tetralogy of Fallot and a diaphragmatic hernia. After birth, Evan underwent repair of the hernia and was placed on ECMO for seven days. He is currently in the NICU awaiting repair of the Tetralogy of Fallot. The physical therapist performed assessments of Evan and found that he had cramped movements consistent with a preterm infant and was hypotonic and scoring below average for motor skills compared to other infants at his adjusted age. The case report provides context on Evan's condition and the role of physical therapy in optimizing outcomes for infants in the N
1. Nutritional programming theories suggest that the prenatal and early life nutritional environment can influence long-term health by permanently programming physiological functions and disease risk.
2. Animal studies demonstrate a direct link between nutrient imbalance during fetal development and later diseases like hypertension, diabetes, and heart disease, independent of growth rates.
3. Exposure to glucocorticoids and alterations in gene expression from nutrient imbalance in early life are thought to be important mechanisms influencing tissue development and function long-term.
Genetics of Obesity: The thrifty gene hypothesisStephen Magness
Early humans faced regular cycles of feast and famine that promoted the evolution and selection of "thrifty genes" that increased the body's ability to efficiently store and utilize fuels like fat and glucose. While these genes provided an evolutionary advantage in the past by helping humans survive periods of starvation, they predispose modern humans to obesity and related diseases due to our current environment of abundant food and low physical activity levels. The "thrifty genotype" hypothesis has been expanded to include the concept of a "thrifty epigenome," where environmental factors like famine experienced by pregnant mothers can epigenetically influence gene expression and metabolic function in offspring in ways that increase disease risk in a modern context of plentiful food.
Clinician Support And Psychosocial Risk Factors Associated With BreastfeedingBiblioteca Virtual
This study examined factors associated with breastfeeding discontinuation at 2 and 12 weeks postpartum in a cohort of 1007 low-risk mothers who initiated breastfeeding. The study found that breastfeeding rates declined over time, with 13% discontinuing by 2 weeks and 45% discontinuing by 12 weeks. Factors associated with earlier discontinuation included lack of breastfeeding confidence, early breastfeeding problems, Asian race, lower education, and depressive symptoms. Receiving encouragement from clinicians was associated with lower risk of discontinuing by 12 weeks, as was not returning to work or school by 12 weeks. The results suggest clinician support and addressing maternal mental health could help promote longer breastfeeding duration.
This document summarizes several studies on the effects of different feeding formulas for preterm infants after hospital discharge. It discusses randomized controlled trials that compared nutrient-enriched formulas to standard formulas. The studies found that infants fed enriched formulas had greater weight gain, length growth, and head circumference increases during the study periods compared to those fed standard formulas. At longer-term follow up of 18 months, infants on enriched formulas continued to show small improvements in weight, length and neurodevelopmental outcomes.
The document provides guidance for health workers on managing childhood illnesses for children ages 2 months to 5 years, outlining how to assess for general danger signs, check main symptoms like cough, diarrhea and fever, evaluate nutritional status, and counsel caretakers on home care and follow-up. Key advice includes classifying diarrhea by severity and dehydration, treating respiratory infections based on breathing rate, and advising caretakers on oral rehydration and continued feeding.
This document discusses PDHPE (Personal Development, Health and Physical Education) and is divided into three parts. Part 1 describes the author's experiences with various physical activities like swimming, dancing, tennis, and netball through school sports. Part 2 examines the role of the PDHPE educator, outlining their physical characteristics, communication skills, teaching abilities, and knowledge. Part 3 addresses the author's views on PDHPE in different educational settings. The document concludes by thanking the reader and providing references.
This document discusses PDHPE (Personal Development, Health and Physical Education) and is divided into three parts. Part 1 describes the author's experiences with swimming, dancing, tennis, netball, and school sports. Part 2 outlines the characteristics, skills, knowledge, and teaching activities of a PDHPE educator. Part 3 indicates that the author will discuss their position on PDHPE in educational settings. The document concludes by thanking the reader and providing references.
This document discusses PDHPE (Personal Development, Health and Physical Education) and is divided into three parts. Part 1 describes the author's experiences with swimming, dancing, tennis, and netball in school sports. Part 2 outlines the characteristics, skills, knowledge, and teaching activities of a PDHPE educator. Part 3 indicates the author will discuss their position on PDHPE in different educational settings. The document concludes by thanking the reader and providing references.
This document summarizes a conference on maternal nutrition and infant feeding practices. The conference was organized to address gaps in understanding how maternal nutrition affects fetal growth, birth outcomes, and infant feeding practices. It covered 3 topics: 1) the effect of maternal nutrition and the placenta on fetal development and birth outcomes, 2) feeding preterm infants, and 3) feeding full-term infants. For topic 1, presentations showed the placenta's role in nutrient transport affects fetal growth and discussed the importance of nutrients like folate and calcium. Research priorities identified included studying nutrient interactions and their effects on different populations. Topic 2 noted a lack of evidence on best practices for preterm infant nutrition. Topic 3 discussed ensuring evidence on human milk
This presentation is adapted from the B.Ed course HUMAN DEVELOPMENT AND LEARNING (Code 8610) by TEACHER EDUCATION DEPARTMENT, FACULTY OF EDUCATION, ALLAMA IQBAL OPEN UNIVERSITY
Nuove strategie terapeutiche per il trattamento del cancro alla prostata refr...Merqurio
This review article discusses novel therapeutic strategies for castration-resistant prostate cancer that target persistent androgen production and androgen receptor signaling. It provides background on androgen deprivation therapy and secondary hormonal therapies. The article then focuses on selective CYP17 inhibitors like abiraterone acetate and second generation antiandrogens like MDV3100, which have shown promising results in clinical trials by further blocking androgen synthesis and receptor activity in castration-resistant prostate cancer. These novel targeted therapies may improve outcomes for patients with castration-resistant disease.
Cross-linking del collagene corneale per il trattamento del cheratocono e del...Merqurio
1) Corneal collagen crosslinking was performed on eyes with keratoconus or ectasia to evaluate 1-year outcomes.
2) Uncorrected and corrected distance visual acuity significantly improved from baseline to 12 months. Topographic measurements like maximum keratometry also significantly decreased.
3) Keratoconus patients had greater improvement in topographic measurements than patients with ectasia over 1 year. Both visual acuity and maximum keratometry initially worsened at 1 month but then improved from 1 to 6 months and stabilized thereafter.
Il trattamento chirurgico dei tumori del labbroMerqurio
This document summarizes a study on the surgical management of lip cancer. The study examined 32 patients treated for lip cancer over 5 years. Most cases involved squamous cell carcinoma of the lower lip. Surgical excision of the tumor was performed with oncologically appropriate margins. Reconstruction after surgery posed challenges, especially for advanced or extensive lesions. Local flaps from the lip or surrounding tissues were often used for reconstruction. Neck dissection was also performed in some cases to control lymph node metastases. While early stage tumors had good postoperative outcomes, advanced lesions resulted in greater functional impairments like drooling or chewing difficulties after surgery. The document discusses the surgical and reconstructive techniques used to treat lip cancers while aiming to preserve lip appearance and
Professor Forsyth studied the health outcomes of 543 children from lower and higher socioeconomic groups. He found that (1) in the lower socioeconomic group, breastfed children had similar or significantly better health outcomes than formula-fed children, even compared to formula-fed children in the higher socioeconomic group. Subsequent studies discussed in the document found that (2) exclusive breastfeeding for at least 15 weeks reduced respiratory illness and that (3) one month of exclusive breastfeeding conferred protection against allergies and respiratory issues into childhood and adolescence. Overall, the document reviews extensive evidence that breastfeeding leads to improved health outcomes related to infectious disease, cognitive development, cardiovascular risk factors, obesity, and diabetes among others.
Prevalence of Early Childhood Caries and its Association with Body Mass Index...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Dr. Narendra Malhotra gave the POGS oration on fetal origins of adult diseases. He has had an illustrious career as an obstetrician and gynecologist in India, holding many leadership positions and publishing extensively. His research has shown that adverse conditions in the womb and early life can program the fetus's development and permanently increase risks for diseases like diabetes, hypertension, and heart disease later in adulthood. Maternal nutrition, infections, and other environmental factors during pregnancy can influence the fetus through hormonal and epigenetic changes leading to effects on organs like the pancreas, kidneys and blood vessels that manifest as disease in later life.
Diabetes has become the fastest growing chronic disease in New Zealand and a major cause of death for Māori. A community-based program in the Waikato region aims to prevent diabetes through health education, screening, and lifestyle changes. Key interventions include raising awareness of diabetes risks and promoting screening to catch cases early. Evaluating the program through surveys before and after will assess if the goal of minimizing complications was achieved to guide future programs.
Vitamin D Deficiency In Pre Birth Studiesalisonegypt
1) Lower maternal vitamin D status was associated with greater femoral metaphyseal cross-sectional area and higher femoral splaying index in fetuses at 19 weeks and 34 weeks gestation, suggesting maternal vitamin D insufficiency can influence fetal femoral development as early as 19 weeks.
2) Over 30% of mothers had vitamin D levels considered insufficient or deficient. Lower maternal vitamin D levels were related to increased femoral splaying and larger femoral cross-sectional area in fetuses.
3) The findings suggest that improving maternal vitamin D status early in pregnancy through supplementation may help support optimal fetal bone development.
1) Lower maternal vitamin D status was associated with greater femoral metaphyseal cross-sectional area and higher femoral splaying index in fetuses at 19 weeks and 34 weeks gestation, suggesting maternal vitamin D insufficiency can influence fetal femoral development as early as 19 weeks.
2) Over a third of mothers had vitamin D levels considered insufficient or deficient. Lower maternal vitamin D levels were related to increased femoral splaying but not femur length in fetuses.
3) Across maternal vitamin D sufficiency groups, femoral splaying indices at 19 weeks increased from 0.074 in sufficient mothers to 0.078 in insufficient and 0.084 in deficient mothers, indicating less optimal fetal bone development with lower maternal vitamin
Positional plagiocephaly from structure to function: Clinical experience of t...Braglia
Objective: Aim of the study is to evaluate disorders related to positional plagiocephaly and introduce a new model of early intervention based on the osteopathic
integrated approach.
Methods: We review clinical experience of the “Program for Neurodevelopmental Follow-up and Pediatric Osteopathy”, a service dedicated to newborns at risk for
developmental disorders.
Results: We present clinical data of 310 newborns followed during first years of life. Data analysis examines perinatal history, general features and disorders that
could be related to plagiocephaly.
Conclusions: The experience confirms that plagiocephaly is not only a problem regarding the shape of the head, it involves the functions. In our Service most babies
(81%) with positional plagiocephaly showed isolated or associated disorders that had an impact on growth, behavior and development. The early intervention based
on the osteopathic integrated approach is addressed not only to the cranial shape but consider the baby as a whole, and the environment where he lives.
Making it Easier for Women to Work & Breastfeed: The Working Parent Support C...Leith Greenslade
Several leading US companies, universities, medical and media associations are joining forces to offer more support to working women so they can exercise a real choice to breastfeed.
This document discusses enteral nutrition in preterm neonates. It notes that providing adequate nutrition to preterm infants is challenging due to immaturity of bowel function and inability to suck and swallow. While parenteral nutrition can provide nutrients, lack of enteral intake can impair gut development and function. The document reviews evidence from several Cochrane reviews on different approaches to enteral feeding in preterm infants, finding insufficient evidence to recommend one approach over others and calling for additional large randomized controlled trials to evaluate effects on important outcomes.
This study analyzed data from over 15,000 infants in the UK Millennium Cohort Study to examine the relationship between breastfeeding and hospitalization for diarrhea and respiratory infections in the first 8 months of life. The results showed that exclusive breastfeeding, compared to no breastfeeding, was associated with a lower risk of hospitalization for both diarrhea and respiratory infections after adjusting for various confounding factors. Partial breastfeeding also showed a protective effect, but it was weaker than exclusive breastfeeding. The protective effects of breastfeeding decreased after breastfeeding cessation. The study suggests that increased rates of exclusive and prolonged breastfeeding could significantly reduce hospitalizations in the UK.
There are two main feeding methods for preterm infants in the NICU - practitioner-driven feeding (PDF) and infant-driven feeding (IDF). Recent research shows IDF decreases time to full oral feeds and earlier hospital discharge. IDF relies on infant feeding cues rather than scheduled intervals. While physicians and nurses initially resisted IDF due to biases, education increased confidence in the method. IDF is now widely adopted as it improves outcomes for infants and lowers hospital costs without compromising safety. Further research is still needed on high-risk infants and implementing IDF protocols.
Oral probiotics reduce the incidence and severity of necrotizingShirlye Cahuaya
This study evaluated the efficacy of probiotics in reducing necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. 367 VLBW infants were enrolled and randomized to receive either Infloran (Lactobacillus acidophilus and Bifidobacterium infantis) with breast milk or breast milk alone. The incidence of death or NEC (> stage 2) and NEC alone was significantly lower in the probiotics group compared to the control group. There were no cases of severe NEC (Bell stage 3) in the probiotics group. The incidence of culture-proven sepsis was also lower in the probiotics group. No adverse effects were observed with the
1) This document discusses the increasing rates of vitamin D deficiency and insufficiency in infants and mothers internationally. Recent studies show deficiency rates as high as 80-92% in some populations.
2) The radiographic findings of congenital and nutritional rickets in young infants can be subtle but include craniotabes, metaphyseal changes in long bones, and flaring of anterior rib ends.
3) The document presents four case studies of young infants who presented with fractures and were initially suspected of abuse, but were later found to have significant vitamin D deficiency based on laboratory tests. This highlights the challenge of differentiating between abuse and nutritional rickets based on radiographic findings alone.
This document summarizes the growing issue of vitamin D deficiency (DD) in infants and children. It discusses how DD rates have risen significantly in recent decades across diverse populations. Multiple factors are contributing to the problem, including decreased food fortification of vitamin D, more sun avoidance behaviors, increased obesity rates, and longer breastfeeding durations without adequate supplementation. The document outlines how DD can manifest radiographically as softening of the skull and indistinct facial bones in young infants, as well as subtle metaphyseal changes in the long bones that could be mistaken for abuse-related fractures without consideration of the underlying DD.
This document outlines strategies and interventions to tackle stunting in children under 2 years old. It recommends preventive and early interventions at the community level through empowerment and improved healthcare services. The key is to assure sustainability through ongoing quality improvement processes. It describes screening children under 2 to identify nutritional needs and providing evidence-based interventions. Interventions discussed include delayed cord clamping, early breastfeeding, dietary diversity, facility-based management of severe and moderate acute malnutrition, community-based management, identifying at-risk children, fortified supplements, deworming, zinc therapy, multivitamin supplements, and vitamin A supplementation. Metrics include decreasing malnutrition and assuring regular quality improvement team meetings.
Dealing With Fears Of Chemical Pollution Of BreastmilkBiblioteca Virtual
This document discusses fears about chemical pollution in breastmilk, specifically related to dioxins. It summarizes several studies that have found:
1) The majority (90-95%) of human exposure to dioxins comes from food, while only 5-10% comes from air.
2) Effects from dioxin exposure were more strongly associated with transplacental (in utero) exposure rather than breastmilk exposure.
3) Ongoing studies support the recommendation that breastfeeding should continue to be promoted due to its overall health benefits for infants, and concerns about dioxin exposure should not unduly influence a mother's decision to breastfeed.
This document contains a bibliography with references on various topics related to infant and child nutrition and feeding. It is divided into several sections covering issues such as the effects of breastfeeding, timing of introducing complementary foods, the impact of breastfeeding on acceptance of different foods and flavors later in life, problems with complementary feeding, the role of parents in children's diet, and more. The references provided include journal articles, books, and studies from around the world published between 2001 and 2011.
The journey of low birth weight infant Khaled Saad
Previously known as ‘failure to thrive’ (FTT), also known as weight faltering
Infant or children whose current weight or rate of weight gain is significantly below that expected of similar children of the same age, sex and ethnicity
Can occur in both infants (< 1 year of age) and in children (> 1 year of age)
at SciVerse ScienceDirectSocial Science & Medicine 75 (201.docxikirkton
at SciVerse ScienceDirect
Social Science & Medicine 75 (2012) 323e330
Contents lists available
Social Science & Medicine
journal homepage: www.elsevier.com/locate/socscimed
Breastfeeding and risk of overweight and obesity at nine-years of age
Cathal McCrory*, Richard Layte 1
The Economic and Social Research Institute, Whitaker Square, Sir John Rogerson’s Quay, Dublin 2, Ireland
a r t i c l e i n f o
Article history:
Available online 17 April 2012
Keywords:
Ireland
Breastfeeding
Children
Overweight
Obesity
Body mass index (BMI)
Cohort study
* Corresponding author. Tel.: þ353 1 8632027; fax:
E-mail address: [email protected] (C. McCror
1 Tel.: þ353 1 8632027; fax: þ353 1 8632100.
0277-9536/$ e see front matter � 2012 Elsevier Ltd.
doi:10.1016/j.socscimed.2012.02.048
a b s t r a c t
Whether breastfeeding is protective against the development of childhood overweight and obesity
remains the subject of considerable debate. Although a number of meta-analyses and syntheses of the
literature have concluded that the greater preponderance of evidence indicates that breastfeeding
reduces the risk of obesity, these findings are by no means conclusive. The present study used data from
the Growing Up in Ireland study to examine the relationship between retrospectively recalled breast-
feeding data and contemporaneously measured weight status for 7798 children at nine-years of age
controlling for a wide range of variables including; socio-demographic factors, the child’s own lifestyle-
related behaviours, and parental BMI. The results of the multivariable analysis indicated that being
breastfed for between 13 and 25 weeks was associated with a 38 percent (p < 0.05) reduction in the risk
of obesity at nine-years of age, while being breastfed for 26 weeks or more was associated with a 51
percent (p < 0.01) reduction in the risk of obesity at nine-years of age. Moreover, results pointed towards
a doseeresponse patterning in the data for those breastfed in excess of 4 weeks. Possible mechanisms
conveying this health benefit include slower patterns of growth among breastfed children, which it is
believed, are largely attributable to differences in the composition of human breast milk compared with
synthesised formula. The suggestion that the choice of infant feeding method has important implications
for health and development is tantalising as it identifies a modifiable health behaviour that is amenable
to intervention in primary health care settings and has the potential to improve the health of the
population.
� 2012 Elsevier Ltd. All rights reserved.
Introduction
The belief that breastfeeding during infancy affords protection
against a number of diseases features prominently in the epide-
miological literature; there is considerable evidence to support this
assertion. Breastfeeding is associated with reduced risk for
a number of neonatal infections including gastro-intestinal infec-
tions, diarrhoeal infections, and types of extra-intestinal infecti ...
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Lo status materno di vitamina d influisce sulla crescita delle ossa nella prima infanzia uno studio prospettico
1. Osteoporos Int (2011) 22:883–891
DOI 10.1007/s00198-010-1499-4
ORIGINAL ARTICLE
Maternal vitamin D status affects bone growth in early
childhood—a prospective cohort study
H. T. Viljakainen & T. Korhonen & T. Hytinantti &
E. K. A. Laitinen & S. Andersson & O. Mäkitie &
C. Lamberg-Allardt
Received: 30 June 2010 / Accepted: 25 October 2010 / Published online: 10 December 2010
# The Author(s) 2010. This article is published with open access at Springerlink.com
Abstract Methods Eighty-seven children were followed from birth to
Summary In this prospective study, 87 children were 14 months. Background data were collected with a
followed up from birth to 14 months with data on maternal questionnaire and a 3-day food record. At 14 months bone
vitamin D status during the pregnancy. Postnatal vitamin D variables were measured with peripheral computed tomog-
supplementation improved vitamin D status but only partly raphy (pQCT) from the left tibia. Serum 25-OHD and bone
eliminated the differences in bone variables induced by turnover markers were determined. Findings were com-
maternal vitamin D status during the fetal period. pared with maternal vitamin D status during pregnancy.
Introduction Intrauterine nutritional deficits may have Results The children were divided into two groups based
permanent consequences despite improved nutritional status on vitamin D status during pregnancy. Despite discrepant
postnatally. We evaluated the role of prenatal and postnatal S-25-OHD at baseline (median 36.3 vs. 52.5 nmol/l, p<
vitamin D status on bone parameters in early infancy. 0.001), the values at 14 months were similar (63 vs.
66 nmol/l, p=0.58) in Low D and High D. Serum 25-OHD
H. T. Viljakainen (*) : T. Hytinantti : S. Andersson : O. Mäkitie increased more in Low D (p<0.001) despite similar total
Hospital for Children and Adolescents, intake of vitamin D (mean 12.3 μg/day). In Low D, tibial
Helsinki University Central Hospital,
Tukholmankatu 2C, PO Box 705, 00029, Helsinki, Finland
bone mineral content (BMC) was lower at birth but BMC
e-mail: heli.viljakainen@helsinki.fi gain was greater (multivariate analysis of variance [MAN-
T. Hytinantti
OVA]; p=0.032) resulting in similar BMC at 14 months in
e-mail: timo.hytinantti@hus.fi the two groups. In High D, tibial total bone cross-sectional
S. Andersson
area was higher at baseline; the difference persisted at
e-mail: sture.andersson@hus.fi 14 months (MANOVA; p=0.068). Bone mineral density
O. Mäkitie
(BMD) and ΔBMD were similar in the two groups.
e-mail: outi.makitie@helsinki.fi Conclusions Postnatal vitamin D supplementation improved
vitamin D status but only partly eliminated the differences in
T. Korhonen : C. Lamberg-Allardt bone variables induced by maternal vitamin D status during
Department of Food and Environmental Sciences,
the fetal period. Further attention should be paid to improving
University of Helsinki,
Helsinki, Finland vitamin D status during pregnancy.
T. Korhonen
e-mail: tuuli.korhonen@helsinki.fi Keywords Bone growth . Development . Maternal vitamin
D status . Pediatric . Vitamin D
C. Lamberg-Allardt
e-mail: christel.lamberg-allardt@helsinki.fi
E. K. A. Laitinen Introduction
Department of Obstetrics and Gynecology,
Helsinki University Central Hospital,
Helsinki, Finland Poor growth during the fetal period, infancy and early child-
e-mail: kalevi.laitinen@hus.fi hood is associated with lower adult bone mass and increased
2. 884 Osteoporos Int (2011) 22:883–891
fracture risk later in life [1–3]. During the fetal period, it is March 2009. The recruitment of families has been
likely that metabolic and endocrine systems are programmed described in detail elsewhere [10]. Only primiparous
to allow the fetus to adapt to the in utero environment [4]. mothers who were healthy, non-smoking, aged between
Vitamin D is a seco sterol that modifies various biological 20 and 40 years, of Caucasian origin, and had an
functions in the body [5], and researchers have identified 37 uneventful, singleton, full-term pregnancy (37–42 weeks)
target organs for vitamin D [5]. Low maternal vitamin D were included. The study protocol was approved by the
status or inadequate dietary vitamin D intake during Ethics Committee of Helsinki University Hospital. All
pregnancy predisposes children to asthma and allergic mothers gave their written informed consent in accordance
rhinitis [6], diabetes [7], acute lower respiratory infection with the Declaration of Helsinki. Maternal vitamin D status
[8], and impaired bone mass accrual. This is evidenced by was assessed in communal prenatal clinics during the first
smaller bone cross-sectional area (CSA) and bone mineral trimesters as part of normal follow-up. A second, fasting
content (BMC) at birth [9, 10] and at 9 years of age [11]. blood sample from the mother was collected 2 days
Programming of skeletal growth may occur through postpartum during the hospital stay between late October
growth hormone—IGF-I axis [4, 12], whereas bone quality and mid-December 2007. At birth, cord blood was obtained
may be determined by factors related to differentiation of from the umbilical vein after cord clamping in 81 subjects.
mesenchymal stem cells [13, 14]. The intrauterine environ- Background data was collected through an extensive
ment strongly affects growth rate in infancy, but may also questionnaire. Records on pregnancy follow-up and the
influence growth in puberty [15]. The extent to which birth report were obtained, including birth weight, length
changes in nutrient supply between intrauterine and and head circumference measured by midwifes, and duration of
postnatal periods affect growth and development, per se, the pregnancy. Birth lengths and weights were transformed into
has not been well established [4]. The most critical views Z-scores using Finnish sex-specific normative data for fetal
predict that intrauterine nutritional deficits have permanent growth [21]. One newborn and her mother were excluded
consequences and that a newborn’s metabolism may not from the initial analysis due to intrauterine growth retardation.
adapt to improved nutritional status; the nutrients may not Eighty-seven (70%) of the original cohort of 124 families
be utilized efficiently and the risk for disease may be agreed to participate in the follow-up visit. Mothers in families
maintained despite improved nutritional status [16]. agreed on follow-up tended to be younger (p<0.1), they were
However, postnatal catch-up occurs in linear growth if more educated (p=0.09) and had smaller family (p=0.08)
the fetal deprivation and its timing and magnitude have than non-participants, but there were no differences in any
not been too critical [17]. pregnancy outcomes. Before the 14-month visit, the families
Previously the authors of the current study have reported received an extensive questionnaire concerning the child’s
that during the pregnancy, 69% of the women and 37% of health and medical history, sunshine exposure, and use of
the newborns at birth were vitamin D deficient (defined in vitamin supplements. The questionnaire included a 3-day
women as S-25-OHD <50 nmol/l [18, 19] and in the food record. During the study visit, one of the researchers
newborn as <37.5 nmol/l [20]). The newborn bone interviewed the family about the child’s development,
variables were measured with peripheral quantitative including motor and language skills. Of those who agreed
computed tomography (pQCT) during the hospital stay. to participate in the follow-up visit, all but three returned the
Based on these results, it was concluded that maternal questionnaire.
vitamin D status affects bone mineral accrual and influences Anthropometric measurements were obtained for each
bone size during the intrauterine period [10]. subject. Height was measured at standing position with a
The present prospective study had two objectives. The wall-mounted height measuring scale and rounded to the
first was to follow whether the vitamin D-associated nearest 0.1 cm. Weight was measured while sitting on a
skeletal effects observed at birth persist during the first scale in light clothing and rounded to the nearest 0.1 kg.
year of life, and the second was to evaluate the impact of Heights were transformed into Z-scores and weights were
postnatal vitamin D status on bone growth and develop- expressed as height-adjusted weights according to Finnish
ment in early infancy. sex-specific normative data for infants [21]. The newborn
bone variables were measured with peripheral computed
tomography (pQCT) from the left tibia. A blood sample
Subjects and methods was obtained for laboratory analyses from all but one child.
Local anaesthetical patches (EMLA R; AstraZeneca AB,
Families (N=124) were initially recruited and assessed Södertälje, Sweden) were used to reduce the discomfort of
between October and December 2007 during their labor venipuncture.
visit to the birth hospital. They were invited for a follow-up Dietary intakes were calculated from 3-day food records
visit approximately 14 months later, between February and with Diet32 software (Aivo Oy Finland, Turku, Finland).
3. Osteoporos Int (2011) 22:883–891 885
The nutrient contents of the foods was based on the Finnish of all the pQCT measurements at 14 months, 67 (78%)
National Food Composition Database, Fineli, version 2001, were successful.
maintained by the National Public Health Institute of
Finland, Nutrition Unit. The total intake of vitamin D Statistical methods
included intake from diet and from supplements.
Statistical analyses were performed with SPSS version 16.0
Laboratory measurements for Windows (SPSS Inc., Chicago, IL). The two groups
were compared using an independent samples t-test.
Serum 25-OHD was measured with an OCTEIA immu- Repeated-measures ANOVA was applied to follow 25-
noenzymometric assay (IDS, Bolton, UK). The intra-assay OHD, BMC, CSA, BMD, BALP and TRACP between
coefficient of variation (CV) was less than 3.9% and baseline and the 14-month visit. These time-points were
interassay variation (4.5%). Reproducibility was ensured compared using contrasts. Determinants for bone analysis
by adhering to the Vitamin D External Quality Assessment were identified with Pearson correlations. Where necessary,
Scheme (DEQAS). EIA results were compared with HPLC variables were transformed using logarithms in order to
results in order to determine the reliability of EIA in satisfy statistical assumptions of normality. Differences
measuring 25-OHD2 concentration. The results were between groups in BMC, CSA and BMD at 14 months,
consistent (r=0.751, p<0.001, R2 =0.495); therefore, the as well as in ΔBMC, ΔCSA and ΔBMD (change from birth
EIA results were used throughout the study. Vitamin D to 14 months), were tested with multivariate analysis
status in children was defined as deficient when S-25-OHD utilizing the same confounding factors. Results are
was below 37.5 nmol/l, insufficient when it was between presented as mean (SD) unless otherwise indicated.
37.6 and 50 nmol/l, and sufficient when it was above Results were considered significant when p<0.05; p
50 nmol/l, according to the published pediatric reference values between 0.05 and 0.10 were considered trends.
values [20]. In adults, a concentration of at least 80 nmol/l is
considered optimal for multiple health outcomes [22].
Serum bone-specific alkaline phosphatase (S-BALP) Results
was assayed with an OCTEIA Octase BAP immunoenzy-
mometric assay (IDS) in order to characterize bone A total of 87 children (57% boys) were followed up for
formation. Samples were diluted 1:5 to meet the standard 14 months. Their mean (SD) values for age, weight, height-
curve. Intra- and interassay CVs were 6.1% and 6.7%, adjusted weight, height, and height Z-score were 14.8 (0.5)
respectively. The bone resorption marker, serum active months, 10.8 (1.3) kg, 0.68 (7.6)%, 78.6 (3.2) cm, and 0.11
isoform 5b of the tartrate-resistant acid phosphatase (S- (1.1), respectively. For data analysis, the participants were
TRACP), was determined with a bone TRAP assay (SBA divided into two groups based on maternal vitamin D status
Sciences, Turku, Finland). Intra- and interassay CVs were during pregnancy. The median maternal S-25-OHD value,
1.2% and 3.0%, respectively. 42.6 nmol/l, was used as the cutoff to define two equal-sized
groups of children with below-median (=Low D; mean S-25-
pQCT bone measurement OHD 35.7 [5.0] nmol/l) and above-median (=High D; mean
S-25-OHD 54.9 [9.1] nmol/l) maternal S-25-OHD concentra-
Peripheral bone variables were determined by pQCT from tion. Table 1 presents the background characteristics of these
the left tibia. One 2.5-mm slice (voxel size, 0.4 mm) at the two groups at baseline and at the 14-month follow-up. The
20% site of distal tibia, was measured with a XCT-2000 duration of exclusive was similar in groups (see Table 1).
scanner (Stratec, Pforzheim, Germany) as described Eighteen children (21.7%) were still breastfed at the time of
previously [10]. Data was analyzed using version 5.50 of the follow-up visit. Dietary intakes of energy, protein,
the manufacturer’s software package, in which the bone vitamin D and calcium did not differ between the groups
contour was analyzed with a single threshold of 180 mg/cm3 and all children had normal development. Only the age when
for the detection of total bone mineral density (BMD), BMC, the children started to walk with support differed between
and CSA. The long-term CVs for the phantom BMD and the groups; all other developmental milestones were similar.
CSA were 1.9% and 1.1%, 2.7% and 0.79%, and 0.50% and Despite lower vitamin D concentration during pregnancy
0.78% in the total, cortical, and trabecular bone, respectively. and at birth in Low D than in High D (means 35.7 vs.
Short-term precision (CV%) was determined with duplicate 54.2 nmol/l, and in the cord 40.5 and 59.3 nmol/l,
measurements of five subjects. CVs for the total bone BMD independent samples t-test; p<0.001, respectively), the 25-
and CSA were 6.0% and 6.5%, respectively. On this basis, OHD concentrations in the two groups at 14 months were
the calculated least significant changes for total bone similar (63 vs. 66 nmol/l, p = 0.58). Serum 25-OHD
BMD and CSA were 16.7% and 18.1%, respectively. Out increased from mean pregnancy value and cord more in
4. 886 Osteoporos Int (2011) 22:883–891
Table 1 Background characteristics and changes in them from baseline value given as mean (SD)
Low D High D Independent samples t-test
N 44 43
Age, months 14.9 (0.5) 14.8 (0.5) 0.336
Males, % 58 55 0.842a
Anthropometric and growth variables
Weight, kg 10.8 (1.3) 10.8 (1.3) 0.997
Relative weight −1.2 (8.1) 0.2 (6.7) 0.382
ΔWeight, kg 7.1 (1.1) 7.2 (1.0) 0.624
Weight velocity, g/month 475 (72) 488 (67) 0.446
Height, cm 79.0 (2.8) 78.4 (3.5) 0.386
Height Z-score 0.25 (1.0) 0.03 (1.2) 0.378
ΔHeight, cm 27.9 (2.0) 27.7 (2.9) 0.732
Height velocity, cm/month 1.88 (0.12) 1.87 (0.19) 0.951
History of breast feeding and dietary intakes
Duration of exclusive breastfeeding, months 4.2 (1.9) 4.3 (2.0) 0.755
Currently breastfed, N (%) 11 (26.8) 7 (16.6) 0.196a
Energy intake, kcal/day 920 (220) 930 (180) 0.770
Fat intake, g/day 28.6 (7.9) 28.0 (6.9) 0.698
Protein intake, g/day 43 (13) 42 (10) 0.481
Calcium intake, mg/day 820 (320) 840 (260) 0.863
Total intake of vitamin D, μg/day 12.4 (3.1) 12.2 (2.9) 0.782
Motor and language skills
Age when learnt to crawl, months 8.0 (1.8) 8.2 (1.8) 0.690
Age when learnt to stand, months 8.4 (1.7) 8.5 (1.6) 0.668
Age when learnt to walk with support, months 8.8 (1.6) 10.1 (1.5) 0.001
Age when learnt to walk without support, months 11.9 (1.6) 12.1 (1.5) 0.458
Number of words in use 5.7 (6.2) 6.8 (7.7) 0.490
a
Pearson chi square
Low D than it did in High D (28 vs. 10 nmol/l and 23.6 vs. Low D and 26 subjects in High D. Determinants of bone
6 nmol/l, respectively; independent samples t-test; p< variables were gender, birth weight Z-score, walking age,
0.001), although the total intake of vitamin D was similar, duration of exclusive breastfeeding and S-25-OHD at
at an average of 12.3 (3.0) μg/day (Table 2). The total 14 months. At the 14-month visit, boys had a higher BMC,
intake of vitamin D correlated positively with 25-OHD ΔBMC and BMD than girls (independent samples t-test; p=
concentration in the whole cohort (r=0.301, p=0.005) and 0.002, p=0.002 and p=0.02, respectively). Birth weight Z-
in High D (r=0.505, p<0.001), but not in Low D (r=0.219, score correlated strongly with BMC and CSA at 14 months
p=0.168) (Fig. 1). Vitamin D status according to several (r=0.507, p<0.001 and r=0.368, p=0.004). Similarly, walking
reference values [20, 22] did not differ between the groups. age was inversely associated with BMC, CSA and S-25-OHD
Of the total cohort, 21%, 62% and 17% had S-25-OHD at 14 months (r=−0.545, p<0.001, r=−0.433, p<0.001, and
below 50 nmol/l, between 50 and 79.9 nmol/l or at least r=−0.194, p=0.083, respectively). The duration of exclusive
80 nmol/l, respectively (Table 3). Higher dietary intake of breastfeeding correlated negatively with BMC, ΔBMC, CSA
vitamin D and use of D3 supplements were related to and ΔCSA (r varying from −0.377 to −0.428, p=0.002). S-25-
improved vitamin D status. OHD at the 14-month visit was only modestly related to BMD
and ΔBMD (r=−0.230, p=0.08 and r=−0.142, p=0.250), but
Tibia BMC, CSA and BMD was included in the model as well.
The development of BMC from baseline to 14 months
Bone measurements were successful in 68 of subjects (78%) at differed between the groups (repeated-measures multivariate
the 14-month visit. For the longitudinal bone analysis, complete analysis of variance [MANOVA]; p=0.023) (Fig. 2a) due to
baseline and follow-up data were available for 29 subjects in greater baseline BMC in High D. However, the total BMC
5. Osteoporos Int (2011) 22:883–891 887
Table 2 Biochemical markers at 14-month visit and changes in them from baseline value given as mean (SD)
Low D High D Independent samples t-test
N 46 40
Mean of first trimester and postpartum maternal 25-OHD, nmol/l 35.7 (5.0) 54.2 (9.1) <0.001
Cord 25-OHD, nmol/l 40.3 (7.2) 59.5 (12.2) <0.001
At 14-month S-25-OHD, nmol/l 63.0 (20.7) 65.6 (21.2) 0.575
S-25-OHD3/total 25-OHDa 0.50 (0.28) 0.50 (0.24) 0.878
ΔS-25-OHDb, nmol/l 27.5 (22.2) 10.2 (19.4) 0.001
ΔS-25-OHDc, nmol/l 23.0 (23.2) 6.0 (22.1) 0.002
S-TRACP, U/l 11.2 (4.0) 10.0 (4.1) 0.199
ΔS-TRACP, U/l −0.28 (4.3) −0.47 (4.7) 0.876
S-BALP,μg/l 124 (38) 122 (38) 0.847
ΔS-BALP, μg/l 69.2 (37.4) 62.4 (42.8) 0.527
a
Based on HPLC
b
An increment of S-25-OHD from mean maternal to 14-month visit
c
An increment of S-25-OHD from cord to 14-month visit; N=30, N=31
gain (ΔBMC=BMC14 month − BMCbaseline) during the first Bone turnover markers
year was 0.062 (SEM=0.029) g/cm greater in Low D
(MANOVA; p=0.032); consequently, no difference was BALP, a surrogate of bone formation, increased dramatically
observed in BMC between the groups at the 14-month visit. from baseline (repeated measures MANOVA; p<0.001)
TB CSA from baseline to the 14-month visit was signifi- (Fig. 3a), while TRACP concentration remained at the same
cantly higher in High D than in Low D (repeated MANOVA; level during the 14 months (Fig. 3b). At the 14-month visit,
p=0.004) (Fig. 2b) due to the higher baseline CSA in High TRACP, BALP, or their ratio did not differ between the
D. ΔCSA did not differ between the groups. Thus, a trend to groups. There was no correlation between BALP and
higher CSA at 14 months by 14.6 (SEM=7.8) mm2 TRACP, but ΔTRACP correlated positively with Δ25-
(MANOVA; p=0.068) remained in High D. There was no OHD (=25-OHD14 month − 25-OHDpregnancy mean) (r=0.345,
difference between the groups in BMD during the 14 months p=0.012). Correspondingly, ΔBALP correlated inversely
(Fig. 2c) or in ΔBMD. The observed decrease in BMD is a with Δ25-OHD (r=−0.213, p=0.034). The correlations were
consequence of a greater increment in CSA compared with similar in both groups.
the gain in BMC (69% vs. 18%).
Discussion
This prospective study made three key findings. Firstly, distal
tibia CSA remained larger at 14 months in infants with higher
maternal vitamin D status during pregnancy than in infants
with lower maternal vitamin D status. Secondly, the increment
in tibial BMC from birth to 14 months was higher in those
with inferior maternal vitamin D status during pregnancy. This
resulted in similar BMC and BMD at 14 months in both study
groups. Finally, 20% of the children had S-25-OHD below
50 nmol/l at 14 months of age, although their median total
intake of vitamin D was 12.2 (3.0) μg, which meets the Nordic
recommendation for this age group [23].
Other interesting findings related to bone growth in this
prospective cohort were that boys had higher BMC, and
BMC increased more during the 14 months and resulted in
Fig. 1 Total intake of vitamin D correlated positively with serum 25-
higher volumetric BMD in distal tibia than in girls.
OHD in High D (r=0.505, p<0.001), but not in Low D (r=0.219, p= Children in high vitamin D group learnt to walk with
0.168). Squares indicate High D and circles indicate Low D support later than children in low vitamin D group,
6. 888 Osteoporos Int (2011) 22:883–891
Table 3 Distribution of vitamin D status in 1-year-old children and Maternal vitamin D status regulates skeletal growth and
mean intake in each category
development during fetal life [9, 10, 28]. The present study
S-25-OHD N (%) Total intake of User of D2 proves that these effects partly persist in early childhood, as
(nmol/l) vitamin D (μg/day)a (%)b has been suggested in a longer prospective study [11]. Tibia
CSA remained somewhat larger in infants whose mothers
<37.5 2 (2.3) 12.2 (4.0) 100
had better vitamin D status during pregnancy. Besides
37.6–50 16 (18.6) 10.6 (3.1) 100
genetic background bone size is affected by various
50.1–79.9 53 (61.6) 12.4 (2.8) 88.5
hormones and it has been shown that growth hormone-
≥80 15 (17.4) 13.1 (2.5) 50
IGF-1 axis is responsible for bone size [29] and periosteal
Total (N) 86 84 84 expansion [30, 31]. Leptin may favor stem cell differentia-
a
Total intake differed between categories of 25-OHD (ANOVA; p=0.03) tion towards osteoblasts rather than adipocytes [32] in
b
Distribution of D2 users differed between categories (chi square; p=
infancy. Furthermore, vitamin D stimulates osteoblasto-
0.001) genesis in human mesenchymal stem cells and production
of IGF-1 in osteoblasts [14]. In infants with rickets vitamin
D supplementation increases serum IGF-1 and accelerates
although other developmental milestones were similar. We linear growth [33]. In this study, we did not measure IGF-1
consider this as a random finding because it is unlikely that and other growth hormone parameters, but height and weight
higher maternal vitamin D status would contribute to this velocities did not differ between the groups. Although all
and several studies have witnessed that vitamin D deficiency infants received vitamin D supplementation, the difference
is related to delayed age of walking [24, 25]. In this study, between the groups in tibia CSA was maintained until
walking age without support was inversely related to tibia 14 months of age. The difference at birth was 16% and 11%
BMC and CSA, suggesting that earlier walking enhances at 14 months. This shows that the fetal bone growth tracks
bone development. Similarly jumping is shown increase during the first year [34], which emphasizes the meaning of
the outer diameter of the tibia in a randomized controlled maternal nutrition for bone trajectory. Bone size is a major
trial of 3- to 5-year-old children [26]. Walking is one of determinant of bone strength [35] and therefore the observed
the first weight-bearing exercises modifying the strength differences in CSA may have significant clinical implica-
of the tibia, but it is unsure if the association between tions in fracture resistance.
walking age and bone health will preserve in the future. Unlike CSA, BMC or BMD did not differ between the
Surprisingly, longer exclusive breastfeeding was linked to study groups at the 14-month visit. This is explained by the
lower bone development, which might be a sum of steep increment of BMC in Low D group. In fact, the BMC
prolonged growth rate [27] and possible lower intakes of accrual was about three times higher in Low D than in High
nutrients. However, infant 25-OHD at 14-month visit was D (28.7% vs. 8.4%), and due to this catch-up in Low D
only modestly related to bone growth; thus, it was there was no difference in distal tibia BMC between the
included as a confounder in the model. groups at 14 months. The greater increase in BMC in Low
a b 160 c
0.50 500
Tibia BMD, mg/cm 3
140 450
0.45
Tibia CSA, mm 2
Tibia BMC, g/cm
120
0.40 400
100
350
0.35 80
300
60
0.2 200
20
0.0 0 0
0 14 0 14 0 14
Time, months Time, months Time, months
Low D High D
Fig. 2 BMC, CSA and BMD in study groups from baseline to D (repeated-measures MANOVA; p=0.004) (b) due to the higher
14 months. Increase in BMC from baseline to 14 months differed baseline CSA in High D. At 14 months, CSA remained 14.6 (SEM=
between the groups (repeated-measures MANOVA; p=0.023) (a) due 7.8) mm2 (MANOVA; p=0.068) higher in High D. There was no
to higher baseline BMC in High D. No difference was observed in difference between the groups in BMD during the 14 months (c) or in
BMC between the groups at the 14-month visit. TB CSA from ΔBMD. Low D and High D groups are represented by circles and
baseline to 14 months was significantly higher in High D than in Low squares, respectively. Error bars represent SEMs
7. Osteoporos Int (2011) 22:883–891 889
a b
14
160
Low D
140 12
S-TRACP, U/L
S-BALP, mg/L
120 High D
10
100
80 8
60 6
40
30
0 0
0 14 0 14
Time, months Time, months
Fig. 3 Concentrations of BALP and TRACP in study groups from from baseline (repeated-measures MANOVA; p<0.001) (a) while
baseline to 14 months. Low D and High D are represented by circles TRACP concentration remained at the same level during the
and squares, respectively. Error bars represent SEM. BALP increased 14 months (b). There were no differences between the study groups
D group is likely to be due to increased calcium accrual, as which means that further comparison between different
reverted vitamin D status enhances calcium absorption. forms of vitamin D is not justified. Because of vitamin D
Some studies have witnessed that insufficient vitamin D supplementation, S-25-OHD concentration increased during
status during pregnancy is related to lower bone mineral the follow-up. Interestingly, the increase was higher in group
status in the newborn [9, 10, 28]. Initially, 70% of the with inferior S-25-OHD during pregnancy than in group with
mothers were vitamin D deficient during the pregnancy as higher 25-OHD during pregnancy (ΔS-25-OHD 27.5 vs.
their mean serum 25-OHD for first trimester and 2 days 10.2 nmol/l). In line with earlier findings [39, 40], a higher
postpartum was less than 50 nmol/l. Improved postnatal response was observed in those with initially lower status.
vitamin D status results in catch-up in BMC, but not in However, neither S-25-OHD nor ΔS-25-OHD was signifi-
CSA. Decline in BMD was similar in both study groups cantly associated with pQCT bone variables at 14 months or
and it reflects a redistribution of bone tissue from the their changes during the 14-month follow-up. The study
endocortical to the periosteal surface. An explanation for shows that fetal vitamin D status, rather than postnatal
declined BMD might be that cortical thickness decreased vitamin D status, affects bone growth during the first year.
during the 14 months while the amount of trabecular bone On the other hand, S-25-OHD reflects relatively short-term
increased [36]. accumulation of dietary vitamin D and solar exposure [41],
In early infancy, peripheral bones grow by increasing the whereas observing differences in bone variables takes more
outer diameter rather than the mineral content [36]. In the time. ΔS-25-OHD correlated positively with ΔS-TRACP and
whole group tibia CSA increased dramatically (68%), inversely with ΔBALP suggesting that vitamin D affects
indicating that the periosteal diameter and circumference bone turnover [42]. Consequently, S-25-OHD may be a
increased. The growth in periosteal circumference occurred significant determinant of bone turnover in infants, although
similarly in groups, but High D group started at a higher growth, diet and motor development also play a part.
level and hence stayed higher at 14-month visit. There was a positive association between total intake of
Vitamin D supplementation is recommended for all vitamin D and 25-OHD in the entire group and in High D,
infants aged between 2 weeks and 3 years in Nordic but not among those infants in Low D whose vitamin D
countries in order to guarantee a total intake of 10 μg/day. status during pregnancy was worse. At the 14-month visit,
All subjects in the present study received supplementation, 2.3%, 18.4% and 79.3% were defined as vitamin D
compared to a representative study cohort in Finland, in deficient, insufficient and sufficient, respectively [20].
which 85% of 1-year-old infants and 70% of 2-year-old Given that more than 20% of the infants had S-25-OHD
infants were reported to receive vitamin D supplementation below 50 nmol/L, despite compliance with supplementa-
[37]. Thus, families in the present study were somewhat tion, higher intake of vitamin D is recommended in order to
selected and possibly more health-orientated than the obtain all the potential health benefits of vitamin D [43,
Finnish population in general. In the present study, 85% 44]. Optimally, vitamin D sufficiency should be guaranteed
of infants had total vitamin D intake that was in line with during fetal life as the findings of the present study suggest
the Nordic recommendation [23]. Interestingly, the use of that the consequences of poor vitamin D status during the
D3 supplements was associated with improved vitamin D fetal period cannot be totally reverted by postnatal vitamin
status to a greater extent than use of D2 supplements, which D supplementation.
is in line with findings of Houghton and Vieth [38]. One of the limitations of the study was that only 70% of
However, the number of D3 users was very low (N=12), the families were willing to attend the 14-month follow-up
8. 890 Osteoporos Int (2011) 22:883–891
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