Full Text (from J Peds twitter feed): All Aboard Meal Train: Can Child-Friendly Menu Labeling Promote Healthier Choices in Hospitals? S Basak et al. J Pediatr 2019; 204: 59-65
Conclusion: “The combination of menu labeling techniques targeted to children in the inpatient hospital setting was an effective short-term tool for increasing the intake of healthier foods, although the effect of labeling waned over time.”
From the discussion: “Our findings in this study show a significantly higher odds of ordering green-light healthier option foods and lower odds of ordering red-light foods when exposed to child-friendly menu labeling. This effect waned over time, such that after 8 meals, proportions of red-light and green-light choices were similar with both menus…
Although most children’s hospital food environments include food items that have low nutritional value, this study highlights that nutrition education using menu labeling can be successfully implemented and can encourage children and their families to make healthier choices. It is our hope that labeling may also encourage hospital food providers to improve food quality at the hospital by decreasing red-light foods and increasing healthy food options at every meal. More research is needed to determine optimal techniques for various age ranges and develop menus that are age-appropriate and tailored for specific patient populations.”
My take: 1. This study from Sick Children’s is important. We can determine more effective healthy eating strategies on a ‘captive’ audience. 2. I remember several years ago when one of my partners ruffled some feathers by asking the hospital to reconsider promoting sugar-sweetened beverages while at the same time posting billboards of obese children.
Related blog posts:
- Lunchroom Makeover
- Eliminating sweetened beverages to help obesity
- In the News: UCSF Soda Ban | gutsandgrowth
- “The Fruit Juice Delusion”
A recent study (JH Savage et al J Pediatr 2018; 203: 47-54) examined the impact of breastfeeding compared with formula on microbiome diversity in 323 infants; this included 95 exclusively breastfed, 169 exclusively formula fed at time of stool collection.
Breastfed infants were more likely to have been born vaginally (74% vs 62%) and less likely to be African-American (11% vs. 36% for hispanic infants, and 52% for caucasian).
- Breastfeeding was independently associated with infant intestinal microbiome diversity at age 3-6 months
- Maternal diet during pregnancy and solid food introduction were less associated with infant gut microbiome changes than breastfeeding status
My take: We still don’t understand the long-term implications of these differences in microbiome alterations between breastfeeding and formula. That being said, the development/evolution of breastmilk has taken place over thousands of years and it is likely that formula, while an important substitute, will never replicate all of the useful components.
Related blog posts:
- With regard to avoiding excess weight gain, breastfeeding is best
- Colic microbiome
- Long-chain polyunsaturated fatty acids, breastmilk, and infant cognition
- Laying to Rest a Breast-Feeding Myth
- Breastfeeding and IQ –the Latest Data
- The Genius of Breastmilk
- More breastmilk, better development | gutsandgrowth
- Feeling Guilty about Stopping Breastfeeding? | gutsandgrowth
- Bioactive Components of Breastmilk | gutsandgrowth
- More on Breastfeeding and Intelligence
To all my colleagues and to others who follow this blog, I wish you a happy new year. Thank you to all of you, especially to those who provide feedback to help improve the content and usefulness.
Recently NASPGHAN released an App, titled NASPGHAN Toolbox. There are some very useful features but also some areas where more work is needed.
Work in progress: Many of the algorithms that are listed are dated and no longer accurate. To list a few examples:
- The UC Algorithm suggests holding off on anti-TNF therapy in severe disease for 7-14 days
- The EoE Algorithm lists only diet treatments and topical steroids and does not list PPIs as a treatment option
- The GERD guidelines are from 2001 rather than more recent recommendations
Also, this ‘algorithms’ section should probably be renamed into ‘algorithms and tables’ as a large amount of the information is not algorithmic.
What I Like:
- Scores and Calculators for items like MELD score, PUCAI score, Mayo score
- Extensive patient education handouts and image atlas -this could facilitate “airdrop”ing or messaging of these items to families. (To be picky –the normal esophagus image could be better)
- Formula charts –though the lists for infants and older children could be more comprehensive
- Bristol charts (especially children version) -listed in algorithm section
My take: This is a very good start and a very helpful toolbox for pediatric gastroenterologists but I would not rely on the algorithms.
Recently, I listed the posts that had the most views in the past year –some dating back to 2012. The following list includes less viewed but some of my favorite posts from 2018:
- Clinical Evaluation Not Sensitive for Aspiration
- Lessons in diarrhea: Part 1 & Part 2
- Parasitology in 2018: Should we still be ordering O&P x 3?
- How many eosinophils indicate eosinophilic gastroenteritis or colitis?
- PEG 3350 is Not associated with elevated glycol levels
- 2018 Pediatric GERD Clinical Practice Guidelines (NASPGHAN)
- Isopropyl Alcohol, antiemetic aromatherapy
Since this blog’s inception, there are now more than 2500 posts; these are the most popular (most views):
- Diet or drugs for cyclic vomiting syndrome July 2012
- Miralax Safety Feb 2013
- Colonoscopy, Split-dosing bowel preps, and Ottawa Scores July 2012
- NAFLD 2012 Guidelines June 2012
- Belching, Hiccups and Aerophagia Jan 2013
- Paris Classification of Pediatric Crohn’s Disease April 2013
- Top Lecture: Enteral Nutrition for Crohn’s Disease Oct 2013
- Green beans for short gut syndrome Jan 2013
- How to dissolve a bezoar Dec 2012
- What to do with delayed gastric emptying/gastroparesis Aug 2012
Most of these posts are referenced in more recent posts on the same or similar subjects.
These five posts were the most popular (most views) in the past year: