Category Archives: Nutrition

Parenteral Omega-3 Lipid Emulsions and Risk of Bleeding

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A recent study indicates that patient’s placed on omega-3 lipid emulsions (eg. Omegaven) may be at risk for bleeding due to platelet dysfunction (J Pediatr 2014; 164: 652-4).

While omega-3 lipid emulsions have received a lot of attention due to improvements in intestinal failure associated liver disease (IFALD) (see previous links to prior posts below), the amount of data supporting their usage and potential advantages compared with standard lipids at similar dosing remains limited.

This case report describes a 9-month old who developed life-threatening hemorrhage following a standard central line placement.  Due to difficulty stopping the bleeding, the patient’s omegaven was discontinued.  Standard workup for bleeding disorders were negative.  Subsequently, the authors investigated clot formation and platelet function in a neonatal animal model.

Key Result: Piglets treated with omegaven had a doubling of time to clot formation and marked platelet agonist inhibition.

The discussion notes that “there is an acknowledged risk of high dose O3FA lipids [omegaven] increasing bleeding time because of competitive inhibition of AA [arachidonic acid] production, hence decreased TxA2 [thromboxane A2].  In addition, platelet-derived growth factor-like protein and endothelial platelet activation factor are decreased.”

Take home points (from the authors):

  • “the case report and piglet studies together demonstrate that there is potential for a significant antiplatelet effect and inhibition of the coagulation cascade with O3FA therapy…”
  • “We would suggest discontinuation of Omegaven therapy 72 hours preoperatively in high-risk cases where bleeding may be difficult to directly control.”
  • “Institutionally, we have abandoned the sole use of Omegaven therapy.”

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Buyer Beware: Supplement at Your Own Risk

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Although I’m a pretty good swimmer, I am always a little uneasy when I see signs that say “Swim at Your Own Risk.” Perhaps, signs like that should accompany ‘dietary supplements’ since they are unregulated and often pose a significant unknown danger.

A fascinating perspective article discusses the myriad of problems with over-the-counter supplements (NEJM 2014; 370: 1277-80).  The article begins by detailing the cases of severe hepatitis and death due to OxyElite Pro, a supplement marketed for weight loss and muscle building.  This agent was linked to 97 patients, 47 required hospitalizations, 3 resulted in liver transplantation (that’s one way to lose weight!), and one death.  An astute liver-transplant surgeon was the first to suspect this supplement.

Since then “nothing has been done to prevent another supplement from causing organ failure or death.”

Key points:

  • Supplement industry: $32 billion spent in U.S. per year on 85,000 different combinations of vitamins, minerals, botanicals, amino acids, probiotics, and other ingredients
  • Supplements do not require premarketing approval.  “Under the Dietary Supplement Health and Education Act of 1994, anything labeled as a dietary supplement is assumed to be safe until proven otherwise.”
  • More than 500 supplements have already been found to be adulterated with pharmaceuticals like anabolic steroids, unapproved antidepressants, banned weight-loss medications, untested sildenafil analogues, and even methamphetamine analogues.
  • The FDAs ability to monitor these supplements is poor.  The MedWatch (https://www.safetyreporting.hhs.gov) is plagued with underreporting and lack of timeliness.  Local health departments have frequently stumbled upon the problem first.

Some common problems with current supplements include the following:

  1. Arrhythmias with agents like Ephedra, horny goat weed, and oleander
  2. Bleeding with Ginkgo
  3. Cancer with anabolic steroids (hepatoma), Beta-carotene (lung cancer), and Vitamin E (prostate cancer)
  4. Hepatotoxicity with numerous supplements including chaparral, comfrey, fo-ti, gerrymander, and kava
  5. Other problems: stroke, kidney stones, panic attacks, rashes, and mood alterations

The perspective notes that a bill in a Senate committee if passed would require that manufacturers register their products and provide some safety information.  This is unlikely to make any significant change.  The author recommends that “every supplement ingredient should undergo rigorous safety testing before marketing.”

Bottomline: when a patient asks you if “this supplement” is OK, the honest answer is nobody knows.

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For Increased Longevity: More Greens are Good

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From NPR, link:http://t.co/07NyZaXqzE

 Excerpt:

A new study linking animal protein-rich diets to increased mortality in middle age adds fuel to the controversy over how much protein — and from what sources — is ideal for health. One thing that seems pretty clear: It doesn’t hurt to go heavy on the greens.

Americans who ate a diet rich in animal protein during middle age were significantly more likely to die from cancer and other causes, compared with people who reported going easy on foods such as red meat and cheese, fresh research suggests.

The study, published Tuesday in the journal Cell Metabolism, was based on an analysis of data from NHANES, an ongoing federally funded study that surveys Americans about their eating habits and behaviors.

In this particular study, researchers tracked about 6,000 older adults included in the survey to find connections between dietary patterns, death and disease.

“The research shows that a low-protein diet in middle age is useful for preventing cancer and overall mortality,” wrote co-author Eileen Crimmins, the AARP Chair in Gerontology at the University of Southern California, in a release about the paper.

But here’s the catch: The researchers also found that for older people, ages 65 and up, there may be a benefit to eating more protein. In this age group, higher levels of protein seemed to be protective against cancer and premature death…

When we’re young, IGF-1 help promotes growth, which is good. But as we age, too much protein in our diets may lead to overly high levels of IGF-1, which may contribute to aging and DNA damage, Longo explains.

Then, after 65, when IGF-I levels trail off, our bodies may benefit from more protein in the diet to help fend of frailty and decline…

In the new study, Longo and his colleagues found that high-protein foods derived from plants, such as beans and nuts, did not have the same effect on mortality as did high-protein foods from animals.

Singling out the effects of protein in the diet is hard to do. For starters, our diets are complex, and sussing out the independent effect of any one component is tough. What’s more, surveying people on what they have eaten, as NHANES does, and then trying to figure out how that influences their health years later is a tricky business. So there are still lots of questions about how to interpret these findings.

In an age when advocates of the Paleo Diet and other low-carb eating plans such as Atkins talk up the virtues of protein because of its satiating effects, expect plenty of people to be skeptical of the new findings.

That said, as we’ve previously reported, several other studies have found a link between a high intake of red meat — especially processed meats like bacon and salami — and other animal proteins and an increased risk of mortality…

according to Dr. Frank Hu, a researcher at the Harvard School of Public Health who studies the links between health, diet and lifestyle.

“The harmful effects of smoking on cancer and mortality are well-established to be substantial, while the harmful effects of red meat consumption are modest in comparison,” Hu wrote to us in an email.

For instance, in a study Hu authored, people who ate a serving of red meat every day had a 13 percent increased risk of mortality, compared with those who ate little meat… Choosing chicken and other poultry decreased the risk by 14 percent, fish decreased the risk by 7 percent and legumes decreased the risk by 10 percent….In the meantime, if you’re feeling confused, consider the one strategy that almost all experts agree on: moderation.

The simplest way to maintain a healthy body weight and cut the risk of so many weight-related diseases is to limit calories.

So eat what you enjoy. Upsize servings of greens and other vegetables. And downsize servings of meat, cheese and other high-calorie foods.

Zip Code or Genetic Code -which is more important for longevity?

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From NY Times: http://t.co/fNm0nFOUdK

An excerpt:

Fairfax County, Va., and McDowell County, W.Va., are separated by 350 miles, about a half-day’s drive. Traveling west from Fairfax County, the gated communities and bland architecture of military contractors give way to exurbs, then to farmland and eventually to McDowell’s coal mines and the forested slopes of the Appalachians. Perhaps the greatest distance between the two counties is this: Fairfax is a place of the haves, and McDowell of the have-nots. Just outside of Washington, fat government contracts and a growing technology sector buoy the median household income in Fairfax County up to $107,000, one of the highest in the nation. McDowell, with the decline of coal, has little in the way of industry. Unemployment is high. Drug abuse is rampant. Median household income is about one-fifth that of Fairfax.

One of the starkest consequences of that divide is seen in the life expectancies of the people there. Residents of Fairfax County are among the longest-lived in the country: Men have an average life expectancy of 82 years and women, 85, about the same as in Sweden. In McDowell, the averages are 64 and 73, about the same as in Iraq….           

There have long been stark economic differences between Fairfax County and McDowell. But as their fortunes have diverged even further over the past generation, their life expectancies have diverged, too. In McDowell, women’s life expectancy has actually fallen by two years since 1985; it grew five years in Fairfax.

“Poverty is a thief,” said Michael Reisch, a professor of social justice at the University of Maryland, testifying before a Senate panel on the issue. “Poverty not only diminishes a person’s life chances, it steals years from one’s life.”

That reality is playing out across the country. For the upper half of the income spectrum, men who reach the age of 65 are living about six years longer than they did in the late 1970s. Men in the lower half are living just 1.3 years longer.

This life-expectancy gap has started to surface in discussions among researchers, public health officials and Washington policy makers. The general trend is for Americans to live longer, and as lawmakers contemplate changes to government programs — like nudging up the Social Security retirement age or changing its cost-of-living adjustment — they are confronted with the potential unfairness to those who die considerably earlier.

The link between income and longevity has been clearly established. Poor people are likelier to smoke. They have less access to the health care system. They tend to weigh more. And their bodies suffer the debilitating effects of more intense and more constant stress. Everywhere, and across time, the poor tend to live shorter lives than the rich, whether researchers compare the Bangladeshis with the Dutch or minimum-wage workers with millionaires.

But is widening income inequality behind the divergence in longevity over the last three decades? …

Living in Fairfax is different than living in McDowell.

In Fairfax, there are ample doctors, hospitals, recreation centers, shops, restaurants, grocery stores, nursing homes and day care centers, with public and private entities providing cradle-to-grave services to prosperous communities…

The jobs tend to be good jobs, providing health insurance and pensions, even if there is a growing low-wage work force of health aides, janitors, fast-food workers and the like. “It’s a knowledge-based work force,” Mr. Fuller said. “And we have an economy built on services, technology-intensive services.”

…350 miles away, …

Coal miners still dig into and blast off the tops of steep Appalachian hills. But the industry that once provided thousands of jobs is slowly disappearing, and the region’s entrenched poverty has persisted. The unemployment rate is 8.8 percent, down from more than 13 percent in the worst of the recession. The current number would be even higher if more residents hadn’t simply given up looking for work.

Government assistance accounts for half of the income of county residents. Social workers described shortages of teachers, nurses, doctors, surgeons, mental health professionals and addiction-treatment workers. There is next to no public transportation…

Many people … have multiple woes: “Diabetes. Obesity. Congestive heart failure. Drug use. Kidney problems. Lung conditions from the mines.” Problems often start young and often result in shorter lives, she said. Earlier that day, she handed me a list of recent funerals with about half highlighted in yellow; they signified that the deceased was under 50…

But dollars in a bank account have never added a day to anyone’s life, researchers stress. Instead, those dollars are at work in a thousand daily-life decisions — about jobs, medical care, housing, food and exercise — with a cumulative effect on longevity…

As such, the health statistics for Fairfax and McDowell are as striking as their income data. In Fairfax, the adult obesity rate is about 24 percent and one in eight residents smokes. In McDowell, the adult obesity rate is more than 30 percent and one in three adults smokes. And the disability rate is about five times higher in McDowell.

In both counties, food availability matters. There are only two full-size grocery stores in McDowell; minimarts and fast-food restaurants are major sources of nutrition. “We don’t have gyms or fitness centers,” said Pamela McPeak, who grew up in McDowell getting creek water to flush her family’s toilet. “It’s cheaper to buy Cheetos rather than apples.” She now runs a nonprofit program that provides tutoring and helps high school students get into college.

Education is also correlated with longevity, as it is with income and employment. Educated individuals are much more likely to work, and much more likely to have higher incomes. In McDowell, about one in 18 adults has a college degree; in Fairfax, the share is 60 percent.

Finally, and perhaps most powerfully, researchers say that a life in poverty is a life of stress that accumulates in a person’s very cells. Being poor is hard in a way that can mean worse sleep, more cortisol in the blood, a greater risk of hypertension and, ultimately, a shorter life…

It is hard to prove causality with the available information. County-level data is the most detailed available, but it is not perfect. People move, and that is a confounding factor. McDowell’s population has dropped by more than half since the late 1970s, whereas Fairfax’s has roughly doubled. Perhaps more educated and healthier people have been relocating from places like McDowell to places like Fairfax. In that case, life expectancy would not have changed; how Americans arrange themselves geographically would have…

In particular, changes in smoking and obesity rates may help explain the connection between bigger bank accounts and longer lives. “Richer people and richer communities smoke less, and that gap is growing,” said Dr. Murray at the Institute for Health Metrics and Evaluation…

To some extent, the broad expansion of health insurance to low-income communities, as called for under Obamacare, may help to mitigate this stark divide, experts say. And it is encouraging that both Republicans and Democrats have recently elevated the issues of poverty, economic mobility and inequality, But the contrast between McDowell and Fairfax shows just how deeply entrenched these trends are, with consequences reaching all the way from people’s pocketbooks to their graves.

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Feeling Guilty about Stopping Breastfeeding? (Part 2)

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Another study (J Pediatr 2014; 164: 487-93, editorial pg 440-42) echoes yesterday’s study.

Design: The authors used a nationally representative sample in a longitudinal survey of 7500 children.  In addition to breastfeeding practices, the authors explored parenting behaviors including putting an infant to bed with a bottle and frequency of reading.

Results: “there is a positive relationship between predominant breastfeeding for 3 months or more and child reading skills, but this link is the result of cognitively supportive parenting behaviors and greater levels of education among women who predominantly breastfed. We found little-to-no relationship between infant feeding practices and the cognitive development of children with less-educated mothers. Instead, reading to a child every day and being sensitive to a child’s development were significant predictors of math and reading readiness outcomes.”

Take-home message: the editorial states that parents should not be concerned that being unable to breastfeed will be detrimental to a child’s cognitive function. But, “encouragement of breastfeeding for other reasons, including health benefits to the infant and enhancement of mother-infant attachment”…merit recommendation along with good parenting practices (eg. reading to infants).

Feeling Guilty about Stopping Breastfeeding?

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From NY Times, Link: http://t.co/rBXCORx3mM

Excerpt:

Many women who are unable to breast-feed feel guilty about it and worry they may be depriving their children of a range of benefits. Groups like the American Academy of Pediatrics and the World Health Organization recommend six months of exclusive breast-feeding for all infants, citing studies that show breast milk is easily digestible and has nutrients that are superior to or absent from infant formulas, including immunological substances that reduce rates of infection and fatty acids important in brain development.

But now a new study suggests that many of the long-term benefits attributed to breast-feeding may be an effect not of breast-feeding or breast milk itself but of the general good health and prosperity of women who choose to breast-feed.

Researchers at Ohio State University compared 1,773 sibling pairs, one of whom had been breast-fed and one bottle-fed, on 11 measures of health and intellectual competency. The children ranged in age from 4 to 14 years.

The researchers recorded various health and behavioral outcomes in the sibling pairs, including body mass index, obesity, asthma, hyperactivity, reading comprehension, math ability and memory-based intelligence. The study, published online in Social Science & Medicine, found no statistically significant differences between the breast-fed and bottle-fed siblings on any of these measures.

By studying “discordant” siblings — one of whom had been breast-fed and the other not — the authors sought to minimize the possibility that racial, socioeconomic, educational or other differences between families could affect the results. Many earlier studies on breast-feeding failed to control for such factors, they say.

… researchers have consistently found large socioeconomic and racial disparities in breast-feeding rates. A C.D.C. survey in 2008 found that 75 percent of white infants and 59 percent of black infants were ever breast-fed, and in 2013, the agency reported that 47 percent of white babies but only 30 percent of black babies were still being breast-fed at 6 months. Compared with bottle-fed infants, breast-fed babies are more likely to be born into families with higher incomes, have parents with higher educational attainments, and live in safer neighborhoods with easier access to health care services.

Still, sibling studies such as this latest one do not solve all the problems of bias…

Geoff Der, a statistician at the University of Glasgow who has worked with the same data in previous studies, said that the findings in the present study were robust and the authors’ method for eliminating selection bias was powerful…“In a society with a clean water supply and modern formulas,” he said, “a woman who isn’t able to breast-feed shouldn’t be feeling guilty, and the likelihood that there’s any harm to the baby is pretty slim.”

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Active Video Games –Part of Weight Loss Program?

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From JAMAPediatrics (full article): http://t.co/CmwQjCyhdJ

An excerpt:

Design, Setting, and Participants      Group-randomized clinical trial conducted during a 16-week period in YMCAs and schools .. Seventy-five overweight or obese children (41 girls [55%], 34 whites [45%], 20 Hispanics [27%], and 17 blacks [23%]) enrolled in a community-based pediatric weight management program. Mean (SD) age of the participants was 10.0 (1.7) years; body mass index (BMI) z score, 2.15 (0.40); and percentage overweight from the median BMI for age and sex, 64.3% (19.9%).

Interventions      All participants received a comprehensive family-based pediatric weight management program (JOIN for ME). Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program. Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program…

Results      Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous (mean [SD], 7.4 [2.7] min/d) and vigorous (2.8 [0.9] min/d) physical activity at week 16 (P < .05). In the program-only group, a decline or no change was observed in the moderate-to-vigorous (mean [SD] net difference, 8.0 [3.8] min/d; P = .04) and vigorous (3.1 [1.3] min/d; P = .02) physical activity. Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16. However, the program and active gaming group exhibited significantly greater reductions in percentage overweight (mean [SD], −10.9% [1.6%] vs −5.5% [1.5%]; P = .02) and BMI z score (−0.25 [0.03] vs −0.11 [0.03]; P < .001).

Conclusions and Relevance      Incorporating active video gaming into an evidence-based pediatric weight management program has positive effects on physical activity and relative weight.

Comment: The costs of the games and game consoles were about $350 according to the authors.  Since this was a short study (16-weeks), it is not clear that this will be cost-effective.  However, any tools that may help kids become more active are certainly welcome.

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7 Ways Parents Can Influence Risk of Obesity

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Here’s a link with some good advice for parents about developing healthy eating habits http://t.co/ChlRj2hEWV from Huffington Post and an excerpt (from Kristin Kirkpatrick, M.S., R.D., L.D):

I was recently called out for not being a “fun” mom because I wouldn’t buy artificially colored “fun” junk food for my son. …

We strive to teach manners, independence and kindness to our children but we often times fail to teach something just as important — the value of exercise and healthy eating. The majority of your child’s attitudes about food and nutrition, they’re desire to be physically active and even their weight will come directly from their parent’s.

Here are eight things about you that will most likely be passed down to your children. 

1. You’ve got a weight problem While part of your child’s risk for obesity, and even how picky they might be about trying certain foods may be caused by genetic factors, the bulk of your child’s predisposition to be overweight may actually be determined by your weight.  That’s right, if you’re overweight or obese, your child’s chances of following the same fate are between 25 to 50 percent. What about your child’s other parent? If he or she is also overweight, the chances just shot up to 75 percent.

A 2012 study found that a simple formula could predict a baby’s propensity to become obese and noted in the study that based on longitudinal cohort data, that 20 percent of children predicted to have the highest risk at birth make up 80 percent of obese children. The calculation is based on five factors including birth weight, the body mass index of the parents, the number of people in the household, the mother’s professional status and whether she smoked during pregnancy…

2. You use food to reward or withhold on a regular basis …

3. In your home, junk food is its own food group A 2014 study  suggested that it wasn’t actually the vast presence of fast food establishments that was to blame for the pediatric obesity epidemic but rather overall bad habits that originated in the home. Homes that followed a “Western diet” defined in the study as having a prevalence of sugared sweetened beverages, salty snacks, high-fat sandwiches, candy and desserts were more likely to have obese or overweight kids with poor dietary habits.

The desire for junk food may actually be affected before birth as well. A 2013 animal study found that pregnant mothers who consumed junk foods, particularly fast food, actually altered the opiate signaling pathways in the brains of their offspring, making their baby’s more likely to crave foods high in fat and sugar.

4. You’re a couch potato A 2013 study found that kids whose moms encouraged them to exercise and eat well (and modeled these behaviors in themselves) were more likely to engage in physical activity and adhere to healthy eating habits. That means more movement, mom and dad, and less couch time! In addition to keeping kids sedentary, spending too much time on the couch as a family exposes your little one to more commercials that promote unhealthy foods, a risk factor for childhood obesity…

Limiting overall “screen time” in young children is also critical and has been shown  to reduce the risk for obesity and chronic conditions. Finally, if you’re thinking about letting your little one have a TV in his or her bedroom, think again! A 2012 study found that children having a TV in their room were more likely to have a higher waist circumference.

5. You’re labeling your child as “picky” Have you ever told another parent that your child is a picky eater? Simply labeling your child as picky could cause them to turn away from fruits and vegetables according to one study. The study showed that moms who labeled their child as “picky” had children who were less likely to try various types of produce and were actually less likely to eat fruits and vegetables themselves.

6. You think breakfast is for sissies Habitual breakfast in children is associated with  higher academic performance, a reduced risk for obesity and an increased intake of vitamins and minerals.

7. There’s no mealtime routine in your family … Eating as a family unit has been linked  with increased fruit and vegetable consumption and lower intakes of soft drink consumption. Further, adolescents who experience family meals often have a better diet as they head into adulthood.

Parents, it’s your job to help shape the taste buds, views about food and weight for life. That doesn’t mean your kid should never have a cookie. It just means that these foods shouldn’t be the norm. Teach your kids about which foods make them strong and which foods make them weak by using words and phrases they’ll understand such as “This salad will help you grow tall,” or “This apple makes mommy’s brain super strong.”

Most importantly, if your child already has a weight problem or less-than-perfect eating habits, it’s not too late to help him or her change. The step is recognizing the problem (few parents  actually do) and working together with your child to change behavior. I’m happy to keep my “non-fun” mom status if that means that I can help my son be a healthy eater and maintain a normal weight throughout his life. One day …perhaps he’ll realize just how “fun” being healthy, staying fit and avoiding sickness can really be.

 

Gluten-free diet “has legs”

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From NY Times: http://t.co/5cQijw7do9

An excerpt:

The Girl Scouts recently introduced a gluten-free chocolate chip shortbread cookie to their annually anticipated line of sweet treats…And Trader Joe’s recently joked in an advertising flier promoting gluten-free foods that it was selling “Gluten Free Greeting Cards 99 Cents Each! Every Day!” — even though it then went on to say the cards were not edible.

Makers of products that have always been gluten-free, including popcorn, potato chips, nuts and rice crackers, are busy hawking that quality in ads and on their packaging.

And consumers are responding with gusto. The portion of households reporting purchases of gluten-free food products to Nielsen hit 11 percent last year, rising from 5 percent in 2010.

In dollars and cents, sales of gluten-free products were expected to total $10.5 billion last year, according to Mintel, a market research company, which estimates the category will produce more than $15 billion in annual sales in 2016…

“About 30 percent of the public says it would like to cut back on the amount of gluten it’s eating, and if you find 30 percent of the public doing anything, you’ll find a lot of marketers right there, too.”

Never mind that a Mayo Clinic survey in 2012 concluded that only 1.8 million Americans have celiac disease, an autoimmune disorder that causes the body to attack the small intestine when gluten is ingested and can lead to other debilitating medical problems if not diagnosed.

An additional 18 million people, or about 6 percent of the population, is believed to have gluten sensitivity, a less severe problem with the protein in wheat, barley and rye and their relatives that gives elasticity to dough and stability to the shape of baked goods.

“There are truly people out there who need gluten-free foods for health reasons, but they are not the majority of consumers who are driving this market,” said Virginia Morris, vice president for consumer strategy and insights at Daymon Worldwide, a private brand and consumer interactions company…

“The reason I do believe this has legs is that it ties into this whole naked and ‘free from’ trend,” she said. “I think we as a country and as a globe will continue to be concerned about what’s going into our food supply.”

Rebecca Thompson, a marketing manager at General Mills, said ..“When you think about the dynamics in a household, where there are likely to be three other people eating at the same time as one person with celiac or gluten sensitivity, it’s much easier to prepare one meal for everyone.”…

General Mills, whose brands include Bisquick, Pillsbury and Betty Crocker, might seem like the least likely company to embrace gluten-free. But in the mid-2000s, more and more customers began seeking alternatives to its traditional products.

So in 2008, it began reformulating its Chex cereals, underscoring the first change, to Rice Chex, with a major marketing effort. It was relatively easy to tweak Chex by switching a few minor ingredients. But the next year, Betty Crocker introduced gluten-free brownies, cookies and cakes in a far more complicated process…

Gluten-free customers are valuable, ringing up roughly $100 in sales with their average grocery basket compared with $33 for the overall average basket, according to Catalina Marketing…

Last August, the Food and Drug Administration, which oversees food labeling, ruled that products labeled gluten free were permitted to contain no more than 20 parts of gluten per million, which made it more difficult for large food companies to get into the business. “You really need to have a captive facility because wheat floats,” Mr. Hughes said.

Sales of Udi’s and Glutino were up 50 percent last year, and Boulder Brands is finding more demand from regional food service businesses and institutions. Udi’s hot dog buns are available now in most major baseball parks, and Dunkin’ Donuts and others are turning to the company for individually wrapped gluten-free bagels and muffins…

Mr. Hughes said. “We think this is a trend with long legs because there is some insulation from the big players — it’s hard to produce gluten-free — and because so much of the category is represented by $10- and $15-million mom-and-pop businesses.”

Interest in gluten-free products also has been a boon for fruits and vegetables and other foods that are inherently gluten-free. Popcorn Indiana, for example, has labeled its ready-to-eat popcorn gluten-free since before the fad began, in part because the chief executive, Hitesh Hajarnavis, has children who have food allergies. “I had become an avid reader of labels, and so when I came over to Popcorn Indiana, I knew the value of having a clear gluten-free label for what was then a very small number of people with gluten allergies,” Mr. Hajarnavis said… “But there is a growing population of people who have somehow heard that gluten-free is healthier or think of it as fashionable, and when they remove gluten from their diet, they’re inadvertently taking out a lot of processed foods and are really feeling the benefits of eating healthier foods.”

Celiac Update: Quinoa –probably OK for gluten-free diet based on small study.  Here’s the link: nature.com/ajg/journal/vaop/ncurrent/full/ajg2013431a.html … (from KT Park twitter feed)

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Can parents not know if their child is overweight?

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Answer to the blog title: Yes

When I look back at classroom pictures from 30 years ago, so many kids look thin compared to today’s kids.  Perhaps, the perception of what is normal has been lost.  In fact, recent studies (doi: 10.1542/peds.2013-2690) indicate that parents often do not know whether their child is overweight,  especially between the ages of 2-5.

A link from NY Times twitter feed: http://nyti.ms/1ctfgcm 

An excerpt:

Many parents apparently believe their children are leaner than they actually are.  A review of studies published in Pediatrics found that two-thirds of parents underestimate the weight of their offspring.

“If parents don’t recognize that their children are overweight, that prevents them from undertaking actions to correct it,” said the lead author, Alyssa Lundahl, a graduate student in psychology at the University of Nebraska-Lincoln…

Ms. Lundahl and her colleagues reviewed 121 studies that included more than 80,000 parental estimates of the weight of their children who were between the ages of 2 and 19. More than half of parents of overweight and obese children underestimated their weight, and so did about 14 percent of parents of normal weight children. Parents were most likely to underestimate the weight of 2- to 5-year olds.

The reasons for the misunderstanding are not known…“When health care professionals are able to correct a parent’s false impression,” Ms. Lundahl said, “they are more likely to do something about it.”

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