Category Archives: Nutrition

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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Is a Three Year-Old Too Young for Bariatric Surgery?

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Maybe not.

Recent article from WSJ (from Jeff Schwimmer’s twitter feed): http://online.wsj.com/news/article_

Here is an excerpt:

Daifailluh al-Bugami was just a year old when his parents noticed that his lips turned blue as he slept at night. It was his weight, doctors said, putting pressure on his delicate airways.

Now Daifailluh is 3, and at 61 pounds he is nearly double the typical weight of a child his age. So the Bugamis are planning the once unthinkable: To have their toddler undergo bariatric surgery to permanently remove part of his stomach in hopes of reducing his appetite and staving off a lifetime of health problems.

That such a young child would be considered for weight-loss surgery—something U.S. surgeons generally won’t do—underscores the growing health crisis here and elsewhere in the Middle East. Widespread access to unhealthy foods, coupled with sedentary behavior brought on by wealth and the absence of a dieting and exercise culture, have caused obesity levels in Saudi Arabia and many other Gulf states to approach or even exceed those in Western countries…

Daifailluh’s doctor, Aayed Alqahtani, is a leading advocate of a radical approach to the problem. Patients travel to him from across the country and the Gulf region. Over the past seven years, he has performed bariatric surgery on nearly 100 children under the age of 14, which experts on the procedure believe is the largest number performed by one doctor on young children… “We should not deprive our patients from bariatric surgery based on their age alone,” the surgeon says. “If they have [medical] conditions that threaten their lives, then we should not deny the bariatric surgery…”

Pediatric surgeons in the U.S. say they also are facing demands from families to operate on younger patients. Thomas Inge, surgical director of the Surgical Weight Loss Program for Teens at Cincinnati Children’s Hospital, says he will be operating on a 12-year-old later this month. He says that as younger and younger children are referred for consideration of surgery, care teams will need to carefully weigh the pros and cons…

Many doctors say they aren’t ready to follow Dr. Alqahtani yet. Kirk Reichard, chairman of the pediatric-surgery committee for the American Society for Metabolic and Bariatric Surgery, notes that there are no data to show that surgery doesn’t affect young children’s long-term sexual maturation or cognitive functioning.

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The Genius of Breastmilk

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While there has been a lot of talk about how breastmilk improves IQ/development (see links below), there are many other reasons why breastmilk is amazing.  For example, breastmilk reduces the risk of necrotizing enterocolitis (NEC).  A recent study on this effect: J Pediatr 2013; 163: 1592-5.

In this multicenter randomized controlled trial involving 7 NICUs, the authors studied extremely premature infants whose mothers did not provide their breastmilk.  Infants were fed either a cows-milk based preterm formula (COW, n=24) or pasteurized donor human milk (HUM, n=29). Birth weight and gestational age were similar in both groups, approximately 990 g and 27.5 weeks respectively.

Results:

  • HUM patients had fewer days of parenteral nutrition: 27 vs. 36, P=.04
  • HUM patients had fewer bouts of NEC: 1 (3%) vs. 5 (21%), P=.08; surgical NEC occurred 4 times in COW group compared with 0 in HUM patients (P=.04)

Take-home message: The data from this study are in line with recent American Academy of Pediatrics policy statement that recommends the following: “premature infants should receive only human milk from their mother and that, if it is not available, pasteurized donor human milk should be used.”

Another relevant study: J Pediatr 2010; 156: 562-7.

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“Fill er up”

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A few years ago my wife took a bunch of kids to a local frozen yogurt place.  The kids take their bowl and choose their frozen yogurt flavor and toppings; the cost is determined at the end of the line based on how much you took.  One of our guests filled her bowl (at a sizable expense) but only ate a small portion.  My wife told her, ‘if you lived in our household, I would insist that you eat what you took.’  And even though we both hate waste, it seems like human nature to have ‘eyes that are bigger than your stomach.’

An interesting publication (J Pediatr 2014; 164: 323-6) on bowl size and cereal consumption did not make the coveted list of articles reviewed by the editors.  But, I think a lot of pediatric providers and anyone who goes to frozen yogurt establishments would find the information useful.

The article consisted of two studies.  In the first, 69 preschool-age children were randomized to either an 8 oz bowl or a 16 oz bowl and asked to tell researchers how much cereal they wanted for a morning snack; the amount consumed was not measured.  In the second study, 18 school-age children at a summer camp were given an 8 oz bowl on one day and a 16 oz bowl on another day.  Each day, they were asked by the cafeteria server how much cereal and milk they wanted for breakfast.  Hidden scales measured how much was served, consumed, and discarded.

Who thinks they can guess the results?

  • In study 1, children with the larger bowl requested 87% more.
  • In study 2, the older children also consumed more (52%) when given a larger bowl; in addition, they wasted 26% more.

The article notes that some studies (eg. J Consumer Res 2012; 39: 215-28) but not all (Appetite 2007; 49: 652-60) have indicated that “when adults serve themselves, they select an amount of food proportional to the size of the plate;” some have suggested this is due to a visual illusion effect —Delboeuf illusion – Wikipedia, the free encyclopedia.

Screen Shot 2014-02-07 at 4.23.54 PM

 

Take-home message: If kids (and probably adults) have a bigger bowl, they will want to “fill er up.”  This will certainly lead to more waste but it may increase their waists too.

What to Make of Dr. Oz and his Detox? Not much

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Although my exposure to Dr. Oz has been limited, he is not one of my favorite TV doctors. He often offers opinions in areas where he clearly is not an expert.  By presenting himself as a doctor who is knowledgeable in so many areas, he has the potential of undermining the credibility of physicians more broadly.  A recent report provides some welcome pushback and at the same time indicates that “detox” treatments are unlikely to be helpful.

Here’s the link: Detox treatments by Dr. Oz and others lack evidence, benefit … – CBC

An excerpt:

Despite bold promises that the treatments would purify, detoxify and boost energy and optimize organ function, the cleanses lacked any scientific evidence of efficacy, or clear idea of what toxins they would actually diminish…

“In looking at the medical literature on these things, there has never been a properly conducted scientific investigation of any of these treatments that I’ve been able to find,” Dr. George Dresser, a toxicologist, pharmacologist and an internal medicine specialist at London Health Sciences Centre, told Marketplace co-host Tom Harrington. “It’s an intensely popular topic. And it’s popular because people are interested in a quick fix to health ”

A group of sorority sisters from Western University volunteered to help Marketplace test the cleanse. Half of the group participated in the Dr. Oz cleanse, which required that the students observe a strict diet and refrain from alcohol and caffeine, and not eat any food after 7 p.m. They also drank detoxifying teas and took soothing baths as prescribed by the diet, while the other students ate and drank normally.

To test the efficacy of the cleanse, all students had their liver and kidney functions tested both before and after the 48-hour period. At the end of the 48-hour period, however, Dr. Dresser was unable to detect any physiological benefit at all, or even tell which students had participated in the cleanse.

Despite a CV that boasts degrees from Harvard and the University of Pennsylvania medical school, Dr. Oz has been the target of growing criticism from fellow medical and science professionals for his promotion of products and methods that lack evidence.

Bottomline: “Given his education and influence,” wrote Erin May on the Harvard University science research blog Policylab, “there’s no excuse for the unsubstantiated claims and sensational language that is so pervasive on his show.”

Perhaps Dr. Oz can garner additional publicity by placing his detox on the following website:  Quackwatch (He’s already frequently cited on this website.)

Brain Response to Physical Activity different in Obesity

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From NY Times (http://nyti.ms/1afnEyJ) review of the following article:

Int J Obes (Lond). 2013 Dec 24. doi: 10.1038/ijo.2013.245. [Epub ahead of print]

Differences in neural activation to depictions of physical exercise and sedentary activity: An fMRI study of overweight and lean chinese women. Jackson T, Gao X, Chen H.

An excerpt:

Overweight women’s brains respond differently to images of exercise than do the brains of leaner women…

The scientists asked their volunteers to complete two questionnaires, one of which probed the extent to which they considered exercise desirable; would they agree, for instance, that, “if I were to be healthy and active, it would help me make friends”? The other set of questions examined whether they expected exercise to be unpleasant; if they were to be physically active on most days, for example, would they expect to wind up feeling sore, or maybe even embarrassed by exercising in public?

The researchers next had each woman lie inside a functional magnetic resonance imaging machine, which scans blood flow to specific areas of the brain, indicating areas of increased activity. Then they started a slide show.

For some time, scientists have known that many overweight people’s brains operate differently than the brains of thinner people when they look at images related to eating. In previous neurological studies, when heavier volunteers viewed pictures of food or food preparation, they typically developed increased activity in portions of the brain involved in reward processing, or an urge to like things, including in an area called the putamen. At the same time, their brains showed relatively blunted activity in areas that are thought to induce satiety, or the ability to know when you are full. These changes generally are reversed in the brains of thinner people shown the same images.

But no brain-scanning studies had examined whether being heavy might also affect people’s brain responses — and presumably their attitudes — toward physical activity.

So, to address that gap, the researchers now flashed a series of photographs before their volunteers. Ninety of the images showed people being joyously active by running, dancing, leaping, playing tennis and such. The women were asked to vividly imagine themselves performing the same actions, using hand gestures and limited bodily contortions, to the extent possible within the confines of the scanner.

Ninety additional images featured relaxed, sedentary behaviors, including stretching out on a sofa and sitting in a desk chair. Again, the women were directed to imagine themselves similarly lounging. The various images of activity and quiet were interspersed with photographs of landscapes.

While the women viewed the pictures, the functional M.R.I. machine monitored their brain activity.

The resulting readouts revealed that overweight women’s brains were put off by exercise. Shown images of people being active, these women developed little activation in the putamen region of the brain, suggesting that they did not enjoy what they were seeing. At the same time, a portion of the brain related to dealing with negative emotions lit up far more when they viewed images of moving than of sitting. Emotionally, the brain scans suggested, they anticipated disliking physical activity much more than they expected to disdain sitting.

Leaner women’s brain activity, by and large, was the opposite, with the putamen lighting up when they watched others work out and envisaged doing the same themselves.