What Infants and Toddlers Should and Should NOT Be Drinking

NY Times: What Should Young Children Drink? Mostly Milk and Water, Scientists Say

An excerpt:

A panel of scientists issued new nutritional guidelines for children on Wednesday, describing in detail what they should be allowed to drink in the first years of life. The recommendations, among the most comprehensive and restrictive to date, may startle some parents.

Babies should receive only breast milk or formula, the panel said. Water may be added to the diet at 6 months; infants receiving formula may be switched to cow’s milk at 12 months. For the first five years, children should drink mostly milk and water, according to the guidelines.

Children aged 5 and under should not be given any drink with sugar or other sweeteners, including low-calorie or artificially sweetened beverages, chocolate milk or other flavored milk, caffeinated drinks and toddler formulas.

Plant-based beverages, like almond, rice or oat milk, also should be avoided. (Soy milk is the preferred alternative for parents who want an alternative to cow’s milk.)…

Young children should drink less than a cup of 100 percent juice per day — and that none at all is a better choice…Children do not need juice and are better off eating fruit, the panel said. ..

With the exception of soy milk, plant-based milks are poor in protein. Though they are often fortified, scientists do not know whether people are able to absorb these nutrients as efficiently as those naturally present in other foods.

Formulas marketed for toddlers are usually unnecessary, since most toddlers eat solid food

My take: These recommendations provide good advice.

 

IBD Briefs: May 2019 (Part 1)

H Khalili et al. Clin Gastroenterol Hepatol 2019; 17: 123-29.  Using data from two prospective Swedish cohort sutdies with 83,042 participants (age 44-83 yrs), the authors determined that there was “no evidence for association between consumption of sweetened beverages and later risk of” Crohn’s disease or Ulcerative Colitis.

WJ Sandborn et al. Gastroenterol 2019; 156: 946-57.  This study published data from 354 patients who received subcutaneous abrilumab, an anti-alpha4beta7 antibody as a treatment for moderate-to-severe colitis. This 8 week treatment increased the odds of remission compared with placebo.

B Wynne et al. Gastroenterol 2019; 156: 935-45. This study showed that a psychological intervention termed “acceptance and commitment therapy (ACT)” was effective in a randomized controlled trial in reducing stress and depression in patients with quiescent or mildly-active IBD (n=122). With ACT, the “primary aim is to encourage subjects to adopt positive life values and to accept adverse experiences, including thoughts, feelings and sensations that are an inevitable consequence of life.”  All program materials are available in article supplement: Full text and supplement: https://doi.org/10.1053/j.gastro.2018.11.030

D Duricova et al. Inflamm Bowel Dis 2019; 25:789-96. This study included 72 consecutive children born to mothers with IBD treated with anti-TNF therapy during pregnancy (2007-16) along with 69 unexposed controls.  Key findings: Anti-TNF therapy exposure in utero was NOT associated with a negative impact on postnatal complications, including infections, allergy, growth, or psychomotor development. Findings are limited by the small number of participants.

AW Gridnal et al. Inflamm Bowel Dis 2019; 25:642-45.  The authors examined the frequency of financial conflicts of interest (FCOI) among authors of 11 relevant clinical practice guidelines for IBD in the US,  the UK, Canada, and Europe. Key finding: FCOI were frequently present with 19% prevalence among US authors, 56% in UK, 84% in Canada, and 94% in Europe.

KN Weaver et al. Inflamm Bowel Dis 2019; 25:767-74. This retrospective study examined the efficacy of ustekinumab for Crohn’s disease of the pouch in 56 patients; 73% had previously been treated with anti-TNF therapy, vedolizumab or both. Key finding: 83% demonstrated a clinical response 6 months and 60% with endoscopic improvement after induction with ustekinumab. Clinical response was defined as “any improvement in symptoms …including a decrease in bowel movements, pain, or fistula drainage.”

Retiro Park, Madrid
Thanks to Jennifer

 

“The Fruit Juice Delusion”

From NY Times: The Fruit Juice Delusion

A recent commentary revisits the common misconception of fruit juice being healthy.

Key points:

  • “Americans drink a lot of juice…children consume on average 10 ounces per day, more than twice the amount recommended by the American Academy of Pediatrics.”
  • “One 12-ounce glass of orange juice contains 10 teaspoons of sugar.”
  • Eating whole fruit is “associated with a reduced risk of diabetes, drinking fruit juice is associated with the opposite.”
  • “Juice may also be a ‘gateway beverage’–[to drink] more soda in their school-age years
  • “There is no evidence that juice improves health…Parents should instead serve water and focus on trying to increase children’s intake of whole fruit.”

My take (borrowed from authors): “we have succeeded in recognizing the harm of sugary beverages like soda. We can’t keep pretending that juice is different.”

Related blog posts:

 

In the News: UCSF Soda Ban

NY Times: Putting Sugary Soda Out of Reach

An excerpt:

Last year, U.C.S.F. removed sugar-sweetened beverages from every store, food truck and vending machine on its campus. Even popular fast-food chains on the campus, like Subway and Panda Express, have stopped selling Sprite, Coca-Cola and their sugary brethren at the university’s request….

“We’re a public health institution, and there’s something not right about us making money off of products that we know are making people sick,” said Laura Schmidt, a professor at the medical school who spearheaded the beverage initiative…

Nationwide, at least 30 medical centers have restricted the sale of soda and full-calorie sports drinks, including the Cleveland Clinic in Ohio and the University of Michigan Health System…

the beverage industry argues that the strategy is flawed. It points out that obesity rates have been climbing even as America’s soda intake has declined in recent years. And it says that focusing blame on soda alone, rather than calories from all foods, is misguided.

Related blog posts:

 

NY Times: Cutting Sugar Improves Children’s Health in Just 10 Days

Perhaps this is not the best day of the year for this topic….

A recent small study of 43 children is summarized by the NY Times: Cutting Sugar Improves Children’s Health in Just 10 Days

An excerpt:

Obese children who cut back on their sugar intake see improvements in their blood pressure, cholesterol readings and other markers of health after just 10 days, a rigorous new study found.

The new research may help shed light on a question scientists have long debated: Is sugar itself harming health, or is the weight gain that comes from consuming sugary drinks and foods mainly what contributes to illness over the long term?

In the new study, which was financed by the National Institutes of Health and published Tuesday in the journal Obesity, scientists designed a clinical experiment to attempt to answer this question. They removed foods with added sugar from a group of children’s diets and replaced them with other types of carbohydrates so that the subjects’ weight and overall calorie intake remained roughly the same.

After 10 days, the children showed dramatic improvements, despite losing little or no weight. The findings add to the argument that all calories are not created equal, and they suggest that those from sugar are especially likely to contribute to Type 2 diabetes and other metabolic diseases, which are on the rise in children, said the study’s lead author, Dr. Robert Lustig, a pediatric endocrinologist at the Benioff Children’s Hospital of the University of California, San Francisco.

My take:  For a long time, I have been telling patients that if they make only one change, I would start by eliminating sugar-sweetened beverages. While this is a small study, it reinforces the view that sugar intake needs to be limited.

This post included last year’s pumpkin (Halloween 2014):  NASPGHAN Postgraduate Course 2014 -Liver Module – gutsandgrow

This year’s pumpkin:

Screen Shot 2015-10-30 at 7.22.05 PM

Do You Think Fruit Drinks Are Healthy?

According to a recent report in USA Today, a large number of parents have been misled into thinking that sugary beverages and fruit drinks are healthy. Here’s an excerpt:

That’s the conclusion of a new study from the Rudd Center for Food Policy and Obesity at University of Connecticut, published today in Public Health Nutrition.

Many parents believe that drinks with high amounts of added sugar — particularly fruit drinks, sports drinks and flavored water — are “healthy” options for kids, according to the report, funded by the Robert Wood Johnson Foundation, which focuses on improving health and health care…

The vast majority of parents give kids sugary drinks regularly…Equally significant, nearly half of parents surveyed rated flavored waters as healthy, and more than one-quarter considered fruit drinks and sports drinks to be healthy…

Parents said they were particularly influenced by nutritional claims appearing on the packages — such as claims that the items are “real” or “natural” or contained vitamin C or antioxidants, or were low in sodium or calories.

Bottomline: This information reinforces the fact that many parents do not realize basic nutrition information.

Related blog posts:

Water -Often Missing from Diet

A recent NPR report indicates that a faction of scientists is pushing for a water icon to be added to the government’s MyPlate.

Here’s the link: Missing from MyPlate? Water

Here’s an excerpt:

“Consumption of sugary beverages is the leading contributor to added sugar in the American diet,” says Christina Hecht, senior policy adviser at the UC Nutrition Policy Institute and one of the water advocates. “If people could make that one change to drink water to quench their thirst instead of sugar beverages, that would solve a big piece of the problem.”

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