A recent study examined the benefits of concurrent use of nicotinamide in newly diagnosed Type I diabetes. Previous research had shown a possibility that glucose control could be improved by using nicotinamide and insulin at onset of treatment.
The study enrolled 52 children who had been recently diagnosed with Type I diabetes (less than 4 weeks prior). The children were randomized to two groups. The treatment group received 25mg/kg/day of nicotinamide in conjunction with daily insulin injections. The control group received only the insulin injections. The treatment was started less than four weeks after diagnosis and continued for 2 years.
The primary outcome of the study was glucose control. This was assessed by measuring serum levels of HbA1C, C-peptide secretion, and also assessing the amount of insulin needed to maintain adequate blood sugar levels.
The results showed that the group receiving nicotinamide and insulin had better glucose control. The treatment group had statistically significantly lower HbA1C levels than the control group. There was no significant difference in C-peptide secretion or insulin requirement between the groups.
This small, preliminary study proved that nicotinamide could improve glucose control in newly diagnosed Type I diabetics. It also was found to be a safe treatment for 2 years duration.
]]>Attention-deficit hyperactivity disorder (ADHD) is the fastest growing behavioral disorder in the U.S. About 5 to 10 percent of children in the U.S. are diagnosed with ADHD. Now research reports that the youngest children in a class are 25 percent more likely to be diagnosed with ADHD than the oldest children in a class. Proper diagnosis is critical since ADHD is treated with stimulant drugs that have serious side effects.
The study, published in the Journal of Health Economics, investigated the association between children's age and rates of ADHD diagnosis and treatment. Researchers at the University of Notre Dame in Indiana analyzed data from national health surveys and private health insurance claims from 1996 to 2006.
The researchers found that children born just after the kindergarten eligibility cutoff date were significantly less likely to be diagnosed with ADHD than those born just before the cutoff date. Children born just before the cutoff date are among the youngest in their class. The researchers suggest the youngest children are mistakenly diagnosed with ADHD because they are less mature for their grade.
"Since ADHD is an underlying neurological problem where incidence rates should not change dramatically from one birth date to the next, these results suggest that age relative to peers in class, and the resulting differences in behavior, directly affects a child's probability of being diagnosed with and treated for ADHD," the study authors conclude.
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The University of British Columbia, in Vancouver, Canada, recently published the results of a study comparing the efficacy of several different methods for evaluating iron intake in children. The primary goal of the study was to evaluate the efficacy of the Food Frequency Questionnaire in regards to iron intake and overall iron status in children. A total of 148 infants age 8-26 months completed the study.
The participants were randomized to three groups. In group one, parents completed a food frequency questionnaire to assess intake of food high in iron. The second group completed a 3 day food record, listing every type of food eaten by the infant with specific amounts. The third and final group received lab testing measuring the Hemoglobin, ferritin and transferring receptor, both the first and second groups also received these tests to confirm efficacy of questionnaire and record.
The researchers found that the overall incidence of iron deficiency anemia was 9%, while 26% of the infants had iron depletion. Food Frequency Questionnaire resulted in a greater estimation of iron intake from dietary sources than the 3 day food record. However, neither the food frequency questionnaire nor the 3 day food record results correlated with overall iron status based on lab work.
The authors conclude that the food frequency questionnaire and 3 day food record are both accurate at determining differences in intake of iron containing foods, the data gathered from either method does not correlate well with serum tests of iron status including hemoglobin and ferritin.
]]>The investigators found that serum concentrations of calcium, zinc, and Vitamin B2 increased significantly in the yogurt group compared to control. The yogurt group also had a significant decline in the incidence of upper respiratory infections and diarrhea compared to the control group. Height and weight increases were both significantly greater in the yogurt group compared to the control at 3, 6, and 9 months. Bone mineral density did not differ significantly between the two groups at baseline, 3 and 6 months, but at 9 months the yogurt group had a significant increase in bone mineral density compared to control.
The authors concluded that supplementation with yogurt in children who are at risk for deficiency is highly effective. Yogurt improved growth statistics as well as bone mineral density in this select population. The nutritional content of yogurt was also very important at improving nutrient status in this population who is at risk for developing deficiencies. Yogurt may also improve immune function as indicated by decreased rates of infection
]]>Cranberry is a common alternative therapy for adults with recurrent urinary tract infections (rUTI). Children with specific renal conditions are also a population with a high incidence of rUTI. Little is known about the use of cranberry in this population. Researchers at Wake Forest University School of Medicine in North Carolina hypothesized that children with rUTI or any renal disease may be high users of cranberry for their conditions due to parent administration.
They conducted an anonymous survey to parents seen in the nephrology department. The survey addressed use of cranberry as a supplemental treatment. It also gathered information about the patient's age, condition, incidence of UTI, and perceived benefit and side effects.
The survey showed that 29% of 117 total parents gave cranberry therapeutically. 15% of parents reported that rUTI was a problem for their child. The average age of children in the nephrology survey was 10 years old. The subset of children with rUTI had a 65% rate of cranberry use. Parents reported that cranberry was given to treat as well as prevent UTI. Most felt that the treatment was beneficial. The only side effect reported was upset stomach (nausea). The survey also addressed physician disclosure, of which only 23% of parents indicated they had told their physician about using cranberry.
The authors concluded that cranberry use among the pediatric population is likely higher than expected. It is perceived as a useful therapy by parents, though rarely discussed with the doctor. Due to this information, the authors feel that clinical trials are necessary to determine the effects, whether beneficial or potentially harmful, of cranberry on renal conditions in the pediatric population.
]]>Organophosphate pesticides are used on conventionally grown fruits and vegetables. Previous studies suggests that organophosphate pesticides may be linked to attention-deficit hyperactivity disorder (ADHD). Now research reports that children's ADHD risk may be associated with pesticide exposure before birth. This suggests that pesticides may affect a fetus' developing nervous system.
The study, published in Environmental Health Perspectives, examined the association between pesticide exposure during pregnancy and ADHD in children. Researchers at University of California Berkeley's Center for Children's Environmental Health analyzed data of 348 Mexican-American pregnant women and their children living in California Salinas Valley agricultural community. Urine samples were obtained from the pregnant women and tested for pesticide residue. ADHD questionnaires and tests were obtained from the children born to the pregnant women at ages 3 1/2 and 5.
The researchers found the highest association between pesticides and ADHD among the 5 year olds. Furthermore, ADHD risk increased with the highest levels of pesticide residue in women's urine. The risk of ADHD increased 5 times in children for every 10 time increase in women's pesticide residue.
"In utero DAPs [dialkyl phosphate] were associated adversely with attention in young children as assessed by maternal report, psychometrician observation, and direct assessment," the study authors write. "These associations were more robust at 5 than 3½ years and stronger in boys."
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Severe acne is commonly treated with a combination of oral antibiotics and topical medication. Tetracycline antibiotics are often prescribed for acne treatment. Now research reports that long-term antibiotic treatment for acne is linked with inflammatory bowel disease. Inflammatory bowel disease (IBD) occurs in ulcerative colitis and Crohn's disease. These diseases cause chronic inflammation and weakness of the gastrointestinal tract.
The study, published in the American Journal of Gastroenterology, examined the association between acne antibiotic use and IBD risk. Researchers at the University of Pennsylvania evaluated 94,000 British acne patients using the UK Health Improvement Network database from 1998 to 2006.
The researchers found that 41 participants taking minocycline, 79 participants taking tetracycline, 32 participants taking doxycline and 55 participants taking no antibiotics developed IBD. Findings also revealed that Crohn's disease had a higher risk than IBD.
"Tetracycline class antibiotics, and particularly doxycycline use may be associated with the development of IBD, particularly CD [Crohn's disease]," the study authors write. "Potential confounding by previous doxycycline exposure should be considered when assessing whether treatment with other acne medications increases the risk of IBD."
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The Journal of Pediatrics published a study in June that examined the factors involved in bone mineral density status in adolescents with CP in cases with no known interventions in place. The study enrolled 69 children and adolescents age 2 thru 17 with moderate to severe spastic CP. The prospective, longitudinal study followed 55 subjects for 2 years and 40 of the original subjects for more than 3 years to observe changes.
The assessment included several measurements of growth. Bone mineral density in the distal femur and spine were assessed throughout the study. General health, nutritional status, growth, Tanner staging, and clinical features of CP were also assessed throughout the study.
The researchers found that more severe forms of CP were associated with a lower bone mineral density at initial evaluation. Severity of CP was scaled based on poor feeding, gross motor function, and poorer growth. Bone mineral density did increase in the study, but the range was wide, from +42% to -31%. Overall, bone mineral density in the distal femur decreased with age according to statistical analysis.
The authors conclude that children with moderate to severe CP are at risk for developing osteopenia and osteoporosis. This is due to a multitude of factors that cause poor bone mineral density growth. This is in contrast to the elderly population that has bone mineral density loss. Children with CP do not have proper growth and development of bone due to poor nutrition associated with poor feeding ability and decreased motor skills which decrease stimulation to the bone to lay down minerals in the bony matrix. The study provides an understanding of the processes at play in the development of osteopenia and can now give greater information in terms of which interventions may best help decrease the rate of osteopenia and improve bone mineral density.
Previous studies suggest that early puberty may be linked to obesity or environmental toxins that interfere with sexual development. Now research reports that more American girls are entering puberty at age 7. Furthermore, girls with higher BMIs (body mass index) were more likely to hit puberty. This could have important health implications since early puberty may increase the risk of breast cancer and heart disease in adulthood.
The study, published in Pediatrics, investigated the maturation status of young girls. Researchers in Ohio, New York and California analyzed data of 1,239 girls ages 6 to 8 years living in Cincinnati, East Harlem and the San Francisco Bay Area, Caregiver interviews and physical examinations and were obtained from the participants.
The researchers found that 10% of white, 23% of black and 15% of Hispanic girls showed breast development at age 7. By age 8, the figures rose to 18%, 43% and 31% respectively. Findings also revealed that obese girls were more likely to reach puberty sooner.
"In this multisite study, there was substantial agreement regarding pubertal staging between examiners across sites," the study authors write. "The proportion of girls who had breast development at ages 7 and 8 years, particularly among white girls, is greater than that reported from studies of girls who were born 10 to 30 years earlier."
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An investigative case-controlled study was published in Pediatrics in August that examined the effect that maternal smoking has on behavioral development and the incidence of hyperkinetic disorders. Hyperkinetic disorders include behavioral disorders such as ADHD. The primary characteristics include hyperactivity and poor social interaction.
The study obtained data from 3765 control children and 170 children with hyperkinetic disorders. Factors such as newborn characteristics, socioeconomic status, and family history of psychiatric disease were accounted for during analysis. Smoking history was obtained through interview or questionnaire.
The research showed that infants born to mothers who smoked cigarettes had 3 times the chance of developing a hyperkinetic disorder such as ADHD compared to an infant with a non-smoking mother. These results were not related to newborn characteristics, family history, or socioeconomic factors.
This research supports the recommendation that women who smoke cigarettes should quit upon the knowing they have become pregnant. Smoking increased neonatal morbidity and mortality and is now proven to affect behavioral development.
]]>Pediatrics published a study in August that examined the differences in lipid status among adolescent children attending a weight management clinic that were normotensive or hypertensive.
It was a retrospective study with 497 participant's age 2-18 years. Lipid profiles were compared between overweight children who were pre-hypertensive and hypertensive and children who were normotensive.
The research found that all children who were overweight had abnormal blood lipids regardless of blood pressure status. However, children who were overweight and also hypertensive had significantly lower levels of HDL. HDL, high density lipoprotein, is known as the good cholesterol and has a protective effect on cardiovascular disease and is associated with a decreased risk of cardiovascular disease. The study also showed that children who are severely obese had a significantly lower HDL compared to mild or moderately obese children regardless of blood pressure status.
In conclusion, overweight children are at increased risk for abnormal lipid levels. Those children who are overweight and also hypertensive (including pre-hypertension) have a greater risk for cardiovascular disease due to increased abnormalities in blood lipid status. This study supports the recent recommendation that blood lipids should be screened in all overweight children and not just those that are both overweight and hypertensive.
]]>A common problem that can occur with preterm delivery and hospital stay is insufficient production of milk by the mother. In that case the current recommendation is supplementation of mother's milk with preterm formula. A study published in the Journal of Pediatrics in August compared the outcomes of preterm infants given mothers milk to those given donor milk or preterm formula.
The study enrolled infants born at less than 30 weeks gestation. A total of 243 infants were enrolled, 70 received only mother's milk. The remaining infants were randomized to receive either pasteurized donors milk or preterm formula. A total of 81 infants did the donors milk and 92 received preterm formulas. The study was conducted from delivery to 90 days or hospital discharge, which ever is the lesser. Outcome measures included rates of infection, hospital stay, growth, LOS, NEC, meningitis, urinary tract infection, and skin to skin contact.
The study showed that there were no differences between LOS, NEC, hospital stay, growth and rates of infection between the groups given donor's milk or preterm formula, however infants given only mother's milk had lower rates of LOS, NEC and infection. The group receiving donor's milk had a lower rate of growth, even though they received more food and nutritional supplementation on an average.
The authors concluded that for preterm infants born before 30 weeks gestation donor milk offered little advantage over preterm formula with mothers milk could not be the sole source of nutrition. Mother's milk is still the superior food source for preterm infants to insure proper growth and decreased rates of infection.
]]>Many studies have documented the effects of Crohn's disease on growth, development, and nutritional status. The effects of Crohn's disease on lean mass and fat mass in children had not been studied until a recent publication in the American Journal of Clinical Nutrition.
The study from the University of Pennsylvania School of Medicine aimed to quantify the lean and fat mass in children and young adult with Crohn's disease and compare to healthy matched control subjects. The study enrolled 104 subjects with Crohn's disease and 233 healthy controls. Fat and lean mass was measured using DEXA.
The results showed that children and young adults have a body composition similar to individuals suffering from cachexia. Subjects with Crohn's disease had a lower height for age and BMI for age. Children with Crohn's disease had decreases in lean mass compared to healthy subjects and normal fat mass. In the control group fat mass and lean mass were positively correlated with one another, as one increase the other would. That trend was not present with the children with Crohn's disease.
These results support past evidence that children with Crohn's disease have significant deficits in growth and development. Understanding the relationship between lean and fat mass assimilation can help determine proper interventions from a nutritional standpoint. This information can also be useful in developing fitness programs to improve body composition in children with Crohn's disease.
]]>High fructose corn syrup is used to sweeten thousands of processed foods and drinks like soft drinks, fruit drinks and bread. Previous studies have linked high levels of fructose to the obesity epidemic. Now research reports that a childhood diet high in fructose may increase dangerous abdominal fat. Abdominal obesity is linked with increased heart disease and diabetes risk. Belly fat is less able to respond to insulin if exposed to fructose.
The study, presented at The Endocrine Society's 52nd Annual Meeting, examined abdominal fat specimens of healthy children. Researchers at the University of Bristol, U.K., obtained subcutaneous and visceral abdominal fat specimens from 32 healthy weight children. They extracted preadipocytes (precursor fat cells) from the specimens and exposed them to normal glucose (blood sugar), high glucose or high fructose.
The researchers found that fructose had different effects than glucose on the fat cells. Fructose caused the precursor fat cells to form more mature fat cells in visceral fat. Furthermore, fructose decreased the cells' insulin sensitivity. Decreased insulin sensitivity is found in Type 2 diabetes.
"Our results suggest that high levels of fructose, which may result from eating a diet high in fructose, throughout childhood may lead to an increase in visceral [abdominal] obesity, which is associated with increased cardiometabolic risk," says researcher Georgina Coade, from the University of Bristol, UK, in a news release.
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Children who develop an allergy to cow's milk must find an adequate source of nutrients from sources such as soymilk or to take a hydrolyzed formula (digested milk proteins). Past studies have supported the belief that children with cow's milk allergies suffer from decreased nutrition. They are often believed to have a lower nutritional status and have reduced mental and physical growth.
A study published in the July issue of American Journal of Clinical Nutrition examined the growth of infants with an existing cow's milk allergy to infants without the allergy. The group with the cow's milk allergy was divided into two smaller subgroups: infants who consumed soymilk substitute and those that consumed a hydrolyzed cow's milk formula.
Growth parameters were compared among the three groups (soy, cow's milk, and hydrolyzed cow's milk). Measurement of weight, height, and head circumference were taken on infants. The participants were followed till the age of 4.
The results of the study find that there is no significant difference in growth parameters among infants with a cow's milk allergy, given either soy or hydrolyzed cow's milk formula, compared to children with no allergy to cow's milk. The study did not compare growth to children given human breast milk.
This study is very beneficial for the healthcare provider as well as the parent. It dispels the belief that children with a cow's milk allergy have special nutritional needs due to lack of proper nutrients because of the existing allergy. Children given a soy or hydrolyzed formula can have adequate growth without the need for additional intervention.
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