Showing posts with label nutrition. Show all posts
Showing posts with label nutrition. Show all posts

Wednesday, May 6, 2015

Two Studies on Anykyloglossia Will Not Leave You Tongue-Tied

     Ever wonder what the evidence is regarding the role of ankyloglossia or tongue-tie in breastfeeding?  Ever wonder what role ankyloglossia might play in not just breastfeeding but also speech, other feeding issues and even a social stigma?  This week we share two systematic reviews by a team of authors focusing on ankyloglossia.   
      The first by McPheeters et al. (doi:10.1542/peds.2015-0658)  systematically identified 29 studies on breastfeeding effectiveness with tongue-tie and found some evidence that frenotomy may be associated with improved breastfeeding—but how strong this evidence is can best be discerned by reading the review.   
     The other study found 13 studies consisting of randomized controlled trials, cohort studies, and case series, looking at  by Chinnadurai et al (doi:10.1542/peds.2015-0660)) focused on the effect of tongue-tie on speech, feeding and social outcomes before and after frenotomy. While the benefits of frenotomy for reasons other than breastfeeding are highlighted, the evidence again may not be as strong as you might think it is.   
     There is more than a mouthful of information to glean from both these two systematic reviews—but we would also love to glean your own personal experience of how you have dealt with anykyloglossia in your own practice. Share your impressions by responding to this blog, or via an e-letter or a posting on our Facebook or Twitter sites.

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Friday, April 10, 2015

Buying Human Milk over the Internet and Cow’s Milk Contamination: A Bad Moo-ve!

By: Lewis First, MD, MS; Editor-in-Chief  
          We read more and more about banked human milk being available for purchase via the internet—but just how sure are we that the human milk being sold is actually pure human milk.  Keim et al. (doi: 10.1542/peds.2014-3554) were anything but cow-ards as they set out to look at the DNA from a little over 100 samples of human milk.  Sadly 10% demonstrated evidence of contamination from bovine milk which could be a problem when it comes to purchasing these online thought to be pure human products to infants who may experience an allergic reaction to cow’s milk protein as a result. 
          Do your patients use purchased human milk obtained via the Internet?  We would be interested to know what you and they think of online purchased human milk services by responding to this blog, sending an e-letter, or posting a response on our Facebook or Twitter websites.

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Tuesday, March 31, 2015

Being PROS at Motivational Interviewing to Combat Being Overweight in Childhood

By: Lewis First, MD, MS; Editor-in-Chief  
      Motivational interviewing (MI) is a patient-centered counseling style by which you work with a patient to facilitate behavioral change through their recognizing their internal desire to change.  It is used for a variety of behavioral disorders by psychologists. 
      This week we publish a fascinating study by Resnicow et al. ( doi: 10.1542/peds.2014-1880) involving a randomized controlled trial performed by pediatric providers and registered dieticians of children in 42 practices enrolled in the AAP’s Pediatric Research in Office Settings (PROS) Network. Overweight children ages 2-8 were randomized to get (1) usual care, (2) four provider trained MI sessions to parents of an index child and (3), four provider trained MI sessions  plus 6 more MI sessions with a registered dietician with outcome being BMI measured at a two-year follow-up. 
     Without spoiling the richness of the data contained in this study, suffice it say that the groups that received MI showed much more impressive reductions in BMI than the group who got routine care.  Before everyone cheers (and cheering is well deserved here), one still needs to ponder whether this study can be generalized to all of us. Fortunately obesity researcher Dr. Cara Ebbeling (doi: 10.1542/peds.2015-0495) offers a commentary on this study that provides further insight as to what we can learn from it. 
     One thing is certain—before your patients can benefit from an MI approach to losing weight, you would need to learn MI, and perhaps hire dieticians if you don’t have some available to you also facile in MI, —which might not be affordable despite the reduction in up-the-road health care costs due to the weight reduction achieved. 
      Would you or registered dieticians in your community or practice be willing to learn motivational interviewing if it can lead to weight reduction in your overweight patients? Why or why not?  Share your thoughts with us as a response to this blog, via an e-letter or via our Facebook or Twitter sites.

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Monday, March 23, 2015

Let Them Eat Cake: Gluten Free Diets In Response To Celiac Disease

By: Joann Schulte  DO, MPH; Editorial Board Member

Public Health Image Library (PHIL)

     Gluten-free dining and groceries are a growth industry these days.   Multiple restaurants, both of   Some charge a higher price for gluten-free items that can include everything from pizza to Mongolian beef to the flourless chocolate cake.  Such items have to be prepared carefully so there’s no cross-contamination in the kitchen from wheat or barley. There’s even a class-action lawsuit that’s been filed in California, claiming that the extra charges and higher prices are a violation of the Americans with Disabilities Act the gourmet type and the chain variety, spout their gluten-free menus.
      The availability of such diets and grocery choices is good news for patients with celiac disease (CD), including the children who are often diagnosed after prolonged complaints of abdominal pain, diarrhea, failure to thrive and nutritional deficiencies.  About 1% of the US population is estimated to have celiac disease, and new research published this month in Pediatrics documents risk factors associated with the disease among a birth cohort followed in six clinical centers located in four countries. 
     Agardh et al. (doi:10.1542/peds.2014-3675) followed a group of 6,706 children who were positive for HLA-DR3-DQ2 and/or DR4-DQ8.  Those HLA types have been associated with a higher risk of celiac disease.  The children were screened annually for tissue transglutaminase antibodies (tTGA) and screened for symptoms via questionnaires.  Those questionnaires include an assessment of abdominal discomfort, anemia, chronic constipation, loose stools, vomiting and poor growth.  The researchers also collected information about children’s height, weight and body mass index. The researchers found a 5% incidence of CD among children with HLA types linked to the disorder.
      Among the screened children, 914 developed persistent positive tTGA, 406 underwent intestinal biopsies and 304 were diagnosed with CD.  The researchers compared their pediatric subjects with age-matched children who were tTGA negative.  The children who were persistently positive were more likely to have symptoms at ages 2 and 3 years and to have higher levels of tTGA at seroconversion.  The levels of tTGA correlated with the severity of mucosal lesions in both symptomatic and asymptomatic children.
      In a related commentary, Dr. Richard Noel (doi:10.1542/peds.2015-0209) suggests that the study offers a tiered approach to CD diagnosis.  The 2-tiered approach of early genetic screening for genetic susceptibility and later screening for the celiac antibodies has been proposed.   Currently an individual physician must undertake the testing.  The study suggests a possible case-finding strategy in a disease that may be more easily managed given the attention it is getting both from medicine and the food industry.

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Wednesday, February 4, 2015

How Sweet It Should Not Be! Sugar and Sodium Content in Complementary Infant and Toddler Foods and Drinks.

By: Lewis First, MD, MS; Editor-in-Chief  
       We are certainly aware of the need to check food labels on the foods we eat so as to maximize our nutritional content (hopefully) and avoid foods that are high calorie due to unhealthy added sugars and often too much salt. But what about the foods our infants and toddlers eat?  Are parents checking the labels on those products?  Should they be? 
Cogswell et al. (doi: 10.1542/peds.2014-3251) provide us with some important food for thought this week in a study they have done categorizing more than 1000 of the most common infant and toddler foods and beverages that are on the shelves of most grocery stores to determine just how many of these contain added sugars and salts in excess of the Food and Drug Administration’s referenced amounts.  The results may surprise you—and the information in this study is well worth sharing with your patients.  At the very least it makes them aware of the need to read food labels even on the starter foods of our youngest patients. 
          What are the risks for infants and toddlers who do experience early exposure to complementary foods rich in added sugar and salt?  Drs. Susan and Robert Baker weigh in with a commentary (doi:10.1542/peds.2014-4028) that puts the study’s results in context and suggests we work with parents even more to advocate for healthier nutritional content of complementary foods and beverages even in those first few years of life. 
There’s lots of helpful data to digest in this study and accompanying commentary—so read both and then share what you are doing to foster healthy eating in your infant and toddler patients by commenting via a response to this blog, an e-letter or by posting on our Facebook or Twitter sites.

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