Factors Associated with Breastfeeding Initiation and Continuation: A Meta-Analysis.

OBJECTIVE: To use a quantitative approach to evaluate the literature for quantity, quality, and consistency of studies of maternal and infant characteristics in association with breastfeeding initiation and continuation, and to conduct a meta-analysis to produce summary relative risks (RRs) for selected factors. STUDY DESIGN: A systematic review using PubMed and CINAHL through March 2016 was conducted to identify relevant observational studies in developed nations, reporting a measure of risk for 1 or more of 6 quantitatively derived, high impact factors in relation to either breastfeeding initiation or continuation. One author abstracted data using a predesigned database, which was reviewed by a second independent author; data evaluation and interpretation included all co-authors. These factors were summarized using standard meta-analysis techniques. RESULTS: Six high impact factors were identified (smoking [39 papers], mode of delivery [47 papers], parity [31 papers], dyad separation [17 papers], maternal education [62 papers], and maternal breastfeeding education [32 papers]). Summary RR from random-effects models for breastfeeding initiation were highest for high vs low maternal education (RR 2.28 [95% CI 1.92-2.70]), dyad connection vs not (RR 2.01 [95% CI 1.38-2.92]), and maternal nonsmoking vs smoking (RR = 1.76 [95% CI 1.59-1.95]); results were similar for breastfeeding continuation. CONCLUSIONS: Despite methodological heterogeneity across studies, relatively consistent results were observed for these perinatally identifiable factors associated with breastfeeding initiation and continuation, which may be informative in developing targeted interventions to provide education and support for successful breastfeeding in more families.

Validity of the shuttle walk test as a functional assessment of walking ability in individuals with polyneuropathy.

PURPOSE: This study assessed the validity of the shuttle walk test (SWT) to evaluate walking ability in patients with polyneuropathy. METHODS: Forty-one patients with chronic idiopathic axonal polyneuropathy (CIAP) and 49 patients with multifocal motor neuropathy (MMN) performed both the 10-meter walk test (10MWT) and the SWT. Face validity was assessed by evaluating whether patients considered both tests to reflect their walking ability (Likert scale: 1 = not at all, 10 = very well). Concurrent validity was determined by Spearman rank-correlation analyses performed on the outcomes of both tests. RESULTS: Mean (SD) scores for how well the 10MWT and SWT reflected daily walking ability were 6.8 (1.3) and 7.4 (1.6) (p = 0.117) in patients with CIAP and 6.9 (1.2) and 7.9 (1.0) (p = 0.001) in patients with MMN, respectively. Correlation scores between both tests ranged from -0.70 to -0.82, except for 18 patients with MMN with a "normal" walking speed at the 10MWT (-0.21). CONCLUSION: The SWT seems a valid instrument for assessing walking ability in individuals with CIAP and MMN. Moreover, the SWT seems to be useful for investigating the symptoms elicited by walking long distances and may be more sensitive to changes when compared to the 10MWT. Implications for Rehabilitation Patients with polyneuropathy mainly experience problems when walking long distances. The 10-meter walk test does not possess sufficient psychometrics to diagnose walking abilities in these circumstances. The shuttle walk test is a valid instrument for assessing walking ability in individuals with polyneuropathy and might be the preferred instrument of choice when compared to the 10-meter walk test.

Longitudinal evolution of true protein, amino acids and bioactive proteins in breast milk: a developmental perspective.

The protein content of breast milk provides a foundation for estimating protein requirements of infants. Because it serves as a guideline for regulatory agencies issuing regulations for infant formula composition, it is critical that information on the protein content of breast milk is reliable. We have therefore carried out a meta-analysis of the protein and amino acid contents of breast milk and how they evolve during lactation. As several bioactive proteins are not completely digested in the infant and therefore represent "non-utilizable" protein, we evaluated the quantity, mechanism of action and digestive fate of several major breast milk proteins. A better knowledge of the development of the protein contents of breast milk and to what extent protein utilization changes with age of the infant will help improve understanding of protein needs in infancy. It is also essential when designing the composition of infant formulas, particularly when the formula uses a "staging" approach in which the composition of the formula is modified in stages to reflect changes in breast milk and changing requirements as the infant ages.

Growth of infants consuming whey-predominant term infant formulas with a protein content of 1.8 g/100 kcal: a multicenter pooled analysis of individual participant data.

BACKGROUND: High protein intake during infancy may contribute to obesity later in life in infants who are not exclusively breastfed. Lowering the protein content of infant formula so it is closer to that of mature breast milk may reduce long-term risk of overweight or obesity in formula-fed infants. OBJECTIVE: We assessed the effects of whey-predominant formulas with a protein content of 1.8 g/100 kcal (lower than that in most current formulas and closer to breast milk) on infant growth by comparing against WHO growth standards and breastfed infants. DESIGN: A multicenter pooled analysis was conducted with the use of individual participant data (n = 1882) from 11 randomized controlled trials of healthy term infants. Mixed-effects models that used ANCOVA were generated to estimate weight-for-age z score (WAZ), as well as length-for-age, BMI-for-age, and head circumference-for-age z scores at age 4 mo in infants fed a lower-protein infant formula (LPF) or a lower-protein infant formula with additional active ingredients (probiotics, prebiotics, or both) (LPFA) and breastfed infants. Estimates, including 95% CIs, were compared with a ±0.5 SD of WHO growth standards, a benchmark for clinically significant differences. RESULTS: The 95% CIs for pooled estimates of WAZ were within ±0.5 SD of WHO growth standards for the LPF [0.07 (-0.16, 0.29)] and LPFA [0.22 (0.01, 0.43)] groups. WAZ was higher in the LPF (P < 0.001) and LPFA (P = 0.003) groups than in the breastfed infants, likely because breastfed infants had a relatively low WAZ [-0.23 (-0.51, 0.05)] compared with WHO growth standards. The 95% CIs for all other z scores in the LPF and LPFA groups were within ±0.5 SD of WHO growth standards, except for head circumference, for which the upper limit of the 95% CI slightly exceeded 0.5 SD. No difference was observed in any z scores between the LPF and LPFA groups. CONCLUSION: Whey-predominant infant formula with a lower protein content that more closely resembles that of breast milk supports healthy growth comparable to the WHO growth standards and close to breastfed infants.

Postnatal High Protein Intake Can Contribute to Accelerated Weight Gain of Infants and Increased Obesity Risk.

Worldwide, 38% of women are now overweight (BMI 25-30) or obese (BMI ≥30). There is increasing evidence that maternal obesity can result in unfavorable (epigenetic) pre- and postnatal programming of important genes of the offspring. Infants of overweight mothers show faster weight gain during infancy, which is associated with higher risk of obesity during childhood and adult life. This can have lifelong consequences such as increased risk of noncommunicable diseases. Many studies indicate that infants of obese and nonobese mothers who were fed traditional (high-protein) formulas gain more rapidly weight than breastfed infants. An updated meta-analysis (n = 1,150) indicates that infants from four continents who were fed a whey-based, low-protein (1.8 g/100 kcal) formula with an essential amino-acid profile closer to breast milk grow in accordance with the World Health Organization (WHO) growth standard (0-4 months). A new experimental low-protein (1.61-1.65 g protein/100 kcal) formula for infants between 3 and 12 months of age was recently tested in two randomized clinical trials. One trial in the general US population indicates lower weight between 4 and 12 months of age in infants fed the low-protein formula when compared to infants on the high-protein formula (p = 0.031). Weight gain was not inferior to the WHO growth standards. Longitudinal analysis of odds ratios from 4 to 12 months of age showed a lower incidence of infants with weight >85th percentile in the low-protein group compared with the high-protein group (p = 0.015). In the second trial, which was conducted in Chile and included infants of mothers with BMI >25, infants fed the low-protein formula gained less weight between 4 and 12 months (p = 0.022) and until 24 months (p = 0.031) than the high-protein group. Weight gain was similar to the breastfed reference group. In both trials, biomarkers of protein metabolism (insulin-like growth factor-1 and C-peptide) of the low-protein groups were closer to breastfed infants than the respective biomarkers of the high-protein groups. Health economic analyses indicate that feeding low-protein formulas to nonbreastfed infants would result in cost savings for both the individual and the society. Preventive measures against childhood and adult obesity should include promotion of breastfeeding for 6 months or longer, and use of low-protein formulas in nonbreastfed infants.

Functioning of patients with multifocal motor neuropathy.

Patients with multifocal motor neuropathy (MMN) have slowly progressive, predominantly distal asymmetric limb weakness without sensory loss. While previous studies have investigated the impact of MMN on body functions and structures, relatively little is known about the impact of patients' weakness on daily functioning. The aim of the present cross-sectional study, involving 47 patients with MMN, was to evaluate determinants of patients' functioning. Most patients showed not only muscle weakness but also fatigue, limited dexterity, and limited walking ability. Regression models showed that age, hand aids, and muscle strength scores together explained 54% of the variance in dexterity scores, which in turn explained 8% of the variance in patients' scores for autonomy indoors. Age, the use of walking aids, and muscle strength scores together explained 58% of the variance in walking ability scores, which in turn explained 18% of the variance in patients' scores for autonomy indoors and 7% of the variance in patients' scores for autonomy outdoors. Assessment of determinants of patient functioning may make it possible to tailor interventions to address these aspects and thereby improve patients' functioning in daily life.

Pain in patients with chronic idiopathic axonal polyneuropathy.

BACKGROUND/AIMS: Pain in patients with chronic idiopathic axonal polyneuropathy (CIAP) has never been studied in detail. The aim of the study was to investigate the pain experienced by patients with CIAP, and to determine whether pain is associated with health-related quality of life (HRQoL). METHODS: The McGill Pain Questionnaire (MPQ) and the RAND-36 were used in a cross-sectional study. RESULTS: Sixty-three of 91 patients with CIAP reported experiencing pain, describing it as nagging (56%) and annoying (52%). Of these patients, 27 were classified in a subgroup with neuropathic pain (median VAS = 33 mm), 25 in a subgroup with non-neuropathic pain (median VAS = 34 mm), and 11 in a mixed-pain subgroup (median VAS = 25 mm). Non-neuropathic pain was as common and as painful as neuropathic pain. Pain was strongly associated with the physical functioning domain of the RAND-36 in patients in the mixed pain subgroup (r = -0.71, p < 0.05). CONCLUSION: Neuropathic and non-neuropathic pain syndromes should be distinguished in patients with CIAP who experience pain, to enable appropriate tailoring of treatment.

Functioning of patients with chronic idiopathic axonal polyneuropathy (CIAP).

Although patients with Chronic Idiopathic Axonal Polyneuropathy (CIAP) report a slow deterioration of sensory and motor functions, the impact of this deterioration on daily functioning has not yet been investigated in detail. The first aim of this cross-sectional study involving 56 patients with CIAP was, therefore, to assess patients' functioning with use of the International Classification of Functioning, Disability and Health (ICF). The second aim was to find determinants of walking ability, dexterity, and autonomy. Fatigue and limited walking ability were present in most patients and differed considerably. In regression models, age, muscle strength, and fatigue together explained 63% of the variance in walking ability, which by itself explained almost 50% of the variance in patients' autonomy indoors and outdoors (42% and 49%, respectively). Muscle strength and sensory function scores together explained 30% of the variance in dexterity scores, which in turn explained only 13% of the variance in autonomy indoors. The diminished autonomy of patients with CIAP might be improved by reducing fatigue, by means of training, and by improving walking ability.

Functional health status of patients with chronic inflammatory neuropathies.

The functioning of 12 patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and 18 patients with multifocal motor neuropathy (MMN) was evaluated to obtain health profiles and appropriate clinimetric instruments. Assessment was made in a cross-sectional study by means of a performance-based body function test (hand-held dynamometry), two performance-based activity tests (10-m walk test and Berg balance scale), a self-reported activity test (Canadian Occupational Performance Measure), and a self-reported functioning test (sickness impact profile 68). In both patient groups, CIDP and MMN, specific health profiles were manifest. A clear relationship between body function, activities, and functioning was not found. Therefore, to assess a patient with inflammatory neuropathy, it is recommended to assess body function as well as activities and functioning and to select appropriate clinimetric instruments specific for each type of neuropathy.

The responsiveness of the ten-meter walking test and other measures in patients with hemiparesis in the acute phase.

The responsiveness of the Ten-Meter Walking Test (10 MWT) for assessing the walking ability of patients with hemiparesis in the acute phase was evaluated. To put this into perspective, the responsiveness of two other measures, the Berg Balance Scale (BBS) and the Motricity Index (MI) were evaluated as well. Nineteen patients with hemiparesis due to stroke or cerebral tumour in the acute phase were recruited to this study. To measure its responsiveness, the 10 MWT was performed three times a week, and the BBS and the MI performed twice a week. The responsiveness of all tests was computed using the Effect Sizes (ES) and Standardized Response Means (SRM). The ES for the 10 MWT was 1.17 and the SRM was 1.68. The ES and SRM of the BBS were 0.59 and 0.99. The ES and SRM of the MI were 0.27 and 0.96. The results of this study indicate that the 10 MWT is a responsive assessment tool, and appears to be more responsive than other commonly used tests.