Breastfed and mixed fed infants who do not consume infant cereal are at risk for inadequate iron intake:data from the feeding infants and toddlers study 2016, a cross-sectional survey.

BACKGROUND: According to the Feeding Infants and Toddlers Study (FITS), the percentage of older infants consuming infant cereal has declined from 72% of 6-11.9 month old infants in 2002 to 52% in 2016. This is especially concerning for breastfed and mixed fed infants because of their increased need for dietary sources of iron. This study explored the association between infant cereal consumption and nutrient intakes among breastfed and mixed fed infants. METHODS: FITS 2016 is the largest cross-sectional survey of food and nutrient intakes among caregivers of children less than 4 years old in the United States. For this analysis, we evaluated 24 h dietary recalls for infants 6-11.9 months who were either breastfed (no infant formula provided, n = 296) or mixed fed (breastmilk and infant formula provided, n = 102). Infants were further categorized as infant cereal consumers or non-consumers. Nutrient intakes were compared with Adequate Intakes or Estimated Average Requirements when available. Differences between cereal consumers and non-consumers were calculated using unpaired T-tests. RESULTS: Significantly fewer breastfed cereal consumers had intakes below the Estimated Average Requirement for iron (19% vs. 96%) and zinc (61% vs. 16%, p < 0.0001). Additionally, significantly more breastfed cereal consumers had intakes above the Adequate Intake level for 12 other nutrients compared to non-consumers. Among mixed fed infants, significantly fewer cereal consumers had intakes below the Estimated Average Requirement for iron compared to non-consumers (5% vs. 70%), but differences in other nutrients were not observed. CONCLUSIONS: Almost all (96%) of the breastfed infants who did not consume infant cereal had inadequate iron intakes. Even among mixed fed infants, significantly fewer infant cereal consumers had inadequate iron intakes compared to non-cereal consumers. Infant cereal is an important source of iron and other key nutrients, especially for infants receiving breastmilk.

Challenges and Considerations When Balancing the Risks of Contaminants with the Benefits of Fruits and Vegetables for Infants and Toddlers.

BACKGROUND: Fruits and vegetables are key to a healthy diet, particularly in children; however, parents may be concerned about contaminants found in fruits and vegetables. Making informed food choices for children requires understanding and balancing the risks of contaminant exposure with the importance of providing a healthy diet. The objective of this work is to identify fruits and vegetables commonly consumed by infants and toddlers; identify potential contaminants in fruits and vegetables; and outline considerations in assessing contaminant risks in food categories with a critical role in a healthy diet. METHOD: Commonly consumed fruits and vegetables were obtained from the Feeding Infants & Toddlers Study (FITS 2016). The US Food and Drug Administration Total Diet Study was reviewed for contaminant occurrence, and multiple experts were consulted on considerations in assessing risk of certain contaminants. RESULTS: FITS data show eight fruits and nine vegetables account for over 80% of consumption in infants and toddlers. Several contaminants have been detected in fruits and vegetables. Questions to be addressed prior to establishing contaminant guidance were identified. CONCLUSION: Contaminant guidance for fruits and vegetables consumed by infants and toddlers raises several challenges. Expertise from multiple disciplines is required to find an approach that maximizes public health benefit.

History of Acquired Monosaccharide Intolerance in Houston, Texas.

It is appropriate that we begin the clinical part of this conference with a discussion of acquired monosaccharide intolerance. This disease is the most severe form of carbohydrate malabsorption and maldigestion that can afflict an infant. The following article describes the pathophysiology of the disease, as well as its treatment, much of which was based on studies done by the Section of Pediatric Gastroenterology and Nutrition at Baylor College of Medicine. Acquired monosaccharide intolerance has almost disappeared from the United States but remains a problem in the developing world where it is included as part of the diagnosis of environmental enteropathy. Present research on this disease seems to sometimes duplicate what is already known.

Chapter 4. The Relationship Between the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition.

This chapter is based on the memories of those who shaped the relationship between the European and the North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition. The first joint meeting of the 2 Societies took place in Paris in 1978, followed by 1 in New York in 1985, 1 in Amsterdam in 1990, 1 in Houston in 1994, and the last one in Toulouse in 1998. The formation of the Federation of the International Societies for Pediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN) preceded the First World Congress of all Societies, which took place in Boston in 2000. The success of this meeting was followed by world congresses in Paris in 2004, Iguassu in 2008, Taiwan in 2012, and Montreal in 2016. NASPGHAN and ESPGHAN jointly took on the direction of the Journal of Pediatric Gastroenterology and Nutrition in 1991. Communication between the 2 Societies is extremely active, with members participating in many joint projects.

A cross-sectional study of osteocalcin and body fat measures among obese adolescents.

UNLABELLED: Osteocalcin (OCN), a marker of osteoblast activity, has been implicated in the regulation of energy metabolism by the skeleton and thus may affect body fat measures. OBJECTIVE: To examine the relationships of OCN to body fat measures and whether they vary according to markers of energy and vitamin D metabolism. DESIGN AND METHODS: Data were obtained from 58 obese adolescents aged 13-17.9 years (38 females, 8 black or African-American). Total fat mass (FM) [dual X-ray absorptiometry (DXA)] and visceral adipose tissue (VAT) [computerized axial tomography (CT)] were calculated. Blood tests included leptin, OCN, 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), thyroid function tests, and triglycerides. Markers of glucose metabolism were obtained from fasting and OGTT samples. RESULTS AND CONCLUSIONS: Adolescents with 25(OH)D <20 ng mL(-1) were considered deficient (n = 17/58); none had high PTH (PTH ≥ 65 pg mL(-1) ). OCN was associated with lower VAT (-84.27 ± 33.89 mm(2) ) and BMI (-0.10 ± 0.05 kg m(-2) ), not FM (P = 0.597) in a core model including age, sex, race, geographic latitude, summer, height z-score, and tanner stage. Adding 25(OH)D deficiency and PTH attenuated the inverse association of OCN to VAT. There was a significant interaction of OCN and 25(OH)D deficiency on FM (0.37 ± 0.18 kg, P = 0.041) and BMI (0.28 ± 0.10 kg m(-2) , P = 0.007) in this adjusted model, which was further explained by leptin. Adding A1C to the core model modified the relationship of OCN to VAT (-93.08 ± 35.05 mm(2) , P = 0.011), which was further explained by HOMA-IR. In summary, these findings provide initial evidence for a relationship between OCN and body fat measures that is dependent on energy metabolism and vitamin D status among obese adolescents.

Multicomponent school-initiated obesity intervention in a high-risk, Hispanic elementary school.

The aim of the study was to determine the effectiveness of a school-initiated cognitive and behavioral program to reduce childhood obesity. Height, weight, body mass index (BMI), and BMI z scores were obtained at the beginning and end of the school year at an intervention school (n = 1022) and at a control school (n = 692). The prevalence of overweight and obesity was 18.9% and 30.4% versus 19% and 30.2%, respectively, in the intervention and control schools. The incidence of overweight increased in the control school, but the incidence of obesity, weight, and BMI z scores increased significantly in the intervention school, suggesting that implementation of any school-based obesity intervention programs requires careful planning to achieve goals.

An innovative summer camp program improves weight and self-esteem in obese children.

To determine the potential benefits of a residential summer camp to treat childhood obesity, 21 obese, multiethnic children (aged 11.4+/-1.4 years; body mass index [BMI] percentile 98.5+/-1.4; BMI z score 2.30+/-0.33) from a diverse socioeconomic background were enrolled in a 2-week summer camp program. Significant improvements (P<0.04) were observed in self-esteem (+0.27+/-0.33 point), body weight (-3.7+/-1.2 kg), BMI (-1.60+/-0.48 kg/m), BMI z score (-0.12+/-0.06), number of curl ups (+10.9+/-21.5), systolic and diastolic blood pressure (-10.8+/-13.4 and -9.4+/-5.5 mmHg, respectively), and heart rate (-8.2+/-12.7 bpm).

Relation of body fat indexes to vitamin D status and deficiency among obese adolescents.

BACKGROUND: Data on the relation between vitamin D status and body fat indexes in adolescence are lacking. OBJECTIVE: The objective was to identify factors associated with vitamin D status and deficiency in obese adolescents to further evaluate the relation of body fat indexes to vitamin D status and deficiency. DESIGN: Data from 58 obese adolescents were obtained. Visceral adipose tissue (VAT) was measured by computed tomography. Dual-energy X-ray absorptiometry was used to measure total bone mineral content, bone mineral density, body fat mass (FM), and lean mass. Relative measures of body fat were calculated. Blood tests included measurements of 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), osteocalcin, type I collagen C-telopeptide, hormones, and metabolic factors. Vitamin D deficiency was defined as 25(OH)D < 20 ng/mL. PTH elevation was defined as PTH > 65 ng/mL. RESULTS: The mean (+/-SD) age of the adolescents was 14.9 +/- 1.4 y; 38 (66%) were female, and 8 (14%) were black. The mean (+/-SD) body mass index (in kg/m(2)) was 36 +/- 5, FM was 40.0 +/- 5.5%, and VAT was 12.4 +/- 4.3%. Seventeen of the adolescents were vitamin D deficient, but none had elevated PTH concentrations. Bone mineral content and bone mineral density were within 2 SDs of national standards. In a multivariate analysis, 25(OH)D decreased by 0.46 +/- 0.22 ng/mL per 1% increment in FM (beta +/- SE, P = 0.05), whereas PTH decreased by 0.78 +/- 0.29 pg/mL per 1% increment in VAT (P = 0.01). CONCLUSIONS: To the best of our knowledge, our results show for the first time that obese adolescents with 25(OH)D deficiency, but without elevated PTH concentrations, have a bone mass within the range of national standards (+/-2 SD). The findings provide initial evidence that the distribution of fat may be associated with vitamin D status, but this relation may be dependent on metabolic factors. This study was registered at www.clinicaltrials.gov as NCT00209482, NCT00120146.

Psychological predictors of success in a pediatric cognitive-behavioral weight-control program.

Carmen Mikhail, PhD, and her coauthors explore the relationship between psychological profiles and success in a pediatric cognitive-behavioral weight-control program.

Age- and ethnic-specific elevation of ALT among obese children at risk for nonalcoholic steatohepatitis (NASH): implications for screening.

The objectives are to: (1) characterize ethnic-specific differences in alanine aminotransferase (ALT) elevation among obese children, (2) investigate the earliest ages at which significant ALT elevation occurs, and (3) determine associations between ALT and biochemical parameters. A cohort of 134 multiethnic obese children and adolescents was analyzed retrospectively. ALT levels > or =45 U/L or <45 U/L, denoting high or normal risk, were used to categorize obese children's risk for developing nonalcoholic steatohepatitis. In all, 60% of Hispanics had high-risk ALT levels compared with 12% of whites and 8% of blacks. A significantly higher proportion of boys had ALT > or = 45 U/L (49.4%, vs 37.9% for girls, P = .002); 17.5% were Hispanic boys less than 7 years old. Obese Hispanic children, particularly boys, not only have higher ALT levels but present alarmingly young with high-risk levels. This study highlights a discrete subgroup of children who may present with fatty liver at a younger age and should be screened earlier.

Steroid responsive eosinophilic gastric outlet obstruction in a child.

Gastric outlet obstruction is a rare complication of eosinophilic gastroenteritis, most commonly treated surgically. We report a case of eosinophilic gastric outlet obstruction in a child that responded to conservative medical management. A brief review of this clinical entity is also provided.

Park-based obesity intervention program for inner-city minority children.

OBJECTIVE: To assess an intervention strategy--a 6-week obesity intervention program, Project KidFIT, at 3 Houston, Texas park centers--to address the obesity epidemic in minority children. STUDY DESIGN: Project KidFIT is a physical fitness and nutrition education program aimed at promoting the benefits of physical activity and improving nutrition knowledge in overweight (body mass index [BMI] > or = 95th percentile) minority children. RESULTS: A total of 120 minority children (77 boys and 43 girls; mean age, 10.1 years) were enrolled in the program. Approximately 71% of these children were at risk of overweight (BMI > or = 85th percentile), and 54% were overweight. Decreases in body weight (0.3 +/- 0.2 kg [mean +/- standard error]) and BMI (0.1 +/- 0.1 kg/m2) were detected in the overweight children, whereas increases in body weight (0.4 +/- 0.1 kg) and BMI (0.2 +/- 0.1 kg/m2) were observed in the children with normal body weight (BMI < 85th percentile but > 5th percentile). Significant improvements (P < .05) in flexibility, muscular endurance, and muscular strength were detected in all children, regardless of weight status. CONCLUSIONS: The findings suggest that the city park-based KidFIT program might be effective at promoting stabilization for body weight and BMI and improving physical activity performance and nutrition knowledge in overweight minority children.

Overweight children and adolescents: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

Childhood overweight and obesity are major health problems with immediate and long-term consequences of staggering magnitude. Despite this, there are few preventive and therapeutic strategies of proven effectiveness available to public health and clinical practitioners. Accruing such evidence is currently and appropriately a health policy priority, but there is an urgent need to intervene even before comprehensive solutions are fully established. The aim of this Clinical Report on Overweight Children and Adolescents is to present information on current understanding of pathogenesis and treatment of overweight and obesity. We report on the epidemiology, molecular biology and medical conditions associated with overweight; on dietary, exercise, behavioral, pharmacological and surgical treatments; and on the primary prevention of overweight in children and adolescents.

Bariatric surgery for severely overweight adolescents: concerns and recommendations.

As the prevalence of obesity and obesity-related disease among adolescents in the United States continues to increase, physicians are increasingly faced with the dilemma of determining the best treatment strategies for affected patients. This report offers an approach for the evaluation of adolescent patients' candidacy for bariatric surgery. In addition to anthropometric measurements and comorbidity assessments, a number of unique factors must be critically assessed among overweight youths. In an effort to reduce the risk of adverse medical and psychosocial outcomes and increase compliance and follow-up monitoring after bariatric surgery, principles of adolescent growth and development, the decisional capacity of the patient, family structure, and barriers to adherence must be considered. Consideration for bariatric surgery is generally warranted only when adolescents have experienced failure of 6 months of organized weight loss attempts and have met certain anthropometric, medical, and psychologic criteria. Adolescent candidates for bariatric surgery should be very severely obese (defined by the World Health Organization as a body mass index of > or =40), have attained a majority of skeletal maturity (generally > or =13 years of age for girls and > or =15 years of age for boys), and have comorbidities related to obesity that might be remedied with durable weight loss. Potential candidates for bariatric surgery should be referred to centers with multidisciplinary weight management teams that have expertise in meeting the unique needs of overweight adolescents. Surgery should be performed in institutions that are equipped to meet the tertiary care needs of severely obese patients and to collect long-term data on the clinical outcomes of these patients.