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Rosen-Carole CB, Greenman S, Wang H, Sonawane S, Misra R, O'Connor T, Järvinen K, D'Angio C, Young BE. Association between maternal stress and premature milk cortisol, milk IgA, and infant health: a cohort study. Front Nutr 2024; 11:1270523. [PMID: 38533463 PMCID: PMC10964987 DOI: 10.3389/fnut.2024.1270523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024] Open
Abstract
Background Maternal stress is pervasive in the neonatal intensive care unit (NICU). Maternal stress is associated with changes in human milk (HM) immunomodulatory agents, which may impact neonatal health. We sought to determine the association between maternal stress, HM immunoglobulin A (IgA) and cortisol, and to assess how these milk components correlate with infant immune and neurodevelopmental outcomes. We then compared how these associations persist over time. Methods The study design involved a cohort study of exclusively breastfeeding mothers and their singleton moderately preterm (28-34 weeks) infants admitted to the NICU. We collected maternal serum, maternal saliva, and first-morning whole milk samples, and administered maternal stress questionnaires at 1 and 5 weeks postpartum. We analyzed the samples for HM IgA (using a customized immunoassay in skim milk) and for HM and salivary cortisol (using a chemiluminescent immunoassay). Infant illness was assessed using the Score for Neonatal Acute Physiology II (SNAP II) and SNAP II with Perinatal Extension (SNAPPE II), and infant neurodevelopment were assessed using the Test of Infant Motor Performance. We analyzed changes in HM IgA and cortisol over time using paired t-tests. Furthermore, we performed correlation and regression analyses after adjusting for gestational age (GA), corrected GA, and infant days of life. Results In our study, we enrolled 26 dyads, with a mean maternal age of 28.1 years, consisting of 69% white, 19% Black, and 8% Hispanic. Cortisol: Salivary and HM cortisol were closely associated in week 1 but not in week 5. Though mean salivary cortisol remained stable over time [2.41 ng/mL (SD 2.43) to 2.32 (SD 1.77), p = 0.17], mean HM cortisol increased [1.96 ng/mL (SD 1.93) to 5.93 ng/mL (SD 3.83), p < 0.001]. Stress measures were inversely associated with HM cortisol at week 1 but not at week 5. IgA: HM IgA decreased over time (mean = -0.14 mg/mL, SD 0.53, p < 0.0001). High maternal stress, as measured by the Parental Stressor Scale: neonatal intensive care unit (PSS:NICU), was positively associated with HM IgA at week 5 (r = 0.79, P ≤ 0.001). Higher IgA was associated with a lower (better) SNAP II score at week 1 (r = -0.74, p = 0.05). No associations were found between maternal stress, salivary cortisol, HM cortisol, or HM IgA and neurodevelopment at discharge (as assessed using the TIMP score). Furthermore, these relationships did not differ by infant sex. Conclusion Maternal stress showed associations with HM cortisol and HM IgA. In turn, HM IgA was associated with lower measures of infant illness.
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Affiliation(s)
- Casey B. Rosen-Carole
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Susan Greenman
- Swedish First Hill Family Medicine, Seattle, WA, United States
| | - Hongyue Wang
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Sharvari Sonawane
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Ravi Misra
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Tom O'Connor
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Kirsi Järvinen
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Carl D'Angio
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Bridget E. Young
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
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Odiase E, Frank DN, Young BE, Robertson CE, Kofonow JM, Davis KN, Berman LM, Krebs NF, Tang M. The Gut Microbiota Differ in Exclusively Breastfed and Formula-Fed United States Infants and are Associated with Growth Status. J Nutr 2023; 153:2612-2621. [PMID: 37506974 PMCID: PMC10517231 DOI: 10.1016/j.tjnut.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Evidence regarding the effects of infant feeding type (exclusive breastfeeding compared with exclusive formula feeding) on the gut microbiota and how it impacts infant growth status is limited. OBJECTIVES The primary objective was to compare gut microbiota by feeding type and characterize the associations between gut microbiota and infant growth status. METHODS Stool samples from healthy, full-term infants (4-5 mo-old) who were either exclusively breastfed (BF) or exclusively formula-fed (FF) in Denver, CO, United States were collected, and fecal 16S ribosomal ribonucleic acid gene-based profiling was conducted. Length and weight were measured at the time of stool collection. Length-for-age z-score, weight-for-age z-scores (WAZ), and weight-for-length z-scores were calculated based on the World Health Organization standards. Associations between gut microbial taxa and anthropometric z-scores were assessed by Spearman's rank correlation test. RESULTS A total of 115 infants (BF n = 54; FF n = 61) were included in this study. Feeding type (BF compared with FF) was the most significant tested variable on gut microbiota composition (P < 1 × 10-⁶), followed by mode of delivery and race. Significant differences were observed in α-diversity, β-diversity, and relative abundances of individual taxa between BF and FF. BF infants had lower α-diversity than FF infants. Abundances of Bifidobacterium and Lactobacillus were greater in the breastfeeding group. FF infants had a higher relative abundance of unclassified Ruminococcaceae (P < 0.001), which was associated with a higher WAZ (P < 0.001) and length-for-age z-score (P < 0.01). Lactobacillus was inversely associated with WAZ (P < 0.05). CONCLUSIONS Feeding type is the main driver of gut microbiota differences in young infants. The gut microbiota differences based on feeding type (exclusive breast- or formula feeding) were associated with observed differences in growth status. This trial was registered at clinicaltrials.gov as NCT02142647, NCT01693406, and NCT04137445.
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Affiliation(s)
- Eunice Odiase
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, University of Virginia, Charlottesville, VA, 22904, USA
| | - Daniel N Frank
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Bridget E Young
- University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Charles E Robertson
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jennifer M Kofonow
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kathryn N Davis
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Lillian M Berman
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Minghua Tang
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
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Lemas DJ, Du X, Dado-Senn B, Xu K, Dobrowolski A, Magalhães M, Aristizabal-Henao JJ, Young BE, Francois M, Thompson LA, Parker LA, Neu J, Laporta J, Misra BB, Wane I, Samaan S, Garrett TJ. Untargeted Metabolomic Analysis of Lactation-Stage-Matched Human and Bovine Milk Samples at 2 Weeks Postnatal. Nutrients 2023; 15:3768. [PMID: 37686800 PMCID: PMC10490210 DOI: 10.3390/nu15173768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Epidemiological data demonstrate that bovine whole milk is often substituted for human milk during the first 12 months of life and may be associated with adverse infant outcomes. The objective of this study is to interrogate the human and bovine milk metabolome at 2 weeks of life to identify unique metabolites that may impact infant health outcomes. Human milk (n = 10) was collected at 2 weeks postpartum from normal-weight mothers (pre-pregnant BMI < 25 kg/m2) that vaginally delivered term infants and were exclusively breastfeeding their infant for at least 2 months. Similarly, bovine milk (n = 10) was collected 2 weeks postpartum from normal-weight primiparous Holstein dairy cows. Untargeted data were acquired on all milk samples using high-resolution liquid chromatography-high-resolution tandem mass spectrometry (HR LC-MS/MS). MS data pre-processing from feature calling to metabolite annotation was performed using MS-DIAL and MS-FLO. Our results revealed that more than 80% of the milk metabolome is shared between human and bovine milk samples during early lactation. Unbiased analysis of identified metabolites revealed that nearly 80% of milk metabolites may contribute to microbial metabolism and microbe-host interactions. Collectively, these results highlight untargeted metabolomics as a potential strategy to identify unique and shared metabolites in bovine and human milk that may relate to and impact infant health outcomes.
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Affiliation(s)
- Dominick J. Lemas
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32608, USA; (X.D.); (K.X.); (A.D.); (M.F.); (L.A.T.); (I.W.); (S.S.)
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL 32608, USA;
- Center for Perinatal Outcomes Research, College of Medicine, University of Florida, Gainesville, FL 32608, USA;
| | - Xinsong Du
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32608, USA; (X.D.); (K.X.); (A.D.); (M.F.); (L.A.T.); (I.W.); (S.S.)
| | - Bethany Dado-Senn
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA;
| | - Ke Xu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32608, USA; (X.D.); (K.X.); (A.D.); (M.F.); (L.A.T.); (I.W.); (S.S.)
| | - Amanda Dobrowolski
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32608, USA; (X.D.); (K.X.); (A.D.); (M.F.); (L.A.T.); (I.W.); (S.S.)
| | - Marina Magalhães
- Department of Behavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL 32603, USA;
| | - Juan J. Aristizabal-Henao
- Department of Physiological Science, Center for Environmental and Human Toxicology, College of Veterinary Science, University of Florida, Gainesville, FL 32608, USA;
| | - Bridget E. Young
- Division of Breastfeeding and Lactation Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Magda Francois
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32608, USA; (X.D.); (K.X.); (A.D.); (M.F.); (L.A.T.); (I.W.); (S.S.)
| | - Lindsay A. Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32608, USA; (X.D.); (K.X.); (A.D.); (M.F.); (L.A.T.); (I.W.); (S.S.)
| | - Leslie A. Parker
- Center for Perinatal Outcomes Research, College of Medicine, University of Florida, Gainesville, FL 32608, USA;
| | - Josef Neu
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL 32608, USA;
| | - Jimena Laporta
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL 32608, USA;
| | | | - Ismael Wane
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32608, USA; (X.D.); (K.X.); (A.D.); (M.F.); (L.A.T.); (I.W.); (S.S.)
| | - Samih Samaan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32608, USA; (X.D.); (K.X.); (A.D.); (M.F.); (L.A.T.); (I.W.); (S.S.)
| | - Timothy J. Garrett
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32608, USA;
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Ackley D, Wang H, D'Angio CT, Meyers J, Young BE. Human milk-derived fortifiers are linked with feed extension due to Hypoglycemia in infants <1250 g or <30 weeks: a matched retrospective chart review. J Perinatol 2023; 43:624-628. [PMID: 36991141 PMCID: PMC10717733 DOI: 10.1038/s41372-023-01654-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To investigate differences in hypoglycemia and extended feed prescriptions among premature infants provided bovine-derived human milk fortifiers (Bov-fort) with mother's milk or formula vs human milk-derived human milk fortifiers (HM-fort) with mother's milk or donor human milk. STUDY DESIGN This was a retrospective chart review (n = 98). Infants receiving HM-fort were matched with infants receiving Bov-fort. Blood glucose values and feed orders were retrieved from the electronic medical record. RESULTS Prevalence of ever having blood glucose <60 mg/dL was 39.1% in the HM-fort group vs. 23.9% in the Bov-fort group (p = 0.09). Blood glucose ≤45 mg/dL occurred in 17.4% of HM-fort vs 4.3% in Bov-fort (p = 0.07). Feeds were extended for any reason in 55% of HM-fort vs. 20% of Bov-fort (p < 0.01). Feed extension due to hypoglycemia occurred in 24% of HM-fort vs. 0% of Bov-fort (p < 0.01). CONCLUSION Predominately HM-based feeds are associated with feed extension due to hypoglycemia. Prospective research is warranted to elucidate underlying mechanisms.
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Affiliation(s)
- Danielle Ackley
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Hongyue Wang
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Carl T D'Angio
- Division of Neonatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jeffrey Meyers
- Division of Neonatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Bridget E Young
- Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Strzalkowski A, Black G, Young BE. Iron and DHA in Infant Formula Purchased in the US Fails to Meet European Nutrition Requirements. Nutrients 2023; 15:nu15081812. [PMID: 37111031 PMCID: PMC10143847 DOI: 10.3390/nu15081812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/22/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Requirements for iron and docosahexaenoic acid (DHA) content of infant formula varies by country. Powdered full-term infant formula purchase data from all major physical stores in the US between 2017-2019 were obtained from CIRCANA, Inc. Iron and DHA composition and scoop sizes for each formula were obtained from manufacturers. The equivalent liquid ounces of prepared formula were calculated. Average iron and DHA content were compared between formula types and to both US and European formula composition requirements. These data represent 55.8 billion ounces of formula. The average iron content of all formula purchased was: 1.80 mg/100 kcal. This iron concentration is within the FDA regulations. However, it exceeds the maximum allowable iron concentration of infant formula (Stage 1) set by the European Commission of 1.3 mg/100 kcal. A total of 96% of formula purchased had an iron concentration of >1.3 mg/100 kcal. DHA is not a required ingredient in US formulas. The average DHA content of all formula purchased was: 12.6 mg/100 kcal. This DHA concentration is far below the minimum required DHA concentrations of infant formula (Stage 1) and follow-on formula (Stage 2) set by the European Commission of 20 mg/100 kcal. These are novel insights into the iron and DHA intake of formula-fed infants in the US. As international infant formulas have entered the US market due to the formula shortage, parents and providers need to be aware of regulatory differences in formula nutrient composition.
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Affiliation(s)
- Alexander Strzalkowski
- Department of Pediatrics, Complex Care Service, Boston Children's Hospital, Boston, MA 02115, USA
| | - Grace Black
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Bridget E Young
- Department of Pediatrics, Breastfeeding and Lactation Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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Smilowitz JT, Allen LH, Dallas DC, McManaman J, Raiten DJ, Rozga M, Sela DA, Seppo A, Williams JE, Young BE, McGuire MK. Ecologies, synergies, and biological systems shaping human milk composition-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 2. Am J Clin Nutr 2023; 117 Suppl 1:S28-S42. [PMID: 37173059 DOI: 10.1016/j.ajcnut.2022.11.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 05/15/2023] Open
Abstract
Human milk is universally recognized as the preferred food for infants during the first 6 mo of life because it provides not only essential and conditionally essential nutrients in necessary amounts but also other biologically active components that are instrumental in protecting, communicating important information to support, and promoting optimal development and growth in infants. Despite decades of research, however, the multifaceted impacts of human milk consumption on infant health are far from understood on a biological or physiological basis. Reasons for this lack of comprehensive knowledge of human milk functions are numerous, including the fact that milk components tend to be studied in isolation, although there is reason to believe that they interact. In addition, milk composition can vary greatly within an individual as well as within and among populations. The objective of this working group within the Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) Project was to provide an overview of human milk composition, factors impacting its variation, and how its components may function to coordinately nourish, protect, and communicate complex information to the recipient infant. Moreover, we discuss the ways whereby milk components might interact such that the benefits of an intact milk matrix are greater than the sum of its parts. We then apply several examples to illustrate how milk is better thought of as a biological system rather than a more simplistic "mixture" of independent components to synergistically support optimal infant health.
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Affiliation(s)
- Jennifer T Smilowitz
- Department of Food Science and Technology, University of California Davis, Davis, CA, USA; Foods for Health Institute, University of California Davis, Davis, CA, USA.
| | - Lindsay H Allen
- United States Department of Agriculture, Agricultural Research Service, Western Human Nutrition Research Center, University of California Davis, Davis, CA, USA
| | - David C Dallas
- Nutrition Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - James McManaman
- Division of Reproductive Sciences, University of Colorado, Aurora, CO, USA
| | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Mary Rozga
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, IL, USA
| | - David A Sela
- Department of Food Science, University of Massachusetts, Amherst, MA, USA; Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA
| | - Antti Seppo
- Department of Pediatrics, Division of Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Janet E Williams
- Department of Animal, Veterinary and Food Sciences, University of Idaho, Moscow, ID, USA
| | - Bridget E Young
- Department of Pediatrics, Division of Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Michelle K McGuire
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, USA.
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7
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Cheung KY, Petrou L, Helfer B, Porubayeva E, Dolgikh E, Ali S, Ali I, Archibald-Durham L, Brockway MM, Bugaeva P, Chooniedass R, Comberiati P, Cortés-Macías E, D'Elios S, Feketea G, Hsu P, Kana MA, Kriulina T, Kunii Y, Madaki C, Omer R, Peroni D, Prokofiev J, Simpson MR, Shimojo N, Siziba LP, Genuneit J, Thakor S, Waris M, Yuan Q, Zaman S, Young BE, Bugos B, Greenhawt M, Levin ME, Zheng J, Boyle RJ, Munblit D. Health and nutrition claims for infant formula: international cross sectional survey. BMJ 2023; 380:e071075. [PMID: 36792145 PMCID: PMC9930154 DOI: 10.1136/bmj-2022-071075] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To review available health and nutrition claims for infant formula products in multiple countries and to evaluate the validity of the evidence used for substantiation of claims. DESIGN International cross sectional survey. SETTING Public facing and healthcare professional facing company owned or company managed formula industry websites providing information about products marketed for healthy infants delivered at full term in 15 countries: Australia, Canada, Germany, India, Italy, Japan, Nigeria, Norway, Pakistan, Russia, Saudi Arabia, South Africa, Spain, the United Kingdom, and the United States in 2020-22. MAIN OUTCOME MEASURES Number and type of claims made for each product and ingredient. References cited were reviewed and risk of bias was assessed for registered clinical trials using the Cochrane risk of bias tool, and for systematic reviews using the Risk Of Bias in Systematic reviews tool. RESULTS 757 infant formula products were identified, each with a median of two claims (range from 1 (Australia) to 4 (US)), and 31 types of claims across all products. Of 608 products with ≥1 claims, the most common claim types were "helps/supports development of brain and/or eyes and/or nervous system" (323 (53%) products, 13 ingredients), "strengthens/supports a healthy immune system" (239 (39%) products, 12 ingredients), and "helps/supports growth and development" (224 (37%) products, 20 ingredients). 41 groups of ingredients were associated with ≥1claims, but many claims were made without reference to a specific ingredient (307 (50%) products). The most common groups of ingredients cited in claims were long chain polyunsaturated fatty acids (278 (46%) products, 9 different claims); prebiotics, probiotics, or synbiotics (225 (37%) products, 19 claims); and hydrolysed protein (120 (20%) products, 9 claims). 161/608 (26%) products with ≥1 claims provided a scientific reference to support the claim-266 unique references were cited for 24 different claim types for 161 products. The reference types most frequently cited were clinical trials (50%, 134/266) and reviews (20%, 52/266). 28% (38/134) of referenced clinical trials were registered, 14% (19/134) prospectively. 58 claims referred to 32 registered clinical trials, of which 51 claims (27 trials) related to a randomised comparison. 46 of 51 claims (90%) referenced registered clinical trial outcomes at high risk of bias, and all cited systematic reviews and pooled analyses, carried a high risk of bias. CONCLUSIONS Most infant formula products had at least one health and nutrition claim. Multiple ingredients were claimed to achieve similar health or nutrition effects, multiple claims were made for the same ingredient type, most products did not provide scientific references to support claims, and referenced claims were not supported by robust clinical trial evidence.
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Affiliation(s)
- Ka Yan Cheung
- Faculty of Medicine, Imperial College London, London, UK
| | - Loukia Petrou
- Faculty of Medicine, Imperial College London, London, UK
| | - Bartosz Helfer
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
- Institute of Psychology, University of Wroclaw, Wroclaw, Poland
- Meta Research Centre, University of Wroclaw, Wroclaw, Poland
| | - Erika Porubayeva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Elena Dolgikh
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Sana Ali
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Insaf Ali
- College of Medicine, King Faisal University, Kingdom Saudi Arabia
| | - Lindsay Archibald-Durham
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | | | - Polina Bugaeva
- Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Rishma Chooniedass
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, Winnipeg, BC, Canada
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Erika Cortés-Macías
- Institute of Agrochemistry and Food Technology (IATA-CSIC), National Research Council, 46980 Valencia, Spain
| | - Sofia D'Elios
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Gavriela Feketea
- Department of Pediatrics, Pediatric Allergy Outpatient Clinic, "Karamandaneio," Children Hospital, Patras, Greece
- Department of Pharmacology, "luliu Hatieganu" University of Medicine and Pharmacy, 400337, Cluj-Napoca, Romania
| | - Peter Hsu
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Musa Abubakar Kana
- Department of Community Medicine, College of Medicine, Kaduna State University, Kaduna, Nigeria
| | - Tatiana Kriulina
- Department of Paediatrics and Paediatric Rheumatology, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yuzuka Kunii
- Centre for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Comfort Madaki
- Kaduna Infant Development (KID) Birth Cohort Study Project, Kaduna, Nigeria
| | - Rihab Omer
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | | | - Melanie Rae Simpson
- Department of Public Health and General Practice, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Laboratory Medicine, St Olavs Hospital, Trondheim, Norway
| | - Naoki Shimojo
- Centre for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Linda P Siziba
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Sohini Thakor
- Faculty of Medicine, Imperial College London, London, UK
| | - Marium Waris
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Quan Yuan
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sadia Zaman
- Faculty of Medicine, Imperial College London, London, UK
| | - Bridget E Young
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Brighid Bugos
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael E Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Jonathan Zheng
- Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Daniel Munblit
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
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8
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Tan JY, Chia YW, Chan M, Lim SL, Chin C, Yap J, Richards AM, Teo ZW, Amanullah MR, Peck KH, Choo TLJ, Sim HW, Young BE, Macary P, Yeo KK. Pathophysiologic mechanism for MYOcarditis in COVID-19 VAccinations ("MYOVAx" Study). Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NMRC COVID-19 Research Fund
Objective
This is the first prospective cohort study in Singapore to investigate the COVID-19 vaccine-associated myocarditis to understand its pathophysiology.
Introduction
Acute myocarditis and other cardiovascular symptoms have been observed to be associated with the two mRNA-based coronavirus disease 2019 (COVID-19) vaccines—namely Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273)—currently in-use in Singapore. The mechanisms through which myocarditis occurs are unknown, hence our study aims to understand the pathophysiology of myocarditis associated with COVID-19 vaccines.
Methods
Patients with onset of cardiac manifestations were recruited from multiple hospital outpatient clinics between November 2021 and September 2022. Clinical history and physical examination data was collected with blood sample collection, echocardiography, 12-lead electrocardiogram (ECG), coronary angiography and magnetic resonance imaging (MRI) at recruitment and 6-month follow-up. Analysis of biomarkers, genetic, serological and MRI data was conducted.
Results
As of 6 September 2022, a total of 5 patients have been enrolled (4 males, 1 female). The most commonly reported symptoms across all patients were chest pain/discomfort (80%), followed by palpitations (40%). MRI evidence of myocarditis has been detected in 2 (50%) of the male patients, of which both reported two or more symptoms occurring 1-2 days post-vaccination. Both patients have each received at least two doses of either the Pfizer-BioNTech BNT162b2 vaccine or Moderna mRNA-1273 vaccine. Their MRI findings were consistent with myocarditis. On late gadolinium enhancement (LGE) imaging, epicardial enhancement at the basal inferolateral segment and mid-wall enhancement at the apical anterior, lateral and inferior walls were observed in one patient. Patchy, mid-wall LGE in the basal inferior/inferolateral wall was observed in the other patient. No MRI evidence of myocarditis was available for the sole female patient.
Conclusion
While more data is needed to definitively prove the association of the two mRNA-based Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273 COVID-19 vaccines with post-vaccination myocarditis, we believe our findings may support further investigations to enable risk stratification for vaccine-associated myocarditis and identify potential preventative strategies accordingly.
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Affiliation(s)
- J Y Tan
- National Heart Centre Singapore, Department of Cardiology , Singapore , Singapore
| | - Y W Chia
- Tan Tock Seng Hospital, Department of Cardiology , Singapore , Singapore
| | - M Chan
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - S L Lim
- National University Hospital, Department of Cardiology , Singapore , Singapore
| | - C Chin
- National Heart Centre Singapore, Department of Cardiology , Singapore , Singapore
| | - J Yap
- National Heart Centre Singapore, Department of Cardiology , Singapore , Singapore
| | - A M Richards
- National University Hospital, Cardiovascular Research Institute , Singapore , Singapore
| | - Z W Teo
- Changi General Hospital, Department of Cardiology , Singapore , Singapore
| | - M R Amanullah
- Sengkang General Hospital, NHCS Cardiology @ SKH , Singapore , Singapore
| | - K H Peck
- Khoo Teck Puat Hospital, Department of Cardiology , Singapore , Singapore
| | - T L J Choo
- KK Women's and Children's Hospital, Cardiology Service , Singapore , Singapore
| | - H W Sim
- Ng Teng Fong General Hospital, Department of Medicine , Singapore , Singapore
| | - B E Young
- National Centre for Infectious Diseases , Singapore , Singapore
| | - P Macary
- National University of Singapore, Department of Microbiology and Immunology , Singapore , Singapore
| | - K K Yeo
- National Heart Centre Singapore, Department of Cardiology , Singapore , Singapore
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9
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Strzalkowski AJ, Järvinen KM, Schmidt B, Young BE. Protein and carbohydrate content of infant formula purchased in the United States. Clin Exp Allergy 2022; 52:1291-1301. [PMID: 36129802 DOI: 10.1111/cea.14232] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The protein and carbohydrate composition of formula fed infants' diets in the United States (US) has not been described. The aims of this study were to characterize these dietary exposures in infant formula purchased in the US and to estimate the proportion of formula purchased which is hypoallergenic or lactose-reduced formula. METHODS Powdered infant formula purchase data from all major physical stores in the US prior to the COVID-19 pandemic, between 2017 and 2019, were obtained from Information Resources, Inc. Protein and carbohydrate composition and scoop sizes for each formula were obtained from manufacturers. Ready to feed liquid products, products for premature infants and products for over 1 year old were not included. RESULTS Total volumes of term formula purchased were 216 million kg of formula powder (equivalent to 1.65 billion litres) over 3 years. Intact protein formula was 67.9% of formula purchased, 26.6% was partially hydrolysed and 5.5% was hypoallergenic (5.2% extensively hydrolysed protein; 0.3% amino acid based). Soy protein formula represented 5.1% of formula purchased. Carbohydrate content overall was 52.7% lactose, 42.3% glucose polymers and 5.0% sucrose. 23.7% of formula purchased included sucrose as a carbohydrate. Of all formula purchased, 59.0% was lactose reduced, containing a non-lactose carbohydrate. Of 'standard' formula, defined as intact protein, non-thickened, cow's milk formula, 32.3% was lactose reduced. The proportion of hypoallergenic formula purchased significantly exceeded the prevalence of cow's milk protein allergy and increased over the 3-year study period from 4.9% to 7.6% of all formula sold. CONCLUSIONS US infants are exposed to unnecessarily high levels of non-lactose carbohydrates and hypoallergenic formula, and this may represent a significant nutritional health risk.
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Affiliation(s)
- Alexander J Strzalkowski
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kirsi M Järvinen
- Department of Pediatrics Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Brianne Schmidt
- Department of Pediatrics Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Bridget E Young
- Department of Pediatrics Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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10
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Young BE, Järvinen KM, Seppo A. Thinking More About Inhibition of Breast Milk on the Infectivity of SARS-CoV-2-Reply. JAMA Pediatr 2022; 176:527-528. [PMID: 35226051 DOI: 10.1001/jamapediatrics.2021.6616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Bridget E Young
- Department of Pediatrics, Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Kirsi M Järvinen
- Department of Pediatrics, Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Antti Seppo
- Department of Pediatrics, Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York
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11
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Wang J, Young BE, Li D, Seppo AE, Zhou Q, Wiltse A, Nowak-Wegrzyn A, Murphy K, Widrick K, Diaz N, Cruz-Vasquez J, Järvinen KM, Zand MS. Broad Cross-reactive IgA and IgG Against Human Coronaviruses in Milk Induced by COVID-19 Vaccination and Infection. medRxiv 2022:2022.03.13.22272281. [PMID: 35313594 PMCID: PMC8936120 DOI: 10.1101/2022.03.13.22272281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
UNLABELLED It is currently unclear if SARS-CoV-2 infection or mRNA vaccination can also induce IgG and IgA against common human coronaviruses (HCoVs) in lactating parents. Here we prospectively analyzed human milk (HM) and blood samples from lactating parents to measure the temporal patterns of anti-SARS-CoV-2 specific and anti-HCoV cross-reactive IgA and IgG responses. Two cohorts were analyzed: a vaccination cohort (n=30) who received mRNA-based vaccines for COVID-19 (mRNA-1273 or BNT162b2), and an infection cohort (n=45) with COVID-19 disease. Longitudinal HM and fingerstick blood samples were collected pre- and post-vaccination or, for infected subjects, at 5 time-points 14 - 28 days after confirmed diagnosis. The anti-spike(S) and antinucleocapsid(N) IgA and IgG antibody levels against SARS-CoV-2 and HCoVs were measured by multiplex immunoassay (mPlex-CoV). We found that vaccination significantly increased the anti-S IgA and IgG levels in HM. In contrast, while IgG levels increased after a second vaccine dose, blood and HM IgA started to decrease. Moreover, HM and blood anti-S IgG levels were significantly correlated, but anti-S IgA levels were not. SARS2 acute infection elicited anti-S IgG and IgA that showed much higher correlations between HM and blood compared to vaccination. Vaccination and infection were able to significantly increase the broadly cross-reactive IgG recognizing HCoVs in HM and blood than the IgA antibodies in HM and blood. In addition, the broader cross-reactivity of IgG in HM versus blood indicates that COVID-19 vaccination and infection might provide passive immunity through HM for the breastfed infants not only against SARS-CoV-2 but also against common cold coronaviruses. IMPORTANCE It is unknown if COVID-19 mRNA vaccination and infection in lactating mothers results in cross-reactive antibodies against other common human coronaviruses. Our study demonstrates that mRNA vaccination and COVID-19 infection increase anti-spike SARS-CoV-2 IgA and IgG in both blood and milk. IgA and IgG antibody concentrations in milk were more tightly correlated with concentrations in blood after infection compared to mRNA vaccination. Notably, both infection and vaccination resulted in increased IgG against common seasonal β -coronaviruses. This suggests that SARS-CoV-2 vaccination or infection in a lactating parent may result in passive immunity against SARS-CoV-2 and seasonal coronaviruses for the recipient infant.
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12
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Young BE, Seppo AE, Diaz N, Rosen-Carole C, Nowak-Wegrzyn A, Cruz Vasquez JM, Ferri-Huerta R, Nguyen-Contant P, Fitzgerald T, Sangster MY, Topham DJ, Järvinen KM. Association of Human Milk Antibody Induction, Persistence, and Neutralizing Capacity With SARS-CoV-2 Infection vs mRNA Vaccination. JAMA Pediatr 2022; 176:159-168. [PMID: 34757387 PMCID: PMC8581794 DOI: 10.1001/jamapediatrics.2021.4897] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/05/2021] [Indexed: 12/25/2022]
Abstract
Importance Long-term effect of parental COVID-19 infection vs vaccination on human milk antibody composition and functional activity remains unclear. Objective To compare temporal IgA and IgG response in human milk and microneutralization activity against SARS-CoV-2 between lactating parents with infection and vaccinated lactating parents out to 90 days after infection or vaccination. Design, Setting, and Participants Convenience sampling observational cohort (recruited July to December 2020) of lactating parents with infection with human milk samples collected at days 0 (within 14 days of diagnosis), 3, 7, 10, 28, and 90. The observational cohort included vaccinated lactating parents with human milk collected prevaccination, 18 days after the first dose, and 18 and 90 days after the second dose. Exposures COVID-19 infection diagnosed by polymerase chain reaction within 14 days of consent or receipt of messenger RNA (mRNA) COVID-19 vaccine (BNT162b2 or mRNA-1273). Main Outcomes and Measures Human milk anti-SARS-CoV-2 receptor-binding domain IgA and IgG and microneutralization activity against live SARS-CoV-2 virus. Results Of 77 individuals, 47 (61.0%) were in the infection group (mean [SD] age, 29.9 [4.4] years), and 30 (39.0%) were in the vaccinated group (mean [SD] age, 33.0 [3.4] years; P = .002). The mean (SD) age of infants in the infection and vaccinated group were 3.1 (2.2) months and 7.5 (5.2) months, respectively (P < .001). Infection was associated with a variable human milk IgA and IgG receptor-binding domain-specific antibody response over time that was classified into different temporal patterns: upward trend and level trend (33 of 45 participants [73%]) and low/no response (12 of 45 participants [27%]). Infection was associated with a robust and quick IgA response in human milk that was stable out to 90 days after diagnosis. Vaccination was associated with a more uniform IgG-dominant response with concentrations increasing after each vaccine dose and beginning to decline by 90 days after the second dose. Vaccination was associated with increased human milk IgA after the first dose only (mean [SD] increase, 31.5 [32.6] antibody units). Human milk collected after infection and vaccination exhibited microneutralization activity. Microneutralization activity increased throughout time in the vaccine group only (median [IQR], 2.2 [0] before vaccine vs 10 [4.0] after the first dose; P = .003) but was higher in the infection group (median [IQR], 20 [67] at day 28) vs the vaccination group after the first-dose human milk samples (P = .002). Both IgA and non-IgA (IgG-containing) fractions of human milk from both participants with infection and those who were vaccinated exhibited microneutralization activity against SARS-CoV-2. Conclusions and Relevance In this cohort study of a convenience sample of lactating parents, the pattern of IgA and IgG antibodies in human milk differed between COVID-19 infection vs mRNA vaccination out to 90 days. While infection was associated with a highly variable IgA-dominant response and vaccination was associated with an IgG-dominant response, both were associated with having human milk that exhibited neutralization activity against live SARS-CoV-2 virus.
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Affiliation(s)
- Bridget E Young
- Division of Allergy and Immunology, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Antti E Seppo
- Division of Allergy and Immunology, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nichole Diaz
- Division of Allergy and Immunology, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Casey Rosen-Carole
- Division of General Pediatrics and Neonatology, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Anna Nowak-Wegrzyn
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Hassenfeld Children's Hospital, NYU Grossman School of Medicine, New York, New York
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Joseline M Cruz Vasquez
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Hassenfeld Children's Hospital, NYU Grossman School of Medicine, New York, New York
| | - Rita Ferri-Huerta
- Division of Allergy and Immunology, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Now with Family Medicine Residency Program, University of Minnesota Medical Center, Minneapolis
| | - Phuong Nguyen-Contant
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York
| | - Theresa Fitzgerald
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York
| | - Mark Y Sangster
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York
| | - David J Topham
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York
| | - Kirsi M Järvinen
- Division of Allergy and Immunology, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
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13
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Young BE, Westcott J, Kemp J, Allen L, Hampel D, Garcés AL, Figueroa L, Goudar SS, Dhaded SM, Somannavar M, Saleem S, Ali SA, Hambidge KM, Krebs NF. B-Vitamins and Choline in Human Milk Are Not Impacted by a Preconception Lipid-Based Nutrient Supplement, but Differ Among Three Low-to-Middle Income Settings-Findings From the Women First Trial. Front Nutr 2022; 8:750680. [PMID: 35004801 PMCID: PMC8733746 DOI: 10.3389/fnut.2021.750680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/22/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction: Optimal human milk (HM) B-vitamin concentrations remain undefined, especially in areas where undernutrition is prevalent. The impact of supplementation pre-conception through pregnancy on HM B-vitamin composition remains unknown. Methods: Human milk (HM) was collected at 2-weeks postpartum from 200 women in Guatemala, India, and Pakistan (the Women First Trial). The women were randomized to start a lipid-based nutrient supplement before conception, at end of the first trimester, or not at all; intervention continued until delivery. HM concentrations of eight B-vitamins and choline were assessed via ultra-performance liquid chromatography-tandem mass spectrometry. Maternal diet was assessed in early pregnancy, and infant growth followed through 6 months post-delivery. Results: Despite supplement exposure averaging 15.7 (pre-conception arm) and 6.0 months (prenatal arm), HM B-vitamins did not differ between arms, but site differences were evident. Guatemala had higher HM concentrations of vitamin B3 than Pakistan and India. Pakistan had higher HM concentrations of thiamin and vitamin B6 than India and Guatemala. Cohort average HM vitamin B2 (162 ± 79 μg/L) and B6 (31.8 ± 24.6 μg/L) fell below values defined as deficient in 81.5 and 85.5% of samples, potentially reflecting sampling procedures and timing. Maternal dietary intakes of only vitamin B6 and choline were associated with the corresponding concentrations in HM (p < 0.005). No HM B-vitamin concentrations were associated with infant growth. Conclusion: Prenatal supplementation for at least 6 months had no impact on HM B-vitamin concentrations at 2-weeks postpartum. Results suggest that the adequacy of HM composition was generally maintained, with potential exceptions of vitamin B2 and B6.
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Affiliation(s)
- Bridget E Young
- Department of Pediatrics Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Jamie Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer Kemp
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lindsay Allen
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States.,Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Daniela Hampel
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States.,Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Ana L Garcés
- Department of Maternal and Newborn Health, Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Lester Figueroa
- Department of Maternal and Newborn Health, Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's, Jawaharlal Nehru Medical College, Belagavi, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research's, Jawaharlal Nehru Medical College, Belagavi, India
| | - Manjunath Somannavar
- KLE Academy of Higher Education and Research's, Jawaharlal Nehru Medical College, Belagavi, India
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sumera Aziz Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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14
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Pace RM, Williams JE, Järvinen KM, Meehan CL, Martin MA, Ley SH, Barbosa-Leiker C, Andres A, Yeruva L, Belfort MB, Caffé B, Navarrete AD, Lackey KA, Pace CDW, Gogel AC, Fehrenkamp BD, Klein M, Young BE, Rosen-Carole C, Diaz N, Gaw SL, Flaherman V, McGuire MA, McGuire MK, Seppo AE. Milk From Women Diagnosed With COVID-19 Does Not Contain SARS-CoV-2 RNA but Has Persistent Levels of SARS-CoV-2-Specific IgA Antibodies. Front Immunol 2021; 12:801797. [PMID: 35003130 PMCID: PMC8733294 DOI: 10.3389/fimmu.2021.801797] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/06/2021] [Indexed: 12/15/2022] Open
Abstract
Background Limited data are available regarding the balance of risks and benefits from human milk and/or breastfeeding during and following maternal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective To investigate whether SARS-CoV-2 can be detected in milk and on the breast after maternal coronavirus disease 2019 (COVID-19) diagnosis; and characterize concentrations of milk immunoglobulin (Ig) A specific to the SARS-CoV-2 spike glycoprotein receptor binding domain (RBD) during the 2 months after onset of symptoms or positive diagnostic test. Methods Using a longitudinal study design, we collected milk and breast skin swabs one to seven times from 64 lactating women with COVID-19 over a 2-month period, beginning as early as the week of diagnosis. Milk and breast swabs were analyzed for SARS-CoV-2 RNA, and milk was tested for anti-RBD IgA. Results SARS-CoV-2 was not detected in any milk sample or on 71% of breast swabs. Twenty-seven out of 29 (93%) breast swabs collected after breast washing tested negative for SARS-CoV-2. Detection of SARS-CoV-2 on the breast was associated with maternal coughing and other household COVID-19. Most (75%; 95% CI, 70-79%; n=316) milk samples contained anti-RBD IgA, and concentrations increased (P=.02) during the first two weeks following onset of COVID-19 symptoms or positive test. Milk-borne anti-RBD IgA persisted for at least two months in 77% of women. Conclusion Milk produced by women with COVID-19 does not contain SARS-CoV-2 and is likely a lasting source of passive immunity via anti-RBD IgA. These results support recommendations encouraging lactating women to continue breastfeeding during and after COVID-19 illness.
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Affiliation(s)
- Ryan M. Pace
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, United States
| | - Janet E. Williams
- Department of Animal, Veterinary and Food Sciences, University of Idaho, Moscow, ID, United States
| | - Kirsi M. Järvinen
- Department of Pediatrics, Division of Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Courtney L. Meehan
- Department of Anthropology, Washington State University, Pullman, WA, United States
| | - Melanie A. Martin
- Department of Anthropology, University of Washington, Seattle, WA, United States
| | - Sylvia H. Ley
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Celestina Barbosa-Leiker
- College of Nursing, Washington State University Health Sciences Spokane, Spokane, WA, United States
| | - Aline Andres
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States,Arkansas Children’s Nutrition Center, Little Rock, AR, United States
| | - Laxmi Yeruva
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States,Arkansas Children’s Nutrition Center, Little Rock, AR, United States
| | - Mandy B. Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Beatrice Caffé
- Department of Anthropology, Washington State University, Pullman, WA, United States
| | - Alexandra D. Navarrete
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Kimberly A. Lackey
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, United States
| | - Christina D. W. Pace
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, United States
| | - Alexandra C. Gogel
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, United States
| | - Bethaney D. Fehrenkamp
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, United States
| | - Miranda Klein
- Department of Pediatrics, Division of Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Bridget E. Young
- Department of Pediatrics, Division of Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Casey Rosen-Carole
- Department of Pediatrics, Division of Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Nichole Diaz
- Department of Pediatrics, Division of Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Stephanie L. Gaw
- Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Valerie Flaherman
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Mark A. McGuire
- Department of Animal, Veterinary and Food Sciences, University of Idaho, Moscow, ID, United States
| | - Michelle K. McGuire
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, United States,*Correspondence: Antti E. Seppo, ; Michelle K. McGuire,
| | - Antti E. Seppo
- Department of Pediatrics, Division of Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States,*Correspondence: Antti E. Seppo, ; Michelle K. McGuire,
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15
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Rodel RL, Farabi SS, Hirsch NM, Rolloff KP, McNair B, Hernandez TL, Krebs NF, Barbour LA, Young BE. Human milk imparts higher insulin concentration in infants born to women with type 2 diabetes mellitus. J Matern Fetal Neonatal Med 2021; 35:7676-7684. [PMID: 34465258 DOI: 10.1080/14767058.2021.1960967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Human milk (HM) insulin plays many roles for the infant, especially for the newborn. We hypothesized HM insulin in women with type 2 diabetes (T2DM) would be higher than BMI-matched women with either gestational diabetes (GDM) or normal glucose tolerance (NGT). In T2DM, we also assessed macronutrient composition and relationships between maternal glycemic control and HM insulin. STUDY DESIGN HM was characterized at 2-weeks postpartum among three BMI-matched groups: T2DM (n= 12), diet-controlled GDM (n= 12), and NGT (n= 12). In T2DM, additional fasting and postprandial HM samples were collected while wearing a continuous glucose monitor (CGM), as well as fasting and 90-minute postprandial samples after a standardized meal at 1-2 weeks postpartum. RESULTS Fasting HM insulin was two times higher in T2DM compared to GDM and NGT (p < .001), which were not different from each other. Among T2DM, fasting (p < .001) and postprandial (p = .01) HM insulin levels were between 2 and 5× higher than plasma. Postprandial HM insulin (p = .03) and glucose (p < .001) were increased compared to fasting. Mean nocturnal glucose (p < .01) and maternal hemoglobin A1c (p < .01) positively associated with fasting HM insulin. CONCLUSIONS These data are the first to show HM insulin concentrations are doubled in T2DM compared to BMI-matched GDM and NGT. In HM of T2DM, insulin increases postprandially, may be concentrated relative to plasma, and is influenced by maternal glycemic control, with potential clinical implications that merit further study.
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Affiliation(s)
- Rachel L Rodel
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah S Farabi
- Office of Nursing Research, Goldfarb School of Nursing, St. Louis, MO, USA
| | - Nicole M Hirsch
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kristy P Rolloff
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Bryan McNair
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.,College of Nursing, University of Colorado, Aurora, CO, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - Linda A Barbour
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Bridget E Young
- Department of Pediatrics, Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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16
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Schinkel ER, Nelson ER, Young BE, Bernstein RM, Taylor SN, Hay WW, Brown LD, Brown KJ, Prenni J. Concentrating human milk: an innovative point-of-care device designed to increase human milk feeding options for preterm infants. J Perinatol 2021; 41:582-589. [PMID: 33060780 PMCID: PMC9848740 DOI: 10.1038/s41372-020-00820-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/17/2020] [Accepted: 09/14/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether a point-of-care osmotic device concentrates important human milk (HM) nutrients to support feeding neonates requiring high-nutrient, low-volume feedings. STUDY DESIGN Raw and pasteurized HM samples were concentrated to determine the effects of time and temperature on concentration. Concentrated samples were compared with matched baseline samples to measure changes in selected nutrient concentrations. Furthermore, changes in concentration of certain bioactive components of raw milk samples were measured. RESULT The device significantly increased the concentrations of the majority of the measured nutrient and bioactive levels (p < 0.05). Increasing temperature of HM from 4 to 37 °C increased the concentration rate >30%. In all cases, the concentration rate of pasteurized HM was greater than that of raw HM. CONCLUSIONS The osmotic concentration of HM is a promising option for neonatal nutrition. Further studies are needed to establish an evidence base for the practical applications of this point-of-care device.
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Affiliation(s)
| | | | - Bridget E. Young
- Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry
| | - Robin M. Bernstein
- Department of Anthropology and Institute of Behavioral Science, University of Colorado, Boulder
| | | | | | | | - Kitty J. Brown
- Center for Proteomics and Metabolomics at Colorado State University
| | - Jessica Prenni
- Center for Proteomics and Metabolomics at Colorado State University
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17
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Soderborg TK, Carpenter CM, Janssen RC, Weir TL, Robertson CE, Ir D, Young BE, Krebs NF, Hernandez TL, Barbour LA, Frank DN, Kroehl M, Friedman JE. Gestational Diabetes Is Uniquely Associated With Altered Early Seeding of the Infant Gut Microbiota. Front Endocrinol (Lausanne) 2020; 11:603021. [PMID: 33329403 PMCID: PMC7729132 DOI: 10.3389/fendo.2020.603021] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a worldwide public health problem affecting up to 27% of pregnancies with high predictive values for childhood obesity and inflammatory diseases. Compromised seeding of the infant gut microbiota is a risk factor for immunologic and metabolic diseases in the offspring; however, how GDM along with maternal obesity interact to alter colonization remains unknown. We hypothesized that GDM individually and in combination with maternal overweight/obesity would alter gut microbial composition, diversity, and short-chain fatty acid (SCFA) levels in neonates. We investigated 46 full-term neonates born to normal-weight or overweight/obese mothers with and without GDM, accounting for confounders including cesarean delivery, lack of breastfeeding, and exposure to antibiotics. Gut microbiota in 2-week-old neonates born to mothers with GDM exhibited differences in abundance of 26 microbial taxa; 14 of which showed persistent differential abundance after adjusting for pre-pregnancy BMI. Key pioneering gut taxa, including potentially important taxa for establishing neonatal immunity, were reduced. Lactobacillus, Flavonifractor, Erysipelotrichaceae, and unspecified families in Gammaproteobacteria were significantly reduced in neonates from mothers with GDM. GDM was associated with an increase in microbes involved in suppressing early immune cell function (Phascolarctobacterium). No differences in infant stool SCFA levels by maternal phenotype were noted; however, significant correlations were found between microbial abundances and SCFA levels in neonates. Our results suggest that GDM alone and together with maternal overweight/obesity uniquely influences seeding of specific infant microbiota in patterns that set the stage for future risk of inflammatory and metabolic disease.
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Affiliation(s)
- Taylor K. Soderborg
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Charles M. Carpenter
- Division of Biostatistics and Epidemiology, University of Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rachel C. Janssen
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Tiffany L. Weir
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, United States
| | - Charles E. Robertson
- Department of Medicine, Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Diana Ir
- Department of Medicine, Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Bridget E. Young
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nancy F. Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Teri L. Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism & Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Linda A. Barbour
- Department of Medicine, Division of Endocrinology, Metabolism & Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel N. Frank
- Department of Medicine, Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Miranda Kroehl
- Division of Biostatistics and Epidemiology, University of Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jacob E. Friedman
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Medicine, Division of Endocrinology, Metabolism & Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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18
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Azad MB, Nickel NC, Bode L, Brockway M, Brown A, Chambers C, Goldhammer C, Hinde K, McGuire M, Munblit D, Patel AL, Pérez-Escamilla R, Rasmussen KM, Shenker N, Young BE, Zuccolo L. Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities. Matern Child Nutr 2020; 17:e13109. [PMID: 33210456 PMCID: PMC7988860 DOI: 10.1111/mcn.13109] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022]
Abstract
Breastfeeding and human milk (HM) are critically important to maternal, infant and population health. This paper summarizes the proceedings of a workshop that convened a multidisciplinary panel of researchers to identify key priorities and anticipated breakthroughs in breastfeeding and HM research, discuss perceived barriers and challenges to achieving these breakthroughs and propose a constructive action plan to maximize the impact of future research in this field. Priority research areas identified were as follows: (1) addressing low breastfeeding rates and inequities using mixed methods, community partnerships and implementation science approaches; (2) improving awareness of evidence-based benefits, challenges and complexities of breastfeeding and HM among health practitioners and the public; (3) identifying differential impacts of alternative modes of HM feeding including expressed/pumped milk, donor milk and shared milk; and (4) developing a mechanistic understanding of the health effects of breastfeeding and the contributors to HM composition and variability. Key barriers and challenges included (1) overcoming methodological limitations of epidemiological breastfeeding research and mechanistic HM research; (2) counteracting 'breastfeeding denialism' arising from negative personal breastfeeding experiences; (3) distinguishing and aligning research and advocacy efforts; and (4) managing real and perceived conflicts of interest. To advance research on breastfeeding and HM and maximize the reach and impact of this research, larger investments are needed, interdisciplinary collaboration is essential, and the scientific community must engage families and other stakeholders in research planning and knowledge translation.
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Affiliation(s)
- Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, Manitoba, Canada.,Human Capital & Economic Opportunity Global Working Group, Center for the Economics of Human Development, University of Chicago, Chicago, Illinois, USA
| | - Nathan C Nickel
- Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, Manitoba, Canada.,Department of Community Health Sciences and Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lars Bode
- Department of Pediatrics and Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence, University of California San Diego, La Jolla, California, USA
| | - Meredith Brockway
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, Manitoba, Canada
| | - Amy Brown
- Department of Public Health, Policy and Social Sciences and Centre for Lactation, Infant Feeding and Translation, Swansea University, Swansea, UK
| | - Christina Chambers
- Mommy's Milk Human Milk Research Biorepository, Center for Better Beginnings, University of California San Diego, San Diego, California, USA
| | | | - Katie Hinde
- Center of Evolution and Medicine and School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
| | - Michelle McGuire
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, Idaho, USA
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia.,Inflammation, Repair and Development Section, National Heart and Lung Institute, Imperial College London, London, UK.,inVIVO Planetary Health, Worldwide Universities Network (WUN), West New York, New Jersey, USA
| | - Aloka L Patel
- Department of Pediatrics, Section of Neonatology, Rush University Children's Hospital, Chicago, Illinois, USA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | | | - Natalie Shenker
- Department of Surgery and Cancer, Imperial College London, London, UK.,Human Milk Foundation, Harpenden, UK
| | - Bridget E Young
- Division of Allergy and Immunology, Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Luisa Zuccolo
- MRC Integrative Epidemiology Unit and Department of Population Health Sciences, University of Bristol, Bristol, UK
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19
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Young BE, Murphy K, Borman LL, Heinrich R, Krebs NF. Milk Bank Pooling Practices Impact Concentrations and Variability of Bioactive Components of Donor Human Milk. Front Nutr 2020; 7:579115. [PMID: 33123548 PMCID: PMC7573550 DOI: 10.3389/fnut.2020.579115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Donor human milk (DHM) bank practices, such as pasteurization and pooling according to postpartum age of milk donations and number of donors included in a pool may impact the resulting concentration of bioactive components of DHM. Aims: We determined the impact of Holder pasteurization, postpartum milk age, and pool donor number (number of donors included in a pool) on resulting concentrations of total immunoglobulin A (IgA; which provides immune protection to the recipient infant) and insulin (an important hormone for gut maturation).We also documented inter-relationships between these bioactive components and macronutrients in DHM pools. Methods: Pre and post-pasteurization aliquots of 128 DHM samples were obtained from the Rocky Mountain Children's Foundation Mother's Milk Bank (a member of the Human Milk Banking Association of North America, HMBANA). Macronutrients were measured via mid-infrared spectroscopy. Total IgA was measured via customized immunoassay in skim milk and insulin was measured via chemiluminescent immunoassay. Results: Mean post-pasteurization total IgA concentration was 0.23 ± 0.10 (range: 0.04-0.65) mg/mL a 17.9% decrease due to pasteurization (n = 126). Mean post-pasteurization DHM insulin concentration was 7.0 ± 4.6 (range: 3-40) μU/mL, a decrease of 13.6% due to pasteurization (n = 128). The average DHM pool postpartum milk age was not associated with total IgA or insulin concentrations, but pool donor number was associated with bioactive components. Pools with only one donor had lower total IgA and lower insulin concentrations than pools with at least 2 donors (p < 0.05). Increasing the number of donors in a pool decreased the variability in total IgA and insulin concentrations (p < 0.04). Conclusion: Increasing the number of donors included in DHM pools may help optimize bioactive components in DHM received by premature infants. These results help inform milk banking practices to decrease compositional variability in produced DHM pools.
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Affiliation(s)
- Bridget E Young
- Department of Pediatrics Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Katherine Murphy
- Department of Pediatrics Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Laraine L Borman
- Mothers' Milk Bank, Rocky Mountain Children's Health Foundation, Arvada, CO, United States
| | - Rebecca Heinrich
- Mothers' Milk Bank, Rocky Mountain Children's Health Foundation, Arvada, CO, United States
| | - Nancy F Krebs
- Department of Pediatrics - Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
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20
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Young BE, Borman LL, Heinrich R, Long J, Pinney S, Westcott J, Krebs NF. Effect of Pooling Practices and Time Postpartum of Milk Donations on the Energy, Macronutrient, and Zinc Concentrations of Resultant Donor Human Milk Pools. J Pediatr 2019; 214:54-59. [PMID: 31558278 PMCID: PMC6886691 DOI: 10.1016/j.jpeds.2019.07.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/21/2019] [Accepted: 07/15/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To characterize the macronutrient, energy, and zinc composition of pasteurized donor human milk pools and evaluate how composition varies based on pooling practices and "time postpartum" (ie, elapsed time from parturition to expression date) of individual milk donations. STUDY DESIGN The Mothers' Milk Bank (Arvada, Colorado) donated 128 donor human milk pools. Caloric density was assessed via mid-infrared spectroscopy, and zinc concentration was measured by atomic absorption spectroscopy. Pool time postpartum was calculated as the unweighted average of the time postpartum of all milk donations included in any given pool. RESULTS Time postpartum of donor human milk pools ranged from 3 days to 9.8 months. The majority (91%) of donor human milk pools included milk from either 1 donor or 2 donors. Pool energy density ranged from 14.7 to 23.1 kcal/oz, and protein ranged from 0.52 to 1.43 g/dL. Milk zinc concentrations were higher in preterm pools and were negatively correlated with pool time postpartum. We present an equation that estimates donor human milk pool zinc content based on time postpartum and explains 49% of the variability in zinc concentrations (P < .0001). Including more donors in donor human milk pools decreased the variability in protein, but not zinc, concentrations. CONCLUSIONS Donor human milk pools were lower in calories than is normally assumed in standard human milk fortification practices. Zinc concentrations were related to donor human milk time postpartum and were on average insufficient to meet preterm and term infants' needs without fortification or supplementation.
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Affiliation(s)
- Bridget E Young
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO; Department of Pediatrics Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Laraine L. Borman
- Mothers’ Milk Bank, Rocky Mountain Children’s Health Foundation, Arvada, CO, United States
| | - Rebecca Heinrich
- Mothers’ Milk Bank, Rocky Mountain Children’s Health Foundation, Arvada, CO, United States
| | - Julie Long
- Department of Pediatrics - Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Sarah Pinney
- Department of Pediatrics - Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jamie Westcott
- Department of Pediatrics - Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Nancy F Krebs
- Department of Pediatrics - Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
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21
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Young BE, Patinkin ZW, Pyle L, de la Houssaye B, Davidson BS, Geraghty S, Morrow AL, Krebs N. Markers of Oxidative Stress in Human Milk do not Differ by Maternal BMI But are Related to Infant Growth Trajectories. Matern Child Health J 2018; 21:1367-1376. [PMID: 28138825 DOI: 10.1007/s10995-016-2243-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective Obesity in adults is associated with inflammation and oxidative stress. Whether or not this phenotype is reflected in human milk (HM) composition, or may impact infant growth remains unknown. We investigated whether HM from overweight/obese (OW/Ob) mothers exhibited higher concentrations of inflammatory cytokines and markers of oxidative stress. We also correlated these bioactive components with infant growth patterns. Methods This was an observational cohort of 56 breastfeeding mothers and their infants [33 normal weight (NW) and 23 OW/Ob]. Infants were followed until 6 months of age and HM collected at 2-weeks and 4-months. Results Markers of oxidative stress, 8-hydroxy-deoxyguanosine (8OHdG) and 4-hydroxynonenol (HNE), decreased in HM over time (p < 0.001) and did not differ between NW and OW/Ob women. Concentrations of inflammatory cytokines, IL-6, IL-8, and TNF-α, were all inter-correlated (p < 0.001) but did not differ between NW and OW/Ob women. HM fat, protein, lactose, and total calories did not differ between NW and OW/Ob women. Infant growth patterns did not differ by group. In a model of infant weight-for-length-Z score trajectory, there was a significant interaction between both lactose and 8OHdG with maternal group: HM lactose and 8OHdG concentrations were both positively associated with increases in WLZ trajectory only among infants breastfed by OW/Ob mothers. Conclusions for Practice HM composition was relatively stable between NW and OW/Ob women. In exclusively breastfed infants, HM concentrations of lactose and 8OHdG, a marker of oxidative stress, may contribute to regulation of infant weight gain, especially among infants of OW/Ob women.
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Affiliation(s)
- Bridget E Young
- Department of Pediatrics Section of Nutrition, University of Colorado School of Medicine, 12700 E 19th Ave, Aurora, CO, 80045, USA.
| | - Zachary W Patinkin
- Department of Pediatrics Section of Nutrition, University of Colorado School of Medicine, 12700 E 19th Ave, Aurora, CO, 80045, USA
| | - Laura Pyle
- Department of Pediatrics Section of Nutrition, University of Colorado School of Medicine, 12700 E 19th Ave, Aurora, CO, 80045, USA.,Department of Biostatistics and Informatics, University of Colorado School of Public Health, 12477 E 19Th Avenue, Box A036, Aurora, CO, 80045, USA
| | - Becky de la Houssaye
- Department of Pediatrics Section of Neonatology, University of Colorado School of Medicine, 12801 East 17th Ave, Box 8106, Aurora, CO, 80045, USA
| | - Barbara S Davidson
- Department of Pediatrics, Center for Interdisciplinary Research in Human Milk and Lactation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Sheela Geraghty
- Center for Breastfeeding Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Ardythe L Morrow
- Department of Pediatrics, Center for Interdisciplinary Research in Human Milk and Lactation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Nancy Krebs
- Department of Pediatrics Section of Nutrition, University of Colorado School of Medicine, 12700 E 19th Ave, Aurora, CO, 80045, USA
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22
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Young BE. Formula Feeding Exposure Not Homogenous. Pediatrics 2017; 140:peds.2017-1918. [PMID: 28860135 DOI: 10.1542/peds.2017-1918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bridget E Young
- Assistant Professor of Pediatric Nutrition, School of Medicine, University of Colorado
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23
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Young BE, Patinkin Z, Palmer C, de la Houssaye B, Barbour LA, Hernandez T, Friedman JE, Krebs NF. Human milk insulin is related to maternal plasma insulin and BMI: but other components of human milk do not differ by BMI. Eur J Clin Nutr 2017; 71:1094-1100. [PMID: 28513622 PMCID: PMC5587359 DOI: 10.1038/ejcn.2017.75] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/28/2017] [Accepted: 03/07/2017] [Indexed: 01/10/2023]
Abstract
Background The impact of maternal BMI and insulin sensitivity on bioactive components of human milk (HM) is not well understood. As the prevalence of obesity and diabetes rises, it is increasingly critical that we understand how maternal BMI and hormones associated with metabolic disease relate to concentrations of bioactive components in HM. Methods This longitudinal cohort design followed 48 breastfeeding mothers through the first four months of lactation, collecting fasting morning HM samples at 2-weeks and 1, 2, 3, and 4-months, and fasting maternal blood at 2-weeks and 4-months. Insulin, glucose, adipokines leptin and adiponectin, appetite regulating hormone ghrelin, marker of oxidative stress 8OHdG, and inflammatory cytokines (IL-6, IL-8, and TNF-a) were measured in HM and maternal plasma. Results 26 normal weight (NW) (BMI=21.4±2.0 kg/m2), and 22 overweight/obese (OW/Ob) (BMI=30.4±4.2 kg/m2) were followed. Of all HM analytes measured, only insulin and leptin were different between groups - consistently higher in the OW/Ob group (leptin: p<0.001; insulin: p<0.03). HM insulin was 98% higher than maternal plasma insulin at 2-weeks and 32% higher at 4-months (p<0.001). Maternal fasting plasma insulin and HOMA-IR were positively related to HM insulin at 2-weeks (p<0.001, R2≥0.38, n=31), and 4-months (p≤0.005, R2≥0.20, n=38). Conclusions The concentrations of insulin in HM are higher than in maternal plasma and are related to maternal BMI and insulin sensitivity. With the exception of leptin, there were minimal other differences observed in HM composition across a wide range in maternal BMI.
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Affiliation(s)
- B E Young
- Department of Pediatrics, Section of Nutrition, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Z Patinkin
- Department of Pediatrics, Section of Nutrition, School of Medicine, University of Colorado, Aurora, CO, USA
| | - C Palmer
- Department of Pediatrics, Section of Nutrition, School of Medicine, University of Colorado, Aurora, CO, USA
| | - B de la Houssaye
- Department of Pediatrics, Section of Neonatology, School of Medicine, University of Colorado, Aurora, CO, USA
| | - L A Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, School of Medicine, University of Colorado, Aurora, CO, USA.,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - T Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, School of Medicine, University of Colorado, Aurora, CO, USA.,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, School of Medicine, University of Colorado, Aurora, CO, USA.,College of Nursing, University of Colorado, Aurora, CO, USA
| | - J E Friedman
- Department of Pediatrics, Section of Neonatology, School of Medicine, University of Colorado, Aurora, CO, USA.,Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, School of Medicine, University of Colorado, Aurora, CO, USA
| | - N F Krebs
- Department of Pediatrics, Section of Nutrition, School of Medicine, University of Colorado, Aurora, CO, USA
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24
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Friedman JE, Young BE, Lemas DJ, Barbour LA, Frank DN, Santorico SA. Reply to M Gotteland and F Magne. Am J Clin Nutr 2017; 105:234-236. [PMID: 28049665 PMCID: PMC5183730 DOI: 10.3945/ajcn.116.140749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jacob E Friedman
- From the Sections of Neonatology (JEF, e-mail: ; DJL, present address: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL) and Nutrition (BEY), Department of Pediatrics, Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (LAB), Division of Infectious Diseases, Department of Medicine (DNF), University of Colorado Anschutz Medical Campus, Aurora, CO; and the Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO (SAS)
| | - Bridget E Young
- From the Sections of Neonatology (JEF, e-mail: ; DJL, present address: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL) and Nutrition (BEY), Department of Pediatrics, Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (LAB), Division of Infectious Diseases, Department of Medicine (DNF), University of Colorado Anschutz Medical Campus, Aurora, CO; and the Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO (SAS)
| | - Dominick J Lemas
- From the Sections of Neonatology (JEF, e-mail: ; DJL, present address: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL) and Nutrition (BEY), Department of Pediatrics, Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (LAB), Division of Infectious Diseases, Department of Medicine (DNF), University of Colorado Anschutz Medical Campus, Aurora, CO; and the Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO (SAS)
| | - Linda A Barbour
- From the Sections of Neonatology (JEF, e-mail: ; DJL, present address: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL) and Nutrition (BEY), Department of Pediatrics, Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (LAB), Division of Infectious Diseases, Department of Medicine (DNF), University of Colorado Anschutz Medical Campus, Aurora, CO; and the Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO (SAS)
| | - Daniel N Frank
- From the Sections of Neonatology (JEF, e-mail: ; DJL, present address: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL) and Nutrition (BEY), Department of Pediatrics, Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (LAB), Division of Infectious Diseases, Department of Medicine (DNF), University of Colorado Anschutz Medical Campus, Aurora, CO; and the Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO (SAS)
| | - Stephanie A Santorico
- From the Sections of Neonatology (JEF, e-mail: ; DJL, present address: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL) and Nutrition (BEY), Department of Pediatrics, Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (LAB), Division of Infectious Diseases, Department of Medicine (DNF), University of Colorado Anschutz Medical Campus, Aurora, CO; and the Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO (SAS)
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Rudolph MC, Young BE, Jackson KH, Krebs NF, Harris WS, MacLean PS. Human Milk Fatty Acid Composition: Comparison of Novel Dried Milk Spot Versus Standard Liquid Extraction Methods. J Mammary Gland Biol Neoplasia 2016; 21:131-138. [PMID: 27796616 PMCID: PMC5161681 DOI: 10.1007/s10911-016-9365-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/20/2016] [Indexed: 11/29/2022] Open
Abstract
Accurate assessment of the long chain polyunsaturated fatty acid (LC-PUFA) content of human milk (HM) provides a powerful means to evaluate the FA nutrient status of breastfed infants. The conventional standard for FA composition analysis of HM is liquid extraction, trans-methylation, and analyte detection resolved by gas chromatography. This standard approach requires fresh or frozen samples, storage in deep freeze, organic solvents, and specialized equipment in processing and analysis. Further, HM collection is often impractical for many studies in the free living environment, particularly for studies in developing countries. In the present study, we compare a novel and more practical approach to sample collection and processing that involves the spotting and drying ~50 μL of HM on a specialized paper stored and transported at ambient temperatures until analysis. Deming regression indicated the two methods aligned very well for all LC-PUFA and the abundant HM FA. Additionally, strong correlations (r > 0.85) were observed for DHA, ARA, EPA, linoleic (LA), and alpha-linolenic acids (ALA), which are of particular interest to the health of the developing infant. Taken together, our data suggest this more practical and inexpensive method of collection, storage, and transport of HM milk samples could dramatically facilitate studies of HM, as well as understanding its lipid composition influences on human health and development.
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Affiliation(s)
- Michael C Rudolph
- Center for Human Nutrition | Division of Endocrinology, Metabolism & Diabetes, University of Colorado Denver, Mail Stop F-8305; RC1 North, 12800 E. 19th Avenue P18-5402 M, Aurora, CO, 80045-2537, USA.
| | - Bridget E Young
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, 12700 East 19th Ave, Box C-225, Aurora, CO, 80045, USA
| | - Kristina Harris Jackson
- OmegaQuant Analytics, LLC, 5009 W. 12th St, Ste 8, Sioux Falls, SD, 57106, USA
- Department of Internal Medicine, University of South Dakota School of Medicine, 5009 W. 12th St, Ste 8, Sioux Falls, SD, 57106, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, 12700 East 19th Ave, Box C-225, Aurora, CO, 80045, USA
| | - William S Harris
- OmegaQuant Analytics, LLC, 5009 W. 12th St, Ste 8, Sioux Falls, SD, 57106, USA
- Department of Internal Medicine, University of South Dakota School of Medicine, 5009 W. 12th St, Ste 8, Sioux Falls, SD, 57106, USA
| | - Paul S MacLean
- Center for Human Nutrition | Division of Endocrinology, Metabolism & Diabetes, University of Colorado Denver, Mail Stop F-8305; RC1 North, 12800 E. 19th Avenue P18-5402 M, Aurora, CO, 80045-2537, USA
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Young BE, Farazandeh S, Westra K, Krebs N. Maternal Beliefs Surrounding Infant Feeding, but Not Maternal BMI or Hospital Experience, Predict Breastfeeding Exclusivity and Behavior. Austin J Pediatr 2016; 3:1041. [PMID: 28553661 PMCID: PMC5444880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Overweight/Obese (OW/Ob) women are at risk for breastfeeding failure. How maternal BMI affects lactation support received in-hospital, or maternal attitudes and beliefs surrounding infant feeding remains poorly understood. We investigated 1) the impact of in-hospital lactation support and maternal attitudes and behaviors regarding infant feeding on breastfeeding exclusivity, and 2) whether these potentially modifiable attitudes and behaviors differed between normal weights (NW) versus OW/Ob women. METHODS NW (n=18) and OW/Ob (n=20) women and their infants were followed from birth to 4-months postpartum. In-hospital experiences, problems and help received regarding breastfeeding were documented. Six maternal attitudes and behaviors surrounding infant feeding were assessed at 2-weeks and 4-months. These factors were compared between NW and OW/OB women, and in relation to breastfeeding exclusivity. RESULTS In-hospital experiences, assistance received regarding breastfeeding difficulties, and infant breastfeeding exposure did not differ between NW and OW/Ob women. At 4-months OW/Ob women were more likely to feed their infant on a schedule (p<0.03); this was the only difference in attitudes/behaviors between BMI-groups. Feeding the infant on a schedule was predictive of lower total breastfeeding exposure (p<0.05). Maternal concern about infant under-eating/becoming underweight was associated with several negative feeding behaviors, including reduced breastfeeding exposure (p<0.02), pressuring feeding style (p<0.01), and feeding to calm fussiness (p<0.01). CONCLUSION This hospital setting provided equitable breastfeeding support to OW/Ob and NW women. Maternal concern over infant under-eating/under-gaining and encouragement to feed on-demand are prime interventional targets to improve breastfeeding outcomes; the latter may be especially relevant to OW/Ob mothers.
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Affiliation(s)
- B E Young
- Department of Pediatrics - Section of Nutrition, University of Colorado Denver, USA
| | - S Farazandeh
- School of Medicine, University of Colorado Denver, USA
| | - K Westra
- School of Medicine, University of Colorado Denver, USA
| | - N Krebs
- Department of Pediatrics - Section of Nutrition, University of Colorado Denver, USA
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Lemas DJ, Young BE, Baker PR, Tomczik AC, Soderborg TK, Hernandez TL, de la Houssaye BA, Robertson CE, Rudolph MC, Ir D, Patinkin ZW, Krebs NF, Santorico SA, Weir T, Barbour LA, Frank DN, Friedman JE. Alterations in human milk leptin and insulin are associated with early changes in the infant intestinal microbiome. Am J Clin Nutr 2016; 103:1291-300. [PMID: 27140533 PMCID: PMC4841936 DOI: 10.3945/ajcn.115.126375] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/08/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Increased maternal body mass index (BMI) is a robust risk factor for later pediatric obesity. Accumulating evidence suggests that human milk (HM) may attenuate the transfer of obesity from mother to offspring, potentially through its effects on early development of the infant microbiome. OBJECTIVES Our objective was to identify early differences in intestinal microbiota in a cohort of breastfeeding infants born to obese compared with normal-weight (NW) mothers. We also investigated relations between HM hormones (leptin and insulin) and both the taxonomic and functional potentials of the infant microbiome. DESIGN Clinical data and infant stool and fasting HM samples were collected from 18 NW [prepregnancy BMI (in kg/m(2)) <24.0] and 12 obese (prepregnancy BMI >30.0) mothers and their exclusively breastfed infants at 2 wk postpartum. Infant body composition at 2 wk was determined by air-displacement plethysmography. Infant gastrointestinal microbes were estimated by using 16S amplicon and whole-genome sequencing. HM insulin and leptin were determined by ELISA; short-chain fatty acids (SCFAs) were measured in stool samples by using gas chromatography. Power was set at 80%. RESULTS Infants born to obese mothers were exposed to 2-fold higher HM insulin and leptin concentrations (P < 0.01) and showed a significant reduction in the early pioneering bacteria Gammaproteobacteria (P = 0.03) and exhibited a trend for elevated total SCFA content (P < 0.06). Independent of maternal prepregnancy BMI, HM insulin was positively associated with both microbial taxonomic diversity (P = 0.03) and Gammaproteobacteria (e.g., Enterobacteriaceae; P = 0.04) and was negatively associated with Lactobacillales (e.g., Streptococcaceae; P = 0.05). Metagenomic analysis showed that HM leptin and insulin were associated with decreased bacterial proteases, which are implicated in intestinal permeability, and reduced concentrations of pyruvate kinase, a biomarker of pediatric gastrointestinal inflammation. CONCLUSION Our results indicate that, although maternal obesity may adversely affect the early infant intestinal microbiome, HM insulin and leptin are independently associated with beneficial microbial metabolic pathways predicted to increase intestinal barrier function and reduce intestinal inflammation. This trial was registered at clinicaltrials.gov as NCT01693406.
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Affiliation(s)
| | | | - Peter R Baker
- Clinical Genetics and Metabolism, Department of Pediatrics
| | | | | | - Teri L Hernandez
- Divisions of Endocrinology, Metabolism, and Diabetes and College of Nursing
| | | | | | | | - Diana Ir
- Infectious Diseases, Department of Medicine
| | | | | | - Stephanie A Santorico
- Human Medical Genetics and Genomics Program; and Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO; and
| | - Tiffany Weir
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Linda A Barbour
- Divisions of Endocrinology, Metabolism, and Diabetes and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Jacob E Friedman
- Sections of Neonatology, Divisions of Endocrinology, Metabolism, and Diabetes and
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Whisner CM, Young BE, Witter FR, Harris ZL, Queenan RA, Cooper EM, O'Brien KO. Reductions in Heel Bone Quality Across Gestation Are Attenuated in Pregnant Adolescents With Higher Prepregnancy Weight and Greater Increases in PTH Across Gestation. J Bone Miner Res 2015; 30:1942. [PMID: 26390979 DOI: 10.1002/jbmr.2571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Wahlqvist ML, Krawetz SA, Rizzo NS, Dominguez-Bello MG, Szymanski LM, Barkin S, Yatkine A, Waterland RA, Mennella JA, Desai M, Ross MG, Krebs NF, Young BE, Wardle J, Wrann CD, Kral JG. Early-life influences on obesity: from preconception to adolescence. Ann N Y Acad Sci 2015; 1347:1-28. [PMID: 26037603 DOI: 10.1111/nyas.12778] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 12/12/2022]
Abstract
The double burden of under- and overnutrition profoundly affects human health globally. According to the World Health Organization, obesity and diabetes rates have almost doubled worldwide since 1980, and, in 2011, more than 40 million children under 5 years of age were overweight. Ecologic factors, parental genetics and fitness, and the intrauterine environment significantly influence the likelihood of offspring developing the dysmetabolic diathesis of obesity. This report examines the effects of these factors, including preconception, intrauterine and postnatal energy balance affecting programming of transgenerational transmission, and development of chronic diseases later in life-in particular, diabesity and its comorbidities.
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Affiliation(s)
| | - Stephen A Krawetz
- C.S. Mott Center for Human Growth and Development and Center for Molecular Medicine and Genetics, Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Nico S Rizzo
- Center of Community Resilience, School of Public Health, Loma Linda University, Loma Linda, California.,Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Shari Barkin
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ann Yatkine
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A Waterland
- Departments of Pediatrics and Molecular and Human Genetics, Baylor College of Medicine and USDA/ARS Children's Nutrition Research Center, Houston, Texas
| | | | - Mina Desai
- University of California Los Angeles Medical Center, Los Angeles, California
| | - Michael G Ross
- University of California Los Angeles Medical Center, Los Angeles, California
| | - Nancy F Krebs
- University of Colorado School of Medicine, Aurora, Colorado
| | | | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Christiane D Wrann
- Dana-Farber Cancer Institute and Department of Cell Biology, Harvard Medical School, Boston, Massachusetts
| | - John G Kral
- SUNY Downstate Medical Center, Brooklyn, New York
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Whisner CM, Young BE, Pressman EK, Queenan RA, Cooper EM, O'Brien KO. Maternal diet but not gestational weight gain predicts central adiposity accretion in utero among pregnant adolescents. Int J Obes (Lond) 2014; 39:565-70. [PMID: 25468827 DOI: 10.1038/ijo.2014.202] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 10/14/2014] [Accepted: 11/10/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Modifiable risk factors during pregnancy, such as diet and weight gain, are associated with fetal birth weight but little is known about how these factors influence fetal fat acquisition in utero among pregnant adolescents. OBJECTIVE To determine whether maternal pre-pregnancy BMI (ppBMI), gestational weight gain (GWG) and dietary intake during pregnancy influence fetal fat accretion in utero. METHODS Longitudinal data were obtained from 121 pregnant adolescents enrolled in a study designed to identify determinants of maternal and fetal bone changes across gestation. Adolescents (ages 13-18 years) completed up to three study visits during early, mid- and late gestation. Maternal anthropometrics, 24 h dietary recalls and measures of fetal biometry were obtained at each visit. Fetal abdominal wall thickness (abdominal subcutaneous fat thickness, AbFat), a measure of fetal subcutaneous fat, was calculated by sonography at each visit. Statistical determinants of AbFat during late pregnancy were explored using simple and multiple regression. RESULTS During late pregnancy (34.8±2.0 weeks; range 31.0-40.6 weeks of gestation), the median (inter-quartile range) fetal AbFat and GWG were 0.44 (0.39, 0.55) cm and 14.6 (9.5, 18.3) kg, respectively. After adjusting for infant birth weight, variables significantly associated with fetal AbFat included gestational age (P<0.0001, 95% confidence interval, CI: 0.01, 0.03), maternal race (P=0.029, 95% CI: -0.04, -0.002) and dietary intake of added sugar (P=0.025, 95% CI: 1.42e-6, 2.06e-5). Fetal AbFat had a significant positive quadratic relationship with total maternal dietary sugar intake such that both low and high extremes of sugar consumption were associated with significantly higher fetal AbFat. Birth weight was not significantly associated with maternal intake of added sugars. CONCLUSION Extreme sugar intakes among pregnant adolescents may lead to increased accumulation of fetal abdominal fat with little net effect on birth weight. This finding suggests that increased sugar consumption during pregnancy promotes shifts in fetal body composition.
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Affiliation(s)
- C M Whisner
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - B E Young
- Pediatric Nutrition, University of Colorado Denver, Aurora, CO, USA
| | - E K Pressman
- The University of Rochester School of Medicine, Rochester, NY, USA
| | - R A Queenan
- The University of Rochester School of Medicine, Rochester, NY, USA
| | - E M Cooper
- The University of Rochester School of Medicine, Rochester, NY, USA
| | - K O O'Brien
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Whisner CM, Young BE, Witter FR, Harris ZL, Queenan RA, Cooper EM, O'Brien KO. Reductions in heel bone quality across gestation are attenuated in pregnant adolescents with higher prepregnancy weight and greater increases in PTH across gestation. J Bone Miner Res 2014; 29:2109-17. [PMID: 24676885 DOI: 10.1002/jbmr.2233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 03/07/2014] [Accepted: 03/17/2014] [Indexed: 11/11/2022]
Abstract
Few studies have examined the effect of maternal calcium intake and vitamin D status on bone health across gestation in pregnant adolescents. This study aimed to characterize maternal bone quality and determinants of bone-quality change across gestation in pregnant adolescents. Healthy pregnant adolescents (n = 156; aged 13 to 18 years) with singleton pregnancies and at 12 to 30 weeks gestation at enrollment were recruited from two urban maternity clinics in Baltimore, MD, and Rochester, NY, for this prospective longitudinal study. Maternal serum was collected at midgestation and at delivery for assessment of bone biomarkers and calcitropic hormones. Maternal bone quality (assessed by heel ultrasound) and sonographic fetal biometry were measured up to three times across pregnancy. Racially diverse teens (64.7% African American, 35.3% white) were followed from 21.0 (interquartile range [IQR] 17.3, 27.0) weeks of gestation until delivery at 40.0 (IQR 39.0, 40.7) weeks. Significant decreases in calcaneal speed of sound (SOS), broadband ultrasound attenuation (BUA), and quantitative ultrasound index (QUI) (-9.2 ± 16.1 m/s, -3.2 (-8.0, 2.1) dB/MHz and -5.3 ± 8.8, respectively) were evident across pregnancy. Multivariate analysis controlling for baseline measures and measurement intervals was used to identify independent predictors of normalized (per week) calcaneal bone loss. Weekly decreases in bone quality were not significantly associated with maternal calcium intake or 25(OH)D concentration. Greater weekly reductions in calcaneal bone quality were evident in teens with lower prepregnancy weight (BUA, p = 0.006 and QUI, p = 0.012) and among those with lower weekly increase in PTH (SOS, p = 0.046). Overall, significant decreases in calcaneal bone quality occurred across pregnancy in adolescents, but the magnitude of this loss was attenuated in those with greater prepregnancy weight and weekly increases in PTH. Further studies are needed to understand the role of elevated PTH and greater prepregnancy weight in preserving adolescent bone during pregnancy.
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Affiliation(s)
- Corrie M Whisner
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Lee S, Young BE, Cooper EM, Pressman E, Queenan RA, Olson CM, Guillet R, O’Brien KO. Nutrient Inadequacy Is Prevalent in Pregnant Adolescents, and Prenatal Supplement Use May Not Fully Compensate for Dietary Deficiencies. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/1941406414525993] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A longitudinal study was undertaken in 156 pregnant adolescents (≤18 years old) to characterize dietary intake and to determine the degree to which prenatal supplement use compensates for dietary deficits. The adequacy of dietary intake was assessed by comparing self-reported intake from up to three 24-hour dietary recalls with the dietary reference intakes. The majority of teens did not meet the estimated average requirements (EAR) for vitamin D (93%), vitamin E (94%), Mg (90%), Fe (76%), and Ca (74%). More than half of the adolescents in each gestational window (<23 weeks; 23-30 weeks; and ≥31 weeks of gestation) self-reported daily use of prenatal supplements, but the additional supplement contributions were not sufficient to meet the EAR for Mg (90%) or Ca (54%). Pregnant adolescents are at risk for insufficient intake of several essential nutrients from diet alone in spite of adequate or excessive energy intakes. Daily use of prenatal supplements reduces the prevalence of dietary inadequacy for many nutrients but may not be sufficient to meet the requirements for Mg and Ca. Practitioners should identify motivators and barriers to adequate diet and prenatal supplement use in order to address key nutrients of concern.
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Affiliation(s)
- Sunmin Lee
- Division of Nutritional Sciences, Cornell University, Ithaca, New York (SL, BEY, CMO, KOO)
- University of Rochester School of Medicine and Dentistry, Rochester, New York (EMC, EP, RAQ, RG)
| | - Bridget E. Young
- Division of Nutritional Sciences, Cornell University, Ithaca, New York (SL, BEY, CMO, KOO)
- University of Rochester School of Medicine and Dentistry, Rochester, New York (EMC, EP, RAQ, RG)
| | - Elizabeth M. Cooper
- Division of Nutritional Sciences, Cornell University, Ithaca, New York (SL, BEY, CMO, KOO)
- University of Rochester School of Medicine and Dentistry, Rochester, New York (EMC, EP, RAQ, RG)
| | - Eva Pressman
- Division of Nutritional Sciences, Cornell University, Ithaca, New York (SL, BEY, CMO, KOO)
- University of Rochester School of Medicine and Dentistry, Rochester, New York (EMC, EP, RAQ, RG)
| | - Ruth Anne Queenan
- Division of Nutritional Sciences, Cornell University, Ithaca, New York (SL, BEY, CMO, KOO)
- University of Rochester School of Medicine and Dentistry, Rochester, New York (EMC, EP, RAQ, RG)
| | - Christine M. Olson
- Division of Nutritional Sciences, Cornell University, Ithaca, New York (SL, BEY, CMO, KOO)
- University of Rochester School of Medicine and Dentistry, Rochester, New York (EMC, EP, RAQ, RG)
| | - Ronnie Guillet
- Division of Nutritional Sciences, Cornell University, Ithaca, New York (SL, BEY, CMO, KOO)
- University of Rochester School of Medicine and Dentistry, Rochester, New York (EMC, EP, RAQ, RG)
| | - Kimberly O. O’Brien
- Division of Nutritional Sciences, Cornell University, Ithaca, New York (SL, BEY, CMO, KOO)
- University of Rochester School of Medicine and Dentistry, Rochester, New York (EMC, EP, RAQ, RG)
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Young BE, Cooper EM, McIntyre AW, Kent T, Witter F, Harris ZL, O'Brien KO. Placental vitamin D receptor (VDR) expression is related to neonatal vitamin D status, placental calcium transfer, and fetal bone length in pregnant adolescents. FASEB J 2014; 28:2029-37. [DOI: 10.1096/fj.13-246736] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Bridget E. Young
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | | | | | - Tera Kent
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Frank Witter
- Johns Hopkins School of MedicineBaltimoreMarylandUSA
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Abstract
This review focuses on complementary feeding (CF) in westernized settings where primary health concerns are risk of obesity and micronutrient inadequacy. The current evidence is reviewed for: (1) when CF should be introduced, (2) what foods (nutrients and food types) should be prioritized and avoided, and (3) how the infant should be fed. Special attention is paid to the underlying physiological differences between breast- and formula-fed infants that often result in distinctly different nutritional and health risks. This difference is particularly acute in the case of micronutrient inadequacy, specifically iron and zinc, but is also relevant to optimal energy and macronutrient intakes. Emphasis is placed on the complex interplay among infants' early dietary exposures; relatively high energy and nutrient requirements; rapid physical, social and emotional development; and the feeding environment-all of which interact to impact health outcomes. This complexity needs to be considered at both individual and population levels and in both clinical and research settings.
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Affiliation(s)
- Bridget E Young
- Section of Nutrition, Department of Pediatrics, University of, Colorado Denver School of Medicine, 12700 E 19th Ave,, Box C-225, Aurora, CO 80045, USA,
| | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of, Colorado Denver School of Medicine, 12700 E 19th Ave,, Box C-225, Aurora, CO 80045, USA
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Young BE, Morrow AL, Davidson BS, Geraghty SR, Krebs NF. Inflammatory cytokines in human milk are inter‐correlated and may be related to infant growth characteristics and maternal weight status. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.629.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bridget E. Young
- Pediatrics ‐ Section of NutritionUniversity of Colorado DenverAuroraCO
| | - Ardythe L. Morrow
- Perinatal Institute Center for Interdisciplinary Research in Human Milk and LactationCincinnati Childern's Medical CenterCincinnatiOH
| | - Barbara S. Davidson
- Perinatal Institute Center for Interdisciplinary Research in Human Milk and LactationCincinnati Childern's Medical CenterCincinnatiOH
| | - Sheela R. Geraghty
- Center for Breastfeeding MedicineCincinnati Childern's Medical CenterCincinnatiOH
| | - Nancy F. Krebs
- Pediatrics ‐ Section of NutritionUniversity of Colorado DenverAuroraCO
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Whisner CM, Pressman EK, Young BE, Cooper BE, Queenan RA, O'Brien KO. Adipocytokines and fetal fat accretion in pregnant teens. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.111.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Beth E Cooper
- School of MedicineUniversity of RochesterRochesterNY
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Young BE, Johnson SL, Krebs NF. Biological determinants linking infant weight gain and child obesity: current knowledge and future directions. Adv Nutr 2012; 3:675-86. [PMID: 22983846 PMCID: PMC3648749 DOI: 10.3945/an.112.002238] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Childhood obesity rates have reached epidemic proportions. Excessive weight gain in infancy is associated with persistence of elevated weight status and later obesity. In this review, we make the case that weight gain in the first 6 mo is especially predictive of later obesity risk due to the metabolic programming that can occur early postpartum. The current state of knowledge regarding the biological determinants of excess infant weight gain is reviewed, with particular focus on infant feeding choice. Potential mechanisms by which different feeding approaches may program the metabolic profile of the infant, causing the link between early weight gain and later obesity are proposed. These mechanisms are likely highly complex and involve synergistic interactions between endocrine effects and factors that alter the inflammatory and oxidative stress status of the infant. Gaps in current knowledge are highlighted. These include a lack of data describing 1) what type of infant body fat distribution may impart risk and 2) how maternal metabolic dysfunction (obesity and/or diabetes) may affect milk composition and exert downstream effects on infant metabolism. Improved understanding and management of these early postnatal determinants of childhood obesity may have great impact on reducing its prevalence.
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Young BE, McNanley TJ, Cooper EM, McIntyre AW, Witter F, Harris ZL, O'Brien KO. Maternal vitamin D status and calcium intake interact to affect fetal skeletal growth in utero in pregnant adolescents. Am J Clin Nutr 2012; 95:1103-12. [PMID: 22492380 PMCID: PMC3325835 DOI: 10.3945/ajcn.111.023861] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Maternal calcium intake and vitamin D status may affect fetal bone development. OBJECTIVE This study was designed to examine relations between maternal calcium intake, 25-hydroxyvitamin D [25(OH)D] status, and fetal bone growth across pregnancy. DESIGN This was a prospective longitudinal design. Maternal 25(OH)D, parathyroid hormone, and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] were determined at midgestation (∼26 wk) and at delivery in 171 adolescents (≤ 18 y). Dietary recalls and fetal sonograms were performed up to 3 times across gestation, and fetal femur and humerus z scores were generated. RESULTS Fetal femur and humerus z scores and neonatal birth length were significantly greater (P < 0.03) in adolescents consuming ≥ 1050 mg than in those consuming <1050 mg Ca/d. Maternal 25(OH)D > 50 nmol/L was significantly positively associated with fetal femur and humerus z scores (P < 0.01). When maternal smoking, height, race, weight gain, and gestational age were controlled for, these relations remained significant. Interactions between calcium intake and 25(OH)D were evident. Calcium intake was associated with fetal femur z scores and birth length only when maternal 25(OH)D was ≤ 50 nmol/L (P < 0.05). Similarly, maternal 25(OH)D was associated with fetal femur and humerus z scores only when maternal calcium intake was <1050 mg/d (P < 0.03). CONCLUSIONS Optimal calcium intake and adequate maternal vitamin D status are both needed to maximize fetal bone growth. Interactions between these nutrients were evident when either calcium or vitamin D status was limited. Improving maternal calcium intake and/or vitamin D status during pregnancy may have a positive effect on fetal skeletal development in pregnant adolescents.
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Affiliation(s)
- Bridget E Young
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
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Young BE, McNanley T, Cooper B, Witter F, Harris ZL, O'Brien K. Pre‐pregnancy BMI Impacts Bone Loss across Pregnancy in Adolescents. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.119.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Beth Cooper
- University of Rochester School of MedicineRochesterNY
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Young BE, McNanley TJ, Cooper EM, McIntyre AW, Witter F, Harris ZL, O'Brien KO. Vitamin D insufficiency is prevalent and vitamin D is inversely associated with parathyroid hormone and calcitriol in pregnant adolescents. J Bone Miner Res 2012; 27:177-86. [PMID: 21956833 PMCID: PMC3291801 DOI: 10.1002/jbmr.526] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 08/28/2011] [Accepted: 09/22/2011] [Indexed: 11/11/2022]
Abstract
Few large studies have assessed changes in calcitropic hormones and maternal 25-hydroxyvitamin D (25(OH)D) status across pregnancy, and how this may impact maternal bone turnover and neonatal hormone status. We aimed to identify determinants of 25(OH)D, parathyroid hormone (PTH), and calcitriol across pregnancy in a longitudinal study of 168 pregnant adolescents (≤18 years of age). Maternal 25(OH)D, PTH, and calcitriol were assessed at mid-gestation (∼26 weeks), delivery, and in cord blood. Data were related to measures of maternal anthropometrics, dietary intake, physical activity, and bone turnover markers. Approximately 50% of teens and their infants had serum 25(OH)D ≤ 20 ng/mL; 25(OH)D was lower in African Americans versus whites (p < 0.001). PTH increased across gestation (p < 0.001). Elevated PTH (≥60 pg/mL) was detected in 25% of adolescents at delivery, and was associated with increased concentrations of serum N-telopeptide (NTX) (p = 0.028). PTH and calcitriol did not significantly differ across the range of Ca intake consumed (257-3220 mg/d). In the group as a whole, PTH was inversely associated with 25(OH)D in maternal circulation at mid-gestation (p = 0.023) and at delivery (p = 0.019). However, when the cohort was partitioned by 25(OH)D status, this relationship was only present in those with 25(OH)D ≤ 20 ng/mL, suggestive of a threshold below which 25(OH)D impacts PTH during pregnancy. Mid-gestation 25(OH)D was inversely associated with calcitriol at delivery (p = 0.023), irrespective of Ca intake. Neonatal PTH and calcitriol were significantly lower than (p < 0.001), but unrelated to maternal concentrations. These findings indicate that maternal 25(OH)D status plays a role in calcitropic hormone regulation in pregnant adolescents.
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Affiliation(s)
- Bridget E Young
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
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Abstract
OBJECTIVE This article is a discussion of the use of large clinical databases in population-based research on psychiatric disorders. METHOD The authors review uses of large clinical databases in research on the etiology, impact, and treatment of psychiatric disorders. They also describe existing privacy safeguards applicable to use of medical records data in research. RESULTS The growth of large medical databases has prompted increasing concern about the confidentiality of patient records. Efforts to restrict access to computerized medical data, however, may preclude use of such data in important and legitimate research. Prior research using large medical databases has made important contributions across a broad range of topics, including epidemiology, genetics, treatment effectiveness, and health policy. Continued population-based research will be essential in order to preserve the accessibility and quality of treatment for people with psychiatric disorders. CONCLUSIONS Public domain research should be distinguished from proprietary or commercial uses of health information, and existing privacy safeguards should be vigorously applied. In our efforts to protect patient privacy, however, we should take care not to endorse or reinforce prejudices against psychiatric treatment and people who suffer from psychiatric disorders. Neither should we ignore important opportunities to improve quality of care and influence public policy through population-based research.
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Affiliation(s)
- G E Simon
- Center ofr Health Studies, Group Health Cooperative, Seattle, WA 98101-1448, USA.
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Bowen M, Lyons KJ, Young BE. Nursing and health care reform: implications for curriculum development. J Nurs Educ 2000; 39:27-33. [PMID: 10647022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The health care system is undergoing profound changes. Cost containment efforts and restructuring have resulted in cutbacks in registered nurse (RN) positions. These changes are often related to the increased market penetration by managed care companies. To determine how RN graduates perceive these changes and their impact on the delivery of patient care, Healthcare Environment Surveys were mailed to graduates of the classes of 1986 and 1991. Using the Survey's 5-point Likert Scale, we measured the graduates' satisfaction with their salary, quality of supervision they received, opportunities for advancement, recognition for their job, working conditions, the overall job and the changes in their careers over the previous five year period. Our study suggests that the changes in the health care system are having an impact on how health care is being delivered and the way nurses view their jobs. Respondents reported that insurance companies are exerting increased control over patient care and perceive that the quality of patient care is declining. Increased workloads and an increase in the amount of paperwork were reported. Participants perceived that there were fewer jobs available and that job security was decreasing. The percentage of nurses who see job satisfaction as remaining the same or increasing are a majority. However, the relatively high percent of nurses who see job satisfaction as declining should provide a note of warning. The major implications of this study are that the professional nursing curriculum must be modified to include content on communication, organization, legislative/policy skills, and leadership. The nation's health care system is undergoing profound changes. There are numerous forces at work that are effecting the delivery of care and, consequently, the work of health professionals. These forces include significant efforts at cost containment, restructuring and downsizing of hospitals, and the movement of health care delivery out of acute care centers and into the community. Even though cutbacks in registered nurse (RN) positions appear to have leveled off in sections of the country that have gone through restructuring and reengineering of the work place, there still remains a heavy emphasis on lowering costs by decreasing employee benefits and increasing productivity through the substitution of part-time RNs for full-time RNs and the substitution of unlicensed assistive personnel (UAP) for RNs. These changes are often related to the increased market penetration by managed care companies, which are not expected to abate any time soon. It is important to determine what impact these changes are having on the delivery of patient care since there is some evidence to suggest that reduction in nursing staff below certain levels is related to poor patient outcomes (Fridken et al, 1996). It is also important to assess the effect of system changes on the satisfaction level health professionals have in their jobs. This is particularly important since some researchers suggest that job dissatisfaction, over a period of time, can result in burnout and eventually, turnover (Cameron, Horsburgh, & Armstrong-Stassen, 1994; Cotterman, 1991). Finally, understanding the impact of these health care delivery system changes has significant implications for baccalaureate nursing education and the preparation needed by future nurses to help them adjust to the changed environment.
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Affiliation(s)
- M Bowen
- Department of Nursing, College of Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Bushway RJ, Young BE, Paradis LR, Perkins LB, Martin SK, Brown MP. Determination of methyl 2-benzimidazolecarbamate in bulk fruit juice concentrates by competitive-inhibition enzyme immunoassay. J AOAC Int 1994; 77:1237-43. [PMID: 7950422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A polyclonal enzyme immunoassay (EIA) was used to quantitate methyl 2-benzimidazolecarbamate (MBC or carbendazim), a degradation product of benomyl, in bulk fruit juice concentrates. These concentrates are used by industrial producers to prepare juice or juice concentrates sold in supermarkets. Total sample analysis time was less than 18 min without cleanup or 35 min with cleanup. As many as 8 samples can be analyzed simultaneously, with a limit of quantitation of 10 ppb. The assay's dynamic range ran from 0.5 to 20 ppb MBC but was best from 0.5 to 10 ppb. Intra-assay coefficients of variation (CVs) varied from 4.0 to 13% for standards and from 4.1 to 26% for samples. Interassay CVs varied from 4.5 to 47% for standards and 5.6 to 22% for samples. Average recovery of several juice concentrates spiked at 10 to 290 ppb was 97%. A total of 140 juice concentrates comprising 20 different kinds of juice were analyzed by 2 EIA methods and one liquid chromatographic (LC) procedure. MBC-positive samples gave the following correlation coefficients: 0.954 for EIA without cleanup vs LC, 0.956 for EIA with cleanup vs LC, and 0.978 for EIA with cleanup vs EIA without cleanup. MBC concentrations in MBC-positive juice samples ranged from 5 to 2960 ppb.
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Affiliation(s)
- R J Bushway
- University of Maine, Department of Food Science, Orono 04469-5736
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Bushway RJ, Young BE, Paradis LR, Perkins LB. Determination of thiabendazole in fruits and vegetables by competitive-inhibition enzyme immunoassay. J AOAC Int 1994; 77:1243-8. [PMID: 7950423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
An enzyme immunoassay (EIA) was developed for analysis of thiabendazole (TBZ) in fruits and vegetables. A commercial kit using a polyclonal antibody for benomyl-carbendazim was used. Total analysis time, including sample preparation, was 35 min. As many as 8 samples can be analyzed simultaneously, with a limit of quantitation of 9 ppb. The assay's dynamic range ran from 9 to 304 ppb TBZ. Intra-assay coefficients of variation (CVs) ranged from 5.0 to 9.6% for standards and 11 to 30% for samples. Interassay CVs varied from 4.4 to 15% for standards and from 10 to 24% for samples. Average recovery from 29 samples spiked at 50-50,000 ppb was 116%. A total of 107 food products comprising 12 different fruits and vegetables and their processed products were analyzed for their TBZ content by EIA and liquid chromatography (LC). Of these samples, 84 were positive for TBZ by both methods, with a correlation coefficient (r) of 0.989. Eight samples had none detected by either technique, and 15 were positive for carbendazim. Concentrations of TBZ ranged from 11 to 94,000 ppb. The immunoassay with methanol sonication shows promise as a rapid screening method for TBZ in foods.
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Affiliation(s)
- R J Bushway
- University of Maine, Department of Food Science 04469-5736
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Abstract
In a survey of avian blood parasites in Costa Rica, 51 (11%) of 479 birds sampled were infected by at least one species of hematozoan. Fourteen of the 60 species of birds in the survey were examined for the first time. Infections were most common in ramphastids and emberizids and infrequent in other taxa. Among resident species, infections were more commonly detected during the wet season when most birds breed than during the dry season when few birds breed. Infections caused by Haemoproteus sp. were most common, while Plasmodium sp., Leucocytozoon sp., Trypanosoma sp., and microfilarial infections were rare. The intensity of the 40 Haemoproteus infections in adult birds was low, with a mean +/- SE of 12.5 +/- 3.7 infected cells per 10,000. Haemoproteus infections did not undergo seasonal changes in intensity.
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Affiliation(s)
- B E Young
- Department of Zoology, University of Washington, Seattle 98195
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Bushway RJ, Paradis LR, Perkins LB, Fan TS, Young BE, Walser PE. Determination of methyl 2-benzimidazolecarbamate in wine by competitive inhibition enzyme immunoassay. J AOAC Int 1993; 76:851-6. [PMID: 8374330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A benomyl polyclonal enzyme immunoassay (EIA) commercial kit was used to quantitate methyl 2-benzimidazolecarbamate (MBC), a degradation product of benomyl in wine. Total analysis time, including sample preparation, was 30 min. As many as 8 samples can be analyzed simultaneously with a limit of quantitation of 5 ppb. The assay logarithmic response was linear from 0.4 to 26 ppb MBC. Intra-assay percent coefficients of variation (%CVs) ranged from 2.4 to 13 for standards and from 7.4 to 21 for actual wine samples. Interassay %CVs varied from 2.6 to 15 for the standards and from 6.9 to 23 for the samples. Average recovery from samples spiked at 10-10,000 ppb was 93% for evaporated red and white wines. MBC was determined in 134 different wines by immunoassay and liquid chromatography (LC). Of these samples, 98 were positive for MBC by both methods with a correlation coefficient (r) of 0.986. The other 36 samples had MBC levels that either were not detectable by either procedure or were below the 10 ppb limit of quantitation for LC. Concentrations of MBC in wine ranged from 5 to 1329 ppb, with the majority ranging from 10 to 300 ppb. Also, a mini-study was conducted using the plate EIA format.
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Affiliation(s)
- R J Bushway
- University of Maine, Department of Food Science, Orono 04469-5736
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Newcomb PA, Weiss NS, Storer BE, Scholes D, Young BE, Voigt LF. Breast self-examination in relation to the occurrence of advanced breast cancer. J Natl Cancer Inst 1991; 83:260-5. [PMID: 1994055 DOI: 10.1093/jnci/83.4.260] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Two hundred nine female enrollees of the Group Health Cooperative of Puget Sound who developed advanced-stage breast cancer during the period 1982-1988 were interviewed about their practice of breast self-examination (BSE), use of other breast cancer screening modalities, and medical and reproductive histories. Each subject's description of how she performed the examination was scored according to her mention of up to 10 recommended BSE techniques. A random sample of 433 women without advanced-stage breast cancer from the same population was interviewed for comparison. Relative to women not practicing BSE, the risk of advanced-stage breast cancer among BSE users was 1.15 (95% confidence interval, 0.73-1.81). Frequency of BSE did not differ between women with advanced-stage breast cancer and control subjects, whether in all subjects or in subgroups defined by age, use of mammography, or frequency of clinical breast examinations. While self-described proficiency in BSE was generally low in both case and control subjects, the small percentage of women reporting more thorough self-examinations, regardless of frequency, had about a 35% decrease in the occurrence of advanced-stage breast cancer compared to women who did not perform BSE. These results suggest that, while carefully performed BSE may avoid the development of some advanced-stage breast cancers, BSE as practiced by most Seattle-area women is of little or no benefit.
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Affiliation(s)
- P A Newcomb
- Fred Hutchinson Cancer Research Center, Seattle, Wash
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Pennington JA, Young BE. Total diet study nutritional elements, 1982-1989. J Am Diet Assoc 1991; 91:179-83. [PMID: 1991931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Daily intakes of sodium, potassium, calcium, phosphorus, magnesium, iron, zinc, selenium, iodine, copper, and manganese for eight age-sex groups are presented for 1982 to 1989. Compared with the intakes recommended by the National Academy of Sciences, sodium intakes (which did not include discretionary salt) exceeded the estimated minimum requirement; intakes of potassium, phosphorus, selenium, and iodine were adequate for all groups; and copper intakes were low (less than 80% of the suggested intake) for all groups. In addition, calcium, magnesium, iron, and manganese were low in the diets of teenage girls; calcium, magnesium, and iron were low in the diets of adult women; calcium, magnesium, and zinc were low in the diets of older women; calcium and zinc were low in the diets of 2-year-olds; and magnesium was low in the diets of teenage boys and older men. The primary food group source for each element was dairy products for potassium, calcium, phosphorus, magnesium, and iodine; grain products for sodium, iron, and manganese; and animal flesh for zinc, selenium, and copper.
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Affiliation(s)
- J A Pennington
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, Washington, DC 20204
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Pennington JA, Young BE, Wilson DB. Nutritional elements in U.S. diets: results from the Total Diet Study, 1982 to 1986. J Am Diet Assoc 1989; 89:659-64. [PMID: 2723289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Through the Food and Drug Administration's Total Diet Study, the levels of 11 nutritional elements (sodium, potassium, calcium, phosphorus, magnesium, iron, zinc, copper, manganese, selenium, and iodine) in the diets of eight age-sex groups were determined for the 4 years between 1982 and 1986. The 234 Total Diet Study foods, which are representative of the U.S. food supply, were purchased, prepared for consumption, and analyzed for the elements four times each year. The results were combined with national food consumption data to estimate intakes for 6- to 11-month-old infants, 2-year-old children, 14- to 16-year-old boys and girls, 25- to 30-year-old men and women, and 60- to 65-year-old men and women. Six elements (calcium, magnesium, iron, zinc, copper, and manganese) were low (less than 80% of the Recommended Dietary Allowance or below the low end of the Estimated Safe and Adequate Daily Dietary Intake range) for three or more of the age-sex groups. Six elements were of concern for teenage girls and adult women, five for older women, three for 2-year-old children, two for teenage boys and older men, and only one for infants and adult men. Sodium levels (which did not include discretionary salt) were elevated for 2-year-old children and teenage boys, and iodine was elevated for all age-sex groups. A significant trend was noted only for iodine, the intake of which decreased during the 4-year period.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J A Pennington
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, Washington, D.C. 20204
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Pennington JA, Wilson DB, Young BE, Johnson RD, Vanderveen JE. Mineral content of market samples of fluid whole milk. J Am Diet Assoc 1987; 87:1036-42. [PMID: 3611549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Results from the Food and Drug Administration's Total Diet Study on the nutrient element content of fluid whole cow's milk are presented and compared with previously published values. Whole milk was collected and analyzed yearly from 1975 through 1985. Yearly and overall means were similar for all elements except iron and iodine. The iron content of milk was generally low, but several samples had high levels. The distribution of iodine in whole milk was quite wide (0.002 to 0.094 mg/100 gm). The iodine content of milk is affected by the level of iodine added to cattle feed and by the use of iodophor sanitizing solutions used by the dairy industry. Overall mean levels of the elements in milligrams per 100 gm whole milk were: sodium, 42; potassium, 134; calcium, 106; phosphorus, 83; magnesium, 9.8; iron, 0.07; zinc, 0.37; copper, 0.009; manganese, 0.004; iodine, 0.034; and selenium, 0.001. Coefficients of variation were high (67% to 117%) for iron, copper, manganese, selenium, and iodine but ranged from 18% to 26% for the other elements. An 8-fl oz serving of whole milk is an excellent source of iodine, calcium, phosphorus, and potassium. It also provides some sodium, magnesium, zinc, and selenium but is not a reliable source of iron, copper, or manganese.
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