The bidirectional relationship between growth and appetite regulation in the first year of life

 

Childhood obesity is a public health crisis. Even though appetite traits in infancy were associated with childhood adiposity, whether early weight gain can influence later appetite has not been researched. Our aim was to prospectively examine the bidirectional association between growth and appetite traits during the first year of life. We followed up 450 healthy term infants for 12 months (m). Appetite traits at 4 weeks (wk), 6m and 12m were assessed using the Baby and Child Eating Behaviour Questionnaires. Infant feeding, anthropometric, socioeconomic and demographic data were also collected. Infant weight-for-age z-scores (WFAZ) were calculated using the WHO 2006 growth reference. Growth was assessed as conditional WFAZ change (cWFAZc) by saving the residuals from linear regression models of WFAZ at each successive time point versus WFAZ at the earlier time point. Multivariable linear regression was used to analyse bidirectional associations between cWFAZc (0-4wk, 4wk-6m, 6-12m) and appetite traits Enjoyment of Food (EF), Food Responsiveness (FR), Satiety Responsiveness (SR) and Slowness in Eating (SE) at 4wk, 6m and 12m. All models were adjusted for relevant confounders. At 4wk, SR score was associated with lower (β:-0.16; 95% CI:-0.28,-0.03), and FR score with higher (β:0.10; 95% CI:0.01,0.19) cWFAZc from 4wk to 12m. SR score at 6m was inversely associated with cWFAZc from 6-12m (β:-0.09; 95% CI:-0.16,-0.01). Conversely, higher cWFAZc between 4wk-6m was associated with higher EF (β:0.10; 95% CI:0.01,0.19) and FR (β:0.16; 95% CI:0.04,0.29) scores at 12m. cWFAZc between 6m-12m was inversely associated with SR at 12m (β:-0.18; 95% CI:-0.35,-0.01). Our results suggest that the growth acceleration hypothesis, where faster growth in infancy leads to later obesity, may be mediated by an up-regulation of appetite traits at 12m. This highlights the public health importance of avoiding growth acceleration in infancy as a way to curb the childhood obesity epidemic.

Key messages

• Weight gain in early infancy impacts appetite regulation in the first year of life and up-regulation of appetite traits at 12 months predisposes to childhood obesity.

• Avoiding growth acceleration in infancy can decrease the risk for childhood obesity.

The development of food portion sizes suitable for 4-18-year-old children used in a theoretical meal plan meeting energy and nutrient requirements

BACKGROUND

Healthy eating guidelines for school-aged children are available but without advice on portion sizes. This is a concern because consuming large portions is associated with an increased risk of overweight/obesity. The present study aimed to calculate recommended portion sizes for school-aged children based on weight for age and use them to develop a meal plan to meet nutritional needs within energy requirements.

METHODS

Portion size data on foods consumed by school-aged children (4-18 years) were extracted from two sources: (i) British National Diet and Nutrition Survey (1997) and (ii) Avon Longitudinal Study of Parents and Children (1997-2006). Foods were allocated to groups based on the UK Eatwell Guide and the US My Plate Model. Portion sizes were developed for a variety of foods. A meal plan that included portion size guidance and met healthy eating guidelines was developed based on the number of portions of each food group needed to meet dietary requirements.

RESULTS

Portion sizes were developed for 131 foods that were commonly eaten by children in age groups 4-6, 7-10, 11-14 and 15-18 years. The meal plan met requirements for energy and nutrients as specified by UK dietary reference values, except for vitamin D for which there are few dietary sources.

CONCLUSIONS

Food portion sizes informed by usual intake in UK children can help inform dietary advice for a range of childhood settings and for parents. The meal plan included a wide variety of foods to encourage dietary diversity and meet energy and nutrient needs for school-aged children.

Dietary nucleotides and early growth in formula-fed infants: a randomized controlled trial

BACKGROUND

Dietary nucleotides are nonprotein nitrogenous compounds that are found in high concentrations in breast milk and are thought to be conditionally essential nutrients in infancy. A high nucleotide intake has been suggested to explain some of the benefits of breastfeeding compared with formula feeding and to promote infant growth. However, relatively few large-scale randomized trials have tested this hypothesis in healthy infants.

OBJECTIVE

We tested the hypothesis that nucleotide supplementation of formula benefits early infant growth.

PATIENTS AND METHODS

Occipitofrontal head circumference, weight, and length were assessed in infants who were randomly assigned to groups fed nucleotide-supplemented (31 mg/L; n=100) or control formula without nucleotide supplementation (n=100) from birth to the age of 20 weeks, and in infants who were breastfed (reference group; n=101).

RESULTS

Infants fed with nucleotide-supplemented formula had greater occipitofrontal head circumference at ages 8, 16, and 20 weeks than infants fed control formula (mean difference in z scores at 8 weeks: 0.4 [95% confidence interval: 0.1-0.7]; P=.006) even after adjustment for potential confounding factors (P=.002). Weight at 8 weeks and the increase in both occipitofrontal head circumference and weight from birth to 8 weeks were also greater in infants fed nucleotide-supplemented formula than in those fed control formula.

CONCLUSIONS

Our data support the hypothesis that nucleotide supplementation leads to increased weight gain and head growth in formula-fed infants. Therefore, nucleotides could be conditionally essential for optimal infant growth in some formula-fed populations. Additional research is needed to test the hypothesis that the benefits of nucleotide supplementation for early head growth, a critical period for brain growth, have advantages for long-term cognitive development.

Technology anxiety as a potential mediating factor in response to medical technology

Technology anxiety, defined as a fear of working with medical equipment, was measured via the use of the Technology Response Questionnaire. Nurses (N = 414) working on nine types of nursing units at two hospitals participated in the study. Nurses working on psychiatric units were found to be most anxious about working with medical equipment, while nurses working on surgical and adult intensive care units were least anxious. A comparison of the nurses who were highest and lowest on technology anxiety indicated that those who were most anxious about technology were less positive toward computers, felt more stressed by their work, were lower on job satisfaction, less positive toward the physicians they worked with, lower on personality scales of autonomy and adaptability, were less likely to do care planning regularly or to use nursing diagnoses, and tended to be older than less anxious nurses.

Retinoic acid induces cyclic changes in epidermal thickness and dermal collagen and glycosaminoglycan biosynthesis rates

The effects of daily topical application onto guinea pig ears of a therapeutic concentration of all trans-retinoic acid (RA) on epidermal thickness and dermal collagen and glycosaminoglycan (GAG) biosynthesis rates were studied during a 40-day period. Clinically, the RA-treated skin became erythematous and scaly beginning at 5-6 days, conditions which persisted throughout the experiment. The epidermis became thickened and hyperplastic with marked psoriasi-form histologic features, and the phenomenon was dependent on RA concentration. The initial hyperplasia resulted from a transient 4-fold increase in epidermal basal cell replication during the first 3-4 days, as shown by the rise and fall of [3H]thymidine labeling index which preceded the hyperplasia. The extent of epidermal hyperplasia as measured by epidermal thickness was not constant throughout the 40-day treatment period, but exhibited maxima on days 11, 25, and 36. These maxima were followed by periods of decreased thickness, although the minima were always greater than the untreated controls. Retinoic acid induced similar temporal cycles in GAG and collagen biosynthesis rates, but the collagen cycles occurred at different times with maxima on days 6, 20, and 34. After 8 weeks' treatment, the blood flow rates in the ear microcirculation (laser Doppler photometry) were increased 81% above that of the water-treated controls. The demonstration of these RA-induced cyclic changes in epidermal hyperplasia and dermal fibroblast biosynthetic activities have revealed the presence of control mechanisms in these tissues which normally operate to maintain tissue homeostasis.

Acute oral testing for determining antiarrhythmic drug efficacy. I. Quinidine

Acute oral drug testing with quinidine was used in 18 patients with high grade ventricular arrhythmia. This method involves administering a single large dose of the antiarrhythmic agent, monitoring heart rhythm by means of programmed trendscription and determining blood drug levels at selected intervals. After quinidine was given in a dose of 0.6 g, 10 patients had a positive response, defined as a 50% or greater reduction in ventricular premature beats and abolition of repetitive ectopic beats. Drug action began a mean of 88 minutes after administration, and the mean peak blood quinidine level was 3.2+/-0.5 (standard error) mug/ml. Four patients had a paradoxic increase in arrhythmia. In nine patients the response to acute drug testing was compared with the response to maintenance quinidine therapy with doses of 1.2 and 1.8 g/day. The presence of arrhythmia was assessed with 24 hour ambulatory monitoring and exercise stress testing. With both techniques, seven of nine patients showed results concordant with those of acute testing. Disparity in results of the two methods of drug administration was explained by the serum concentration of quinidine. Acute oral drug testing provides a new approach for determining expeditiously whether quinidine is effective or hazardous in an individual patient.