Search

Families increasingly raise questions about the use of genetically modified organism (GMO)-containing food products. These products are widely found in the US food supply but originate from a narrow list of crops. Although GMO technology could be used to increase the micronutrient content of foods, this does not occur in the United States; instead, GMO technology has been used to make crops resistant to chemical herbicides. As a result, herbicide use has increased exponentially. The World Health Organization's International Agency on Research for Cancer has determined that glyphosate, an herbicide widely used in producing GMO food crops, is a probable human carcinogen. Measurable quantities of glyphosate are detected in some GMO foods. Families who wish to minimize GMO food products can do so by focusing on a dietary pattern of primarily whole, plant-based foods while minimizing ultra-processed foods. Pediatricians play a vital role in their efforts to minimize fear-based messaging and support families through shared decision-making. Pediatrician awareness of GMO labeling can guide individualized conversations, particularly that non-GMO labeling does not indicate organic status and that increased cost of some non-GMO foods, especially if also organic, may limit this choice for many families. [ABSTRACT FROM AUTHOR]

Background Maternal vitamin D status during pregnancy and lactation is a modifiable factor that may influence offspring musculoskeletal outcomes. However, few randomized trials have tested the effects of prenatal or postpartum vitamin D supplementation on offspring bone and muscle development. Objectives The aim was to examine hypothesized effects of improvements in early-life vitamin D status on childhood musculoskeletal health in Dhaka, Bangladesh. Methods In a previously completed, double-blind, dose-ranging trial, healthy pregnant women (n  = 1300) were recruited at 17–24 weeks' gestation and randomly assigned to a prenatal/postpartum regimen of 0/0, 4200/0, 16,800/0, 28,000/0, or 28,000/28,000 IU cholecalciferol (vitamin D3)/wk until 26 wk postpartum. In this new report, we describe additional follow-up at 4 y of age (n  = 642) for longer-term outcomes. Bone mineral content (BMC) and areal bone mineral density (aBMD) were measured by DXA. Grip strength was tested using a hand-held dynamometer. The primary comparison was children of women assigned to 28,000 IU/wk prenatally compared with placebo. Differences are expressed as means and 95% CIs. Results Total-body-less-head (TBLH) BMC, TBLH aBMD, and grip strength were similar in the combined high-dose prenatal (28,000/0 and 28,000/28,000 IU/wk) compared with placebo groups (mean difference [95% CI] = 0.61 g [–10.90, 12.13], 0.0004 g/cm2 [–0.0089, 0.0097], and 0.02 kg [–0.26, 0.31], respectively). In dose-ranging analyses, TBLH BMC and aBMD, whole-body BMC and aBMD, and grip strength in each of the prenatal vitamin D groups were not significantly different from placebo (P  > 0.05 for all comparisons). Only head aBMD was greater in children of women assigned to the 28,000/28,000-IU regimen compared with placebo (mean difference [95% CI] = 0.024 g/cm2 [0.0009, 0.047], P  = 0.042); the effect was attenuated upon adjustment for child height, weight, and sex (P  = 0.11). Conclusions Maternal prenatal, with or without postpartum, vitamin D supplementation does not improve child BMC, aBMD, or grip strength at 4 y of age. The MDIG trial and present follow-up study were registered prospectively at www.clinicaltrials.gov as NCT01924013 and NCT03537443, respectively. [ABSTRACT FROM AUTHOR]

Recently we published a meta-analyses of morbidity seen with the use of cow's milk derived fortifier (CMDF) rather than human milk derived fortifier (HMDF) in very low birthweight (VLBW) infants. Here, we further analyse these data to estimate the annual population risk of CMDF-related major morbidity in the United States and Canada. The outcome used was a mortality/morbidity index which was positive if the infants had one or more of death, necrotising enterocolitis, sepsis retinopathy of prematurity or bronchopulmonary dysplasia. Using the risk difference (RD) between the CMDF and HMDF groups we estimated, provisionally, that 4150 additional VLBW infants in the United States and Canada each year, or an additional infant approximately every 2 hours, may be expected to develop a positive mortality/morbidity index in relation to being fed CMDF - over and above the number of infants with a positive index if fed HMDF. We provide an in-depth discussion of the limitations of our estimate. This analysis provides preliminary evidence of the magnitude of population risk of major neonatal morbidity with use of CMDF versus HMDF in VLBW infants in current practice. [ABSTRACT FROM AUTHOR]

Background: Effects of prenatal iron supplementation on maternal postpartum iron status and early infant iron homeostasis remain largely unknown. Objective: We examined iron absorption and growth in exclusively breastfed infants in relation to fetal iron exposure and iron status during early infancy. Design: Longitudinal, paired iron-absorption (58Fe) studies were conducted in 59 exclusively breastfed Peruvian infants at 2-3 mo of age (2M) and 5-6 mo of age (5M). Infants were born to women who received ≥5100 or ≤1320 mg supplemental prenatal Fe. Iron status was assessed in mothers and infants at 2M and 5M. Results: Infant iron absorption from breast milk averaged 7.1% and 13.9% at 2M and 5M. Maternal iron status (at 2M) predicted infant iron deficiency (ID) at 5M. Although no infants were iron deficient at 2M, 28.6% of infants had depleted iron stores (ferritin concentration <12 µg/L) by 5M. Infant serum ferritin decreased (P < 0.0001), serum transferrin receptor (sTfR) increased (P < 0.0001), and serum iron decreased from 2M to 5M (P < 0.01). Higher infant sTfR (P < 0.01) and breast-milk copper (P < 0.01) predicted increased iron absorption at 5M. Prenatal iron supplementation had no effects on infant iron status or breast-milk nutrient concentrations at 2M or 5M. However, fetal iron exposure predicted increased infant length at 2M (P < 0.01) and 5M (P < 0.05). Conclusions: Fetal iron exposure affected early infant growth but did not significantly improve iron status or absorption. Young, exclusively breastfed infants upregulated iron absorption when iron stores were depleted at both 2M and 5M. characterized. Several studies have shown no significant association between maternal and infant iron status (9, 10), whereas other evidence has suggested an association between maternal iron status in pregnancy and infant iron stores postpartum (11- 14); maternal iron-deficiency anemia (IDA) in pregnancy has been associated with compromised fetal iron reserves (11, 15-17). Recent data by Roberfroid et al (18) have indicated that the physiologic anemia of pregnancy occurs even in women receiving iron supplementation. Several studies have shown that placental iron transfer can be upregulated when maternal or fetal iron stores are limited (19-23). We have previously reported that a significantly larger fraction of maternally ingested iron is transferred to the fetus in women with depleted iron stores (23, 24). Recent animal studies also suggested that the timing at which iron supplementation is initiated during pregnancy may also influence subsequent neonatal outcomes (25). Although acute studies of placental iron transport have highlighted the adaptability of maternal-fetal iron partitioning, little is known about the long-term impact of this transfer on early iron homeostasis. In Peru, the estimated prevalence of anemia in infants 6-8 mo old is 69.3% (26); reasons for this high prevalence in relation to early iron absorption need to be investigated. To address this issue, we conducted longitudinal, paired iron-absorption studies in exclusively breastfed Peruvian infants at 2 and 5 mo of age to 1) characterize longitudinal determinants of iron absorption from breast milk in young infants as the iron stores of birth are depleted and 2) examine the impact of fetal iron exposure on early infant iron homeostasis and growth. [ABSTRACT FROM AUTHOR]

Background: The effects of vitamin D supplementation in healthy prepubertal children on physiologic outcomes have not been investigated. Objective: The objective was to evaluate the effects of supplementation with 1000 IU vitamin D3/d on calcium absorption. Design: In a double-blind, placebo-controlled trial, we randomly assigned 64 children to 1000 IU vitamin D3/d (n = 32) or placebo (n = 32) for 8 wk. Stable isotopes were used to assess calcium absorption. The main outcome measure was calcium absorption before and after supplementation. Results: All of the data are shown as means ± SDs. At baseline, vitamin D intake was 221 ±79 1U/d and calcium intake was 830 ± 197 mg/d. Baseline serum 25-hydroxyvitamin D [25(OH)D] was not significantly correlated with fractional or total calcium absorption. After 8 wk, with baseline values used as a covariate, no differences were seen in fractional or total calcium absorption based on supplementation group (P = 0.75 and 0.36, respectively). Supplemented children had a significant increase in 25(OH)D concentrations (from 27.7 ± 7.4 to 36.0 ± 10.3 ng/mL; P < 0.0001) and a decrease in parathyroid hormone (from 21.4 ± 10.4 to 12.9 ± 7.1 pg/mL; P < 0.001); no significant changes in the placebo group were observed. No adverse side effects were noted in either group. Conclusions: Vitamin D3 supplementation at 1000 IU/d increases 25(OH)D and decreases parathyroid hormone in children with average vitamin D intakes below the dietary recommendations of the Institute of Medicine. However, no significant effects of this change on calcium absorption occurred. This trial was registered at clinicaltrials.gov as NCT 00868738. [ABSTRACT FROM AUTHOR]

The importance of vitamin D for ensuring the health of children has long been understood. Over time, however, dietary recommendations for vitamin D intake have varied, with some eras seeing higher levels recommended and some lower. Remarkably, the current recommendations from the Institute of Medicine are not much different from those released with the first edition of the recommended dietary allowances in 1941. The present review examines the evolution of vitamin D recommendations over time and considers the differences and potential consequences related to the various recommendations in effect today. In considering strategies to evaluate the vitamin D status of children and efforts to assure its adequacy, individual caregivers and policy makers need to consider carefully the costs and potential risks of different screening strategies involving blood testing in children and of supplementation. More data on the long-term risks and benefits are needed before widespread screening or supplementation can be advocated. [ABSTRACT FROM AUTHOR]

Nutritional rickets has long been considered a disease caused by vitamin D deficiency, but recent data indicate that inadequate dietary calcium intake is an important cause of rickets, particularly in tropical countries. Children with rickets due to calcium deficiency do not have very low 25(OH)D concentrations, and serum 1,25(OH)D values are markedly elevated. Studies of Nigerian children with rickets demonstrated they have high fractional calcium absorption. A high-phytate diet was demonstrated to increase calcium absorption compared with the fasting state, and enzymatic dephytinization did not significantly improve calcium absorption. When given vitamin D, children with rickets have a marked increase in 1,25(OH)D concentrations without any change in fractional calcium absorption. No positive relationship was found between fractional calcium absorption and serum 25(OH)D concentrations in children on low-calcium diets. More research is needed to understand the interaction between calcium and vitamin D and the role of vitamin D in calcium absorption. [ABSTRACT FROM AUTHOR]

Few data have evaluated Zn balance in young children after the first year of life. The objective of the present study was to study the relationships among Zn intake, absorption, endogenous faecal excretion, and retention in a group of healthy children. Thirty children, aged 15???48 months, were studied on a diet representative of their usual daily mineral intake. Zn absorption was assessed using a dual-tracer stable-isotope technique. Endogenous Zn faecal excretion and Cu absorption were determined in a subset of children. We found that Zn intake from the in-patient weighed dietary record (5??0 (sd 2??1) mg/d) was significantly greater than the current estimated average requirement (EAR; 2??5??mg/d; P??0??4, for all). Absolute Zn absorption was significantly related to Zn intake (r2 0??696; P??

Stable isotope absorption studies of iron have been limited by the high cost and limited availability of isotope ratio analysis using thermal ionization MS (TIMS). The development of high-resolution double focusing inductively coupled plasma MS (ICP-MS) may permit more cost-efficient sample analysis due to its high through- put, lower cost, easy sample pretreatment, and greater availability. Our objective was to develop an ICP-MS methodology for the measurement of iron isotope ratios using very small blood volumes. We developed a technique using multiple iron-nickel mixing standard solutions to adjust for nickel interference calibration. RBC samples from human subjects previously given 58Fe and 57Fe were analyzed for iron isotope ratios and compared with our current methodology (TIMS). Reproducibility of iron isotope ratios provided external relative SD < 0.5 and 0.7% (1 SD) for 57Fe/54Fe and 58Fe/54Fe, respectively. Iron isotope ratios from ICP-MS analysis did not differ from those from TIMS based on statistical analyses, nor did the calculated iron absorption values. The mean and SD of iron absorption did not differ when measured by TIMS or ICR-MS. A 2-μL RBC sample was sufficient for ICP-MS iron isotope ratio analysis with an internal relative SD < 0.5% and analytical time < 5 mm. This technique may assist groups in increasing their use of stable isotope methods to assess iron absorption in infants and children. [ABSTRACT FROM AUTHOR]

Provision of the bone minerals and vitamin D as fortificants in food or as dietary supplements designed for older infants and toddlers in Latin America is likely to be beneficial and safe. Currently available data are inadequate to establish the precise amounts of these nutrients that would be required for such a supplement. These amounts would vary according to the local base diet. However, reasonable estimates can be made on the basis of current dietary recommendations as well as existing data on bioavailability and customary intake. The strongest case can be made for calcium and vitamin D supplementation. Because excessive dietary calcium can reduce zinc absorption as a result of interactive effects within the intestine, an appropriate ratio of calcium to zinc should be used, even if this means adding zinc as a fortificant or supplement. Magnesium supplementation may be appropriate in some circumstances but it cannot be routinely advocated at present. It is unlikely that phosphorus supplementation is needed for most population groups because of the relatively high usual dietary phosphorus intakes, primarily from phosphate salts added to carbonated beverages and as food preservatives. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency is a major nutritional concern in developing countries, and food fortification is a common strategy to treat it. In Indonesia wheat flour is fortified with 60 mg Fe/kg, but because of increasing concerns about marginal zinc status in at-risk populations, consideration is being given to cofortifying flour with zinc. However, little is known about the effect of zinc fortification of flour on iron bioavailability or about the optimum form of zinc supplementation. Objective:We measured iron and zinc bioavailability from wheatflour dumplings containing 25 g flour fortified with 60 mg Fe/kg, either alone or with 60 mg Zn/kg as zinc oxide or as zinc sulfate. Design: Ninety children aged 4-8 y were recruited and assigned randomly to the 3 groups; 86 completed the study. Iron and zinc absorption were measured with established stable-isotope methods. Results: Iron absorption from the flour fortified with iron only was good (15.9 ± 6.8%), but when corrections were made for hemoglobin concentrations, it was significantly lower from the flour cofortified with zinc sulfate (11.5 ± 4.9%; P < 0.05) but not from the flour cofortified with zinc oxide (14.0 ± 8.9%). Zinc absorption was not significantly different between the zinc oxide and zinc sulfate cofortified flours (24.1 ± 8.2% compared with 23.7 ± 11.2%; P = 0.87). Conclusions: Iron and zinc appear to be highly bioavailable from foods made from fortified flour, but zinc sulfate cofortification may have a detrimental effect on iron absorption. [ABSTRACT FROM AUTHOR]

Focuses on a study which examined the the level of calcium and magnesium balance in children age 9 to 14 years old. How the study was conducted; Number of participants involved in the study; What the study revealed; Discussion of the results.

Intramuscular administration of vitamin K for prevention of vitamin K deficiency bleeding (VKDB) has been a standard of care since the American Academy of Pediatrics recommended it in 1961. Despite the success of prevention of VKDB with vitamin K administration, the incidence of VKDB appears to be on the rise. This increase in incidence of VKDB is attributable to parental refusal as well as lowered efficacy of alternate methods of administration. The aim of this statement is to discuss the current knowledge of prevention of VKDB with respect to the term and preterm infant and address parental concerns regarding vitamin K administration. [ABSTRACT FROM AUTHOR]

The article discusses the impact of fruit juice on child health. Topics covered include how clinicians have described the experience of patients who reportedly created a healthier diet for their overweight or obese child through the substitution of fruit juice for sugar-sweetened sodas, the uncertain effects of small amount of juice on dental caries, and the need for pediatricians to limit the consumption of fruit juice.

A letter to the editor is presented in response to the article "The demise of calcium-based phosphate binders—is this appropriate for children?" by L. Rees and colleagues that was published in the previous issue.