Malnutrition and pectoralis muscle index in medical intensive care unit patients: A matched cohort study.

BACKGROUND: Muscle assessment is an important component of nutrition assessment. The Global Leadership Initiative on Malnutrition (GLIM) consortium recently underscored the need for more objective muscle assessment methods in clinical settings. Various assessment techniques are available; however, many have limitations in clinical populations. Computed tomography (CT) scans, obtained for diagnostic reasons, could serve multiple purposes, including muscle measurement for nutrition assessment. Although CT scans of the chest are commonly performed clinically, there is little research surrounding the utility of pectoralis muscle measurements in nutrition assessment. The primary aim was to determine whether CT-derived measures of pectoralis major cross-sectional area (PMA) and quality (defined as mean pectoralis major Hounsfield units [PMHU]) could be used to identify malnutrition in patients who are mechanically ventilated in an intensive care unit (ICU). A secondary aim was to evaluate the relationship between these measures and clinical outcomes in this population. METHODS: A retrospective analysis was conducted on 33 pairs of age- and sex-matched adult patients who are being mechanically ventilated in the ICU. Patients were grouped by nutrition status. Analyses were performed to determine differences in PMA and mean PMHU between groups. Associations between muscle and clinical outcomes were also investigated. RESULTS: Compared with nonmalnourished controls, malnourished patients had a significantly lower PMA (P = 0.001) and pectoralis major (PM) index (PMA/height in m2; P = 0.001). No associations were drawn between PM measures and clinical outcomes. CONCLUSION: These findings regarding CT PM measures lay the groundwork for actualizing the GLIM call to action to validate quantitative, objective muscle assessment methods in clinical settings.

Breastfeeding Characteristics and Duration of Feeding Human Milk in Infants With Congenital Heart Disease.

BACKGROUND: Although infants with congenital heart disease (CHD) are able to breastfeed successfully, the factors that affect feeding human milk across the first year are not well established. PURPOSE: The objective of this study was to examine breastfeeding characteristics and their relationships to the exclusivity and duration of feeding human milk among infants with CHD. METHODS: Breastfeeding characteristics data from a cohort of 75 infants with CHD enrolled in a study that examined relationships among milk type and infant growth in the first year of life were analyzed. RESULTS: Infants whose mothers reported not having enough milk were exclusively fed human milk for a shorter duration than those who did not have this challenge ( P = .04); however, the duration of feeding any human milk did not differ ( P = .18). Average daily volume expressed at 1 month was positively related to the duration of exclusive human milk (ß = .07, P = .04) and any human milk (ß = .07, P = .04) feeding. CONCLUSIONS: Future efforts to support feeding human milk in infants with CHD should emphasize practices that support maximal human milk production.

Effects of prebiotics, probiotics, and synbiotics on the infant gut microbiota and other health outcomes: A systematic review.

The primary aim of this review was to systematically evaluate the literature regarding the effect of pre-, pro-, or synbiotic supplementation in infant formula on the gastrointestinal microbiota. The Cochrane methodology for systematic reviews of randomized controlled trials (RCTs) was employed. Five databases were searched and 32 RCTs (2010-2021) were identified for inclusion: 20 prebiotic, 6 probiotic, and 6 synbiotic. The methods utilized to evaluate gastrointestinal microbiota varied across studies and included colony plating, fluorescence in situ hybridization, quantitative real-time polymerase chain reaction, or tagged sequencing of the 16S rRNA gene. Fecal Bifidobacterium levels increased with supplementation of prebiotics and synbiotics but not with probiotics alone. Probiotic and synbiotic supplementation generally increased fecal levels of the bacterial strain supplemented in the formula. Across all pre-, pro-, and synbiotic-supplemented formulas, results were inconsistent regarding fecal Clostridium levels. Fecal pH was lower with some prebiotic and synbiotic supplementation; however, no difference was seen with probiotics. Softer stools were often reported in infants supplemented with pre- and synbiotics, yet results were inconsistent for probiotic-supplemented formula. Limited evidence demonstrates that pre- and synbiotic supplementation increases fecal Bifidobacterium levels. Future studies utilizing comprehensive methodologies and additional studies in probiotics and synbiotics are warranted.

Glutamic acid intake by formula-fed infants: are acceptable daily intakes appropriate?

The 2017 European Food Safety Authority (EFSA) recommendation of an acceptable daily intake (ADI) of 30 mg glutamic acid/kg bw/day did not take into consideration the primary energy sources during infancy, including infant formulas. In the present study, we determined total daily intakes of glutamic acid in a contemporary cohort of healthy infants who were fed either cow milk formula (CMF) or extensive protein hydrolysate formula (EHF); the formulas differed substantially in glutamic acid content. The infants (n = 141) were randomized to be fed either CMF or EHF. Dietary intakes were determined from weighed bottle methods and/or prospective diet records, and body weights were measured on 14 occasions from 0.5 to 12.5 months. Secondary data analysis determined the glutamic acid content of the diet over time. The trial was registered at  http://www. CLINICALTRIALS: gov/ as NCT01700205, 3 October 2012. Glutamic acid intake from formula and other foods was significantly higher in infants fed EHF when compared to CMF. As glutamic acid intake from formula decreased, intake from other nutritional sources steadily increased from 5.5 months. Regardless of formula type, every infant exceeded the ADI of 30 mg/kg bw/day from 0.5 to 12.5 months.   Conclusion: Given that the ADI recommendation was not based on actual intake data of primary energy sources during infancy, the present findings on the growing child's ingestion of glutamic acid from infant formula and the complementary diet may be of interest when developing future guidelines and communications to parents, clinical care providers, and policy makers. WHAT IS KNOWN: • The 2017 re-evaluation of the safety of glutamic acid-glutamates and the recommended acceptable daily intake (ADI) of 30 mg/kg bw/d by the European Food Safety Authority (EFSA) did not include actual intake data of the primary energy sources during infancy. WHAT IS NEW: • During the first year, glutamic acid intake from infant formula and other food sources exceeded the ADI of 30 mg/kg bw/day.

Glutamic Acid Intake by Formula-Fed Infants: Are Acceptable Daily Intakes Feasible?

PURPOSE: The 2017 European Food Safety Authority (EFSA) recommendation of an acceptable daily intake (ADI) of 30 mg glutamic acid/kg bw/d did not take into consideration the primary energy sources during infancy, including infant formulas. In the present study, we determined total daily intakes of glutamic acid in a contemporary cohort of healthy infants who were fed either cow milk formula (CMF) or extensive protein hydrolysate formulas (EHF); the formulas differed in glutamic acid content (262.4 mg/100ml, CMF; 436.2 mg/100ml, EHF). METHODS: The infants ( n = 141) were randomized to be fed either CMF or EHF. Daily intakes were determined from weighed bottle methods and/or prospective diet records, and body weights and lengths were measured on 15 occasions from 0.5 to 12.5 months. The trial was registered on http://www. CLINICALTRIALS: gov/ as trial registration number NCT01700205 on 3 October 2012. RESULTS: Glutamic acid intake from formula and other foods was significantly higher in infants fed EHF when compared to CMF. As glutamic acid intake from formula decreased, intake from other nutritional sources steadily increased from 5.5 months. Regardless of formula type, every infant exceeded the ADI of 30 mg/kg bw/d from 0.5 to 12.5 months. CONCLUSIONS: Faced with the knowledge that the EFSA health-based guidance value (ADI) was not based on actual intake data and did not account for the primary energy sources during infancy, EFSA may reconsider the scientific literature on growing children's intakes from human milk, infant formula, and the complementary diet to provide parents and health care providers with revised guidelines.

Factors Affecting BMI Changes in Mothers during the First Year Postpartum.

We tested the hypotheses that mothers of infants who exclusively breastfed would differ in the trajectories of postpartum BMI changes than mothers of infants who exclusively formula fed, but such benefits would differ based on the maternal BMI status prepregnancy (primary hypothesis) and that psychological eating behavior traits would have independent effects on postpartum BMI changes (secondary hypothesis). To these aims, linear mixed-effects models analyzed measured anthropometric data collected monthly from 0.5 month (baseline) to 1 year postpartum from two groups of mothers distinct in infant feeding modality (Lactating vs. Non-lactating). While infant feeding modality group and prepregnancy BMI status had independent effects on postpartum BMI changes, the benefits of lactation on BMI changes differed based on prepregnancy BMI. When compared to lactating women, initial rates of BMI loss were significantly slower in the non-lactating women who were with Prepregnancy Healthy Weight (ß = 0.63 percent BMI change, 95% CI: 0.19, 1.06) and with Prepregnancy Overweight (ß = 2.10 percent BMI change, 95% CI: 1.16, 3.03); the difference was only a trend for those in the Prepregnancy Obesity group (ß = 0.60 percent BMI change, 95% CI: -0.03, 1.23). For those with Prepregnancy Overweight, a greater percentage of non-lactating mothers (47%) gained ≥ 3 BMI units by 1 year postpartum than did lactating mothers (9%; p < 0.04). Psychological eating behavior traits of higher dietary restraint, higher disinhibition, and lower susceptibility to hunger were associated with greater BMI loss. In conclusion, while there are myriad advantages to lactation, including greater initial rates of postpartum weight loss regardless of prepregnancy BMI, mothers who were with overweight prior to the pregnancy experienced substantially greater loss if they breastfed their infants. Individual differences in psychological eating behavior traits hold promise as modifiable targets for postpartum weight management.

Relationship Between Human Milk Feeding Patterns and Growth in the First Year of Life in Infants with Congenital Heart Defects.

The purpose of this study was to determine the relationship between patterning of human milk feeding and growth of infants with congenital heart defects in the first year of life. Inclusion criteria for this prospective cohort study included infants 0-21 days, who had undergone or had planned neonatal corrective or palliative surgery prior to hospital discharge, and whose mothers planned to feed human milk. Data on anthropometric measures (weight, length, head circumference) and infant milk type (human milk, formula, other) were collected at nine time points (0.5, 1, 2, 3, 4, 6, 8, 10, 12 months). Anthropometric data were converted to weight-for-age, length-for-age, head circumference-for-age, and weight-for-length Z-scores using World Health Organization growth reference data. Cluster analysis identified three milk type feeding patterns in the first year: Infants fed human milk only with no formula supplementation, infants fed human milk who then transitioned to a mix of human milk and formula, and infants who fed human milk and transitioned to formula only. General linear models assessed the effect of milk type feeding patterns on growth parameters over time. No effect of milk type pattern × time was found on longitudinal changes in weight-for-age (p for interaction = 0.228), length-for-age (p for interaction = 0.173), weight-for-length (p for interaction = 0.507), or head circumference-for-age (p for interaction = 0.311) Z-scores. In this cohort study, human milk alone or combined with infant formula supported age-appropriate growth in infants with congenital heart defects in the first year.

Human Milk, Infant Formula, and Other Milks Fed to Infants and Toddlers in the United States, NHANES 2007-2018.

BACKGROUND: For the first time, the 2020-2025 Dietary Guidelines for Americans provide specific guidance regarding the types of foods and beverages that should be offered in the first 2 years of life. Milk, in various forms (eg, human milk, infant formula, and cow's milk) contributes a large proportion of key nutrients to the diets of infants and toddlers in the United States. OBJECTIVE: The aim of this study was to determine the types of milk (human milk, infant formula, and other milk) fed to US infants and toddlers in the past 12 years and to describe trends over time. DESIGN: This was a cross-sectional analysis of 2-day, 24-hour dietary recalls. PARTICIPANTS/SETTING: Data from the 2007-2018 National Health and Nutrition Examination Survey were used for these analyses. Infants and toddlers aged 0 through 23.9 months with 2 days of dietary recall data (n = 3,079) were included. MAIN OUTCOME MEASURES: The main outcome was proportion of infants and toddlers fed different milk types. STATISTICAL ANALYSES PERFORMED: Survey-adjusted weighted percentages were used to report sociodemographic characteristics and the proportion of subjects fed each milk type category by age group and survey cycles. Binary and multinomial logistic regressions were used to assess differences in subject characteristics by age groups. RESULTS: Sociodemographic characteristics did not differ by age group. The proportion of infants aged 0 to <6 months fed infant formula only was 60.2% in 2007-2012 and 44.8% in 2013-2018. The proportion of infants aged 6 to <12 months fed partially hydrolyzed infant formula only was 7.3% in 2007-2012 and 13.1% in 2013-2018. In toddlers (>12 months old), cow's milk was the predominant milk type in both 2007-2012 and 2013-2018. CONCLUSIONS: The percentage of infants fed any human milk increased over the past decade. Unsweetened cow's milk was the most predominate milk type consumed among toddlers.

Dietary Energy Density from Infancy to 5 Years: Results from NHANES 2009-2018.

BACKGROUND: Nutrient-dense foods, which are often low in energy density (ED), are recommended for a healthy diet in infants and children. How ED changes during the transition from a complementary diet in infancy to a conventional diet is unknown. OBJECTIVES: We aimed to describe the ED, the amount of energy (e.g., kcal) per weight (e.g., g), of food or beverage in infants and preschool-age children. It was hypothesized that ED would be higher among older children. METHODS: The ED of food (ED-Food Only) and of food and all beverages excluding human milk and infant formula (ED-Food and Beverages) of children's (6 mo-5 y) diets were examined overall and by age subgroups using data from the NHANES (2009-2018). Survey-adjusted linear regression followed by pairwise comparisons were used to compare ED across age subgroups. The percentages of calories consumed from low-, medium-, and high-ED foods across age subgroups were also examined. RESULTS: Mean ED-Food Only was 1.21 kcal/g (95% CI: 1.13, 1.29 kcal/g) among 6- to 11-mo-olds and 1.62 kcal/g (95% CI: 1.54, 1.69 kcal/g) among 12- to 17-mo-olds (P < 0.05). ED-Food and Beverages was higher across consecutive age subgroups from 0.99 kcal/g (95% CI: 0.96, 1.02 kcal/g) in 12-17 mo through 3 y (1.22 kcal/g; 95% CI: 1.19, 1.26 kcal/g; P < 0.05). Mean percentage of calories consumed from low-ED food (≤1.0 kcal/g) became lower with age from 6- to 11-mo-olds (47.3%; 95% CI: 44.3%, 50.4%) through 18- to 23-mo-olds (16.2%; 95% CI: 14.5%, 17.9%; P < 0.05). A greater percentage of calories was consumed from high-ED food (≥3.0 kcal/g) among 18- to 23-mo-olds (39.0%; 95% CI: 37.1%, 40.9%) than among 12- to 17-mo-olds (34.0%; 95% CI: 32.0%, 35.9%; P < 0.05). CONCLUSIONS: ED increased across age subgroups, driven by a decrease in the percentage of calories consumed from low-ED food and an increase in the percentage of calories consumed from high-ED food.

Feasibility of Implementing a Food Skills Intervention.

BACKGROUND: Food skills are defined as meal planning, preparation, shopping, budgeting, resourcefulness, and label reading/consumer awareness. To date, food skills have not been tested in intervention-based studies. OBJECTIVE: To evaluate the feasibility of implementing a food skills intervention. DESIGN: This was an 8-week prospective food skills intervention. Study measures were completed through questionnaires provided before the start of the intervention and after the intervention was completed. For questionnaires, the web platform REDCap was used. PARTICIPANTS AND SETTING: Thirty parents (aged 18 years or older) with at least one child (aged 2 to 12 years), attended weekly virtual intervention sessions via Zoom. The intervention took place from August to October 2020 with assessment measures collected within 2 months of the start and end date of the intervention. Participants were from the mid-Atlantic region of the United States INTERVENTION: A food skills intervention based on behavior modification strategies from the Social Cognitive Theory was implemented. Intervention goals included meal planning (six of seven dinner meals per week), meal plan implementation (at least four of six planned dinner meals), and always using a grocery list when shopping. MAIN OUTCOME MEASURES: Feasibility was evaluated based on parent attendance, number of self-monitoring booklets completed, adherence to goals, implementation fidelity, and qualitative responses to interviews. Change in food skills confidence and nutrition knowledge were also assessed. STATISTICAL ANALYSIS: Descriptive statistics and qualitative responses were used to describe feasibility. Paired t tests were used to evaluate change in food skills confidence and nutrition knowledge from baseline to 8 weeks. RESULTS: Parents attended a mean of 7.6 ± 1.0 (out of eight) sessions and completed a mean of 6.2 ± 1.7 (out of seven) self-monitoring booklets. Parents planned a mean of 6.1 ± 1.5 dinners per week and implemented a mean of 4.7 ± 1.6 of the six planned dinners, achieving the intervention goals. Of the mean 1.2 ± 0.6 trips/week to the grocery store reported, grocery lists were used a mean of 1.1 ± 0.6 times. Mean food skills confidence score increased significantly from baseline to 8 weeks (baseline = 86.5 ± 18.0; 8 weeks = 101.4 ± 15.3; P < 0.001). Mean nutrition knowledge score also significantly increased (baseline = 64.1 ± 7.2; 8 weeks = 69.1 ± 6.6; P < 0.001). Parents reported on a scale of zero ("easy") to 10 ("difficult") a mean difficulty rating of 2.4 ± 2.4 for meal planning, a mean of 2.1 ± 2.1 for meal plan implementation, and a mean of 1.0 ± 1.7 for always using a grocery shopping list indicating acceptability of goals. CONCLUSIONS: Feasibility of a food skills intervention was demonstrated by high session attendance, high numbers of self-monitoring booklets turned in, high achievement of intervention goals, parent acceptability, and high ratings of implementation fidelity. There was an increase in food skill confidence and nutrition knowledge. Future research should examine the efficacy of changing food skill behaviors on dietary intake.

The Macronutrient Composition of Infant Formula Produces Differences in Gut Microbiota Maturation That Associate with Weight Gain Velocity and Weight Status.

This proof-of-principle study analyzed fecal samples from 30 infants who participated in a randomized controlled trial on the effects of the macronutrient composition of infant formula on growth and energy balance. In that study, infants randomized to be fed cow milk formula (CMF) had faster weight-gain velocity during the first 4 months and higher weight-for-length Z scores up to 11.5 months than those randomized to an isocaloric extensive protein hydrolysate formula (EHF). Here we examined associations among infant formula composition, gut microbial composition and maturation, and children's weight status. Fecal samples collected before and monthly up to 4.5 months after randomization were analyzed by shotgun metagenomic sequencing and targeted metabolomics. The EHF group had faster maturation of gut microbiota than the CMF group, and increased alpha diversity driven by Clostridia taxa. Abundance of Ruminococcus gnavus distinguished the two groups after exclusive feeding of the assigned formula for 3 months. Abundance of Clostridia at 3-4 months negatively correlated with prior weight-gain velocity and body weight phenotypes when they became toddlers. Macronutrient differences between the formulas likely led to the observed divergence in gut microbiota composition that was associated with differences in transient rapid weight gain, a well-established predictor of childhood obesity and other comorbidities.

Apiaceous vegetables protect against acrolein-induced pulmonary injuries through modulating hepatic detoxification and inflammation in C57BL/6 male mice.

Acrolein (Acr) is a reactive aldehyde in the environment. Acr causes oxidative stress and a cascade of catalytic events and has, thereby, been associated with increased risk of pulmonary diseases. Whether apiaceous vegetables (API) consumption can prevent Acr-induced pulmonary toxicity has not yet been explored hence, we investigated the effects of API on Acr-induced pulmonary damages in C57BL/6J mice. The mice were assigned into either negative control [NEG group; American Institute of Nutrition (AIN)-93G diet only], positive control (POS group; AIN-93G+Acr) or API intervention group (API group; AIN-93G+21% API+Acr). After 1 week of dietary intervention, the POS and API mice were exposed to Acr (10 µmol/kg body weight/day) for 5 days. During the exposure period, assigned diets remained the same. Prominent indicators lung of toxicity of POS mice were found, including mucus accumulation, macrophage infiltration, and hemorrhage, all of which were ameliorated by the API. Serum and lung inflammation markers, such as a tumor necrosis factor alpha were also increased by Acr while reduced by API. In the liver, API upregulated expression of glutathione S-transferases, which enhanced the metabolism of Acr into water-soluble 3-hydroxypropyl mercapturic acid for excretion. This is consistent with observed reductions in serum Acr-protein adducts. Taken together, our results suggest that API may provide protection against Acr-induced pulmonary damages and inflammation via enhancement of the hepatic detoxification of Acr.

Prevalence and characteristics of starvation-related malnutrition in a mid-Atlantic healthcare system: A cohort study.

BACKGROUND: Malnutrition in the hospital negatively impacts outcomes, including readmissions, mortality, and cost. Starvation-related malnutrition (SRM) is a state of chronic undernutrition with little to no inflammation. Research on SRM within the hospital setting is lacking. Our objective was to determine the prevalence and characteristics of malnutrition within the hospital, focusing on characteristics associated with readmissions in those with SRM. METHODS: We conducted a retrospective cohort study analyzing characteristics of adult in patients with acute disease-related malnutrition (ADM) and chronic disease-related malnutrition (CDM) compared with patients with SRM. Prevalence of all malnutrition types was calculated as the total number of malnourished patients divided by the total number of hospital discharges. Analysis of variance with Tukey post hoc analysis was performed to determine differences between characteristics of patients with SRM and other forms of malnutrition. RESULTS: Total prevalence of malnutrition was 2.8%. Of malnourished patients, 17.6%, 79.9%, and 2.5% had ADM, CDM, and SRM, respectively. Patients with SRM had lower body mass index (BMI) (P < .001) and higher rates of readmission (P = 0.046), infectious disease (P < .001), psychiatric disease (P < .001), and substance abuse (P < .001) than patients with ADM or CDM. Readmitted patients with SRM had lower BMI and higher rates of infection and drug abuse than those without readmission. CONCLUSION: The high incidence of comorbid substance abuse and mental illness in patients with SRM provide important targets for treatment that might reduce readmission and improve outcomes.

Effects of Early Weight Gain Velocity, Diet Quality, and Snack Food Access on Toddler Weight Status at 1.5 Years: Follow-Up of a Randomized Controlled Infant Formula Trial.

This study followed children who participated in a feeding trial in which the type of randomized infant formula fed from 2 weeks significantly affected weight gain velocity during the first 4 months and weight-for-length Z (WLZ) scores up to 11.5 months. We focused on measures of anthropometry, dietary intakes, and parenting related to the provision of snack foods that were collected at the end of the trial (1 year) and the 1.5 years follow-up visit. We not only describe what toddlers are eating, but we also determined the independent and/or interactive effects of randomized formula group, early weight gain velocity, the nutrient content of the post-formula diet, and maternal snack food practices, on toddlers' weight status. Diet quality underwent drastic changes during this 6-month period. As infant formula disappeared from the diet, fruit and 100% fruit juice intake increased slightly, while intake of "What We Eat in America" food categories sweetened beverages and snacks and sweets more than doubled. Added sugars accounted for 5% of energy needs at 1 year and 9% at 1.5 years. Generalized linear mixed models revealed that, independent of the randomized formula group, greater velocities of weight gain during early infancy and lower access to snacks as toddlers predicted higher WLZ and a greater proportion of toddlers with overweight at 1.5 years. Energy and added sugar intake had no significant effects. These findings add to the growing body of evidence that unhealthy dietary habits are formed even before formula weaning and that, along with improving early diet, transient rapid weight gain and parental feeding practices are modifiable determinants that may reduce risks for obesity.

Impact of early rapid weight gain on odds for overweight at one year differs between breastfed and formula-fed infants.

BACKGROUND: Early rapid weight gain (RWG) increases, whereas longer durations of breastfeeding decreases, odds for later obesity. OBJECTIVES: To determine the independent and interactive effects of early weight gain and diet on infant weight status trajectories and odds for overweight at 1 year. METHODS: We conducted secondary analysis on data from two longitudinal trials with repeated anthropometric measures. One trial consisted of predominantly or exclusively breastfed (BF, n = 97) infants, whereas the other consisted of exclusively formula-fed (FF, n = 113) infants. Weight-for-length z-score (WLZ) change from 0.5 to 4.5 months was used to categorize early weight gain as slow (<-0.67; SWG), normal (-0.67 to 0.67; NWG) or rapid (>0.67; RWG). Linear-mixed effects models were fit to examine the independent effects and interaction of early diet (BF, FF) and weight gain (SWG, NWG, RWG) groups on WLZ trajectories; logistic regression was used to assess odds for overweight at 1 year. RESULTS: While similar percentages (41%) of BF and FF infants experienced RWG, we found a significant diet × early weight gain group interaction (P < .001) on weight status. At 1 year, the WLZ of FF infants with RWG (1.57 ± 0.99) was twice that of BF infants with RWG (0.83 ± 0.92). Using BF infants with NWG as the reference group, FF infants with RWG had increased odds [OR: 25.3 (95% CI: 3.21, 199.7)] for overweight at 1 year, whereas BF infants with RWG did not. CONCLUSIONS: Early diet interacts with early weight gain and influences weight status trajectories and overweight risk at 1 year.

Early Weight Gain Forecasts Accelerated Eruption of Deciduous Teeth and Later Overweight Status during the First Year.

OBJECTIVES: To determine whether early diet and weight gain velocity have independent or interactive effects on deciduous teeth emergence and overweight status during the first year. STUDY DESIGN: Monthly measures of anthropometry and teeth eruption were collected during a 1-year trial (0.5-12.5 months) on formula-fed infants in which the type of randomized infant formula (cow milk or extensively hydrolyzed protein) diet significantly affected early (0.5-4.5 months) weight gain velocity. Generalized linear mixed models determined whether early diet and weight gain velocity had independent or interactive effects on timing and pattern of teeth eruption. Data from a trial on breastfed infants were used to explore effects of breast milk vs infant formula diets on teeth eruption and overweight status at 10.5 months. RESULTS: Independent of infant formula diet, velocities of weight gain had direct effects on the age of first deciduous tooth (P < .04) and number of erupted teeth over time (P < .002). Greater velocity of weight gain from 0.5 to 4.5 months caused earlier and more frequent eruption of deciduous teeth from 4.5 to 12.5 months. Exploratory follow-up analyses on the breastfed and formula-fed diet groups found early weight gain velocity (P = .001), but not diet or its interaction, had significant effects. Infants in the upper quartile for weight gain velocity had more primary teeth (P = .002), and a greater proportion of them were overweight (P < .001) at 10.5 months. CONCLUSIONS: Faster weight gain accretion forecasted accelerated primary teeth eruption and increased percentage of children who were overweight-risk factors for dental caries and obesity. TRIAL REGISTRATION: ClinicalTrials.govNCT01700205 [2012-2015] and NCT01667549 [2012-2015].

Guidance for the Conduct and Reporting of Clinical Trials of Breast Milk Substitutes.

Importance: Breast milk substitutes (BMS) are important nutritional products evaluated in clinical trials. Concerns have been raised about the risk of bias in BMS trials, the reliability of claims that arise from such trials, and the potential for BMS trials to undermine breastfeeding in trial participants. Existing clinical trial guidance does not fully address issues specific to BMS trials. Objectives: To establish new methodological criteria to guide the design, conduct, analysis, and reporting of BMS trials and to support clinical trialists designing and undertaking BMS trials, editors and peer reviewers assessing trial reports for publication, and regulators evaluating the safety, nutritional adequacy, and efficacy of BMS products. Design, Setting, and Participants: A modified Delphi method was conducted, involving 3 rounds of anonymous questionnaires and a face-to-face consensus meeting between January 1 and October 24, 2018. Participants were 23 experts in BMS trials, BMS regulation, trial methods, breastfeeding support, infant feeding research, and medical publishing, and were affiliated with institutions across Europe, North America, and Australasia. Guidance development was supported by an industry consultation, analysis of methodological issues in a sample of published BMS trials, and consultations with BMS trial participants and a research ethics committee. Results: An initial 73 criteria, derived from the literature, were sent to the experts. The final consensus guidance contains 54 essential criteria and 4 recommended criteria. An 18-point checklist summarizes the criteria that are specific to BMS trials. Key themes emphasized in the guidance are research integrity and transparency of reporting, supporting breastfeeding in trial participants, accurate description of trial interventions, and use of valid and meaningful outcome measures. Conclusions and Relevance: Implementation of this guidance should enhance the quality and validity of BMS trials, protect BMS trial participants, and better inform the infant nutrition community about BMS products.

Qualitative Research on the Real-Time Decision Making of WIC Participants While Food Shopping: Use of Think-Aloud Methodology.

BACKGROUND: People of lower socioeconomic status often experience disparities related to dietary intake as compared with People of higher socioeconomic status. Foods purchased influence the availability of foods in the home environment, and availability of foods in the home environment is associated with dietary intake. OBJECTIVE: To identify what factors influence food purchasing decisions of low-income parents while food shopping. DESIGN: A qualitative study using think-aloud methodology, the processing of information through verbalization concurrent with task performance, was used to verbally capture real-time decision making. PARTICIPANTS AND SETTING: Twenty-eight parents with a preschool-aged child enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Study visits took place at the WIC clinic office and local grocery stores. MAIN OUTCOMES: Reasons for making decisions while food shopping. ANALYSIS: Audio recordings were transcribed, and thematic analysis was used to analyze the data. Descriptive statistics were used to characterize demographics and shopping behaviors. RESULTS: A parent's decision in a food purchase was based on child preference, value, need of an item, or the parent choice for a product. In addition, themes emerged related to participant shopping behavior included the influence of participation in WIC on food and beverage purchases, multiple trips to the store, and a frequent focus on purchasing bottled water and juice. The average shopping trip was 31.5±15.7 minutes, and the median amount spent was $38.61. CONCLUSION: Understanding the influences of parent decisions while making food purchases can better help inform the nutrition education provided as part of WIC.

Food Purchasing Behaviors of WIC Participants: What Non-WIC Eligible Foods Items Are Being Purchased.

PURPOSE: To describe items purchased during a shopping trip by families enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). DESIGN: Cross-sectional, quantitative, observational study. SETTING: Grocery stores in the Newark, Delaware area. PARTICIPANTS: A convenience sample of mothers (n = 35) were recruited from a local WIC Clinic waiting room. MEASURES: The number of items categorized into 12 food groups, (baby food, beverages, dairy, fats/oils, fruit, vegetables, grains, protein, preprepared, seasonings, sweets, and other) extracted from grocery receipts. ANALYSIS: Means and frequencies were used to analyze continuous and categorical data, respectively, for receipt data and demographics. RESULTS: The most common foods purchased not included as part of the WIC food package included protein (1.0 [standard deviation, SD 3.0]), preprepared foods (0.9 [SD 2.0]), and other foods (1.0 [SD 1.9]). The most frequent foods purchased included as part of the WIC food package included fruit (2.3 [SD 1.5]), grains (1.7 [SD 1.6]), and dairy (1.5 [SD 0.8]). CONCLUSIONS: Further investigation of foods purchased that were not part of the WIC food package is warranted, as understanding food purchases particularly among low-income mothers may inform nutrition education practices.

Energy balance in obese, mechanically ventilated intensive care unit patients.

OBJECTIVES: The aims of this study were, first, to compare the predicted (calculated) energy requirements based on standard equations with target energy requirement based on indirect calorimetry (IC) in critically ill, obese mechanically ventilated patients; and second, to compare actual energy intake to target energy requirements. METHODS: We conducted a prospective cohort study of mechanically ventilated critically ill patients with body mass index ≥30.0 kg/m2 for whom enteral feeding was planned. Clinical and demographic data were prospectively collected. Resting energy expenditure was measured by open-circuit IC. American Society of Parenteral and Enteral Nutrition (APSPEN)/Society of Critical Care Medicine (SCCM) 2016 equations were used to determine predicted (calculated) energy requirements. Target energy requirements were set at 65% to 70% of measured resting energy expenditure as recommended by ASPEN/SCCM. Nitrogen balance was determined via simultaneous measurement of 24-h urinary nitrogen concentration and protein intake. RESULTS: Twenty-five patients (mean age: 64.5 ± 11.8 y, mean body mass index: 35.2 ± 3.6 kg/m2) underwent IC. The mean predicted energy requirement was 1227 kcal/d compared with mean measured target energy requirement of 1691 kcal/d. Predicted (calculated) energy requirements derived from ASPEN/SCCM equations were less than the target energy requirements in most cases. Actual energy intake from enteral nutrition met 57% of target energy requirements. Protein intake met 25% of target protein requirement and the mean nitrogen balance was -2.3 ± 5.1 g/d. CONCLUSIONS: Predictive equations underestimated target energy needs in this population. Further, we found that feeding to goal was often delayed resulting in failure to meet both protein and energy intake goals.