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BACKGROUND: The effects of plant-based milk consumption on the growth of children are unclear. OBJECTIVES: We aimed to evaluate the relationship between plant-based milk consumption and BMI in childhood. Secondary objectives were to examine the association with height and whether these relationships are mediated by dairy milk intake and modified by age or the type of plant-based milk consumed. METHODS: A prospective cohort study was conducted in healthy children aged 1-10 y through the TARGet Kids! primary care research network in Toronto, Canada. Linear mixed-effect modeling and logistic generalized estimating equations were used to evaluate the association between plant-based milk consumption (number of 250 mL cups/d) and BMI. A mediation analysis was conducted to examine whether dairy milk intake mediated these relationships. Effect modification by age and type of plant-based milk was explored. RESULTS: Among 7195 children (mean age: 3.1 y; 52.3% male), higher plant-based milk consumption was associated with lower BMI (P = 0.0002) and height (P = 0.005). No association was found with BMI categories. Lower dairy milk intake partially mediated these relationships. A child aged 5 y who consumed 3 cups of plant-based milk compared with 3 cups of dairy milk had a lower weight of 0.5 kg and lower height of 0.8 cm. Associations did not change over time and were similar for children who consumed soy milk compared with other plant-based milks. CONCLUSIONS: Plant-based milk consumption was associated with lower BMI and height, but both were within the normal range on average. Future longitudinal studies are needed to determine whether these associations persist over time.
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Leche , Niño , Humanos , Preescolar , Lactante , Animales , Índice de Masa Corporal , Estudios Prospectivos , Estudios Longitudinales , CanadáRESUMEN
OBJECTIVE: Processing speed is suboptimal among preterm-born children which is of concern as it is a foundational skill supporting higher-level cognitive functions. The study objective was to evaluate associations between early-life nutrition and processing speed in childhood. METHODS: Macronutrient and human milk (mother's own, donor) intakes from 137 children born preterm with very low birth weight enrolled in a nutrition feeding trial were included. Processing speed was evaluated at age 5 using the Wechsler Preschool and Primary Scale of Intelligence-fourth edition Processing Speed Index. Associations between early-life nutrition and processing speed were explored through linear regression. RESULTS: Children had a mean (standard deviation [SD]) birth gestational age of 28.1 (2.5) weeks, weight of 1036 (260) g and 52% were male. The mean (SD) assessment age was 5.7 (0.2) years. Sex-dependent relationships were identified between first postnatal month protein, lipid and energy intakes and processing speed at 5 years. For females, lower protein (per 0.1 g/kg/d: -0.88, 95% confidence interval [CI]: -1.53, -0.23; p = 0.01) and energy (per 10 kcal/kg/d: -2.38, 95% CI: -4.70, -0.05; p = 0.03) intakes were related to higher processing speed scores. Mother's milk provision was positively associated (per 10% increase: 0.80, 95% CI: 0.22, 1.37; p = 0.01) and donor milk was negatively associated (per 10% increase: -1.15, 95% CI: -2.22, -0.08; p = 0.04) with processing speed scores; no sex differences were observed. CONCLUSIONS: First postnatal month nutrition was related to processing speed at age 5 in children born preterm with very low birth weight. Early-life nutrition that supports processing speed may be leveraged to improve later cognitive outcomes for this vulnerable population.
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Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Leche Humana , Humanos , Masculino , Femenino , Recién Nacido de muy Bajo Peso/crecimiento & desarrollo , Preescolar , Recien Nacido Prematuro/crecimiento & desarrollo , Recién Nacido , Fenómenos Fisiológicos Nutricionales del Lactante , Cognición , Estado Nutricional , Desarrollo Infantil , Edad Gestacional , Velocidad de ProcesamientoRESUMEN
Mother's/parent milk is the optimal way to feed infants and when unavailable, supplemental donor human milk is preferred. A safe supply of donor human milk should be available for all low birthweight infants for whom it has been shown to reduce morbidity. Human milk banking has been in existence for more than a century, although largely shut down during the 1980s, primarily due to fears of human immunodeficiency virus transmission. With renewed security in milk banking, has come an exponential growth in human donor milk use. Guidelines for milk banking have been published in many countries including Australia, France, India, Italy, Spain, Switzerland, the United Kingdom and the nonprofit organization PATH. The European Milk Bank Association and the Human Milk Banking Association of North America have also published recommendations for milk banks throughout Europe and North America, respectively. Although there is variability among these guidelines, there is general consensus on quality control measures required to provide a supply of safe donor milk. These measures include effective donor screening, safe collection, transport and storage of milk, standardized pasteurization and bacteriological testing. Operational considerations are also critical, such as appropriate training for staff, equipment maintenance and cleaning, protocol and record keeping and inspection and accreditation. Clearly delineating these key quality control measures provides an excellent foundation for establishing international guidelines. Acceptable modifications must be established for low- and middle-income countries that do not have sufficient resources; overly burdensome guidelines may make establishing a milk bank unnecessarily prohibitive. This review presents a summary of current best practices for human milk banking.
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Bancos de Leche Humana , Leche Humana , Bancos de Leche Humana/normas , Humanos , Control de Calidad , Pasteurización/métodos , Recién Nacido , Guías de Práctica Clínica como Asunto , Lactante , FemeninoRESUMEN
BACKGROUND: Rapid growth and excess weight in early childhood are associated with obesity risk. While maternal preconception BMI has been identified as a potential risk factor, the role of paternal preconception BMI is less clear. OBJECTIVES: To examine the association between paternal preconception BMI and age- and sex-standardized WHO BMI z-score (zBMI) growth rates, zBMI, and weight status, in 0- to 10-year-old children. To determine whether these associations differed by child sex and maternal preconception weight status. METHODS: A longitudinal cohort study was conducted through The Applied Research Group for Kids (TARGet Kids!). Children (n = 218) underwent repeated measures of height and weight from birth to 10 years old. Piecewise linear mixed models were used to assess the association between paternal preconception BMI and child zBMI growth rates (zBMI SD units/month) between 0, 4, 30, 48 and 120 months of age. Linear mixed models were used to examine the association with child zBMI, and logistic generalized estimation equations (GEE) were used to assess the association with child weight status. Child sex and maternal preconception weight status were tested as effect modifiers. RESULTS: Paternal preconception BMI was associated with child zBMI growth rate, mean zBMI and weight status in boys, but not girls. A 5 kg/m2 higher paternal preconception BMI was associated with approximately 0.01 zBMI SD unit/month higher growth rate for boys born to mothers with preconception overweight. Higher paternal BMI was associated with higher mean zBMI and increased odds of overweight and obesity in boys, with greater effects seen when mothers had preconception overweight compared to normal weight. CONCLUSION: Paternal preconception BMI was associated with child zBMI growth rate, zBMI and weight status in boys, with greater effects when the biological mother had preconception overweight or obesity. Further understanding of sex differences in paternal preconception weight effects in children is needed.
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Padre , Sobrepeso , Humanos , Niño , Masculino , Preescolar , Femenino , Recién Nacido , Lactante , Sobrepeso/epidemiología , Sobrepeso/complicaciones , Estudios Longitudinales , Índice de Masa Corporal , Obesidad/epidemiología , Obesidad/complicacionesRESUMEN
OBJECTIVE: To examine associations between weight and head circumference (HC) changes and neurodevelopment in preterm infants. STUDY DESIGN: This retrospective cohort study of Canadian Neonatal Network and Canadian Neonatal Follow-Up Network sites included preterm infants born 2010-2018. Logistic regression and model diagnostics evaluated relationships between changes in z score and velocity of weight and HC from birth to discharge from a tertiary neonatal intensive care unit, discharge to 18-24 months corrected age (CA), and birth to 18-24 months CA and significant cognitive/motor impairment at 18-24 months CA classified using a Bayley Scales of Infant and Toddler Development-Third Edition cognitive or motor composite score <70. RESULTS: In total, 4530 infants (53.0% male) with a mean (SD) gestational age of 26.3 (1.4) weeks and birth weight of 920 (227) g were included. Weight and HC changes were associated with lower odds of significant cognitive/motor impairment including an OR of 0.87 (95% CI: 0.83, 0.91; P < .001) for a 1-g/d increase in weight from discharge to 18-24 months CA and 0.81 (95% CI: 0.75, 0.88; P < .001) for a 1-unit increase in HC z score from birth to 18-24 months CA. Associations were not statistically significant in morbidity-free neonates. Weight and HC gains poorly discriminated between infants with and without significant cognitive/motor impairment (areas under the receiver operating characteristic curve of <0.64). No growth measure had a clinically useful balance of sensitivity and specificity. CONCLUSIONS: Weight and HC changes were associated with significant cognitive/motor impairment but had poor discriminatory capability. Neonatal morbidities may make a larger contribution than postnatal growth to neurodevelopment.
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Desarrollo Infantil , Recien Nacido Prematuro , Lactante , Recién Nacido , Humanos , Masculino , Embarazo , Femenino , Edad Gestacional , Estudios Retrospectivos , Canadá/epidemiologíaRESUMEN
BACKGROUND: Risk factors for problematic child eating behaviors and food preferences are thought to begin during the preconception period. It is unknown if maternal preconception body mass index (BMI) is associated with child nutritional risk factors (eg, poor dietary intake and eating behaviors). OBJECTIVES: We aimed to determine whether maternal preconception BMI was associated with child nutritional risk. METHODS: In this longitudinal cohort study, a secondary data analysis of children ages 18 mo to 5 y were recruited from The Applied Research Group for Kids (TARGet Kids!), a primary care practice-based research network in Canada. The primary exposure was maternal preconception BMI. The primary outcome was parent-reported child nutritional risk score, measured using the Nutrition Screening for Every Preschooler/Toddler (NutriSTEP), an age-appropriate validated questionnaire. Fitted linear mixed effects models analyzed associations between maternal preconception BMI and child nutritional risk after adjusting for covariates. RESULTS: This study included 4733 children with 8611 repeated NutriSTEP observations obtained between ages 18 mo to 5 y. The mean (standard deviation [SD]) maternal preconception BMI was 23.6 (4.4), where 73.1% of mothers had a BMI ≤24.9 kg/m2, and 26.9% had a BMI ≥25 kg/m2. The mean (SD) NutriSTEP total score was 13.5 (6.2), with 86.6% at low risk (score <21) and 13.4% at high risk (score ≥21). Each 1 unit increase in maternal preconception BMI was associated with a 0.09 increase in NutriSTEP total score (95% confidence interval [CI]: 0.05, 0.12; P ≤ 0.001). After stratification, each 1 unit increase in maternal BMI was associated with a 0.06 increase in mean NutriSTEP total score (95% CI: 0.007, 0.11; P = 0.025) in toddlers and 0.11 increase in mean NutriSTEP total score (95% CI: 0.07, 0.15; P < 0.001) in preschoolers. CONCLUSION: Higher maternal preconception BMI is associated with slightly higher NutriSTEP total scores. This provides evidence that the preconception period may be an important time to focus on for improving childhood nutrition. This study was registered at clinicaltrials.gov as NCT01869530.
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Conducta Alimentaria , Estado Nutricional , Femenino , Humanos , Preescolar , Índice de Masa Corporal , Estudios Longitudinales , Factores de RiesgoRESUMEN
OBJECTIVE: To assess the prevalence, severity and socio-demographic predictors of household food insecurity among vulnerable women accessing the Canada Prenatal Nutrition Program (CPNP) and to examine associations between household food insecurity and breastfeeding practices to 6 months. DESIGN: Cohort investigation pooling data from two studies which administered the 18-item Household Food Security Survey Module at 6 months postpartum and collected prospective infant feeding data at 2 weeks and 2, 4 and 6 months. Household food insecurity was classified as none, marginal, moderate or severe. Logistic regression analyses were performed to assess predictors of household food insecurity and associations between household food security (any and severity) and continued and exclusive breastfeeding. SETTING: Three Toronto sites of the CPNP, a federal initiative targeting socially and/or economically vulnerable women. PARTICIPANTS: 316 birth mothers registered prenatally in the CPNP from 2017 to 2020. RESULTS: Household food insecurity at 6 months postpartum was highly prevalent (44 %), including 11 % in the severe category. Risk of household food insecurity varied by CPNP site (P < 0·001) and was higher among multiparous participants (OR 2·08; 95 % CI 1·28, 3·39). There was no association between the prevalence or severity of food insecurity and continued or exclusive breastfeeding to 6 months postpartum in the adjusted analyses. CONCLUSIONS: Household food insecurity affected nearly half of this cohort of women accessing the CPNP. Further research is needed on household food insecurity across the national CPNP and other similar programmes, with consideration of the implications for programme design, service delivery and policy responses.
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Abastecimiento de Alimentos , Periodo Posparto , Lactante , Embarazo , Humanos , Femenino , Estudios Prospectivos , Canadá , Inseguridad AlimentariaRESUMEN
BACKGROUND: The timing of introduction to solid food has been associated with eczema and wheezing in childhood. Our aim was to determine whether differences persist within the recommended 4 to 6 month age range. METHODS: A longitudinal cohort study with repeated measures was conducted among children from birth to 10 years of age who were participating in the TARGet Kids! practice based research network in Toronto, Canada. The primary exposure was the timing of introduction to infant cereal as the first solid food. The primary outcome was eczema and the secondary outcome was wheezing collected by parent report using the validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Multinomial generalized estimating equations were used and effect modification by family history of asthma and breastfeeding duration were explored. RESULTS: Of the 7843 children included, the mean (standard deviation) age of introduction to infant cereal was 5.7 (1.9) months. There was evidence for family history of asthma and breastfeeding duration to be effect modifiers in the eczema (P = 0.04) and wheezing (P = 0.05) models. Introduction to infant cereal at 4 vs. 6 months of age was associated with higher odds of eczema (OR 1.62; 95% CI: 1.12, 2.35; P = 0.01) among children without a family history of asthma who were not breastfeeding when solid foods were introduced. Introduction to infant cereal at 4 vs. 6 months of age was associated with a higher odds of wheezing (OR 1.31; 95% CI: 1.13, 1.52; P < .001) among children without a family history of asthma who were breastfeeding when solid foods were introduced. There was little evidence of an association among the remaining strata for either outcome. CONCLUSION: The findings of this study support recommendations to introduce solid food around 6 months of age.
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Asma , Eccema , Lactante , Niño , Femenino , Humanos , Estudios Longitudinales , Ruidos Respiratorios/etiología , Factores de Riesgo , Eccema/epidemiología , Eccema/etiología , Estudios de Cohortes , Lactancia Materna , Asma/epidemiología , Asma/etiología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Many children born very low birth weight (VLBW) experience school struggles with preparedness requiring adequate physical, social, behavioural, cognitive and communication skills. A global assessment of proficiency is necessary to identify those at risk in any such area and direct early intervention accordingly. Study objectives were to characterize developmental vulnerability and school readiness scores in these key domains in a sample of children born VLBW versus their provincial public school system peers and identify early-life infant and parent factors related to suboptimal school readiness. METHODS: The Early Development Instrument teacher assessments of school readiness were collected for a Canadian VLBW sample (NCT02759809). Comparisons between children born VLBW and peers were made. Group differences between children born VLBW considered vulnerable (<10th percentile, not developmentally ready for learning) and not vulnerable were tested and linear regression explored associations between early-life factors and domain scores. RESULTS: Of 77 available Early Development Instrument assessments, median (interquartile range) assessment age was 6.0 (5.7, 6.2) years, birth weight 950 (793, 1250) grammes and birth gestation 27.4 (25.6, 29.7) weeks. A higher proportion of children born VLBW versus peers exhibited vulnerability in Physical Health and Well-being (24.7% vs. 16.1%, p = 0.04), Communication Skills and General Knowledge (23.4% vs. 10.2%, p = 0.0001) and vulnerability in ≥2 domains (26.0% vs. 14.4%, p = 0.004). Children born VLBW classified as vulnerable versus not vulnerable had lower birth gestation and 5-min Apgar. Adjusted regression models found Apgar <7 associated with lower scores for Physical Health and Well-being (-0.86; 95%CI: -1.71, -0.00; p = 0.049), Social Competence (-1.77; 95%CI: -2.92, -0.62; p = 0.003), Emotional Maturity (-1.55; 95%CI: -2.43, -0.66; p = 0.0009) and Communication Skills and General Knowledge (-1.63; 95%CI: -3.19, -0.06; p = 0.04). CONCLUSIONS: This VLBW sample exhibited poor school readiness in multiple domains. Identification of lower birth gestation and Apgar may assist targeted early interventions to mitigate vulnerability.
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Desarrollo Infantil , Recién Nacido de muy Bajo Peso , Recién Nacido , Lactante , Niño , Humanos , Canadá/epidemiología , Peso al Nacer , Instituciones AcadémicasRESUMEN
Background: Parent and physician perceptions of plant milk are unclear. Aim: To explore parent and physician perceptions of plant milk for children and to gain a better understanding of why parents and physicians might choose plant milk for children. Methods: A mixed methods study was conducted using a questionnaire and interviews with parents and physicians participating in the TARGet Kids! cohort study. Questionnaire data were analyzed using descriptive statistics. Interview transcripts were analyzed using thematic analysis. Results: Parents reported a variety of reasons for choosing plant milk for their children including concerns around allergies, the environment, animal welfare, plant-based diet, health benefits, taste and hormones in cow's milk. Parents gave their children various types of plant milks and physicians provided various recommendations to parents of children not consuming cow's milk. Our study identified that 79% of parents and 51% of physicians were unaware that soy milk is the recommended cow's milk substitute for children. Additionally, 26% of parents did not know some plant milks are not fortified and can contain added sugar. Three main themes were identified from interviews about why parents and physicians may choose plant milk for children: (i) healthiness of plant milk; (ii) concerns about hormones; and (iii) environmental impacts. Conclusions: Parents and physicians choose the milk that they believe is healthiest for their child or patient. However, a lack of clarity on the effects of plant milk consumption on children's health resulted in conflicting views on whether plant milk or cow's milk is healthier for children.
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OBJECTIVE: To evaluate the relationship between the timing of infant cereal introduction between 4 and 6 months of age and growth and dietary intake in later childhood. STUDY DESIGN: A longitudinal cohort study was conducted among healthy children 0-10 years of age participating in The Applied Research Group for Kids cohort study between June 2008 and August 2019 in Toronto, Canada. RESULTS: Of 8943 children included, the mean (SD) age of infant cereal introduction was 5.7 (2.1) months. In the primary analysis, children who were introduced to infant cereal at 4 vs 6 months had 0.17 greater body mass index z score (95% CI 0.06-0.28; P = .002) and greater odds of obesity (OR 1.82; 95% CI 1.18-2.80; P = .006) at 10 years of age. In the secondary analysis, children who were introduced to infant cereal at 4 vs 6 months had 0.09 greater height-for-age z score (95% CI 0.04-0.15; P = .002) at 1 year of age, an association that was not observed at 5 or 10 years of age. Children who were introduced to infant cereal at 4 vs 6 months had greater nutrition risk which was primarily determined by a less-favorable eating behavior score at 18 months to 5 years of age (0.18 units higher; 95% CI 0.07-0.29; P = .001). CONCLUSIONS: Introduction of infant cereal at 4 vs 6 months was associated with greater body mass index z score, greater odds of obesity, similar height-for-age z score, and less favorable eating behavior. These findings support recommendations for introducing solid food around 6 months of age.
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Desarrollo Infantil , Grano Comestible , Alimentos Infantiles , Factores de Edad , Estatura , Índice de Masa Corporal , Niño , Preescolar , Estudios de Cohortes , Conducta Alimentaria , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Obesidad Infantil/epidemiología , MuestreoRESUMEN
Infants born preterm or low birth weight are at risk for morbidity, mortality and later neuroimpairment. Appropriate early post-natal growth is associated with better outcomes in-hospital and post-discharge. Therefore, nutritional strategies that support growth may improve the long-term health of this population. Mother's milk with donor milk as a supplement are preferred sources of nutrition for these infants but may not always support growth, especially amongst infants born of very low birth weight (<1500 g) and or those with a major morbidity. Systematic reviews of randomised controlled trials to date demonstrate that multi-nutrient fortification of human milk improves in-hospital growth of preterm infants although data on long-term neurodevelopment are lacking. Further, individualised approaches to fortification based on milk analysis or the infant's metabolic response may improve growth over standard fortification. The evidence is insufficient to inform the timing of introducing fortifier, routine fortification of feeds post-discharge or routine use of fortifiers made from human instead of bovine milk. Importantly, there is insufficient data to determine if these fortification practices improve relevant clinical or neurodevelopmental outcomes. In sum, there is an urgent need for well-designed clinical trials to assess potential benefits and risks of fortification practices and at what cost.
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Recien Nacido Prematuro , Leche Humana , Cuidados Posteriores , Ensayos Clínicos como Asunto , Alimentos Fortificados , Humanos , Lactante , Recién Nacido , Recién Nacido de muy Bajo Peso , Alta del PacienteRESUMEN
OBJECTIVE: To provide updated guidance on pre-conception folic acid and multivitamin supplementation for primary and secondary (recurrence) prevention of neural tube defects and other folate-sensitive congenital anomalies. TARGET POPULATION: Women aged 12-45 years who could become pregnant should be aware of the risk of serious birth defects without adequate pre-conception and first-trimester folic acid supplementation. OPTIONS: Optimizing folic acid supplementation is complex and depends on factors including dosage; type of supplement; bioavailability of folate from food, timing of initiating supplementation; and metabolic and genetic factors. For all women who could become pregnant, a low daily dosage of folic acid is recommended before conception and throughout pregnancy and breastfeeding. High-dosage folic acid supplementation is recommended only for women who can become pregnant and have had a previous pregnancy affected by a neural tube defect or other folate-sensitive congenital anomaly. Directed personalized approaches could be considered and adopted for women who can become pregnant and have complex risks (genetic, medical, or surgical risk factors), using new knowledge of co-factor metabolism and synergy, as well as red blood cell or serum folate testing. Such approaches would require changes to current provincial health care maternal serum folate screening/testing. OUTCOMES: New approaches to oral folic acid supplementation, including triage tools, need to be considered to optimize the benefits of decreasing risk of neural tube defects and folate-sensitive congenital anomalies. BENEFITS, HARMS, AND COSTS: Oral folic acid supplementation, or dietary folate intake combined with a multivitamin/micronutrient supplement, is associated with lower rates of neural tube defects, other folate-sensitive birth defects, and obstetrical complications. The costs are those attributable to daily vitamin supplementation and a healthy, folate-rich diet. EVIDENCE: A literature search was designed and carried in PubMed and the Cochrane Library databases from 1990 to 2021 using following MeSH terms and keywords (and variants): folic acid supplementation; folate food fortification; primary neural tube defect prevention; prevention of recurrence of neural tube defects; folate-sensitive birth defects; folate supplementation benefit; folate supplementation risk; folate pregnant woman physiology; pregnant woman RBC folate level; pregnant woman serum folate levels; folate and epilepsy; folate and obesity. This guideline was based upon expert guidelines or opinions, systematic reviews, randomized controlled clinical trials, and observational case-control studies and case series retrieved, published in English from 1990 to 2021. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: Maternity health care providers (physicians, midwives, nurses) and other providers of pregnancy-related wellness and health counselling. SUMMARY STATEMENTS: RECOMMENDATIONS.
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Ácido Fólico , Defectos del Tubo Neural , Suplementos Dietéticos , Femenino , Ácido Fólico/uso terapéutico , Humanos , Defectos del Tubo Neural/prevención & control , Embarazo , Vitaminas/uso terapéuticoRESUMEN
OBJECTIF: Offrir des recommandations à jour sur l'utilisation de multivitamines et de suppléments d'acide folique avant la conception pour la prévention primaire et secondaire (récidive) des anomalies du tube neural et des autres anomalies congénitales sensibles à l'acide folique. POPULATION CIBLE: Les femmes de 12 à 45 ans qui pourraient devenir enceintes doivent être informées des risques importants d'anomalies congénitales en l'absence d'une supplémentation adéquate en acide folique avant la conception et pendant le premier trimestre. OPTIONS: La supplémentation optimale en acide folique est complexe et repose sur divers facteurs tels que la dose, le type de suppléments, la biodisponibilité du folate dans l'alimentation, le moment du début de la supplémentation ainsi que sur les facteurs métaboliques et génétiques. Pour toutes les femmes qui peuvent devenir enceintes, une faible dose quotidienne d'acide folique est recommandée avant la conception et pendant la grossesse et l'allaitement. La supplémentation à forte dose d'acide folique est recommandée uniquement chez les femmes qui peuvent devenir enceintes et qui ont un antécédent de grossesse avec anomalie du tube neural ou toute autre anomalie congénitale sensible à l'acide folique. Il est possible d'envisager et d'adopter une approche personnalisée chez les femmes qui peuvent devenir enceintes et qui présentent des risques complexes (facteurs de risque génétiques, médicaux ou chirurgicaux) en se fondant sur les nouvelles connaissances en matière de métabolisme et synergie des cofacteurs et sur l'analyse du taux sérique et érythrocytaire d'acide folique. Ce genre d'approche exige une modification des protocoles provinciaux actuels de santé publique concernant le dépistage et l'analyse du taux sérique maternel d'acide folique. RéSULTATS: Les nouvelles stratégies de supplémentation en acide folique par voie orale, y compris dans les outils de triage, doivent être prises en compte pour diminuer de façon optimale le risque d'anomalies du tube neural et d'anomalies congénitales sensibles à l'acide folique. BéNéFICES, RISQUES ET COûTS: On observe une diminution du taux d'anomalies du tube neural, des autres anomalies congénitales sensibles à l'acide folique et des complications obstétricales chez les femmes qui prennent des suppléments oraux d'acide folique ou qui complémentent leur apport alimentaire en folate au moyen de multivitamines ou de suppléments de micronutriments. Les coûts relatifs sont liés à la prise quotidienne de suppléments vitaminiques et à l'adoption d'un régime alimentaire sain et riche en folate. DONNéES PROBANTES: Une recherche a été effectuée dans les bases de données PubMed et Cochrane Library pour trouver des articles publiés entre 1990 et 2021, en utilisant les termes MeSH et mots-clés (et leurs variantes) suivants : folate food fortification; primary neural tube defect prevention; prevention of recurrence of neural tube defects; folate-sensitive birth defects; folate supplementation benefit; folate supplementation risk; folate pregnant woman physiology; pregnant woman RBC folate level; pregnant woman serum folate levels; folate and epilepsy; folate and obesity. Cette directive clinique repose sur des lignes directrices et opinions de spécialistes, des revues systématiques, des essais cliniques randomisés et des études observationnelles de cas-témoin et de séries de cas qui ont été publiés en anglais entre 1990 et 2021. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Fournisseurs de soins de maternité (médecins, sages-femmes et infirmières) et autres fournisseurs d'accompagnement en santé et bien-être lié à la grossesse. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Defectos del Tubo Neural , Suplementos Dietéticos , Femenino , Ácido Fólico , Humanos , EmbarazoRESUMEN
Folates are critical for central nervous system function. Folate transport is mediated by 3 major pathways, reduced folate carrier (RFC), proton-coupled folate transporter (PCFT), and folate receptor alpha (FRα/Folr1), known to be regulated by ligand-activated nuclear receptors. Cerebral folate delivery primarily occurs at the choroid plexus through FRα and PCFT; inactivation of these transport systems can result in very low folate levels in the cerebrospinal fluid causing childhood neurodegenerative disorders. These disorders have devastating effects in young children, and current therapeutic approaches are not sufficiently effective. Our group has previously reported in vitro that functional expression of RFC at the blood-brain barrier (BBB) and its upregulation by the vitamin D nuclear receptor (VDR) could provide an alternative route for brain folate uptake. In this study, we further demonstrated in vivo, using Folr1 knockout (KO) mice, that loss of FRα led to a substantial decrease of folate delivery to the brain and that pretreatment of Folr1 KO mice with the VDR activating ligand, calcitriol (1,25-dihydroxyvitamin D3), resulted in over a 6-fold increase in [13C5]-5-formyltetrahydrofolate ([13C5]-5-formylTHF) concentration in brain tissues, with levels comparable to wild-type animals. Brain-to-plasma concentration ratio of [13C5]-5-formylTHF was also significantly higher in calcitriol-treated Folr1 KO mice (15-fold), indicating a remarkable enhancement in brain folate delivery. These findings demonstrate that augmenting RFC functional expression at the BBB could effectively compensate for the loss of Folr1-mediated folate uptake at the choroid plexus, providing a therapeutic approach for neurometabolic disorders caused by defective brain folate transport.
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Encéfalo/metabolismo , Receptor 1 de Folato/metabolismo , Ácido Fólico/metabolismo , Proteína Portadora de Folato Reducido/metabolismo , Vitamina D/metabolismo , Animales , Transporte Biológico , Biomarcadores , Barrera Hematoencefálica/metabolismo , Cromatografía Liquida , Femenino , Receptor 1 de Folato/genética , Expresión Génica , Inmunohistoquímica , Ratones , Ratones Noqueados , Espectrometría de Masas en TándemRESUMEN
Exclusive breastfeeding (EBF) for 6 months is a global public health goal, but measuring its achievement as a marker of population breastmilk feeding practices is insufficient. Additional measures are needed to understand variation in non-EBF practices and inform intervention priorities. We collected infant feeding data prospectively at seven time points to 6 months post-partum from a cohort of vulnerable women (n = 151) registered at two Canada Prenatal Nutrition Program sites in Toronto, Canada. Four categories of breastmilk feeding intensity were defined. Descriptive analyses included the (i) proportion of participants in each feeding category by time point, (ii) use of formula and non-formula supplements to breastmilk, (iii) proportion of participants practising EBF continuously for at least 3 months; and (iv) frequency of transitions between feeding categories. All participants initiated breastmilk feeding with 70% continuing for 6 months. Only 18% practised EBF for 6 months, but 48% did so for at least 3 continuous months. The proportion in the EBF category was highest from 2 to 4 months post-partum. Supplemental formula use was highest in the first 3 months; early introduction of solids and non-formula fluids further compromised EBF at 5 and 6 months post-partum. Most participants (75%) transitioned between categories of breastmilk feeding intensity, with 35% making two or more transitions. Our data show high levels of breastmilk provision despite a low rate of EBF for 6 months. Inclusion of similar analyses in future prospective studies is recommended to provide more nuanced reporting of breastmilk feeding practices and guide intervention designs.
Asunto(s)
Lactancia Materna , Leche Humana , Estudios de Cohortes , Femenino , Humanos , Lactante , Periodo Posparto , Embarazo , Fenómenos Fisiologicos de la Nutrición PrenatalRESUMEN
BACKGROUND: International guidelines recommend children aged 9 months to 2 years consume whole (3.25%) fat cow's milk, and children older than age 2 years consume reduced (0.1-2%) fat cow's milk to prevent obesity. The objective of this study was to evaluate the longitudinal relationship between cow's milk fat (0.1-3.25%) intake and body mass index z-score (zBMI) in childhood. We hypothesized that higher cow's milk fat intake was associated with lower zBMI. METHODS: A prospective cohort study of children aged 9 months to 8 years was conducted through the TARGet Kids! primary care research network. The exposure was cow's milk fat consumption (skim (0.1%), 1%, 2%, whole (3.25%)), measured by parental report. The outcome was zBMI. Height and weight were measured by trained research assistants and zBMI was determined according to WHO growth standards. A linear mixed effects model and logistic generalized estimating equations were used to determine the longitudinal association between cow's milk fat intake and child zBMI. RESULTS: Among children aged 9 months to 8 years (N = 7467; 4699 of whom had repeated measures), each 1% increase in cow's milk fat consumed was associated with a 0.05 lower zBMI score (95% CI -0.07 to -0.03, p < 0.0001) after adjustment for covariates including volume of milk consumed. Compared to children who consumed reduced fat (0.1-2%) milk, there was evidence that children who consumed whole milk had 16% lower odds of overweight (OR = 0.84, 95% CI 0.77 to 0.91, p < 0.0001) and 18% lower odds of obesity (OR = 0.82, 95% CI 0.68 to 1.00, p = 0.047). CONCLUSIONS: Guidelines for reduced fat instead of whole cow's milk during childhood may not be effective in preventing overweight or obesity.
Asunto(s)
Leche/metabolismo , Obesidad Infantil/metabolismo , Animales , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Masculino , Leche/clasificación , Obesidad Infantil/epidemiología , Estudios ProspectivosRESUMEN
Donor human milk is recommended by the World Health Organization both for its advantageous nutritional and biological properties when mother's own milk is not available and for its recognized support for lactation and breastfeeding when used appropriately. An increasing number of human milk banks are being established around the world, especially in low- and middle-income countries, to facilitate the collection, processing and distribution of donor human milk. In contrast to other medical products of human origin, however, there are no minimum quality, safety and ethical standards for donor human milk and no coordinating global body to inform national policies. We present the key issues impeding progress in human milk banking, including the lack of clear definitions or registries of products; issues around regulation, quality and safety; and ethical concerns about commercialization and potential exploitation of women. Recognizing that progress in human milk banking is limited by a lack of comparable evidence, we recommend further research in this field to fill the knowledge gaps and provide evidence-based guidance. We also highlight the need for optimal support for mothers to provide their own breastmilk and establish breastfeeding as soon as and wherever possible after birth.
Lorsque la mère est dans l'impossibilité d'allaiter, l'Organisation mondiale de la Santé recommande d'opter pour le lait humain provenant de donneuses, tant pour ses propriétés nutritionnelles et biologiques que pour la contribution avérée qu'il apporte à la lactation et à l'allaitement quand il est utilisé à bon escient. Un nombre croissant de banques de lait humain s'établissent dans le monde entier, en particulier dans les pays à faible et moyen revenu, afin de faciliter la collecte, le traitement et la distribution de lait humain provenant de donneuses. Cependant, contrairement à d'autres produits médicaux d'origine humaine, il n'existe aucune norme minimale de qualité, de sécurité et d'éthique en la matière, et aucun organe de coordination global n'a été créé pour guider les politiques nationales. Dans le présent document, nous évoquons les principaux obstacles à la progression des banques de lait humain, notamment l'absence de définition claire ou de registre de produits; les problèmes relatifs à la réglementation, la qualité et la sécurité; ainsi que les questions éthiques entourant la commercialisation et l'exploitation potentielle des femmes. Jugeant cette progression limitée par le manque de données comparables, nous encourageons à mener d'autres recherches dans ce domaine pour combler les lacunes et fournir des orientations fondées sur des preuves. Nous soulignons également la nécessité d'offrir un soutien optimal aux mères afin qu'elles puissent produire leur propre lait et allaiter autant que possible immédiatement après la naissance.
La Organización Mundial de la Salud recomienda la leche humana donada tanto por sus ventajosas propiedades nutricionales y biológicas cuando no se dispone de la propia leche materna como por su reconocido apoyo a la lactancia y al amamantamiento cuando se utiliza de manera adecuada. Cada vez se crean más bancos de leche humana en todo el mundo, sobre todo en los países de ingresos bajos y medios, para facilitar la recogida, el procesamiento y la distribución de leche humana donada. Sin embargo, a diferencia de lo que ocurre con otros productos médicos de origen humano, no existen estándares mínimos de calidad, seguridad y ética para la leche humana donada ni un organismo mundial de coordinación que sirva de base a las políticas nacionales. En este documento se exponen los principales problemas que impiden el progreso de los bancos de leche humana, como la falta de definiciones claras o de registros de productos; los problemas relacionados con la regulación, la calidad y la seguridad; y las preocupaciones éticas sobre la comercialización y la posible explotación de las mujeres. Dado que el progreso de los bancos de leche humana se ve limitado por la falta de evidencias comparables, se recomienda seguir investigando en este campo para compensar los vacíos de conocimiento y proporcionar una guía asistencial. Asimismo, se destaca la necesidad de apoyar al máximo a las madres para que se provean de su propia leche materna y establezcan la lactancia materna tan pronto y siempre que sea posible después del nacimiento.
Asunto(s)
Bancos de Leche Humana , Leche Humana , Lactancia Materna , Femenino , Humanos , Madres , Donantes de TejidosRESUMEN
BACKGROUND: The increase in childhood allergic disease in recent decades has coincided with increased folic acid intakes during pregnancy. Circulating unmetabolized folic acid (UMFA) has been proposed as a biomarker of excessive folic acid intake. OBJECTIVE: We aimed to determine if late-pregnancy serum UMFA and total folate concentrations were associated with allergic disease risk in the offspring at 1 y of age in a population at high risk of allergy. METHODS: The cohort consisted of 561 mother-infant pairs from Western Australia. To be eligible the infant had to have a first-degree relative (mother, father, or sibling) with a history of medically diagnosed allergic disease. Maternal venous blood was collected between 36 and 40 wk of gestation. Serum UMFA was measured by LC-tandem MS. Serum total folate was determined using a microbiological method with chloramphenicol-resistant Lactobacillus rhamnosus as the test organism, and was collected between 36 and 40 wk of gestation. UMFA concentrations were measured by tandem MS using stable isotope dilution; folate concentrations were determined using the microbiological method with standardized kits. Infant allergic disease outcomes of medically diagnosed eczema, steroid-treated eczema, atopic eczema, IgE-mediated food allergy, allergen sensitization, and medically diagnosed wheeze were assessed at 1 y of age. RESULTS: Median (IQR) concentrations for UMFA and serum folate were 1.6 (0.6-4.7) and 53.2 (32.6-74.5) nmol/L, respectively. Of the infants, 34.6% had medically diagnosed eczema, 26.4% allergen sensitization, and 14.9% had an IgE-mediated food allergy. In both adjusted and unadjusted models there was little evidence of association between UMFA or serum folate and any of the infant allergy outcomes. CONCLUSIONS: In this cohort of children at high risk of allergic disease there was no association between maternal UMFA or serum folate concentrations measured in late pregnancy and allergic disease outcomes at 1 y of age.
Asunto(s)
Ácido Fólico/sangre , Hipersensibilidad/epidemiología , Exposición Materna , Alérgenos , Estudios de Cohortes , Eccema/epidemiología , Femenino , Ácido Fólico/metabolismo , Hipersensibilidad a los Alimentos , Humanos , Inmunoglobulina E , Lactante , Embarazo , Estudios Prospectivos , Australia OccidentalRESUMEN
BACKGROUND: Donor milk is the standard of care for hospitalized very low birth weight (VLBW) infants when mother's milk is unavailable; however, growth of donor milk-fed infants is frequently suboptimal. Variability in nutrient composition of donated milk complicates the production of a uniform pooled product and, subsequently, the provision of adequate nutrition to promote optimal growth and development of VLBW infants. We reasoned a machine learning approach to construct batches using characteristics of the milk donation might be an effective strategy in reducing the variability in donor milk product composition. OBJECTIVE: The objective of this study was to identify whether machine learning models can accurately predict donor milk macronutrient content. We focused on predicting fat and protein, given their well-established importance in VLBW infant growth outcomes. METHODS: Samples of donor milk, consisting of 272 individual donations and 61 pool samples, were collected from the Rogers Hixon Ontario Human Milk Bank and analyzed for macronutrient content. Four different machine learning models were constructed using independent variable groups associated with donations, donors, and donor-pumping practices. A baseline model was established using lactation stage and infant gestational status. Predictions were made for individual donations and resultant pools. RESULTS: Machine learning models predicted protein of individual donations and pools with a mean absolute error (MAE) of 0.16 g/dL and 0.10 g/dL, respectively. Individual donation and pooled fat predictions had an MAE of 0.91 g/dL and 0.42 g/dL, respectively. At both the individual donation and pool levels, protein predictions were significantly more accurate than baseline, whereas fat predictions were competitive with baseline. CONCLUSIONS: Machine learning models can provide accurate predictions of macronutrient content in donor milk. The macronutrient content of pooled milk had a lower prediction error, reinforcing the value of pooling practices. Future research should examine how macronutrient content predictions can be used to facilitate milk bank pooling strategies.