Frequent Use of Baby Food Pouches in Infants and Young Children and Associations with Energy Intake and BMI: An Observational Study.

OBJECTIVE: Most wet commercial infant foods are now sold in squeezable 'pouches'. While multiple expert groups have expressed concern about their use, it is not known how commonly they are consumed and whether they impact energy intake or body mass index (BMI). The objectives were to describe pouch use, and determine associations with energy intake and BMI, in infants and young children. METHODS: In this observational cross-sectional study of 933 young New Zealand children (6.0 months-3.9 years), pouch use was assessed by a questionnaire ('frequent' use was consuming food from a baby food pouch ≥5 times/week in the past month), usual energy intake using two 24-h recalls, and BMI z-score calculated using World Health Organization standards. RESULTS: The sample broadly represented the wider population (27.1% high socioeconomic deprivation, 22.5% Maori). Frequent pouch use declined with age (infants 27%, toddlers 16%, preschoolers 8%). Few children were both frequent pouch users and regularly used the nozzle (infants 5%, toddlers 13%, preschoolers 8%). Preschoolers who were frequent pouch users consumed significantly less energy than non-users (-580 kJ [-1094, -67]), but infants (115 [-35, 265]) and toddlers (-206 [-789, 378]) did not appear to have a different energy intake than non-users. There were no statistically significant differences in the BMI z-score by pouch use. CONCLUSIONS: These results do not support the strong concerns expressed about their use, particularly given the lack of evidence for higher energy intake or BMI.

Impact of bariatric surgery on premenopausal women's womanliness: A qualitative systematic review and meta-synthesis.

INTRODUCTION: Obesity is associated with several co-morbidities in women, including disturbed sex hormone regulation with menstrual disturbances, subfertility, hirsutism, and central fat dispersion, all with an impact on sexual function and quality of life. There are few investigations regarding women's experiences of obesity-related altered sex hormone regulation and resolution after bariatric surgery. OBJECTIVES: This systematic review and interpretive meta-synthesis aim to identify the current qualitative knowledge base concerning women undergoing bariatric surgery and experiences of changes after weight loss, emphasising aspects of womanliness. METHODS: A systematic review and qualitative meta-synthesis was conducted to gain a deeper and broader understanding of the available knowledge about premenopausal women's experienced changes after bariatric surgery. Relevant papers were identified by systematically searching PubMed, CINAHL, Embase, PsycInfo, PsycArticles, Scopus, Cochrane Library, Web of Science and Open Grey. The quality of the included studies was assessed, and the data was interpreted and synthesised using Gadamer's hermeneutics. The review protocol was registered on PROSPERO (CRD42023394225). RESULTS: A total of 10 studies were considered relevant and included in the qualitative meta-synthesis. Three fusions were identified and interpreted as: "Womanliness," "A healthy and functioning body," and "Mind and Body Connection." Women experienced a return to womanliness after undergoing bariatric surgery with restored menstruation cycles, improved fertility and changed hair and fat dispersion signalling restored sex hormones. Women value a return to a healthy and functioning body that improves their experience of life and ability to take part in it. However, women experienced difficulties in adapting mentally to the drastic physical changes that occur after undergoing surgery. CONCLUSIONS: Women that have undergone bariatric surgery report several benefits to their health and well-being, although difficulties in adapting mentally to changes in outer appearance need to be managed in order to successfully move forward with a new life after surgery.

Baby Food Pouches, Baby-Led Weaning, and Iron Status in New Zealand Infants: An Observational Study.

Iron deficiency in infants can impact development, and there are concerns that the use of baby food pouches and baby-led weaning may impair iron status. First Foods New Zealand (FFNZ) was an observational study of 625 New Zealand infants aged 6.9 to 10.1 months. Feeding methods were defined based on parental reports of infant feeding at "around 6 months of age": "frequent" baby food pouch use (five+ times per week) and "full baby-led weaning" (the infant primarily self-feeds). Iron status was assessed using a venepuncture blood sample. The estimated prevalence of suboptimal iron status was 23%, but neither feeding method significantly predicted body iron concentrations nor the odds of iron sufficiency after controlling for potential confounding factors including infant formula intake. Adjusted ORs for iron sufficiency were 1.50 (95% CI: 0.67-3.39) for frequent pouch users compared to non-pouch users and 0.91 (95% CI: 0.45-1.87) for baby-led weaning compared to traditional spoon-feeding. Contrary to concerns, there was no evidence that baby food pouch use or baby-led weaning, as currently practiced in New Zealand, were associated with poorer iron status in this age group. However, notable levels of suboptimal iron status, regardless of the feeding method, emphasise the ongoing need for paying attention to infant iron nutrition.

Baby food pouches and Baby-Led Weaning: Associations with energy intake, eating behaviour and infant weight status.

Although concern is frequently expressed regarding the potential impact of baby food pouch use and Baby-Led Weaning (BLW) on infant health, research is scarce. Data on pouch use, BLW, energy intake, eating behaviour and body mass index (BMI) were obtained for 625 infants aged 7-10 months in the First Foods New Zealand study. Frequent pouch use was defined as ≥5 times/week during the past month. Traditional spoon-feeding (TSF), "partial" BLW and "full" BLW referred to the relative proportions of spoon-feeding versus infant self-feeding, assessed at 6 months (retrospectively) and current age. Daily energy intake was determined using two 24-h dietary recalls, and caregivers reported on a variety of eating behaviours. Researchers measured infant length and weight, and BMI z-scores were calculated (World Health Organization Child Growth Standards). In total, 28% of infants consumed food from pouches frequently. Frequent pouch use was not significantly related to BMI z-score (mean difference, 0.09; 95% CI -0.09, 0.27) or energy intake (92 kJ/day; -19, 202), but was associated with greater food responsiveness (standardised mean difference, 0.3; 95% CI 0.1, 0.4), food fussiness (0.3; 0.1, 0.4) and selective/restrictive eating (0.3; 0.2, 0.5). Compared to TSF, full BLW was associated with greater daily energy intake (BLW at 6 months: mean difference 150 kJ/day; 95% CI 4, 297; BLW at current age: 180 kJ/day; 62, 299) and with a range of eating behaviours, including greater satiety responsiveness, but not BMI z-score (6 months: 0.06 (-0.18, 0.30); current age: 0.06 (-0.13, 0.26)). In conclusion, neither feeding approach was associated with weight in infants, despite BLW being associated with greater energy intake compared with TSF. However, infants who consumed pouches frequently displayed higher food fussiness and more selective eating.

Adherence to Infant Feeding Guidelines in the First Foods New Zealand Study.

Infant feeding guidelines provide evidence-based recommendations to support optimal infant health, growth, and development, and exploring adherence to guidelines is a useful way of assessing diet quality. The aim of this study was to determine adherence to the recently updated Ministry of Health "Healthy Eating Guidelines for New Zealand Babies and Toddlers (0-2 years old)". Data were obtained from First Foods New Zealand, a multicentre observational study of 625 infants aged 7.0-10.0 months. Caregivers completed two 24-h diet recalls and a demographic and feeding questionnaire. Nearly all caregivers (97.9%) initiated breastfeeding, 37.8% exclusively breastfed to around six months of age, and 66.2% were currently breastfeeding (mean age 8.4 months). Most caregivers met recommendations for solid food introduction, including appropriate age (75.4%), iron-rich foods (88.3%), puréed textures (80.3%), and spoon-feeding (74.1%). Infants consumed vegetables (63.2%) and fruit (53.9%) more frequently than grain foods (49.5%), milk and milk products (38.6%), and meat and protein-rich foods (31.8%). Most caregivers avoided inappropriate beverages (93.9%) and adding salt (76.5%) and sugar (90.6%). Our findings indicated that while most infants met the recommendations for the introduction of appropriate solid foods, the prevalence of exclusive breastfeeding could be improved, indicating that New Zealand families may need more support.

Women's lived experiences of sex hormones and life-related to bariatric surgery: an interpretative qualitative study.

OBJECTIVES: The study aimed to explore the lived experiences of women with severe obesity before and after undergoing bariatric surgery with a special focus on possible effects of changed sex hormone levels. DESIGN: A qualitative interview study with transcribed text analysis based on Gadamer's hermeneutics. SETTING: Regional hospital and outpatient bariatric clinic in central Sweden. PARTICIPANTS: Ten women (age 23-38 years) having undergone Roux-en-Y gastric bypass surgery between 2016 and 2019 were interviewed. RESULTS: The transcribed interviews were analysed according to Gadamer's hermeneutics. Text horizons, interpreter horizons and fact horizons were derived and formed the fusions 'Recognition of unhealthy body weight', 'Dealing with other people's opinions and society's norms', 'Life has changed in a positive way' and 'Accepting inner self and bodily changes'. CONCLUSION: Women highlighted weight and body size in their responses. The study provided a deeper understanding of the situation of women living with obesity and pros and cons of having undergone bariatric surgery. Experiences of changes in sex hormones and fertility were discussed but not central to the informants. Participants emphasised the need to be prepared and properly supported in dealing with changes in life after bariatric surgery and subsequent weight loss.

Complications following dental treatment in a child with haemophilia A: lessons to be learnt.

A boy in his middle childhood with severe haemophilia reported with facial swelling following dental treatment for a carious upper primary molar done at a private dental clinic elsewhere. On presentation, he had a large, tense and tender swelling of the left cheek and a haematoma on the buccal mucosa adjacent to the treated tooth. The child was found to have a low haemoglobin level. He was taken for an emergency procedure under general anaesthesia for dental extraction with incision and drainage, and simultaneously underwent packed cells and factor replacement. He recovered in the ward postoperatively with no complications and with a gradual reduction of the swelling. This report highlights the importance of caries prevention in children, especially those with haemophilia. They need to be educated about restricting cariogenic foods in their diet and maintaining good oral hygiene. Management of such patients should be carefully coordinated to minimise undesirable outcomes.

Motherhood and motivations for bariatric surgery - a qualitative study.

Obesity and its concomitant comorbidities have a myriad of detrimental effects on health, fertility, and quality of life. Bariatric surgery is an effective treatment for inducing weight loss and reduction of obesity-related comorbidities including subfertility. The aim of this study was to explore the expectations and experiences of women with a desire to have children as a motivation for undergoing bariatric surgery. An inductive qualitative design was used. Fourteen women were interviewed, and transcriptions were analysed with thematic analysis. Two themes emerged: (i) Motherhood and Femininity and (ii) A Normal Life. Participants found no other solution than to seek bariatric surgery to be able to become pregnant and carry a child to term. Coping physically with pregnancy and being an active mother were important factors. Overall, postoperative expectations were met, and the women experienced the effects of normalised sex hormone levels, were more physically mobile, and were released from the previous social hindrances that obesity caused them. This study has clinical implications for providing support and information to women with subfertility considering bariatric surgery and to better understand their experiences of life after bariatric surgery.

Health-Related Quality of Life, Sexuality and Hormone Status after Laparoscopic Roux-En-Y Gastric Bypass in Women.

OBJECTIVE: Few studies have been carried out concerning the influence of bariatric surgery on female sexuality and hormones, particularly utilizing hormone-based questionnaires. The effect of bariatric surgery on sex hormone levels, sexual function and health-related quality of life (HRQL) in women was analyzed in this study. Participants were included in a single-center study at a regional hospital in Sweden, with a duration of one-year follow-up. METHODS: One hundred non-smoking women, undergoing laparoscopic Roux-en-Y gastric bypass, were included in the study. Blood assay for sex-hormone binding globulin (SHBG), testosterone, estrogen, progesterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was analyzed. Participants completed the Female Sexual Function Index (FSFI), Women's Health Questionnaire (WHQ) and Psychological General Well-being Inventory (PGWB) parallel to lab testing. RESULTS: At one-year follow-up, several significant results were found concerning hormones and questionnaires. Testosterone decreased and SHBG increased, N = 68/100. Desire, arousal, orgasm, satisfaction and total score domains for the FSFI increased after one year, N = 53/100. WHQ domains concerning depressed mood, somatic symptoms, memory, anxiety, sexual behavior and attractiveness improved after one year, N = 47/100. All domains in the PGWB (N = 52), including anxiety, depressed mood, positive well-being, self-control, general health, vitality and total score improved at follow-up. Spearman's Rho coefficient analysis found correlation between testosterone/WHQ-sexual problems (0.3), SHBG/WHQ-general health (0.3) and SHBG/FSFI-arousal (-0.3). CONCLUSIONS: Bariatric surgery normalizes levels of sex-hormones in women, and results in improved sexual function, health-related quality of life and psychological well-being.

A comparative analysis of mandated benefit laws, 1949-2002.

OBJECTIVE: To understand and compare the trends in mandated benefits laws in the United States. DATA SOURCES/STUDY SETTING: Mandated benefit laws enacted in 50 states and the District of Columbia for the period 1949-2002 were compiled from multiple published compendia. STUDY DESIGN: Laws that require private insurers and health plans to cover particular services, types of diseases, or care by specific providers in 50 states and the District of Columbia are compared for the period 1949-2002. Legislation is compared by year, by average and total frequency, by state, by type (provider, health care service, or preventive), and according to whether it requires coverage or an offer of coverage. DATA COLLECTION/EXTRACTION METHOD: Data from published tables were entered into a spreadsheet and analyzed using statistical software. PRINCIPAL FINDINGS: A total of 1,471 laws mandated coverage for 76 types of providers and services. The most common type of mandated coverage is for specific health care services (670 laws for 34 different services), followed by laws for services offered by specific professionals and other providers (507 mandated benefits laws for 25 types of providers), and coverage for specific preventive services (295 laws for 17 benefits). On average, a mandated benefit law has been adopted or significantly revised by 19 states, and each state has approximately 29 mandates. Only two benefits (minimum maternity stay and breast reconstruction) are mandated in all 51 jurisdictions and these were also federally mandated benefits. The mean number of total mandated benefit laws adopted or significantly revised per year was 17 per year in the 1970s, 36 per year in the 1980s, 59 per year in the 1990s, and 76 per year between 2000 and 2002. Since 1990, mandate adoption increased substantially, with around 55 percent of all mandated benefit laws enacted between 1990 and 2002. CONCLUSIONS: There was a large increase in the number of mandated benefits laws during the managed care "backlash" of the 1990s. Many states now use mandated benefits to prescribe not only what services and benefits would be provided but how, where, and when services will be provided.

A time contraction effect of acute tail-pinch stress on the associative learning of rats.

The effect of tail-pinch stress interpolated between the saccharin conditioned stimulus (CS) and the illness-inducing unconditioned stimulus (US) during long-trace taste-aversion conditioning was examined in young- and old adult rats with a two-cylinder (saccharin versus water) test. A 2 x 2 x 4 factorial ANOVA was performed on percent-preference-for-saccharin data, with age (young, old), stress condition (stressed, non-stressed), and CS-US interval (22.5-, 45-, 90-, and 180-min) being the factors under consideration. The ANOVA yielded only significant main effects of stress condition and CS-US interval. These findings indicate that stress weakens the CS-US association as evidenced by a higher percent preference for saccharin in the stressed rats than in non-stressed rats at all CS-US intervals. A comparison of the stressed and non-stressed conditioned rats with pseudo-conditioned controls showed that the non-stressed rats formed strong aversions up to the 45-min CS-US interval whereas the stressed rats showed no conditioning beyond the 22.5 min CS-US interval, indicating that stress decreases the effective CS-US interval. Results were interpreted in terms of time-contraction and an internal biological countdown timer hypothesized to govern processes involved in associative learning over long delays.