Comparison of the effects of different growth standards on infants in Urban Shanghai: a cluster-randomized controlled trial.

BACKGROUND: The Shanghai growth standards are higher than World Health Organization (WHO) growth standards, which may influence the feeding practices of the caregivers and increase the risk of overweight in these infants. This study aimed to compare the effects of different growth standards on childhood obesity in Shanghai metropolitan area. METHODS: This was a cluster-randomized controlled trial conducted in 2 downtown areas with 19 community health service centers in Shanghai from November 2013 to December 2015. Randomization was done at the level of the community. Infants (health newborns) were assessed and monitored by the Shanghai growth standards (S-group) and the 2006 WHO growth standards (W-group), respectively. Measurements were taken at 1.0, 2.0, 4.0, 6.0, 9.0 and 12.0 months of age during follow-up period. Based on the values of length and weight measurements, according to the group's growth standards, doctors provided the caregivers with corresponding clinical consultation. Changes in weight-for-age z-score (WAZ), length-for-age z-score (LAZ), and weight-for length z-score (WLZ) between 2 groups were assessed using mixed regression models. Overweight was compared between 2 group at all follow-up measurements. RESULTS: A total of 6509 infants (52.1% were boys) were in the W-group, and 8510 infants (51.4% were boys) were in the S-group. The overweight ratios between two groups were distinct at 9 months of age (3.4% in W-group and 4.3% in S-group) and 12 months of age (2.2% in W-group and 3.8% in S-group), and the differences were statistically significant (P = 0.020 and P < 0.001, respectively). Compared to W-group, the increase in WAZ (coefficient = 0.04, P = 0.004) and WLZ (coefficient = 0.09, P < 0.001) were significantly greater, and the LAZ was lower (coefficient = -0.04, P = 0.047) in S-group (W-group values were used as reference in mixed regression models). CONCLUSION: Compared to the Shanghai growth standards, the adoption of WHO 2006 growth standards would reduce the risk of infant overweight in Shanghai metropolitan area up to 1 year of age. TRIAL REGISTRATION NUMBER: ChiCTR1800015371, http://www.chictr.org.cn/ Chinese Clinical Trial Registry.

[Establishment of a rat model of oral food allergy].

OBJECTIVE: To establish a food allergy model in Brown Norway (BN) rats by gavage of ovalbumin (OVA) without any adjuvant, and to evaluate this model. METHODS: A total of 20 male BN rats aged 3 weeks were randomly divided into allergy group and control group (n=10 each). BN rats in the allergy group were given OVA 1 mg per day by gavage, and all the rats were treated for 41 days continuously. On day 42, the rats in the allergy group were given OVA 100 mg by gavage for challenge. The rats in the control group were given normal saline of the same volume by gavage. Differences in body length, body weight, and food intake were compared between the two groups on days 7, 14, 21, 28, 35, and 42. ELISA was used to measure the serum OVA-IgE level and plasma histamine level after challenge on day 42, and the changes in rats' appearance and fecal properties were observed. The model of food allergy was considered successful when the serum OVA-IgE level in the allergy group was no less than the mean serum OVA-IgE level + 3 standard deviation in the control group. RESULTS: There were no significant differences in body length, body weight or food intake between the allergy and control groups at all time points (P>0.05). On day 21, the control group had a significantly higher food intake than the allergy group (P<0.05). On day 42 after challenge, the allergy group showed significantly higher serum OVA-IgE and plasma histamine levels than the control group (P<0.05). The sensitization rate (rate of successful modeling) was 90%. The fecal properties showed no significant differences between the two groups. CONCLUSIONS: OVA by gavage without any adjuvant can successfully establish the model of food allergy in BN rats and has a high success rate. Food allergy induced by OVA may reduce food intake within a short period of time, but no influence on rats' body length or body weight has been observed.

Vitamin D Insufficiency and Its Association with Biochemical and Anthropometric Variables of Young Children in Rural Southwestern China.

BACKGROUND: With recognition of the important roles of Vitamin D (VitD) in various physiological processes, increasing attention has been drawn to the status of VitD in early life. However, the VitD status of young children and the related factors in rural areas of Southwestern China remain unclear. This study aimed to explore VitD status and its seasonal variation in 18-month-old children living in rural Southwestern China. The association of VitD with biochemical and anthropometric variables was also investigated. METHODS: A total of 177 18-month-old children in a rural area of Yunnan Province, Southwestern China, were enrolled. Serum concentrations of 25-hydroxy Vitamin D (25(OH)D) were measured through high-performance liquid chromatogram-tandem mass spectrometry. Parathyroid hormone (PTH) levels were measured with a chemiluminescence assay. Serum concentrations of calcium, phosphorus, and alkaline phosphatase (ALP) were also measured. Anthropometric data and the outdoor activity time of each participant were collected. RESULTS: The serum 25(OH)D concentration was 26.61 ± 7.26 ng/ml; concentrations lower than 30 ng/ml accounted for 70.6% of the participants and concentrations lower than 20 ng/ml accounted for 16.4%. The level of serum 25(OH)D was not significantly different among four seasons (P >0.05). A positive relationship was found between 25(OH)D concentration and the time of outdoor activities (r = 0.168, P < 0.05). Serum PTH concentration was negatively correlated with 25(OH)D concentration (r = -0.163, P < 0.05). A positive relationship was found between the serum concentrations of 25(OH)D and calcium (r = 0.154, P < 0.05). No significant association was observed between 25(OH)D and ALP, phosphorus, or anthropometric variables. CONCLUSIONS: The prevalence of VitD insufficiency is high among young children in the rural Southwestern China regardless of the seasons. VitD supplementation is still essential to maintain VitD sufficiency for children living in rural area.

Association between feeding practices and weight status in young children.

BACKGROUND: Inappropriate feeding practices during infancy may lead to overweight. The aims of this study are to investigate the growth of children in the first 18 months of life; to evaluate the feeding practices of caregivers using developed Young Child Feeding Questionnaire; and to investigate caregivers' feeding attitudes and behaviors associated with infants' weight status. METHODS: Six month-old infants and their main caregivers entering the Kongjiang Community Health Center for a routine well-child check were recruited for this study and followed up every 6 months for 12 months. Questionnaire survey was carried out through on-site face-to-face interview at each visit with the main caregivers of children using Young Child Feeding Questionnaire, which included caregivers' feeding attitudes and behaviors. The weight and length of children were measured at each visit. RESULTS: Among 197 children who completed the investigation at 18 months of age, 64 (32.49%) children were overweight (BMI-for-age z scores > +1). The increases in weight-for-age z scores and BMI-for-age z scores from birth to 6 months, 12 to 18 months and birth to 18 months in overweight children were significantly higher than those in normal weight children (P < 0.001). In normal weight children, caregivers worried more about children's being "underweight" and "eating less" (P = 0.001), whereas caregivers with overweight children worried more about children's "eating too much" and being "overweight" (P < 0.001). In 64 overweight infants, the scores of "concern about child's food intake" were significantly correlated with increase in BAZ between 12 and 18 months (Bata = 0.293, P = 0.029). CONCLUSIONS: Young Child Feeding Questionnaire is a valid tool for evaluating feeding practice of caregivers. The rapid BMI gain in overweight children may be associated with some inappropriate feeding attitudes and behaviors of caregivers.

Feeding and growth of normal birth weight infants during the first year of life in Shanghai.

AIM: This study aimed to explore the relationship between infant feeding practices and growth outcomes in the first 12 months of life. DESIGN: Investigators completed 262 questionnaires, which included infant feeding patterns, feeding environment, feeding beliefs/attitudes and caregivers' feeding behaviors through on-site face-to-face interviews with the main caregivers of infants at 12 months of age. The infant's weight and length at ages 6 and 12 months were measured. SETTING: The study was conducted in urban Shanghai, China. SUBJECTS: This study included 262 healthy normal birth weight full-term singleton 6-month-old infants and their main caregivers. RESULTS: Among 262 infants, 86 (32.82%) infants were overweight [BMI-for-age z scores (BAZ)>+1] at 12 months. Compared with normal weight infants, the overweight infants had higher birth weights (P=0.009). Furthermore, the overweight infants gained significantly more weight (P<0.001) in the first year of life. In normal weight infants, caregivers worried more about infants being "underweight" and "eating less" (P<0.001) whereas caregivers with overweight infants worried more about infants being "overweight" (P<0.001). Consequently, the total score of caregivers' over-feeding behaviors was significantly higher in normal weight infants (P=0.029). However, in overweight infants, the scores of "fed quickly within 10 min" (r=0.223, P=0.039) and "feeding was the best way to stop the infant's fussiness" (r=0.285, P=0.008) were positively correlated with BAZ. CONCLUSIONS: Overweight in early life is associated with carelessness about excessive appetite and some particular infant feeding behaviors of caregivers in Shanghai.

A summary index of infant and child feeding practices is associated with child growth in urban Shanghai.

BACKGROUND: Recently, an infant and child feeding index (ICFI) constructed on brief recalls of breastfeeding, feeding frequency and food diversification was assumed to provide long-term prediction about child feeding practices. The aim of this study was to investigate the association between the cross-sectional ICFI (CS-ICFI) or longitudinal ICFI (L-ICFI) and child anthropometric indices in downtown Shanghai, China. METHODS: The prospective cohort study included 180 infants aged 5-7 mo with their main caregivers who were visited 3 times every 6 months over 12 months. A CS-ICFI was constructed for each visit by using data on feeding practices based on 24-h and 7-d recalls. An L-ICFI was constructed with use of the 3 CS-ICFIs. The associations between ICFI and length-for-age z score (LAZ), weight-for-age z score (WAZ), and weight-for-length z score (WLZ) were examined. The stability of the CS-ICFI was assessed by using repeatability coefficient (RC). RESULTS: The L-ICFI was positively associated with LAZ and WAZ at Visit 3(beta = 0.151, P = 0.040 and beta = 0.173, P = 0.024, respectively). Moreover, the CS-ICFI at Visit 1 was positively associated with LAZ, WAZ and WLZ (beta = 0.160, P = 0.029; beta = 0.191, P = 0.009; beta = 0.176, P = 0.020) at Visit 3, and the CS-ICFI at Visit 3 was also positively associated with LAZ (beta = 0.176, P = 0.016). Stability of the CS-ICFI was shown by the value of 0.14 (95% CI: 0.07, 0.31) of the RC, which differed significantly from 0 (P < 0.05). CONCLUSIONS: The ICFI constructed on brief recalls based on cross-sectional studies can be used to evaluate the effects of child feeding practice on child growth.

[Intestinal inflammation-induced child growth failure: immunologic and endocrine mechanisms].

Faltering linear growth is commonly encountered in children with intestinal inflammation. Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) are important regulators of postnatal longitudinal bone growth. Inhibition of GH/IGF axis will result in growth failure in young children. Pro-inflammatory cytokines such as interleukin-1ß (IL-1ß), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) abnormally increase in children with intestinal inflammation, and may affect linear growth both systemically and locally at the level of the growth plate though disturbing the GH/IGF axis.