The role of physical activity on obstructive sleep apnea severity and hypoxic load, and the mismatch between subjective and objective physical activity assessments.

Obesity is the primary risk factor for the development of obstructive sleep apnea, and physical inactivity plays an important role. However, most studies have either only evaluated physical activity subjectively or objectively in obstructive sleep apnea. The objectives of this study were: (i) to assess the relationship between obstructive sleep apnea severity (both apnea-hypopnea index and desaturation parameters) and both objectively and subjectively measured physical activity after adjustment for anthropometry and body composition parameters; and (ii) to assess the relationship between objective and subjective physical activity parameters and whether obstructive sleep apnea severity has a modulatory effect on this relationship. Fifty-four subjects (age 47.7 ± 15.0 years, 46% males) were categorized into groups according to obstructive sleep apnea severity: no obstructive sleep apnea; mild obstructive sleep apnea; and moderate-to-severe obstructive sleep apnea. All subjects were evaluated with subjective and objective physical activity, anthropometric and body composition measurements, and 3-night self-applied polysomnography. A one-way ANOVA was used to evaluate the differences between the three obstructive sleep apnea severity groups and multiple linear regression to predict obstructive sleep apnea severity. Differences in subjectively reported sitting time (p ≤ 0.004) were found between participants with moderate-to-severe obstructive sleep apnea, and those with either mild or no obstructive sleep apnea (p = 0.004). Age, body mass index and neck circumference explained 63.3% of the variance in the apnea-hypopnea index, and age, body mass index and visceral adiposity explained 67.8% of the variance in desaturation parameters. The results showed that the person's physical activity does not affect obstructive sleep apnea severity. A weak correlation was found between objective and subjective physical activity measures, which could be relevant for healthcare staff encouraging patients with obstructive sleep apnea to increase their physical activity.

Are they all born to score? The relationship between throwing arm and scoring from the 7-meter line in semi-professional handball.

ABSTRACTIndications of laterall biases favouring left-handers have been found in various sports; especially interactive sports where the athletes have limited time to react to incoming objects. The aim of this study was therefore to explore whether any lateral biases exist in handball by examining 7-meter shots. A total of 6846 7-meter throws from 240 7-meter shooters across four seasons in the semi-professional Icelandic elite handball division (male and female) were analyzed. Out of the 240 7-meter shooters, of which 151 were male and 89 were female, 22% were left-handed (22% of the males and 20% of the females). The left-handed 7-meter shooters took a disproportionate number of the 7-meter shots, with left-handed shooters performing 29% of the 7-meter shots (27% in the male league and 33% in the female league). The results of a Bayesian two-level analysis indicated that left-handedness is not associated with greater success from the 7-meter line at the semi-professional level.

The Sleep Revolution project: the concept and objectives.

Obstructive sleep apnea is linked to severe health consequences such as hypertension, daytime sleepiness, and cardiovascular disease. Nearly a billion people are estimated to have obstructive sleep apnea with a substantial economic burden. However, the current diagnostic parameter of obstructive sleep apnea, the apnea-hypopnea index, correlates poorly with related comorbidities and symptoms. Obstructive sleep apnea severity is measured by counting respiratory events, while other physiologically relevant consequences are ignored. Furthermore, as the clinical methods for analysing polysomnographic signals are outdated, laborious, and expensive, most patients with obstructive sleep apnea remain undiagnosed. Therefore, more personalised diagnostic approaches are urgently needed. The Sleep Revolution, funded by the European Union's Horizon 2020 Research and Innovation Programme, aims to tackle these shortcomings by developing machine learning tools to better estimate obstructive sleep apnea severity and phenotypes. This allows for improved personalised treatment options, including increased patient participation. Also, implementing these tools will alleviate the costs and increase the availability of sleep studies by decreasing manual scoring labour. Finally, the project aims to design a digital platform that functions as a bridge between researchers, patients, and clinicians, with an electronic sleep diary, objective cognitive tests, and questionnaires in a mobile application. These ambitious goals will be achieved through extensive collaboration between 39 centres, including expertise from sleep medicine, computer science, and industry and by utilising tens of thousands of retrospectively and prospectively collected sleep recordings. With the commitment of the European Sleep Research Society and Assembly of National Sleep Societies, the Sleep Revolution has the unique possibility to create new standardised guidelines for sleep medicine.

The Changing Landscape of Children's Diet and Nutrition: New Threats, New Opportunities.

BACKGROUND: Over the last 30-40 years, we have seen an improvement in global child undernutrition, with major reductions in wasting and stunting. Meanwhile, childhood obesity has dramatically increased, initially in high-income populations and subsequently in the more economically vulnerable. These trends are related to significant changes in diet and external factors, including new environmental threats. SUMMARY: Obesity rates first increased in older children, then gradually in infants. And in the next couple of years, there will be more overweight and obese than moderately or severely underweight children in the world. The changes in childhood nutritional landscape are a result of poor diets. Today, almost 50% of the world's population consumes either too many or too few calories. Dietary disparities between countries result in disparities of under- and overnutrition and impact the global health landscape. Most children with obesity, wasting, and micronutrient deficiencies live in lower income countries and in lower income families within any country. High energy-low nutrient diets are contributing to the increase in non-communicable diseases, which will manifest later in this generation of children. In 1990, child wasting was the #1 leading risk factor for mortality for all ages, and high BMI was #16; today, they are #11 and #5, respectively. COVID-19 and climate change are new major threats to global nutrition. Current and future efforts to improve the state of child nutrition require multisectoral approaches to reprioritize actions which address current trends and emerging threats.

Psychological characteristics in women football players: Skills, mental toughness, and anxiety.

Women's football has been far less studied than men's. This work's objectives were to: (1) analyze the differences in psychological skills, mental toughness (MT), and anxiety in women football players according to their level (national team, first division, and second division); and (2) predict those three levels (using a multivariate model) according to the players' psychological skills, mental toughness, and anxiety. One hundred and forty-two Icelandic women football players (23.5 ± 3.5 years) participated in the study. They were classified into three groups according to their level: national team, and first and second divisions. Three questionnaires were used: the Test of Performance Strategies Questionnaire, the Sport Mental Toughness Questionnaire, and the Sport Anxiety Scale-2 questionnaire. A one-way ANOVA with Bonferroni post hoc correction was used to examine differences between teams. Applying a classification tree analysis, the participants were classified into three groups according to their level. There were few differences between the three groups in psychological skills, but in mental toughness and anxiety the national team had the highest and lowest values respectively, and the first and second division players differed in relaxation in competition (TOPS), total score and confidence (SMTQ), and worry (SAS-2). The classification tree correctly classified 54.9% of the sample with the variables total score (SMTQ) and activation in practice (TOPS). Therefore, given the relevance that psychological attributes appear to have for women football players' performance, it would seem indispensable to incorporate the figure of the sports psychologist into national and club teams.

Factors Associated with Breastfeeding Initiation and Continuation: A Meta-Analysis.

OBJECTIVE: To use a quantitative approach to evaluate the literature for quantity, quality, and consistency of studies of maternal and infant characteristics in association with breastfeeding initiation and continuation, and to conduct a meta-analysis to produce summary relative risks (RRs) for selected factors. STUDY DESIGN: A systematic review using PubMed and CINAHL through March 2016 was conducted to identify relevant observational studies in developed nations, reporting a measure of risk for 1 or more of 6 quantitatively derived, high impact factors in relation to either breastfeeding initiation or continuation. One author abstracted data using a predesigned database, which was reviewed by a second independent author; data evaluation and interpretation included all co-authors. These factors were summarized using standard meta-analysis techniques. RESULTS: Six high impact factors were identified (smoking [39 papers], mode of delivery [47 papers], parity [31 papers], dyad separation [17 papers], maternal education [62 papers], and maternal breastfeeding education [32 papers]). Summary RR from random-effects models for breastfeeding initiation were highest for high vs low maternal education (RR 2.28 [95% CI 1.92-2.70]), dyad connection vs not (RR 2.01 [95% CI 1.38-2.92]), and maternal nonsmoking vs smoking (RR = 1.76 [95% CI 1.59-1.95]); results were similar for breastfeeding continuation. CONCLUSIONS: Despite methodological heterogeneity across studies, relatively consistent results were observed for these perinatally identifiable factors associated with breastfeeding initiation and continuation, which may be informative in developing targeted interventions to provide education and support for successful breastfeeding in more families.

Effects of Exercise on Depression and Anxiety. A Comparison to Transdiagnostic Cognitive Behavioral Therapy.

The aims of this study were (i) to know the effects of an exercise program on a group of people with depression and anxiety and (ii) to compare theses effects with a transdiagnostic cognitive behavioral group therapy (TCBGT). The participants were 15 people with depression and/or anxiety symptoms. The participants followed an exercise program. Depression and anxiety symptoms were assessed with validated questionnaires. An exercise program can be used as a treatment option for people with depression and/or anxiety with good results in comparison with TCBGT.

Anthropometric Characteristics, Physical Fitness, and Throwing Velocity in Elite women's Handball Teams.

Saavedra, JM, Kristjánsdóttir, H, Einarsson, IÞ, Guðmundsdóttir, ML, Þorgeirsson, S, and Stefansson, A. Anthropometric characteristics, physical fitness, and throwing velocity in elite women's handball teams. J Strength Cond Res 32(8): 2294-2301, 2018-The aims of this study were (a) to analyze anthropometric, physical fitness, and throwing speed in women elite handball players of different ages and (b) to develop a multivariate model explaining handball performance from a multidimensional perspective. Eighty women handball players (18.2 ± 4.0 years in age) from national team selections participated in the study. The players belonged to A Team, under-19, under-17, and under-15 national teams. All were evaluated by basic anthropometry, physical fitness tests, and handball throwing speed. A 1-way analysis of variance was used to establish the differences between teams with a Bonferroni post hoc test. For each team, a discriminant analysis was performed to determine the predictor variables of performance. Pearson's simple correlation coefficients were calculated between each of the variables. The results of this particular study showed that (a) between the A Team and the U19 team, there were only differences in mass, countermovement jump (CMJ), medicine ball throw, and yo-yo test, (b) the A Team and U19 predictive models correctly classified 76 and 90% of the samples, respectively, with the variables involved being mass and body mass index (A Team) and 30-m sprint and 7-m throwing speed (U19 team), and (c) the 7- and 9-m throwing speeds were correlated with each other and with stature, mass, CMJ, and medicine ball throw (0.367 ≤ r ≤ 0.533; 0.001 ≤ p ≤ 0.05). These results could help improve coaches' knowledge of elite female teams, in particular, in the country where the study was conducted and in others of similar characteristics.

Examination of Factors Explaining Coaching Strategy and Training Methodology as Correlates of Potential Doping Behavior in High-Level Swimming.

Although coaching is considered an important determinant of athletes' potential doping behavior (PDB), there is an evident lack of studies that have examined coaching-strategy-and-training-methodology (CS&TM) in relation to PDB. This study was aimed to identify the specific associations that may exist between CS&TM -factors and other factors, and PDB in high-level swimming. The sample comprised 94 swimmers (35 females; 19.7 ± 2.3 years of age) and consisted of swimmers older than 18 years who participated in the 2017 National Championship. Variables were collected by previously validated questionnaires, with the addition of questions where athletes were asked about CS&TM to which they had been exposed. Multinomial logistic regression was applied for the criterion PDB (Negative PDB - Neutral PDB - Positive PDB). The higher risk for positive-PDB was found in males (OR: 6.58; 95%CI: 1.01-9.12); therefore, all regressions were adjusted for gender. Those swimmers who achieved better competitive result were less prone to neutral-PDB (0.41; 0.17-0.98). The positive-PDB was evidenced in those swimmers who perceived that their training was monotonous and lacked diversity (1.82; 1.41-5.11), and who were involved in training which was mostly oriented toward volume (1.76; 1.11-7.12). The lower likelihood of positive-PDB is found in those who replied that technique is practiced frequently (0.12; 0.01-0.81), those who replied that coach regularly provided the attention to explain the training aims (0.21; 0.04-0.81), and that coach frequently reviewed and discussed the quality of execution of specific tasks (0.41; 0.02-0.81). The findings on the relationships between the studied variables and PDB should be incorporated into targeted anti-doping efforts in swimming. Further studies examining sport-specific variables of CS&TM in younger swimmers and other sports are warranted.

Eyes of Things.

Embedded systems control and monitor a great deal of our reality. While some "classic" features are intrinsically necessary, such as low power consumption, rugged operating ranges, fast response and low cost, these systems have evolved in the last few years to emphasize connectivity functions, thus contributing to the Internet of Things paradigm. A myriad of sensing/computing devices are being attached to everyday objects, each able to send and receive data and to act as a unique node in the Internet. Apart from the obvious necessity to process at least some data at the edge (to increase security and reduce power consumption and latency), a major breakthrough will arguably come when such devices are endowed with some level of autonomous "intelligence". Intelligent computing aims to solve problems for which no efficient exact algorithm can exist or for which we cannot conceive an exact algorithm. Central to such intelligence is Computer Vision (CV), i.e., extracting meaning from images and video. While not everything needs CV, visual information is the richest source of information about the real world: people, places and things. The possibilities of embedded CV are endless if we consider new applications and technologies, such as deep learning, drones, home robotics, intelligent surveillance, intelligent toys, wearable cameras, etc. This paper describes the Eyes of Things (EoT) platform, a versatile computer vision platform tackling those challenges and opportunities.

Associations between the duration of active commuting to school and academic achievement in rural Chilean adolescents.

BACKGROUND: Habitual active commuting to school may be positively associated with academic achievement. The aim of this study was to examine the relationship between duration of walking or otherwise actively commuting to school and academic achievement. METHODS: This cross-sectional study included 389 adolescents from seven rural schools (12-13 years). Mode and duration of active commuting to school (use of active means such as walking or biking to and from school) and screen time were self-reported. Academic achievement was determined by the outcome in basic grades (language and mathematics). RESULTS: Active commuting to school was not associated with higher scores in any grades after adjustment for potential confounders. No evidence was found of interactions between gender and academic achievement, but there was interaction with duration of walking (<30 min, 30-60 min, and >60 min). Adjusted binary logistic regression analysis suggested that adolescents who spent between 30 and 60 min actively commuting were more likely to obtain high academic achievement (language and mathematics). CONCLUSIONS: Thirty to 60 min of ACS may have a positive influence on academic achievement in adolescents, so, it is necessary to make recommendations for the children to walk from and/or to school. This could help society to recognize the relevance of physical activity to health as well as to academic performance.

Exercise-based interventions and C-reactive protein in overweight and obese youths: a meta-analysis of randomized controlled trials.

BACKGROUND: One of the most commonly measured markers of inflammation in clinical settings is C-reactive protein (CRP). The purpose of this meta-analysis was to examine the evidence for the effectiveness of physical exercise interventions on modifying the levels of serum CRP in children and adolescents with excess of weight. METHODS: Two independent reviewers assessed articles from seven databases. Studies were limited to physical exercise interventions in children and adolescents diagnosed as overweight or obese, and including a comparison control group. Weighted mean difference (WMD) was calculated using random-effects model and potential moderators were explored (i.e., weight status, ages, duration of study, frequency of exercise per week, and duration of session). The heterogeneity of the studies was estimated using Cochran's Q-statistic and I(2). RESULTS: Nine randomized controlled trials met the inclusion criteria (n = 427 youths). Overall, results suggest a nonsignificant trend toward a reduction CRP levels (WMD = -0.72 mg/l; 95% confidence interval: -1.52 to 0.08; P = 0.077). Also, there were not significant moderators of exercise effects on CRP. CONCLUSION: These results suggest that exercise programs in children and adolescents not mitigate the inflammatory effects of excess weight, although there was a trend toward reduction.

Economic Burden of Atopic Dermatitis in High-Risk Infants Receiving Cow's Milk or Partially Hydrolyzed 100% Whey-Based Formula.

OBJECTIVE: To estimate the health and economic impact of feeding partially hydrolyzed formula-whey (PHF-W) instead of standard cow's milk formula (CMF) for the first 4 months of life among US infants at high risk for developing atopic dermatitis (AD). STUDY DESIGN: A Markov model was developed integrating published data, a survey of US pediatricians, costing sources and market data, and expert opinion. Key modeled outcomes included reduction in AD risk, time spent post AD diagnosis, days without AD flare, and AD-related costs. Costs and clinical consequences were discounted at 3% annually. RESULTS: An estimated absolute 14-percentage point reduction in AD risk was calculated with the use of PHF-W compared with CMF (95% CI for difference, 3%-22%). Relative to CMF, PHF-W decreased the time spent post-AD diagnosis by 8.3 months (95% CI, 2.78-13.31) per child and increased days without AD flare by 39 days (95% CI, 13-63) per child. The AD-related, 6-year total cost estimate was $495 less (95% CI, -$813 to -$157) per child with PHF-W ($724 per child; 95% CI, $385-$1269) compared with CMF ($1219 per child; 95% CI, $741-$1824). CONCLUSION: Utilization of PHF-W in place of CMF as the initial infant formula administered to high-risk US infants not exclusively breastfed during the first 4 months of life may reduce the incidence and economic burden of AD. Broad implementation of this strategy could result in a minimum savings of $355 million per year to society.

Relationship between exchange block time in swim starts and final performance in relay races in international championships.

The purpose of this study was to investigate the association between relay exchange block time and final performance in 4 × 100-m and 4 × 200-m freestyle and 4 × 100-m medley relays as a function of sex (men and women) and classification (medallists and non-medallists) in international competitions. Nineteen international competitions covering a 13-year period (2000-2012) were analysed retrospectively. The data corresponded to a total of 827 team relay histories (407 men, 420 women). Kruskal-Wallis and Mann-Whitney tests were performed to determine any differences by sex, classification, and event. Similarly, the relationship between the exchange block times and final performance was examined by means of a Pearson correlation analysis. In the three events, the men's exchange block times were shorter than those of the women (η(2) = 0.049-0.109; P < 0.001). The exchange block time was especially relevant for the women's relay medallists in the 4 × 100-m freestyle (r = 0.306, P = 0.021) and 4 × 100-m medley (r = 0.385, P = 0.011), while for men the relationship was clearer for the non-medallists. These results suggest that the exchange block time should be considered as one of the performance parameters of swimming relay starts, and thus should be included explicitly as part of training. In particular, the coach could design training targeted at standardising an optimal exchange block time equal to or less than that expected for other teams in the competition.

Comparison of game-related statistics in men's international championships between winning and losing teams according to margin of victory.

The aims of this study were (i) to compare water polo game-related statistics by game outcome (winning and losing teams) and margins of victory (close games, unbalanced games, and very unbalanced games), and (ii) to identify characteristics that mark the differences in performances for each group of margin of victory. The game-related statistics of the 308 men's matches played in seven International Championships (Olympic Games, World and European Championships) were analysed. A cluster analysis established three groups (close games, unbalanced games, and very unbalanced games) according to the margin of victory. Differences between game outcomes (winning or losing teams) and margins of victory (close, unbalanced, and very unbalanced games) were determined using the chi-squared statistic, also calculating the effect sizes of the differences. A discriminant analysis was then performed applying the sample-splitting method according to game outcome (winning and losing teams) by margin of victory. It was found that the game-related statistics differentiate the winning from the losing teams in each final score group, with 7 (offensive and defensive) variables differentiating winners from losers in close games, 16 in unbalanced games, and 11 in very unbalanced games. In all three types of game, the game-related statistics were shown to discriminate performance (85% or more), with two variables being discriminatory by game outcome (winning or losing teams) in all three cases: shots and goalkeeper-blocked shots.

Analysis of Movement and Actions of Wingers as Second-Line Players in Organized Attack in Handball.

In modern handball, one of the important performance indicators is the effectiveness of the attack, especially the running-in of wingers as line players which has not been explored adequately. The purpose of the study was to analyze the movements of wingers in the organized attack when they run in. Fifty-eight matches were analyzed from the 2022 EHF European Men's Handball Championship. A total of 491 attacks were recorded and 45 variables were analyzed in which wingers ran in as second pivots and the outcome was a throw. For the statistical analysis, descriptive and inductive statistics were used. The results showed that the average time of the running-in was 12.11 ± 9.28 s, the left wing ran in more often (60.1%) and wingers tended to move outside the defense formation (72.5%). Wingers ran in without the ball in possession (81.1%), moved toward defenders 2 and 5 and stood next to defenders, and occasionally blocked, slid or left their position. The defense's central zone was preferred by players to make a throw. Correspondence analysis showed that wingers finally returned to their initial position regardless of the evolution of the attack. Their role was to block a specific defender or disorganize the defense, for one defender to be isolated so that one attacking player could execute a shot from the central area. Conclusively, wingers play an important role, especially in run-in actions, at the completion of an attack, and in the final throw.

The training times of athletes could play a role in clinical sleep problems due to their associations with sleep difficulty scores.

OBJECTIVES: Sleep is a key component of athletic recovery, yet training times could influence the sleep of athletes. The aim of the current study was to compare sleep difficulties in athletes across different training time groups (early morning, daytime, late evening, early morning plus late evening) and to investigate whether training time can predict sleep difficulties. METHODS: Athletes from various sports who performed at a national-level (n = 273) answered the Athlete Sleep Screening Questionnaire (ASSQ) along with several other questionnaires related to demographics, exercise training, and mental health. From the ASSQ, a Sleep Difficulty Score (SDS) was calculated. Transformed SDS (tSDS) was compared across different training time categories using multiple one-way ANOVAs. A stepwise regression was then used to predict tSDS from various sleep-related factors. RESULTS: SDSs ranged from none (31%), mild (38%), moderate (22%), and severe (9%). However, the one-way ANOVAs revealed training earlier or later vs. training daytime shifted the tSDS in a negative direction, a trend toward increased sleep difficulty. In particular, athletes training in the late evening (>20:00 or >21:00) had a significantly higher tSDS when compared to daytime training (p = .03 and p < .01, respectively). The regression model (p < .001) explained 27% of variance in the tSDS using depression score, age, training time, and chronotype score. CONCLUSION: Among a heterogeneous sample of national-level athletes, 31% displayed moderate to severe SDSs regardless of their training time. However, when athletes trained outside daytime hours there was a tendency for the prevalence of sleep difficulties to increase.

Review and perspective on sleep-disordered breathing research and translation to clinics.

Sleep-disordered breathing, ranging from habitual snoring to severe obstructive sleep apnea, is a prevalent public health issue. Despite rising interest in sleep and awareness of sleep disorders, sleep research and diagnostic practices still rely on outdated metrics and laborious methods reducing the diagnostic capacity and preventing timely diagnosis and treatment. Consequently, a significant portion of individuals affected by sleep-disordered breathing remain undiagnosed or are misdiagnosed. Taking advantage of state-of-the-art scientific, technological, and computational advances could be an effective way to optimize the diagnostic and treatment pathways. We discuss state-of-the-art multidisciplinary research, review the shortcomings in the current practices of SDB diagnosis and management in adult populations, and provide possible future directions. We critically review the opportunities for modern data analysis methods and machine learning to combine multimodal information, provide a perspective on the pitfalls of big data analysis, and discuss approaches for developing analysis strategies that overcome current limitations. We argue that large-scale and multidisciplinary collaborative efforts based on clinical, scientific, and technical knowledge and rigorous clinical validation and implementation of the outcomes in practice are needed to move the research of sleep-disordered breathing forward, thus increasing the quality of diagnostics and treatment.

Patterns of clinical management of atopic dermatitis in infants and toddlers: a survey of three physician specialties in the United States.

OBJECTIVE: To describe atopic dermatitis (AD) management patterns in children ≤36 months old as reported by pediatricians, dermatologists, and allergists in the US. STUDY DESIGN: A nationally-representative survey was administered to pediatricians (n = 101), dermatologists (n = 26), and allergists (n = 26). Main outcomes included referrals to health care professionals, suggested/ordered laboratory tests, management approach (dietary, pharmacologic, or combination of both) by age, AD location, and severity. RESULTS: Significant differences were observed in referrals to healthcare professionals (P < .001). Pediatricians more frequently referred to dermatologists than allergists in mild (52.4% vs 32.0%) and moderate/severe (60.6% vs 38.1%) cases. Dermatologists referred to allergists less frequently for mild (9.1%) than moderate/severe (40.7%) AD cases. Pediatricians (59%), allergists (61.5%), and dermatologists (26.9%) reported treating at least some of their patients with AD with dietary management (infant formula change) alone (with or without emollients). Soy-based formulas were often used. For mild AD, the most commonly reported first-line pharmacologic treatments included topical emollients, topical corticosteroids, and barrier repair topical therapy/medical devices. Over 80% of physicians used a dietary and pharmacologic combination approach. Dermatologists were most likely to manage AD symptoms with a pharmacologic-only approach. AD lesion location influenced pharmacologic treatment in >80% of physicians. CONCLUSIONS: Significant and distinct differences in AD treatment approach exist among physicians surveyed. Most pediatricians and allergists use formula change as a management strategy in some patients, whereas dermatologists favor a pharmacologic approach. This diversity may result from inadequate evidence for a standard approach. Consistent methods for managing AD are needed.

Lessons from the feeding infants and toddlers study in North America: what children eat, and implications for obesity prevention.

The latest exhaustive survey of dietary patterns in infants from the Feeding Infants and Toddlers Study (FITS) in North America documents and quantifies current trends in infant feeding. These include higher than generally recommended energy, protein, and saturated fat intakes. The majority of infants are bottle fed at some point in their first year of life, and their weaning diet often includes low intakes of fruits and vegetables, with high starchy, rather than green or yellow, vegetables. Early introduction of solids, use of cow's milk prior to 1 year of age, and high juice intake in the first 2 years - all less desirable diet practices - are improving, but are still prevalent. More preschoolers are likely to get sweets or sweetened beverages than a serving of fruit or a vegetable on a given day. These food intake patterns mimic the adult American diet and are associated with an increased risk of obesity in childhood and later life. But more importantly, these patterns appear to be set as early as 18 months of age, and by 20 months of age, they mimic the adult diet. Despite increase in total energy intake, and greater variety of foods, the basic characteristics of macronutrient intake distribution and food group contribution of energy to the diet before 2 years of age remain remarkably stable and similar to the family table. Obesity prevention needs to include specific targets in terms of breastfeeding and adequate formula feeding, as well as appropriate introduction of weaning foods with goals of changing the inadequate patterns documented in the FITS. These interventions will also require addressing parent and caregiver behaviors, including attending to hunger satiety cues (responsive feeding), and shaping early food preferences. This needs to be done starting at birth, in the first months of life. Early intervention offers a unique and potentially efficacious opportunity to shape the future dietary patterns of the next generation.