From Medscape Internal Medicine
Surgeon General Urges Exercise for Optimal Health
Regina M. Benjamin, MD, MBA
Editor's Note:
The following commentary from US Surgeon General Regina Benjamin, MD, MBA, is a collaboration between the US Department of Health and Human Services (HHS), the American College of Sports Medicine (ACSM), and Medscape.
As Surgeon General, my priorities focus on wellness and prevention. Earlier this year, I released my paper, The Surgeon General's Vision for a Healthy and Fit Nation [2010].
There is, perhaps, no more serious challenges to the nation's health and well-being than those posed by obesity and overweight. Since 1980, obesity rates have doubled in adults and more than tripled in children, and the problem is even worse among black, Hispanic, and Native American children. We see the sobering impact of these numbers in the high rates of chronic diseases, such as diabetes, heart disease, and other chronic illnesses, that are starting to affect our children more and more.
A few months ago, a study from The University of North Carolina [at Chapel Hill] School of Medicine reported that obese children as young as age 3 show signs of an inflammatory response that has been linked to heart disease later in life. I was pleased to join the First Lady for the launch of her Let's Move! campaign to solve the problem of childhood obesity within 1 generation.
Both my Vision for a Healthy and Fit Nation and the First Lady's Let's Move! campaign take a comprehensive approach that engages families and communities, as well as the public and private sectors. My Vision for a Healthy and Fit Nation is an attempt to change the national conversation from a negative one about obesity and illness to a positive conversation about being healthy and being fit. I want to encourage Americans to eat more nutritiously, exercise regularly, and maintain healthier lifestyles.
That is why I am asking healthcare organizations across this country to join the Exercise is Medicine initiative. Exercise is Medicine is a multinational, multiorganizational initiative. It brings physical activity to the forefront of disease prevention and treatment, by making exercise a part of every patient's interaction with a health clinician. Exercise is Medicine strives to provide the essential connection between clinicians, fitness professionals, and the public, so that everyone can receive the guidance they need to stay healthy and active. All the partners in this initiative are dedicated to the idea that exercise is the new medicine. Partners are asked to continue to build, support, and advocate for physical activity as an essential element of global health and well-being by committing to action:
Policy makers are asked to change policies to support physical activity as a major component of health.
Clinicians and fitness professionals are asked to integrate exercise into every patient and client interaction.
Communities, workplaces, and schools are asked to promote physical activity as an essential part of health and well-being.
Members of the public are asked to educate and empower themselves to seek appropriate counseling on physical activity.
As health professionals, we should remember that patients are more likely to change their behavior if they have a meaningful reward -- something more than reaching a certain weight or dress size. The reward has to be something that each person can feel, enjoy, and celebrate. The reward is optimal health that allows people to embrace each day and live their lives to the fullest -- without disease, disability, or lost productivity. I hope you will join the Exercise is Medicine initiative. Together, America can become a Healthy and Fit Nation.
Friday, June 25, 2010
Breast-Feeding Until 4 Months May Protect Infants From Respiratory, GI Infections
From Medscape Medical News
Laurie Barclay, MD
June 21, 2010 — Breast-feeding until age 4 months is linked to lower rates of respiratory and gastrointestinal (GI) infection morbidity, according to the results of a population-based, prospective, cohort study reported online June 21 in Pediatrics.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed.
Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write.
"Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010.
Laurie Barclay, MD
June 21, 2010 — Breast-feeding until age 4 months is linked to lower rates of respiratory and gastrointestinal (GI) infection morbidity, according to the results of a population-based, prospective, cohort study reported online June 21 in Pediatrics.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed.
Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write.
"Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010.
Thursday, June 24, 2010
CDC Commentary: New Safety Data on the HPV Vaccine -- Reassure Your Patients
From Centers for Disease Control and Prevention (CDC): Expert Commentary
Claudia Vellozzi, MD, MPH
Hello. I'm Dr. Claudia Vellozzi. I'm a family practitioner and the deputy director of CDC's Immunization Safety Office. Our office, along with the Food and Drug Administration monitors the safety of vaccines after they are licensed.
Today, I'm pleased to share with you important safety data on the human papillomavirus, or HPV vaccine as part of the CDC Expert Commentary Series on Medscape.
As healthcare providers, we know that clear communication goes hand in hand with good quality patient care. Talking with your patients about the safety of HPV vaccines can help to address common concerns about vaccination and may lead your patients, or their parents, to make more informed decisions about their health.
Although there are 2 licensed HPV vaccines in use in the United States (Gardasil and Cervarix), we currently have more available data on Gardasil. As of January 1, 2010, 28 million doses of Gardasil have been distributed in the US.
CDC and FDA manage the Vaccine Adverse Event Reporting System (or VAERS), a system which accepts reports for any adverse event after vaccination from healthcare providers, patients, or family members, or manufacturers. VAERS is one of the systems that helps us to monitor the safety of vaccines in this country. It is a front-line system to detect possible safety concerns. VAERS has several limitations. It is always important to keep these in mind when you are reviewing VAERS data.
The main limitations are:
VAERS usually cannot assess causality;
VAERS has variable quality of data;
VAERS lacks denominator data (the total number of vaccinated persons is not known); and,
VAERS is subject to variable reporting (both underreporting and stimulated reporting can occur).
As of January 31, 2010, VAERS had received nearly 16,000 reports of adverse events following Gardasil vaccination. An overwhelming majority of these (over 90%) were non-serious, such as syncope (or fainting), local injection site reactions, dizziness, nausea, and headache. These findings are similar to the safety reviews of other vaccines recommended for a similar age group (such as meningitis and Tdap vaccines).
Based on the review of available vaccine safety monitoring data by FDA and CDC, HPV vaccination continues to be recommended and its benefits continue to outweigh its risks.
Now, let's talk about some of the serious adverse event reports. All serious reports were analyzed by medical experts and additional medical records were requested to better understand the adverse events. Some of the serious reports were reports of venous thrombotic events or VTE. In VAERS, most individuals who reported VTEs post-vaccination were also found to have other high risk conditions documented in their medical records, such as use of oral contraceptives, smoking, obesity, or other contributing factors.
All of the death reports in VAERS were fully investigated, and there was no unusual pattern or clustering that would suggest that they were caused by the HPV vaccine. The reported causes of death could be explained by factors including diabetes, viral illness, illicit drug use, and heart failure.
Like any medication, vaccines can have some side effects. After HPV vaccination, your patients may experience mild events such as local injection site reaction (including soreness, redness, or swelling where the shot was given), and some patients may be prone to syncope. Syncope after vaccination is not uncommon among adolescents and young adults. Be sure your patient is vaccinated while sitting or lying down and is observed for at least 15 minutes after vaccination to avoid potential injury from a fall in the event of syncope. If syncope does occur, observe your patient and evaluate them after they regain consciousness to determine if there is a need for further treatment. Fainting after vaccination itself is usually not a serious event, and patients generally recover within a few minutes.
Remember, one limitation of VAERS is that it cannot determine causality. A report to VAERS is only an association in time, meaning that the adverse event occurred some time after vaccination. CDC and FDA thoroughly investigate all serious reports to better assess whether more studies are needed to help determine if an adverse event could be associated with a vaccine. Although the media has paid particular attention to these adverse event reports, it is important to know and share with your patients that we have not found any information to conclude that these events were associated with the vaccine.
I would like to summarize with the following points:
First, based on the review of available information by FDA and CDC, the HPV vaccine continues to be recommended for girls and women, ages 9 to 26 years, as an important strategy to prevent cervical cancer. Gardasil can protect males against most genital warts and may be given to boys and men, ages 9 through 26 years.
Second, you should consider watching your patients carefully for 15 minutes after any vaccination, including administration of the HPV vaccine, to avoid potential injury from a fall in the event of syncope.
Third, discuss with your patients what to expect and to contact you if they experience additional symptoms after HPV vaccination.
And finally, if your patient experiences any adverse events after HPV vaccination, you or your patient should report them to VAERS. For more information on the safety data of the HPV vaccine, please see the resources on this page. Thank you.
Web Resources
Summary of HPV Adverse Events:
http://www.cdc.gov/vaccinesafety/Vaccines/HPV/gardasil.html.
Questions and Answers about HPV Vaccines (Patient Information)
http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm
Dr. Claudia Vellozzi completed her medical degree at Loyola Stritch School of Medicine in Chicago and her MPH at Johns Hopkins in Baltimore. She is board certified in both Family Medicine and Preventive Medicine.
Dr Vellozzi has extensive clinical and public health experience, both domestically and internationally. Her clinical experience includes starting a clinic for underserved Hispanics in Orange County, California, serving as faculty at a Family Medicine Residency Program in Greeley, Colorado, primary clinical care at a rural hospital in Nigeria and she continues to care for patients one-half day weekly at a Grady Neighborhood clinic, in Atlanta. Her areas of work in public health include HIV/AIDS, vaccines and immunization safety, health services research and maternal infant health. She has worked with the Centers for Disease Control and Prevention, World Health Organization and the Commonwealth Fund.
Dr Vellozzi recently returned to the Immunization Safety Office as Deputy Director and has led the H1N1 vaccine safety surveillance activities at the Centers for Disease Control and Prevention.
Dr Vellozzi has published numerous manuscripts in peer reviewed literature.
Claudia Vellozzi, MD, MPH
Hello. I'm Dr. Claudia Vellozzi. I'm a family practitioner and the deputy director of CDC's Immunization Safety Office. Our office, along with the Food and Drug Administration monitors the safety of vaccines after they are licensed.
Today, I'm pleased to share with you important safety data on the human papillomavirus, or HPV vaccine as part of the CDC Expert Commentary Series on Medscape.
As healthcare providers, we know that clear communication goes hand in hand with good quality patient care. Talking with your patients about the safety of HPV vaccines can help to address common concerns about vaccination and may lead your patients, or their parents, to make more informed decisions about their health.
Although there are 2 licensed HPV vaccines in use in the United States (Gardasil and Cervarix), we currently have more available data on Gardasil. As of January 1, 2010, 28 million doses of Gardasil have been distributed in the US.
CDC and FDA manage the Vaccine Adverse Event Reporting System (or VAERS), a system which accepts reports for any adverse event after vaccination from healthcare providers, patients, or family members, or manufacturers. VAERS is one of the systems that helps us to monitor the safety of vaccines in this country. It is a front-line system to detect possible safety concerns. VAERS has several limitations. It is always important to keep these in mind when you are reviewing VAERS data.
The main limitations are:
VAERS usually cannot assess causality;
VAERS has variable quality of data;
VAERS lacks denominator data (the total number of vaccinated persons is not known); and,
VAERS is subject to variable reporting (both underreporting and stimulated reporting can occur).
As of January 31, 2010, VAERS had received nearly 16,000 reports of adverse events following Gardasil vaccination. An overwhelming majority of these (over 90%) were non-serious, such as syncope (or fainting), local injection site reactions, dizziness, nausea, and headache. These findings are similar to the safety reviews of other vaccines recommended for a similar age group (such as meningitis and Tdap vaccines).
Based on the review of available vaccine safety monitoring data by FDA and CDC, HPV vaccination continues to be recommended and its benefits continue to outweigh its risks.
Now, let's talk about some of the serious adverse event reports. All serious reports were analyzed by medical experts and additional medical records were requested to better understand the adverse events. Some of the serious reports were reports of venous thrombotic events or VTE. In VAERS, most individuals who reported VTEs post-vaccination were also found to have other high risk conditions documented in their medical records, such as use of oral contraceptives, smoking, obesity, or other contributing factors.
All of the death reports in VAERS were fully investigated, and there was no unusual pattern or clustering that would suggest that they were caused by the HPV vaccine. The reported causes of death could be explained by factors including diabetes, viral illness, illicit drug use, and heart failure.
Like any medication, vaccines can have some side effects. After HPV vaccination, your patients may experience mild events such as local injection site reaction (including soreness, redness, or swelling where the shot was given), and some patients may be prone to syncope. Syncope after vaccination is not uncommon among adolescents and young adults. Be sure your patient is vaccinated while sitting or lying down and is observed for at least 15 minutes after vaccination to avoid potential injury from a fall in the event of syncope. If syncope does occur, observe your patient and evaluate them after they regain consciousness to determine if there is a need for further treatment. Fainting after vaccination itself is usually not a serious event, and patients generally recover within a few minutes.
Remember, one limitation of VAERS is that it cannot determine causality. A report to VAERS is only an association in time, meaning that the adverse event occurred some time after vaccination. CDC and FDA thoroughly investigate all serious reports to better assess whether more studies are needed to help determine if an adverse event could be associated with a vaccine. Although the media has paid particular attention to these adverse event reports, it is important to know and share with your patients that we have not found any information to conclude that these events were associated with the vaccine.
I would like to summarize with the following points:
First, based on the review of available information by FDA and CDC, the HPV vaccine continues to be recommended for girls and women, ages 9 to 26 years, as an important strategy to prevent cervical cancer. Gardasil can protect males against most genital warts and may be given to boys and men, ages 9 through 26 years.
Second, you should consider watching your patients carefully for 15 minutes after any vaccination, including administration of the HPV vaccine, to avoid potential injury from a fall in the event of syncope.
Third, discuss with your patients what to expect and to contact you if they experience additional symptoms after HPV vaccination.
And finally, if your patient experiences any adverse events after HPV vaccination, you or your patient should report them to VAERS. For more information on the safety data of the HPV vaccine, please see the resources on this page. Thank you.
Web Resources
Summary of HPV Adverse Events:
http://www.cdc.gov/vaccinesafety/Vaccines/HPV/gardasil.html.
Questions and Answers about HPV Vaccines (Patient Information)
http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm
Dr. Claudia Vellozzi completed her medical degree at Loyola Stritch School of Medicine in Chicago and her MPH at Johns Hopkins in Baltimore. She is board certified in both Family Medicine and Preventive Medicine.
Dr Vellozzi has extensive clinical and public health experience, both domestically and internationally. Her clinical experience includes starting a clinic for underserved Hispanics in Orange County, California, serving as faculty at a Family Medicine Residency Program in Greeley, Colorado, primary clinical care at a rural hospital in Nigeria and she continues to care for patients one-half day weekly at a Grady Neighborhood clinic, in Atlanta. Her areas of work in public health include HIV/AIDS, vaccines and immunization safety, health services research and maternal infant health. She has worked with the Centers for Disease Control and Prevention, World Health Organization and the Commonwealth Fund.
Dr Vellozzi recently returned to the Immunization Safety Office as Deputy Director and has led the H1N1 vaccine safety surveillance activities at the Centers for Disease Control and Prevention.
Dr Vellozzi has published numerous manuscripts in peer reviewed literature.
Sunday, June 6, 2010
More Rapid Weight Gain by Age 1 Year May Improve Neurodevelopment of Preterm Infants
Laurie Barclay, MD & Désirée Lie, MD, MSEd
From MedscapeCME Clinical Briefs
May 25, 2010 — In preterm infants, more rapid weight gain in the first year of life is associated with modest neurodevelopmental advantages and only small blood pressure (BP)–related effects at school age, according to the results of a study reported online May 17 in Pediatrics.
"More rapid infant weight gain may have benefits, such as to neurodevelopment, as well as risks, such as higher BP," write Mandy B. Belfort, MD, MPH, from Children's Hospital Boston in Boston, Massachusetts, and colleagues. "The balance of risks and benefits of rapid infant weight gain for preterm infants is poorly understood."
The goal of the study was to evaluate the association of infant weight gain with systolic BP (SBP) and IQ at school age in former preterm, low-birth-weight infants. In the Infant Health and Development Program, an 8-center longitudinal study, 911 children born at 37 weeks' gestation or less and weighing 2500 g or less were weighed at term and at 4 and 12 months' corrected ages.
Blood pressure was measured 3 times at 6.5 years, and the Wechsler Intelligence Scale for Children, Third Edition (WISC-III) was administered at 8 years to test IQ. The exposure "infant weight gain" was modeled in linear regression as the 12-month weight z score adjusted for the term weight z score.
At 12 months, median weight z score was –0.7 (interquartile range, –1.5 to –0.0). At 6.5 years, mean SBP was 104.2 ± 8.4 mm Hg, and at 8 years, mean WISC-III total score was 91 ± 18. For each z score additional weight gain from term to 12 months, SBP was 0.7 mm Hg higher, and WISC-III total score was 1.9 points higher, after adjustment for child age, sex, and race and maternal education, income, age, IQ, and smoking.
"In preterm infants, there seem to be modest neurodevelopmental advantages of more rapid weight gain in the first year of life and only small BP-related effects," the study authors write.
Limitations of this study include birth of the cohort in the 1980s, when neonatal intensive care unit practices differed from current practices; and lower socioeconomic status of mothers of the infants in this cohort, possibly limiting generalizability.
"Increased nutritional support for preterm infants after NICU [neonatal intensive care unit] discharge might benefit long-term neurodevelopmental outcomes, with only a small effect on BP-related health," the study authors conclude. "Although small IQ differences are not clinically significant for individuals, shifting the IQ curve of a population upward by a few points can have an important impact."
The National Institutes of Health, the Robert Wood Johnson Foundation, Maternal and Child Health Bureau, and Pew Charitable Trust supported this study. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online May 17, 2010. Abstract
Clinical Context
Approximately 12.7% of all births in the United States in 2005 were preterm, and there is an increasing burden of neurodevelopmental problems among preterm infants. Although infant weight gain has been associated with a reduced risk for low IQ among preterm infants, it is unclear if greater weight gain in infancy is associated with adverse metabolic factors such as BP.
This is a longitudinal cohort study of preterm infants at 8 US centers to examine the association between weight gain between birth and 12 months and SBP at age 6.5 years and IQ at age 8 years.
•Greater weight gain in the first year for preterm low-birth-weight infants is associated with a small increase in SBP (0.7 mm Hg) at age 6.5 years.
•Greater weight gain in the first year for preterm low-birth-weight infants is associated with a significant increase in IQ at age 8 years
From MedscapeCME Clinical Briefs
May 25, 2010 — In preterm infants, more rapid weight gain in the first year of life is associated with modest neurodevelopmental advantages and only small blood pressure (BP)–related effects at school age, according to the results of a study reported online May 17 in Pediatrics.
"More rapid infant weight gain may have benefits, such as to neurodevelopment, as well as risks, such as higher BP," write Mandy B. Belfort, MD, MPH, from Children's Hospital Boston in Boston, Massachusetts, and colleagues. "The balance of risks and benefits of rapid infant weight gain for preterm infants is poorly understood."
The goal of the study was to evaluate the association of infant weight gain with systolic BP (SBP) and IQ at school age in former preterm, low-birth-weight infants. In the Infant Health and Development Program, an 8-center longitudinal study, 911 children born at 37 weeks' gestation or less and weighing 2500 g or less were weighed at term and at 4 and 12 months' corrected ages.
Blood pressure was measured 3 times at 6.5 years, and the Wechsler Intelligence Scale for Children, Third Edition (WISC-III) was administered at 8 years to test IQ. The exposure "infant weight gain" was modeled in linear regression as the 12-month weight z score adjusted for the term weight z score.
At 12 months, median weight z score was –0.7 (interquartile range, –1.5 to –0.0). At 6.5 years, mean SBP was 104.2 ± 8.4 mm Hg, and at 8 years, mean WISC-III total score was 91 ± 18. For each z score additional weight gain from term to 12 months, SBP was 0.7 mm Hg higher, and WISC-III total score was 1.9 points higher, after adjustment for child age, sex, and race and maternal education, income, age, IQ, and smoking.
"In preterm infants, there seem to be modest neurodevelopmental advantages of more rapid weight gain in the first year of life and only small BP-related effects," the study authors write.
Limitations of this study include birth of the cohort in the 1980s, when neonatal intensive care unit practices differed from current practices; and lower socioeconomic status of mothers of the infants in this cohort, possibly limiting generalizability.
"Increased nutritional support for preterm infants after NICU [neonatal intensive care unit] discharge might benefit long-term neurodevelopmental outcomes, with only a small effect on BP-related health," the study authors conclude. "Although small IQ differences are not clinically significant for individuals, shifting the IQ curve of a population upward by a few points can have an important impact."
The National Institutes of Health, the Robert Wood Johnson Foundation, Maternal and Child Health Bureau, and Pew Charitable Trust supported this study. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online May 17, 2010. Abstract
Clinical Context
Approximately 12.7% of all births in the United States in 2005 were preterm, and there is an increasing burden of neurodevelopmental problems among preterm infants. Although infant weight gain has been associated with a reduced risk for low IQ among preterm infants, it is unclear if greater weight gain in infancy is associated with adverse metabolic factors such as BP.
This is a longitudinal cohort study of preterm infants at 8 US centers to examine the association between weight gain between birth and 12 months and SBP at age 6.5 years and IQ at age 8 years.
•Greater weight gain in the first year for preterm low-birth-weight infants is associated with a small increase in SBP (0.7 mm Hg) at age 6.5 years.
•Greater weight gain in the first year for preterm low-birth-weight infants is associated with a significant increase in IQ at age 8 years
High Caffeine Intake During Pregnancy Linked to Reduced Fetal Length
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
May 26, 2010 — Caffeine intake of 6 or more units per day during pregnancy is associated with impaired fetal length growth, according to the results of a cohort study reported online April 28 in the American Journal of Clinical Nutrition.
"Caffeine is a widely used and accepted pharmacologically active substance," write Rachel Bakker, from Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues from the Generation R Study. "The effect of caffeine intake during pregnancy on fetal growth and development is still unclear."
The goal of the study was to evaluate the associations of maternal caffeine intake from coffee and tea with fetal growth measured during each trimester of pregnancy and with the risks for adverse birth outcomes. From 2001 to 2005, a total of 7346 pregnant women in the Netherlands participated in a population-based prospective cohort study from early pregnancy onward.
Questionnaires were used to determine coffee and tea consumption in the first, second, and third trimesters. Serial ultrasound studies allowed determination of fetal growth characteristics, and hospital record review allowed determination of birth outcomes.
A regular serving of 125 mL of coffee in the Netherlands contains approximately 90 mg of caffeine (caffeinated), decaffeinated coffee contains 3 mg, and tea contains 45 mg per 125-mL serving. This was used as the standard for calculation of daily caffeine consumption.
Each unit of caffeine exposure was based on 1 cup of coffee (90 mg of caffeine), and total caffeine intake was categorized as less than 2 units, 2 to 3.9 units, 4 to 5.9 units, and 6 or more units per day.
Caffeine consumption was not consistently associated with fetal head circumference or with estimated fetal weight in any trimester. In contrast, higher caffeine consumption was associated with smaller first-trimester crown-rump length, second- and third-trimester femur length, and birth length (P for trend < .05). The risk of having a small-for-gestational-age infant at birth was increased in mothers who consumed at least 6 caffeine units per day.
"Our results suggest that caffeine intake of ≥6 units/d during pregnancy is associated with impaired fetal length growth," the study authors write. "Caffeine exposure might preferentially adversely affect fetal skeletal growth. Further studies are needed to assess these associations in non-European populations and to assess the postnatal consequences."
Limitations of this study include observational design with possible residual confounding; and missing data on coffee and tea consumption, which may have led to loss of power.
"Length- or skeletal-related fetal growth characteristics seemed to be most consistently affected from the first trimester onward," the study authors conclude. "Further structural and functional studies are needed to assess organ-specific effects. Our results suggest that pregnant women should be advised to not consume ≥6 caffeine units (.540 mg) per day during pregnancy."
The Erasmus Medical Center Rotterdam, the Erasmus University Rotterdam, and the Netherlands Organization for Health Research and Development (ZonMw) financially supported the first phase of the Generation R Study. One of the study authors was supported by the Netherlands Organization for Health Research.
Am J Clin Nutr. Published online April 28, 2010.
Clinical Context
Caffeine is widely used and freely passes the placenta, thus exposing the fetus to its influence during pregnancy. Caffeine intake during pregnancy has also been associated with higher rates of miscarriage and fetal death as well as lower birth weight, but the associations have been inconsistent.
This is a population-based cohort study embedded in the Generation R Study from fetal life to adulthood conducted in a city in the Netherlands with enrollment between 2001 and 2005 to examine the association between maternal caffeine intake from coffee and tea and fetal and birth growth measures.
CME Author: Désirée Lie, MD, MSEd
May 26, 2010 — Caffeine intake of 6 or more units per day during pregnancy is associated with impaired fetal length growth, according to the results of a cohort study reported online April 28 in the American Journal of Clinical Nutrition.
"Caffeine is a widely used and accepted pharmacologically active substance," write Rachel Bakker, from Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues from the Generation R Study. "The effect of caffeine intake during pregnancy on fetal growth and development is still unclear."
The goal of the study was to evaluate the associations of maternal caffeine intake from coffee and tea with fetal growth measured during each trimester of pregnancy and with the risks for adverse birth outcomes. From 2001 to 2005, a total of 7346 pregnant women in the Netherlands participated in a population-based prospective cohort study from early pregnancy onward.
Questionnaires were used to determine coffee and tea consumption in the first, second, and third trimesters. Serial ultrasound studies allowed determination of fetal growth characteristics, and hospital record review allowed determination of birth outcomes.
A regular serving of 125 mL of coffee in the Netherlands contains approximately 90 mg of caffeine (caffeinated), decaffeinated coffee contains 3 mg, and tea contains 45 mg per 125-mL serving. This was used as the standard for calculation of daily caffeine consumption.
Each unit of caffeine exposure was based on 1 cup of coffee (90 mg of caffeine), and total caffeine intake was categorized as less than 2 units, 2 to 3.9 units, 4 to 5.9 units, and 6 or more units per day.
Caffeine consumption was not consistently associated with fetal head circumference or with estimated fetal weight in any trimester. In contrast, higher caffeine consumption was associated with smaller first-trimester crown-rump length, second- and third-trimester femur length, and birth length (P for trend < .05). The risk of having a small-for-gestational-age infant at birth was increased in mothers who consumed at least 6 caffeine units per day.
"Our results suggest that caffeine intake of ≥6 units/d during pregnancy is associated with impaired fetal length growth," the study authors write. "Caffeine exposure might preferentially adversely affect fetal skeletal growth. Further studies are needed to assess these associations in non-European populations and to assess the postnatal consequences."
Limitations of this study include observational design with possible residual confounding; and missing data on coffee and tea consumption, which may have led to loss of power.
"Length- or skeletal-related fetal growth characteristics seemed to be most consistently affected from the first trimester onward," the study authors conclude. "Further structural and functional studies are needed to assess organ-specific effects. Our results suggest that pregnant women should be advised to not consume ≥6 caffeine units (.540 mg) per day during pregnancy."
The Erasmus Medical Center Rotterdam, the Erasmus University Rotterdam, and the Netherlands Organization for Health Research and Development (ZonMw) financially supported the first phase of the Generation R Study. One of the study authors was supported by the Netherlands Organization for Health Research.
Am J Clin Nutr. Published online April 28, 2010.
Clinical Context
Caffeine is widely used and freely passes the placenta, thus exposing the fetus to its influence during pregnancy. Caffeine intake during pregnancy has also been associated with higher rates of miscarriage and fetal death as well as lower birth weight, but the associations have been inconsistent.
This is a population-based cohort study embedded in the Generation R Study from fetal life to adulthood conducted in a city in the Netherlands with enrollment between 2001 and 2005 to examine the association between maternal caffeine intake from coffee and tea and fetal and birth growth measures.
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