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PubMed2006

Ghrelin secretion in preterm neonates progressively increases and is refractory to the inhibitory effect of food intake.

CONTEXT: Ghrelin, a natural GH secretagogue, is mainly characterized by nonendocrine activities such as orexigenic effect and modulation of the endocrine and metabolic response to variations in energy balance. Ghrelin levels have been reported to be negatively associated with insulin secretion, enhanced in anorexia, and reduced in obesity. Ghrelin levels in newborns were shown to be similar to those found in children and adults without any gender-related difference. OBJECTIVE: The aim of this study was to evaluate ghrelin variations in preterm newborns as a function of fasting and feeding. METHODS: To this end, in 31 preterm neonates (13 males and 18 females) categorized as appropriate for gestational age, total ghrelin levels were measured in cord blood and then on the fourth day of life before and after meals. RESULTS: Ghrelin levels in cord blood [(median 25th-75th centile) 184; 122-275 pg/ml] were higher (P < 0.006) than levels measured in the mothers at delivery (167.0; 89-190 pg/ml). In newborns on the fourth day of life, ghrelin levels in fasting conditions (451; 348-649 pg/ml) were higher (P < 0.0004) than those in cord blood. The meal did not at all modify ghrelin levels (476; 302-775 pg/ml), which were unchanged, compared with those in fasting condition. Total ghrelin levels in cord blood were not associated with weight and length; conversely, on the fourth day of life ghrelin levels in newborns were negatively correlated to birth weight as well as the present weight (P = 0.05, r = -0.4). Ghrelin levels were independent of gender, type of delivery, and the kind of feeding regimen. CONCLUSIONS: The secretion of total ghrelin increases from delivery to the fourth day of life when it is refractory to the inhibitory effect of food intake, but it is negatively correlated to body weight.

Body Height↗

PubMed1998

Breastfeeding information and support services offered by Melbourne hospitals in antenatal classes.

Breastfeeding in industrialised societies is affected by a number of factors including antenatal class participation, timing of breastfeeding education, support networks available, and fathers' opinions. This study aimed to investigate the availability and type of breastfeeding information and support services offered by Melbourne hospitals. This was discussed in regard to the possible effect this may have on mothers' choice of feeding method. All hospitals known by Nursing Mothers' Association of Australia (NMAA) to be involved in obstetric care were asked to complete a questionnaire. Factors such as antenatal class timing, attendance, cost and content were investigated as indicators of the extent of services available. Specifically, services and information offered for women from non English speaking backgrounds (NESB) and from Aboriginal and Torres Strait Islands were identified. The study found that breastfeeding education is a small part of antenatal education in Melbourne hospitals. The inclusion of NMAA was widespread among hospitals, allowing access to information and support services. The amount of information and support services available for women from NESB and Aboriginal and Torres Strait Islander background needs to be expanded.

Breast Feeding↗

PubMed1999

You can make a difference: increasing breastfeeding rates in an inner-city clinic.

Breastfeeding is endorsed in the United States as the ideal infant feeding method, but initiation rates are far behind U.S. national goals, and are generally lower in poorer socioeconomic groups. The goal of the project described was to increase breastfeeding rates in an inner-city clinic. The intervention consisted of prenatal breastfeeding education for all pregnant women, postpartum gift packs, and support groups. During the study, the breastfeeding initiation rate rose from 36% to 66% (p < 0.05) and the proportion still breastfeeding at 2 weeks postpartum increased from 35% to 57% (p < 0.05). The cost of the project was minimal. The biggest expense was the discharge packets. We conclude that relatively inexpensive interventions can have a significant impact on breastfeeding initiation, even in a population at high risk of not breastfeeding.

Breast Feeding↗

PubMed1997

Effect of choice feeding on the performance of broilers.

1. Male broilers from, 21 to 56 d of age were fed their diet either mixed as pellets or mash, or as separate ingredients presented on a free-choice basis, to determine whether feeding method affected growth, carcase composition or profitability to 56 d of age. 2. The 12 treatments were: 2 completely balanced diets fed as mash or pellets, 8 choice fed diets containing maize or sorghum as the energy source (whole or mash) and protein concentrate (pellets or mash) and 2 unbalanced mixed mash diets containing 50% grain (maize or sorghum) plus 50% protein concentrate. 3. For the choice treatments, one food, grain (maize or sorghum) or protein concentrate (mash or pellets), was placed in each feeder. Broilers fed the complete pelleted or mash diet received the diet in both feeders. Food consumption was recorded weekly. Broilers were weighed at 42 and 56 d of age. 4. There were no significant differences between treatments and the pelleted control diet with regard to body weight, food consumed, food efficiency, carcase, ash, dressing percentage and mortality. 5. Choice fed broilers receiving the energy source as whole grains had larger gizzards while the higher protein diets (50/50) resulted in a higher carcase moisture and protein but lower carcase fat than the broilers fed the pelleted control diet. 6. The main advantage of choice feeding appears to be the economical savings of feeding whole grains as the energy source.

Analysis of Variance↗

PubMed1998

Significant decrease of serum vitamin A level in Japanese Black beef steers after introduction to a farm.

Significant decrease of serum vitamin A (V.A) level in 4 out of 5 Japanese Black beef steers on day 7 after introduction was described in the present study. The feeder steers were fed the diets containing much more V.A than they required. In the farm where they were introduced, the productivity was high and the frequency was low in bovine cases of death and disease. The herd management; i.e. feeding method and environment of the farm were properly arranged. Results obtained from blood serum analyses revealed that health and nutritional status of the feeder steers were good on the day of introduction. The feeder steers, clinically healthy on the day of introduction, manifested mild bronchitis and diarrhea on days 2 and 10 after introduction, respectively, and slightly decreased dietary intake on both days. Serum V.A levels of the feeder steers were within the normal range. However, significantly decreased serum V.A level was detected in 4 feeder steers out of 5 on day 7 after introduction. This may be attributed to stress-increased V.A consumption rather than the decreased V.A intake.

Animal Feed↗

PubMed2003

Management of hyperbilirubinemia in newborns: measuring performance by using a benchmarking model.

BACKGROUND: Accreditors hold hospitals accountable for harm from serious newborn hyperbilirubinemia, yet standards for evaluating performance in prevention are lacking. OBJECTIVE: We confirmed prognostic variables for newborn hyperbilirubinemia and developed a benchmarking model for self-evaluation of hyperbilirubinemia management. METHODS: We conducted a 3-year prospective cohort study in the Henry Ford Health System (HFHS) on 5507 healthy newborns of >or=35 weeks' gestational age. HFHS follows a rigorous protocol for hyperbilirubinemia management. Defining hyperbilirubinemia as age-specific levels of total serum bilirubin exceeding American Academy of Pediatrics criteria for considering phototherapy and severe hyperbilirubinemia as total serum bilirubin >or=20 mg/dL, we used logistic and Poisson regressions to determine predictors and estimate parameters for a benchmarking model. We compared incidence rates for severe hyperbilirubinemia from HFHS to aggregate data from 11 hospitals reported to have less rigorous management. RESULTS: Newborns were 52.9% black, 14.4% white, 24.3% Latino, and 2.4% Asian; 30% were exclusively and 28% partially breastfed. Regression analyses revealed associations for hyperbilirubinemia and severe hyperbilirubinemia with black mothers (negative) and exclusive or partial breastfeeding and younger gestational age (positive). Male newborns and older mothers were also associated with severe hyperbilirubinemia. For all 5 variables, we found a lower risk for severe hyperbilirubinemia at HFHS than in the comparison hospital group. To compare hospitals, we developed a benchmarking model for incidence of hyperbilirubinemia adjusting for race, feeding method, and gestational age. CONCLUSIONS: Hospitals with access to newborns' inpatient and postdischarge data can use our benchmarking model to compare their management of hyperbilirubinemia with a reference population that received rigorous care.

Benchmarking↗

PubMed1991

Effect of an acute zinc depletion on rat lipoprotein distribution and peroxidation.

The aim of this study was to determine the extent to which zinc depletion leads to lipoprotein modifications by measuring both lipoprotein-fraction distribution and peroxidation in zinc-depleted rats. The animals were divided into three groups and fed for 8 wk a zinc-adequate diet (100 ppm) ad libitum (AL), a zinc-deficient diet (0.2 ppm) ad libitum (ZD), or a zinc-adequate diet according to the pair feeding method (PF). Trace-element status, tissular lipids, and lipoprotein-fraction study were performed. The MDA production by the lipoprotein fraction was measured before and after induced peroxidation. Cholesterol and phospholipids were increased in ZD rats. An important increase of VLDL and IDL was observed and a significant enhanced production of MDA by the LDL was related to zinc deficiency. From this observation, we may conclude that LDL fractions of ZD rats are more susceptible to induced oxidative damage. These results suggest that in zinc deficiency, the lipoprotein fragility is an aggravating factor of peroxidation and the dyslipoproteinemia may lead to an atherogenic risk.

Animals↗

PubMed2006

Early versus delayed enteral nutrition support for burn injuries.

BACKGROUND: A burn injury increases the body's metabolic demands, and therefore nutritional requirements. Provision of an adequate supply of nutrients is believed to lower the incidence of metabolic abnormalities, thus reducing septic morbidity, improving survival rates, and decreasing hospital length of stay. Enteral nutrition support is the best feeding method for patients who are unable to achieve an adequate oral intake to maintain gastrointestinal functioning, however, its timing (i.e. early versus late) needs to be established. OBJECTIVES: To assess the effectiveness and safety of early versus late enteral nutrition support in adults with burn injury. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, issue 1, 2006), the Cochrane Injuries Group's Specialised Register, MEDLINE (1966 to May week 1, 2006), EMBASE (1980 to week 17, 2005) and CINAHL (1982 to May week 1, 2006). SELECTION CRITERIA: We included all randomised controlled trials comparing early enteral nutrition support (within 24 hours of injury) versus delayed enteral support (greater than 24 hours). DATA COLLECTION AND ANALYSIS: Two authors used standardised forms to independently extract the data. Each trial was assessed for internal validity with differences resolved by discussion. MAIN RESULTS: A total of three randomised controlled trials were eligible for inclusion in this review. Results of the studies indicate that evidence about the benefit of early enteral nutritional support on standardised clinical outcomes such as length of hospital stay and mortality, remains inconclusive. Similarly, the question of whether early enteral feeding influenced or decreased metabolic rate as documented in part by our included studies, remains uncertain. AUTHORS' CONCLUSIONS: This systematic review has not found sufficient evidence to support or refute the effectiveness of early versus late enteral nutrition support in adults with burn injury. The trials showed some promising results that would suggest early enteral nutrition support may blunt the hypermetabolic response to thermal injury, but this is insufficient to provide clear guidelines for practice. Further research incorporating larger sample sizes and rigorous methodology that utilises valid and reliable outcome measures, is essential.

Adult↗

PubMed1995

Factors associated with low body mass index and weight loss in nursing home residents.

BACKGROUND: Undernutrition in nursing home residents is a significant and possibly modifiable public health problem. We evaluated the hypothesis that some potentially modifiable factors are associated with resident undernutrition. METHODS: This study is a cross-sectional, secondary data analysis of 6,832 community nursing home residents sampled from 202 nursing homes in 7 states. Data were from the Minimum Data Set (MDS), and HCFA-mandated resident assessment instrument used in U.S. community nursing homes. Two dependent variables represented undernutrition: (a) low body mass index (BMI), defined as the lowest quartile BMI of the sample (19.42 kg/m2 and below); and (b) weight loss, an MDS measure defined as 5% decrease in weight in 30 days, or a 10% decrease in 180 days (9.9% of the sample). Independent variables included resident demographics, eating-related variables, variables measuring functional, cognitive, and affective statuses, and medical conditions. Separate logistic regression models were estimated for low BMI and weight loss to test multivariate associations. RESULTS: Poor oral intake, eating dependency, decubiti, and chewing problems increase the likelihood of both low BMI and weight loss. Female gender, age 85 or older, bedfast, and hip fracture increase the odds of low BMI only; depressed behaviors and two or more chronic diseases increase the odds of weight loss only. CONCLUSION: Undernutrition in nursing home residents is a multifactorial syndrome. Improved oral feeding methods and treatment of depression are potentially important ways to counteract undernutrition in nursing home residents by targeting reversible features.

Activities of Daily Living↗

PubMed1998

[Breast feeding. Health related and sociocultural influences and challenges].

Breastfeeding is being abandoned as the preferred feeding method in the early months of baby's life, and many early failures take place among the few mothers who attempt to breastfeed their babies. For that reason, sanitation professionals must encourage breastfeeding and convince mothers to keep it up, at least, for 4-6 months after giving birth. Analysis of pregnancy, delivery and after delivery sociocultural and sanitary conditions may help sanitation workers to elaborate an educational strategy that considers breastfeeding as healthy behavior that should he encouraged. The support of sanitation professionals is considered fundamental for breastfeeding maintenance, and a more profound training of these professionals about every aspect of breastfeeding is necessary. More active sanitary policies supporting this healthy behavior should also be established.

Attitude to Health↗

PubMed2001

[A study of the relation between providing healthcare information and behavior changes of people in Japan. Parental behavior changes after receiving information about the sudden infant death syndrome].

OBJECTIVE: Considering the lack of evidence concerning the relationship between providing healthcare information and behavior of people in Japan, we utilized a questionnaire to survey the parents of infants to evaluate behavior change after receiving information about the Sudden Infant Death Syndrome (SIDS). METHODS: A questionnaire about SIDS information was administered in 234 municipalities in Niigata, Gifu, Shizuoka, and Hiroshima Prefectures and in Yokohama City in November and December of 1999 to 14,879 parents who visited for the 18-month health examination of their children. The questionnaire did not ask for the participants' names. Logistic regression analysis was used to study the connection between behavior change and SIDS information sources. RESULTS: 10,900 parents returned the questionnaire to give a 73.3% response rate, 19.0% of these receiving information about SIDS risk factors from hospitals or clinics, 3.7% from public health centers, and 9.2% from their friends. More received information from the mass media such as TV programs, which provided the main source for 71.1% of the parents. The degree of behavior change was evaluated after adjustment for variables concerning a variety of information sources and other appropriate factors such as the age and sex of parents and the number of their children. We found that receiving information from hospitals or clinics significantly influences behavior changes for all kinds of risk factors. Information from public health centers, baby-care groups, and friends influenced behavior changes relevant to the risk factors for feeding methods, sleeping position, and parents' smoking. There was no relation between receiving information from the mass media and behavior change of parents. CONCLUSIONS: The mass media provide far more information than do medical facilities, public health centers, baby-care groups and personal contacts but the latter played much more effective roles in making parents change their baby care behavior. These results point to an obvious discrepancy between efficiency in providing information and the degree of behavior change elicited. We should thus take the source of information and the target population into consideration when we examine the best way to provide healthcare information for people in the future.

Adult↗

PubMed2001

Use of sertraline, paroxetine and fluvoxamine by nursing women.

BACKGROUND: The pharmacological treatment of depression in nursing women requires information on the magnitude of medication exposure to the infant that may occur through breast milk. AIMS: To examine serum concentrations of antidepressants in infants exposed to these medications through breast-feeding. METHOD: Maternal and infant serum concentrations of sertraline, paroxetine and fluvoxamine were determined with high-performance liquid chromatography (limit of detection=1 ng/ml). RESULTS: No detectable medication was present in any infant exposed to paroxetine (n=16) or fluvoxamine (n=4). Among infants exposed to sertraline (n=30), detectable medication was present in 24% of serum samples. A significant negative correlation was found between infant age and infant serum concentration. Sertraline was significantly more likely to be detected in an infant if the mother's daily dose was 100 mg or higher. No adverse sequelae occurred in any infant. CONCLUSIONS: This study shows that paroxetine, fluvoxamine and sertraline produce minimal exposure to infants when taken by nursing mothers.

Breast Feeding↗

PubMed2006

Exploring the subconcepts of the Wittmann-Price theory of emancipated decision-making in women's health care.

PURPOSE: To explore the subconcepts of the Wittmann-Price Theory of Emancipated Decision-Making (EDM); which is proposed as a new theoretical model for the nursing care of women to increase women's satisfaction with decision-making about healthcare issues. Infant feeding method was used as the clinical exemplar. DESIGN AND METHOD: A descriptive correlational design was used to test the five identified subconcepts of EDM (empowerment, flexible environment, personal knowledge, reflection, and social norms) in women's healthcare. The relationship of emancipated decision-making and satisfaction were explored with the Subject Demographic Questionnaire (SDQ), the Wittmann-Price Theory of Emancipated Decision-making Scale (EDMS), and the Satisfaction with Decision (SWD) scale. The research design was retrospective, without random sampling of subjects. Four research questions were posed for this investigation. Women who had uncomplicated deliveries and met the selected criteria were enrolled (N=97). FINDINGS: All five subconcepts of EDM were scored on subscales on the EDMS; flexible environment and personal knowledge had the highest mean scores. Pearson correlations showed that all five subscales were significantly related to each other except reflection with personal knowledge and reflection with social norms. A significant relationship was found between the EDM and satisfaction with the decision. Personal knowledge and flexible environment were the best predictors of satisfaction with the decision. CONCLUSIONS: The Wittmann-Price Theory of EDM is a theoretical model with implications for nursing care of women who are involved in a healthcare decision, such as choice of infant feeding. Further studies are needed to determine the importance of each of the subconcepts in relation to emancipated decision-making.

Adolescent↗

PubMed1988

Promoting breastfeeding at a migrant health center.

A program to promote breastfeeding was introduced at a migrant health center in North Carolina. Strategies for promoting breastfeeding as a feeding method particularly suited to the migrant lifestyle were identified and implemented. Donated layettes were used to encourage attendance of prenatal patients at a class on breastfeeding. Women planning to breastfeed were given cards to alert the delivering hospital of their intention. These hospitals were provided with bilingual flipcharts to use in communicating with non-English speaking patients. Of the 158 women who came to the center for one or more prenatal visits, 101 attended a class or received individual counseling on breastfeeding; during this 13-month period, 52 per cent of 64 women who attended the class were breastfeeding at time of their hospital discharge (Mexican-Americans 60%, Black Americans 44%). In a comparison of similar ethnic distribution, the corresponding rate was 10%.

Black or African American↗

PubMed2000

Serum valproate levels in 6 breastfeeding mother-infant pairs.

BACKGROUND: Women with bipolar disorder are at high risk for recurrence of an affective episode in the postpartum period, and treatment with a mood stabilizer may be indicated. Few data are available to inform the risk-benefit decision regarding the use of valproate for women with bipolar disorder who elect to breast-feed. METHOD: Serum valproate levels were obtained from 6 breastfeeding mother-infant pairs. All mothers had a diagnosis of bipolar disorder (Research Diagnostic Criteria) and were taking divalproex sodium as prophylaxis for or treatment of a recurrent affective episode. None of the mothers received valproate during pregnancy. RESULTS: The mothers had serum valproate levels near or within the therapeutic range (39.4 to 79.0 microg/mL). Infant serum levels were low, ranging from 0.7 to 1.5 microg/mL (0.9%-2.3% of maternal serum levels). No adverse clinical effects were observed in the infants. CONCLUSION: Serum valproate levels were low in nurslings of mothers treated with valproate. These data can be used to inform clinical decisions regarding the use of valproate during breastfeeding.

Age Factors↗

PubMed2003

Breastfeeding does not pose any additional risk of immunoprophylaxis failure on infants of HBV carrier mothers.

Whether babies born to hepatitis B (HB) carrier mothers with HB immunoprophylaxis at birth can be breastfed safely is controversial. A total of 230 such babies were followed up for one year to assess the influence of feeding method on the efficacy of HB immunoprophylaxis. The positive rates of anti-HBs at different ages are not statistically different between the breastfed group and the bottle-fed group. At 1 year, the rate was 80.9% in the breastfed group and 73.2% in the bottle-fed group in infants with HB vaccine alone, and 90.9% in the breastfed group and 90.3% in the bottle-fed group in infants with HBIG plus HB vaccine. There were no significant differences in the incidence of immunoprophylaxis failure between breastfed and bottle-fed babies. The results indicated that breastfeeding does not have a negative influence on the response of anti-HBs and on the failure rates of immunoprophylaxis in the infants born to HB carrier mothers.

Bottle Feeding↗

PubMed1994

Fecal IgE levels in infants at 1 month of age as indicator of atopic disease.

Fecal IgE levels were investigated in 165 asymptomatic infants at 1 month of age under two nutritional regimens, breast-feeding and formula feeding, and the possibility of predicting by fecal IgE levels the onset of atopic disease was studied in these infants. IgE levels were measured by time-resolved fluoroimmunometric assay. IgE antibodies are detectable in fecal extracts, and we have already reported that IgE levels are increased in food-allergy patients after administration of food allergens, and this increase in fecal IgE levels may be a specific consequence of the local immune response to food-allergen stimulation in the gut mucosa. The presence of atopic disease and the feeding method during the nursing period were surveyed by questionnaire in 89 of these 165 infants when they were 18 months old. In an analysis of the present results, IgE values above 0.015 U/ml, the lower limit of measurement, were considered to be high. Forty-eight (29%) of the 165 subjects showed a high fecal IgE level. Thirty-seven (35%) of 105 formula-fed infants had high fecal IgE levels, whereas only 11 (18%) of 60 breast-fed infants had high levels (P < 0.05). With respect to atopic family history, 30 (39%) of the 77 infants with atopic family history had high fecal IgE levels, as compared with 18 (20%) of the 88 infants without atopic family history (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers↗

PubMed2005

Could associations between breastfeeding and insulin-like growth factors underlie associations of breastfeeding with adult chronic disease? The Avon Longitudinal Study of Parents and Children.

OBJECTIVE: The influence of infant feeding method (breast/formula) on growth factor levels could underlie associations of breastfeeding with childhood growth and risk factors for cardiovascular disease. We investigated associations of having been breastfed with serum IGF-I and IGFBP-3 in childhood. METHODS: Prospective birth cohort study (subsample of the Avon Longitudinal Study of Parents and Children, UK) based on 871 children born in 1991/1992 who underwent clinical follow-up and blood tests at age 7-8 years. A total of 488 (56%) children had complete data. RESULTS: In children with complete data, the age- and sex-standardized IGF-I levels of those who were partially or exclusively breastfed were 6.1 and 13.8 ng/ml higher, respectively, than those who were never breastfed (increase in IGF-I levels per category of breastfeeding exclusivity: 7.1 ng/ml; 95% CI: 0.3-13.9; P = 0.04). In models also controlling for birthweight, gestational age, mother's age, and socioeconomic and dietary factors, the breastfeeding-IGF-I association was attenuated (regression coefficient: 3.3 ng/ml; -4.2-10.7; P = 0.4); further adjustment for IGFBP-3 made little difference (regression coefficient: 4.1 ng/ml; -2.8-10.9; P = 0.2). There was little evidence for an association between breastfeeding and IGFBP-3 or the molar ratio IGF-I/IGFBP-3. CONCLUSIONS: The positive association between breastfeeding and IGF-I could be due to residual confounding or to chance. Nevertheless, the magnitude of the fully adjusted effect estimate and the novelty of the association suggest that larger studies should now be conducted to confirm or refute the hypothesis that variations in IGF-I by infant feeding mode explain associations of breastfeeding with health in later life.

Breast Feeding↗