Lead in calcium supplements. (41/891)

Intercalibrated measurements of lead in calcium supplements indicate the importance of rigorous analytical techniques to accurately quantify contaminant exposures in complex matrices. Without such techniques, measurements of lead concentrations in calcium supplements may be either erroneously low, by as much as 50%, or below the detection limit needed for new public health criteria. In this study, we determined the lead content of 136 brands of supplements that were purchased in 1996. The calcium in the products was derived from natural sources (bonemeal, dolomite, or oyster shell) or was synthesized and/or refined (chelated and nonchelated calcium). The dried products were acid digested and analyzed for lead by high resolution-inductively coupled plasma-mass spectrometry. The method's limit of quantitation averaged 0.06 microg/g, with a coefficient of variation of 1.7% and a 90-100% lead recovery of a bonemeal standard reference material. Two-thirds of those calcium supplements failed to meet the 1999 California criteria for acceptable lead levels (1.5 microg/daily dose of calcium) in consumer products. The nonchelated synthesized and/or refined calcium products, specifically antacids and infant formulas, had the lowest lead concentrations, ranging from nondetectable to 2.9 microg Pb/g calcium, and had the largest proportion of brands meeting the new criteria (85% of the antacids and 100% of the infant formulas).  (+info)

Effect of early emptying on quantitation and interpretation of liquid gastric emptying studies of infants and young children. (42/891)

This study assesses the effect of emptying that occurs during feeding on quantitation and interpretation of liquid gastric emptying studies of infants and young children. METHODS: Forty-nine 99mTc-sulfur colloid liquid gastric emptying studies of 44 children (22 boys, 22 girls; mean age, 20 mo; age range, 2-46 mo) fed orally or by gastrostomy tubes were evaluated. Gastric residuals quantitated by 2 commonly used methods, the first of which does not account for early emptying and the second of which does, were compared. With the first method, residual relative to activity in the stomach at the start of imaging (Rg) was quantified by comparing activity in a region of interest (ROI) drawn about the stomach on the final image to activity in an ROI drawn about only the stomach at the start of imaging. With the second method, residual relative to total dose (Rt) was quantified by comparing activity in the same final ROI to activity in an ROI that included stomach and small bowel at the start of imaging. Studies were interpreted independently for Rg and Rt considering a value >70% as evidence of delayed emptying. RESULTS: Rt was lower than Rg by 15%-16% for the entire population, for patients fed orally, and for patients fed by gastrostomy tube. These differences reached statistical significance (P < 0.0001). In 31 of 49 studies, R1 was lower than Rg by > or =10%. In 8 studies, emptying classified as delayed on the basis of Rg was classified as nondelayed on the basis of Rt. Clinical decisions based on Rt did not require later management changes that would have indicated that treatment of gastric dysmotility had been postponed in any patient. CONCLUSION: Emptying that occurs during feeding should be factored into quantitation of liquid gastric emptying in infants and young children. Not recognizing and accounting for early emptying results in overestimated gastric residuals and can lead to classification of emptying as delayed in children whose residuals of the total administered dose are within a recognized range of normal.  (+info)

Culturally appropriate nutrition education improves infant feeding and growth in rural Sichuan, China. (43/891)

Chinese studies indicate that the growth of rural infants and children lags behind that of their urban counterparts after 4 mo of age and that the gap is widening. However, the rural areas are home to >85% of China's 300 million children. Clearly, culturally appropriate rural complementary feeding interventions are needed to close the growth and health gaps. After a 1990 survey of infants in rural Sichuan confirmed that poor infant feeding practices rather than inadequate household food resources were responsible for the growth faltering, a year-long community-based pilot nutrition education intervention (n congruent with 250 infants each in Education and Control groups) was undertaken in four townships. The goal was to improve infant growth by improving infant feeding practices. Features of the intervention included the training and mobilizing of village nutrition educators who made monthly growth monitoring and complementary feeding counseling visits to all pregnant women and families with infants born during the intervention in the study villages. After 1 y, the Education group mothers showed significantly higher nutrition knowledge and better reported infant feeding practices than their Control group counterparts. Also, the Education group infants were significantly heavier and longer, but only at 12 mo (weight-for-age -1.17 vs. -1.93; P = 0.004; height-for-age -1.32 vs. -1.96; P = 0.022), had higher breast-feeding rates overall (83% vs. 75%; P = 0.034) and lower anemia rates (22% vs. 32%; P = 0.008) than the Control group infants. We conclude that these methods have potential for adaptation and development to other rural areas in the county, province and nation.  (+info)

Innate recognition of bacteria in human milk is mediated by a milk-derived highly expressed pattern recognition receptor, soluble CD14. (44/891)

Little is known about innate immunity to bacteria after birth in the hitherto sterile fetal intestine. Breast-feeding has long been associated with a lower incidence of gastrointestinal infections and inflammatory and allergic diseases. We found in human breast milk a 48-kD polypeptide, which we confirmed by mass spectrometry and sequencing to be a soluble form of the bacterial pattern recognition receptor CD14 (sCD14). Milk sCD14 (m-sCD14) concentrations were up to 20-fold higher than serum sCD14 from nonpregnant, pregnant, or lactating women. In contrast, lipopolysaccharide (LPS)-binding protein was at very low levels. Mammary epithelial cells produced 48-kD sCD14. m-sCD14 mediated activation by LPS and whole bacteria of CD14 negative cells, including intestinal epithelial cells, resulting in release of innate immune response molecules. m-sCD14 was undetectable in the infant formulas and commercial (cows') milk tested, although it was present in bovine colostrum. These findings indicate a sentinel role for sCD14 in human milk during bacterial colonization of the gut, and suggest that m-sCD14 may be involved in modulating local innate and adaptive immune responses, thus controlling homeostasis in the neonatal intestine.  (+info)

Poor maternal schooling is the main constraint to good child care practices in Accra. (45/891)

Life in urban areas presents special challenges for maternal child care practices. Data from a representative quantitative survey of households with children < 3 y of age in Accra, Ghana were used to test a number of hypothesized constraints to child care including various maternal (anthropometry, education, employment, marital status, age and ethnic group) and household-level factors (income, availability of food, quality of housing and asset ownership, availability of services, household size and crowding). Three care indices were created as follows: 1) a child feeding index; 2) a preventive health seeking index; and 3) a hygiene index. The first two indices were based on data from maternal recall; the hygiene index was based on spot-check observations of proxies of hygiene behaviors. Multivariate analyses (ordinary least-squares regression for the child feeding index and ordered probit for the two other indices) showed that maternal schooling was the most consistent constraint to all three categories of child care practices. None of the household-level characteristics were associated with child feeding practices, but household socioeconomic factors were associated with better preventive health seeking and hygiene behaviors. Thus, poor maternal schooling was a main constraint for child feeding, health seeking and hygiene practices in Accra, but the lack of household resources was a constraint only for health seeking and hygiene. The programmatic implications of these findings for interventions in nutrition education and behaviors in Accra are discussed.  (+info)

Iron bioavailability in infants from an infant cereal fortified with ferric pyrophosphate or ferrous fumarate. (46/891)

BACKGROUND: Infant cereals are commonly fortified with insoluble iron compounds with low relative bioavailability, such as ferric pyrophosphate, because of organoleptic changes that occur after addition of water-soluble iron sources. OBJECTIVE: Our objective was to compare iron bioavailability from ferric pyrophosphate with an alternative iron source that is soluble in dilute acid, ferrous fumarate, and to evaluate the influence of ascorbic acid on iron bioavailability from ferrous fumarate in infants. DESIGN: Iron bioavailability was measured as the incorporation of stable iron isotopes into erythrocytes 14 d after administration of labeled test meals (25 g dry wheat and soy infant cereal, 100 g water, and 2.5 mg Fe as [57Fe]ferric pyrophosphate or [57Fe]ferrous fumarate). Ascorbic acid was added to all test meals (25 mg in study 1 or 25 or 50 mg in study 2). Infants were fed each test meal on 4 consecutive days under standardized conditions. The 2 different test meals within each study were administered 2 wk apart in a crossover design. RESULTS: Geometric mean iron bioavailability was significantly higher from [57Fe]ferrous fumarate than from [57Fe]ferric pyrophosphate [4.1% (range: 1.7-14.7%) compared with 1.3% (range: 0. 7-2.7%); n = 8, P = 0.008]. In this study, doubling the ascorbic acid content did not further enhance iron bioavailability; the geometric means (range) were 3.4% (1.9-6.6%) and 4.2% (1.2-18.7%) for the test meals with 25 and 50 mg ascorbic acid added, respectively (n = 9). CONCLUSION: Iron bioavailability from iron-fortified infant cereals can be improved by using an iron compound with high relative bioavailability and by ensuring adequate ascorbic acid content of the product.  (+info)

Early infant feeding and growth status of US-born infants and children aged 4-71 mo: analyses from the third National Health and Nutrition Examination Survey, 1988-1994. (47/891)

BACKGROUND: There is controversy over what growth references to use in evaluating breast-fed infants and concern about whether never-breast-fed infants are at risk of overweight in childhood. OBJECTIVE: The objective of this study was to determine whether infants who are exclusively breast-fed for 4 mo differ in average size from infants who are fed in other ways and whether such differences persist through age 5 y. DESIGN: Data from the third National Health and Nutrition Examination Survey (NHANES III) were linked to birth certificates of US-born infants and children. Feeding groups were defined on the basis of feeding patterns over the first 4 mo of life: exclusively breast-fed for 4 mo, partially breast-fed, breast-fed for <4 mo, and never breast-fed. Growth status, indexed as internally derived z scores (SD units) for weight, length (height), weight-for-length (height), midupper arm circumference, and triceps skinfold thickness, was compared among feeding groups. RESULTS: The final sample consisted of 5594 non-Hispanic white, non-Hispanic black, and Mexican American infants and children aged 4-71 mo. Of these, 21% were exclusively breast-fed for 4 mo, 10% were partially breast-fed, 24% were breast-fed for <4 mo, and 45% were never breast-fed. At 8-11 mo, infants who were exclusively breast-fed for4 mo had adjusted mean z scores for weight (-0.21; -0.2 kg), weight-for-length (-0.27), and midupper arm circumference (-0.15) that differed significantly from zero (P < 0. 05). By 12-23 mo, the differences had dissipated; there were no significant differences subsequent to 5 y. Triceps skinfold thickness was not related to early infant feeding. CONCLUSION: Infants who were exclusively breast-fed for 4 mo weighed less at 8-11 mo than did infants who were fed in other ways, but there were few other significant differences in growth status through age 5 y associated with early infant feeding.  (+info)

Blue babies and nitrate-contaminated well water. (48/891)

The use of nitrate-contaminated drinking water to prepare infant formula is a well-known risk factor for infant methemoglobinemia. Affected infants develop a peculiar blue-gray skin color and may become irritable or lethargic, depending on the severity of their condition. The condition can progress rapidly to cause coma and death if it is not recognized and treated appropriately. Two cases of blue baby syndrome were recently investigated. Both cases involved infants who became ill after being fed formula that was reconstituted with water from private wells. Water samples collected from these wells during the infants' illnesses contained nitrate-nitrogen concentrations of 22.9 and 27.4 mg/L.  (+info)