Prevalence of enamel defects and the relationship to dental caries in deciduous and permanent dentition in Indaiatuba, São Paulo, Brazil

The aim of this study was to determine the prevalence of hypoplasia, demarcated opacity and dental fluorosis among schoolchildren with deciduous and permanent dentition. The association between enamel defects and dental caries was also verified. The sample consisted of 624 schoolchildren aged 5 and 309 aged 12. The dmft and DMFT indexes were used to assess dental caries prevalence, DDE to assess enamel defects, and Dean to assess fluorosis. Chi-squared test was used to test significance (p < 0.05) and odds ratio to analyze prevalence of dental caries and enamel defects. A positive association between dental caries and enamel defects (hypoplasia, demarcated opacity and dental fluorosis) was observed for schoolchildren aged 5. However, only hypoplasia and demarcated opacity were associated with caries experience in permanent dentition. The results of this study indicated that children had increased odds of dental caries when enamel defect was present, both in deciduous and permanent dentition; further studies are needed to give evidence to this association.     

How Close Are We to Achieving Energy and Nutrient Goals for Very Low Birth Weight Infants in the First Week?

Background: Emerging evidence suggests intakes of protein and energy as early as the first week of life in preterm very low birth weight (VLBW) infants are associated with improved neurodevelopment. In response, many neonatal intensive care units (NICUs) have launched new, more aggressive early feeding guidelines. The aim of this study was to evaluate enteral and parenteral energy and macronutrient intakes during the first postnatal week in VLBW infants admitted to NICUs that have introduced more aggressive early feeding guidelines. Materials and Methods: Estimated energy and macronutrient intakes were prospectively collected from VLBW infants fed exclusively mother's own milk and/or parenteral nutrition and compared with expert recommendations. Days to reach full enteral feeds (150 mL/kg/d) and discharge anthropometrics were examined. Results: By days 6 and 7, median protein and lipid intakes, respectively, reached recommended values (3.5 and 3.0 g/kg/d). However, by day 8, many infants remained below recommended intakes for protein (34%), lipid (34%), carbohydrate (68%), and energy (71%). Late‐onset sepsis was associated with a decreased likelihood of reaching full enteral feeds on any given day (hazard ratio, 0.2; 95% confidence interval, 0.1–0.5; P ≤ .0009). There was no significant relationship between week 1 nutrient intakes and anthropometrics at discharge. Conclusion: Despite the introduction of more aggressive early feeding guidelines and improved energy and nutrient intakes compared with literature values, many VLBW infants remain below recommended nutrition goals in the first week.     

Glutamine-enriched enteral nutrition in very-low-birth-weight infants and effects on feeding tolerance and infectious morbidity: a randomized controlled trial

BACKGROUND: Glutamine depletion has negative effects on the functional integrity of the gut and leads to immunosuppression. Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion because nutrition is limited in the first weeks of life. OBJECTIVE: The objective was to determine the effect of glutamine-enriched enteral nutrition on feeding tolerance, infectious morbidity, and short-term outcome in VLBW infants. DESIGN: In a double-blind randomized controlled trial, VLBW infants (gestational age <32 wk or birth weight <1500 g) were allocated to receive enteral glutamine supplementation (0.3 g . kg(-1) . d(-1)) or isonitrogenous control supplementation (alanine) between days 3 and 30 of life. The supplementations were added to breast milk or to preterm formula. The primary endpoint for the study was time to full enteral feeding. Secondary endpoints were other variables of feeding tolerance, infectious morbidity, and short-term outcome. RESULTS: Baseline patient and nutritional characteristics were not significantly different in the glutamine-supplemented (n = 52) and the control (n = 50) groups. The median time to full enteral feeding was 13 d (range: 7-31 d) in the glutamine-supplemented group and 13 d (range: 6-35 d) in the control group (hazard ratio: 1.19; 95% CI: 0.79, 1.79; P = 0.40). In the glutamine-supplemented group, 26 of 52 infants (50%) had >/=1 serious infection compared with 38 of 50 (76%) in the control group (odds ratio: 0.32; 95% CI: 0.14, 0.74; P = 0.008). Other variables of feeding tolerance and short-term outcome were not significantly different between groups. CONCLUSIONS: Glutamine-enriched enteral nutrition did not improve feeding tolerance or short-term outcome in VLBW infants. However, infectious morbidity was significantly lowered in infants who received glutamine-enriched enteral nutrition.     

Two‐Year Follow‐up of a Randomized Controlled Nutrition Intervention Trial in Very Low‐Birth‐Weight Infants

Background: Very low‐birth‐weight (VLBW) infants are at risk for neurodevelopment impairment. This study assessed the effect of early aggressive parenteral nutrition (PN) on long‐term outcome in VLBW infants. Materials and Methods: Directly after birth, VLBW infants (birth weight <1500 g, n = 142) were randomized to 5 different PN regimes. Controls (n = 46) received glucose and standard‐dose amino acids (AAs; 2.4 g/[kg·d]) from birth onward and pure soybean oil fat emulsion (SOY) on the second day of life. Two intervention groups received glucose, standard‐dose AAs, and lipids from birth onward: SOY (n = 24) or mixed fat emulsion (MIX, n = 25). The 2 other intervention groups received glucose, high‐dose AAs (3.6 g/[kg·d]), and lipids from birth onward: SOY (n = 24) or MIX (n = 23). The primary outcome of this follow‐up study was the composite outcome of “death or major disability” at 2 years corrected age. Secondary outcomes were death, major disabilities, neurodevelopmental scores, and anthropometry. Results: Follow‐up rate was 92% (n = 134). Thirty‐five (26%) infants had died or had a major disability, with no differences between intervention groups and controls. Increased odds for death were observed in the standard‐dose AA‐MIX group (odds ratio, 5.4; 95% confidence interval [CI], 1.1–27.0). Neurodevelopmental scores and incidence of major disabilities did not differ between groups. Growth in the high‐dose AA‐MIX group was enhanced compared with growth in controls at 2 years corrected age (+0.51 [0.01–1.02] weight SDS). Conclusion: This randomized controlled hypothesis‐generating study demonstrated no beneficial effect of early high‐dose AA administration and mixed fat emulsions on survival and neurodevelopmental outcome in VLBW infants, although growth was enhanced.     

Delivering A Very Low Birth Weight Infant and The Subsequent Risk of Divorce or Separation

Background: The simultaneous rise over the last two decades in the U.S. in the proportion of VLBW (<1500 grams) deliveries and the improvement in their chance of survival has increased the number of families caring for VLBW infants and children. The families of VLBW infants with adverse outcomes can face psychological and monetary stresses, which in turn may influence marital instability and increase the risk of divorce or separation. The purpose of this paper is to identify the relationship of having a VLBW birth with the probability of divorce or separation in the first two years following delivery. Methods: We use data from the 1988 National Maternal and Infant Health Survey (NMIHS). This national stratified, systematic “follow-back” survey augments information from birth records in 1988 by obtaining information on social, demographic, and economic variables from women that delivered a baby in 1988. We estimate a proportional discrete time hazard model of transitions to divorce/separation. Results: Parents of a VLBW infant have 2-fold higher odds of divorce/separation compared with parents of a child with a birth weight greater than 1500 grams. Two years after delivery of a non-VLBW baby 95 percent of the marriages remain stable, while about 90 percent of the marriages remain stable following the birth of a VLBW baby. If the pregnancy was not desired, then only 85 percent of the marriages remain stable 2 years following the delivery of a VLBW infant. Conclusions: There is an evident need to counsel and support families with VLBW infants on mechanisms to cope with the initial stressors that can be anticipated to arise.     

Thyroid Dysfunction and the Effect of Iodine-Deficient Parenteral Nutrition in Very Low Birth Weight Infants: A Nationwide Analysis of a Korean Neonatal Network Database

Background: To investigate the impact of nutritional iodine deficiency on thyroid dysfunction (TD) in very low birth weight (VLBW) infants, we analyzed the association between iodine-deficient parenteral nutrition (PN) and TD requiring L-thyroxine (TD-LT4). Methods: Data of VLBW infants were obtained from the Korean Neonatal Network registry. Factors including duration of PN were analyzed according to TD-LT4. Results: TD-LT4 occurred in 490 (8.7%) of 5635 infants, and more frequently occurred in infants requiring PN for ≥4 weeks (10.2%). PN ≥ 4 weeks was one of the risk factors for TD-LT4, with an odds ratio (OR) of 1.346, p = 0.002. However, multivariate analysis showed that TD-LT4 was more of a risk for infants that were small for gestational age (OR 2.987, p < 0.001) and for other neonatal morbidities such as seizures (OR 1.787, p = 0.002) and persistent pulmonary hypertension (OR 1.501, p = 0.039) than PN ≥ 4 weeks (OR 0.791, p = 0.080). Conclusions: Prolonged iodine-deficient PN might affect TD-LT4 in VLBW infants. However, the effect of nutritional iodine deficiency on TD-LT4 risk was less than that of SGA or severe neonatal morbidities in Korean VLBW infants.     

Association Between the 7‐Day Moving Average for Nutrition and Growth in Very Low Birth Weight Infants

Background: Very low birth weight (VLBW) infants remain at risk for postnatal growth restriction. Clinicians may have difficulty identifying growth patterns resulting from nutrition interventions, impeding prompt management changes intended to increase growth velocity. This study aimed to quantify the association between growth and nutrition intake through 7‐day moving averages (SDMAs). Methods: The first 6 weeks of daily nutrition intake and growth measurements were collected from VLBW infants admitted to a level 4 neonatal intensive care unit (2011–2014). The association between SDMA for energy and macronutrients and subsequent 7‐day growth velocities for weight, length, and head circumference were determined using mixed effects linear regression. Analyses were adjusted for fluid intake, infant characteristics, and comorbid conditions. Results: Detailed enteral and parenteral caloric provisions were ascertained for 115 infants (n = 4643 patient‐days). Each 10‐kcal/kg/d increase over 7 days was independently associated with increased weight (1.7 g/kg/d), length (0.4 mm/wk), and head circumference (0.9 mm/wk; P < .001, for weight and head circumference; P = .041 for length). Each 1 g/kg/d macronutrient increase was also associated with increased weight (protein, P = .027; fat and carbohydrates, P < .001), increased length (fat, P = .032), and increased head circumference (fat and carbohydrates, P < .001). Conclusions: The SDMA identifies clinically meaningful associations among total energy, macronutrient dosing, and growth in VLBW infants. Whether SDMA is a clinically useful tool for providing clinicians with prompt feedback to improve growth warrants further attention.     

Neonatal Morbidity Count Is Associated With a Reduced Likelihood of Achieving Recommendations for Protein,Lipid, and Energy in Very Low Birth Weight Infants: A Prospective Cohort Study

Background: Serious morbidity may elevate nutrient requirements and affect adherence to feeding guidelines for very low birth weight (VLBW) infants. An understanding of factors affecting nutrient intakes of VLBW infants will facilitate development of strategies to improve nutrient provision. Our aim was to examine the impact of neonatal morbidity count on achieving recommended nutrient intakes in VLBW infants. Methods: VLBW infants enrolled in the Donor Milk for Improved Neurodevelopmental Outcomes trial (ISRCTN35317141, n = 363) were included. Serious morbidities and daily parenteral and enteral intakes were collected prospectively. Results: Median intakes of infants with and without ≥1 morbidity met protein recommendations (3.5–4.5 g/kg/d) by week 2, although not maintained after week 4. Infants with ≥1 morbidity (vs without) were 2 weeks slower in achieving lipid (4.8–6.6 g/kg/d; week 4 vs 2) and energy (110–130 kcal/kg/d; week 5 vs 3) and 1 week slower in achieving carbohydrate recommendations (11.6–13.2 g/kg/d; week 4 vs 3). Adjusted hazard ratios of first achieving recommendations on any given day in infants with any 1 or 2 morbidities were 0.6 (95% confidence interval [CI], 0.5–0.9) and 0.6 (0.4–0.9), respectively, for protein; 0.5 (0.4–0.7) and 0.3 (0.2–0.5) for lipid; and 0.5 (0.4–0.7) and 0.3 (0.2–0.4) for energy. Conclusion: Morbidity is associated with a decreased likelihood of achieving lipid and consequently energy recommendations. This and the decline in protein intakes after the early neonatal period require further investigation to ensure optimal nutrition in this vulnerable population.     

The effect of glutamine-enriched enteral nutrition on intestinal permeability in very-low-birth-weight infants: a randomized controlled trial

BACKGROUND: Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion. Glutamine depletion has negative effects on intestinal integrity. The lower infection rate in VLBW infants receiving glutamine-enriched enteral nutrition may originate from improved intestinal integrity, as reflected by decreased intestinal permeability. The aim of our study was to investigate whether glutamine-enriched enteral nutrition in VLBW infants enhances the normal decrease in intestinal permeability, as measured by the sugar absorption test (SAT). METHODS: In a double-blind, randomized, placebo-controlled trial, VLBW infants (gestational age <32 weeks or birth weight <1,500 g) received enteral glutamine supplementation (0.3 g/kg/d) or an isonitrogenous placebo supplementation (alanine) between days 3 and 30 of life. Intestinal permeability, determined from the urinary lactulose/mannitol (L/M) ratio after an oral dose of lactulose and mannitol, was assessed at 4 time points: before the start of the study, and at days 7, 14, and 30 of life. RESULTS: At least 2 SATs were performed in 45/52 (86%) and 45/50 (90%) infants in the glutamine-supplemented and control groups, respectively. Baseline patient and nutrition characteristics were not different between the groups. There was no effect of glutamine-enriched enteral nutrition on the decrease of the L/M ratio between the start and end of the study (p = .78). In both treatment groups, median urinary lactulose concentrations decreased (p < .001), whereas median urinary mannitol concentrations increased (p = .003). CONCLUSIONS: Glutamine-enriched enteral nutrition does not enhance the postnatal decrease in intestinal permeability in VLBW infants. Any beneficial effect of glutamine may involve other aspects of intestinal integrity; for example, modulation of the intestinal inflammatory response.     

Low-dose vancomycin prophylaxis reduces coagulase-negative staphylococcal bacteraemia in very low birthweight infants

Very low birthweight (VLBW) infants undergoing neonatal intensive care are at risk of infection with coagulase-negative staphylococci (CONS). This study investigates the efficacy of twice daily, 1 h infusions of vancomycin (5 mg kg) in reducing CONS infection in VLBW infants receiving parenteral nutrition. Of 72 infants in the study, 37 were randomized to vancomycin and 35 to the control group. Clinical variables and mortality were similar in both groups. In the vancomycin group, 11 infants had one or more episodes of CONS bacteraemia compared with 17 in the control group. Two babies in the treatment group had more than one episode of CONS bacteraemia, compared with nine in the control group (P = 0·02). There were 13 episodes of CONS bacteraemia in the vancomycin group compared with 29 in the control group. When only positive blood-cultures associated with a rise in C-reactive protein were considered, there were six episodes of CONS bacteraemia in the vancomycin group compared with 18 in the control group. Similarly there were five infants with one or more CONS infections compared with 11 in controls and one with more than one episode compared with six in the control group (P = 0·05). Prophylaxis with intermittent low-dose vancomycin infusions may help reduce recurrent CONS bacteraemia in VLBW infants receiving parenteral nutrition.     

Update on Calcium and Phosphorus Requirements of Preterm Infants and Recommendations for Enteral Mineral Intake

Background: With current Ca and P recommendations for enteral nutrition, preterm infants, especially VLBW, fail to achieve a bone mineral content (BMC) equivalent to term infants. During the first 3 years, most notably in light at term equivalent age (<−2 Z score) VLBW infants’ BMC does not catch up. In adults born preterm with VLBW or SGA, lower adult bone mass, lower peak bone mass, and higher frequency of osteopenia/osteoporosis have been found, implying an increased risk for future bone fractures. The aim of the present narrative review was to provide recommendation for enteral mineral intake for improving bone mineral accretion. Methods: Current preterm infant mineral recommendations together with fetal and preterm infant physiology of mineral accretion were reviewed to provide recommendations for improving bone mineral accretion. Results: Current Ca and P recommendations systematically underestimate the needs, especially for Ca. Conclusion: Higher enteral fortifier/formula mineral content or individual supplementation is required. Higher general mineral intake (especially Ca) will most likely improve bone mineralization in preterm infants and possibly the long-term bone health. However, the nephrocalcinosis risk may increase in infants with high Ca absorption. Therefore, individual additional enteral Ca and/or P supplementations are recommended to improve current fortifier/formula mineral intake.     

Mortality among very low-birthweight infants in hospitals serving minority populations

OBJECTIVE: We investigated whether the proportion of Black very low-birth-weight (VLBW) infants treated by hospitals is associated with neonatal mortality for Black and White VLBW infants. METHODS: We analyzed medical records linked to secondary data sources for 74050 Black and White VLBW infants (501 g to 1500 g) treated by 332 hospitals participating in the Vermont Oxford Network from 1995 to 2000. Hospitals where more than 35% of VLBW infants treated were Black were defined as "minority-serving." RESULTS: Compared with hospitals where less than 15% of the VLBW infants were Black, minority-serving hospitals had significantly higher risk-adjusted neonatal mortality rates (White infants: odds ratio [OR]=1.30, 95% confidence interval [CI] = 1.09, 1.56; Black infants: OR = 1.29, 95% CI = 1.01, 1.64; Pooled: OR = 1.28, 95% CI=1.10, 1.50). Higher neonatal mortality in minority-serving hospitals was not explained by either hospital or treatment variables. CONCLUSIONS: Minority-serving hospitals may provide lower quality of care to VLBW infants compared with other hospitals. Because VLBW Black infants are disproportionately treated by minority-serving hospitals, higher neonatal mortality rates at these hospitals may contribute to racial disparities in infant mortality in the United States.     

Feeding Tolerance in Preterm Infants: Randomized Trial of Bolus and Continuous Feeding

Objective: To test the hypothesis that continuous gastric infusion (CGI) is better tolerated than intermittent gastric bolus (IGB) in small very low birth weight (VLBW) infants.

Design: Two-center, prospective, randomized, unmasked clinical trial.

Patients: 28 VLBW infants (birth weight <1250 g). A strict feeding protocol was followed.

Intervention: Patients were randomized to IGB or CGI.

Main outcome measures: Time to reach full feeds (160 cc/kg/d)(by design and real), daily weight, caloric intake, residual gastric volume and type of feeding (formula vs. human milk vs. both).

Results: Five infants failed to complete the study because of death (n = 4) or protocol violation (n = 1). The two groups did not differ by birth weight or gestational age; infants fed via IGB reached full feeds earlier (p = 0.03) and had less delay in reaching full feeds than infants fed via CGI.

Conclusion: Contrary to our hypothesis, gravity IGB is more effective than CGI in improving feeding tolerance in small VLBW infants.     

Enteral L‐Arginine Supplementation for Prevention of Necrotizing Enterocolitis in Very Low Birth Weight Neonates

Background: Necrotizing enterocolitis (NEC) is the most common acquired gastrointestinal disease in premature infants and has high mortality and morbidity. Endothelial nitric oxide is an important regulator of vascular perfusion and is synthetized from the amino acid L‐arginine. Hypoargininemia is frequently observed in preterm neonates and may predispose them to NEC. Our objective was to determine the effect of enteral L‐arginine supplementation on the incidence and severity of NEC in very low birth weight (VLBW) neonates. Materials and Methods: We conducted a parallel blind randomized pilot study, comprising VLBW neonates with birth weight ≤1500 g and gestational age ≤34 weeks. VLBW neonates were randomly assigned to receive enteral L‐arginine supplementation (1.5 mmol/kg/d bid) between the 3rd and 28th day of life or placebo. Diagnosis and classification of NEC were done according to modified Bell's criteria. Results: Eighty‐three neonates were randomized to the arginine (n = 40) or placebo (n = 43) group. No adverse effects were observed in neonates receiving L‐arginine supplementation. The incidence of NEC stage III was significantly lower in the arginine‐supplemented group (2.5% vs 18.6%, P = .030). Conclusions: Enteral L‐arginine supplementation of 1.5 mmol/kg/d bid can be safely administered in VLBW neonates from the 3rd to the 28th day of life. Enteral L‐arginine supplementation appears to reduce the incidence of stage III NEC in VLBW infants. Larger studies are needed to further evaluate the effect of L‐arginine supplementation in preventing NEC in VLBW infants.     

Effects of Early Nutrition on Free Radical Formation in VLBW Infants with Respiratory Distress

Objective: We studied the development of essential fatty acid deficiency (EFAD) and its effects together with those of vitamin E deficiency on the free radical formation of very low birth weight (VLBW) infants with respiratory distress.

Methods: Infants were divided into three groups based on the way each was supplied with daily total energy intake: (1) by fat free parenteral nutrition only or by nutrition composed of (2) less than or (3) higher than 25% of total daily energy intake given in oral feeding. We measured plasma lipid parameters and autoxidative susceptibility (AOS) of red blood cells (RBCs).

Results: Plasma concentrations of linoleic acid were low in all the groups. After at least 14 days of feeding, eicosatrienoic acid (EA) was not detected. One week after the introduction of oral feeding, the abnormal triene/tetraene ratio of the groups had decreased, but was not normalized. Vitamin E deficiency was associated with significantly increased AOS, but EFAD was not. The two factors together caused an increase of AOS, that was additive.

Conclusions: Our data confirm that EFAD increases AOS of RBCs in VLBW infants. We assume that prevention of EFAD in VLBW infants could decrease the prevalence of complications associated with free radical formation.     

Geographic Accessibility to Health Services and Neonatal Mortality Among Very-Low Birthweight Infants in South Carolina

Introduction Mortality for infants born with very-low birthweight (VLBW, 500–1499 grams) is markedly higher than for babies born with normal birthweight (2500–4000 grams). Although these high-risk infants show better outcomes in advanced care settings, only 80 % of VLBW infants born in South Carolina (SC) are delivered in hospitals with a level-III neonatal intensive care unit (NICU). The purpose of this research project was to assess geographic access to delivery hospitals and risk of neonatal death among singleton VLBW infants born in SC. Methods The linked birth and death records of a cross-sectional, population-based study of singleton VLBW infants born in SC between 2010 and 2012 were used (n = 2030). We assessed the impact of travel time from maternal residence to delivery hospital. Logistic regression modeling was performed with adjustments for maternal, newborn, and hospital characteristics. Results The neonatal mortality rate among singleton VLBW infants was 11.03 deaths per 100 live births in 2010–2012. We did not find a significant association between travel time to delivery hospital and neonatal mortality after adjusting for confounders. However, we found that a 1-week increase in gestational age (odds ratio (OR): 0.61) and non-Hispanic black mothers (versus non-Hispanic white mothers) (OR: 0.68) were associated with lower odds of neonatal death, whereas non-NICU admission at birth (OR: 5.90) was associated with increased odds of death. The results of the sensitivity analyses including both singleton and multiple births did not yield significant results for travel time and neonatal mortality in VLBW infants. Discussion Although we found no significant association between travel time and neonatal mortality in singleton VLBW births in SC, we identified significant factors consistent with those found in previous studies that may affect neonatal mortality.     

Hospital volume and mortality of very low-birthweight infants in South America

Objective

To assess the effects of hospital volume of very low-birthweight (VLBW) infants on in-hospital mortality of VLBW and very preterm birth (VPB) infants in South America.

Data Sources/Study Setting

Birth-registry data for infants born in 1982–2008 at VLBW or very preterm in 66 hospitals in Argentina, Brazil, and Chile.

Design

Regression analyses that adjust for several individual-level demographic, socioeconomic, and health factors; hospital-level characteristics; and country-fixed effects are employed.

Data Collection/Extraction Methods

Physicians interviewed mothers before hospital discharge and abstracted hospital medical records using similar methods at all hospitals.

Principal Findings

Volume has significant nonlinear beneficial effects on VLBW and VPB in-hospital survival. The largest survival benefits––more than 80 percent decrease in mortality rates––are with volume increases from low to medium or medium-high levels (from ≤25 to 72 infants annually) with significantly lower incremental benefits thereafter. The cumulative volume effects are maximized at the 121–144 annual VLBW infant range––about 90 percent decrease in mortality rates compared to <25 VLBW infants annually.

Conclusions

Increasing the access of pregnancies at-risk of VLBW and VPB to medium- or high-volume hospitals up to 144 VLBW infants per year may substantially improve in-hospital infant survival in the study countries.     

Investigating the Relationship Between Fatherhood and Provider Weight-Related Practices and Counseling in Clinical Settings

ObjectiveTo assess whether weight-related practices and counseling between men and their medical providers are associated with the patient's fatherhood status.MethodsUsing the 2015–2017 National Survey of Family Growth, logistic regression models were constructed to examine the odds of men being weighed, told a weight status, or referred for nutrition/exercise counseling during a medical visit in the previous year.ResultsThe sample included 2,562 men and 1,272 fathers. Overall, 90%, 76%, and 49% of fathers were weighed by a provider, told their weight status, and referred for nutrition/exercise counseling, respectively. There were no associations between fatherhood status and being weighed or provider weight status communication. Fathers were more likely to be referred for nutrition/exercise counseling compared with those without children during a medical (adjusted odds ratio, 1.61; 95% confidence interval, 1.003–2.583) or routine visit (adjusted odds ratio, 1.81; 95% confidence interval, 1.04–3.16).Conclusions and ImplicationsThe increased likelihood of nutrition or exercise counseling referrals among fathers presents an opportunity to address obesity within families.     

The Prevalence of Socioeconomic and Behavioral Characteristics and their Impact on Very Low Birth Weight in Black and White Infants in Georgia

Objectives: We examined possible reasons for the disparity in the rate of very low birth weight (VLBW) delivery (<1500 g) in the United States between black women and white women. Methods: Using data from a population-based, case–control study of very low birth weight infants, we compared the prevalence of sociodemographic and behavioral characteristics between black and white mothers of normal birth weight infants; the difference in these characteristics between case and control mothers; and, using logistic regression, calculated odds ratios for VLBW for black versus white infants, adjusting for these characteristics. Results: Although black women were disadvantaged on every variable examined, they did not report more behavioral risk factors. Among white women, several traditional risk factors were associated with VLBW, while among black women, only marital status, cigarette smoking, and vitamin nonuse were associated with VLBW delivery. Controlling for the socioeconomic and behavioral factors reduced the odds ratio for VLBW delivery among black mothers from 3.7 to 3.3. Conclusions: Racial disparity in socioeconomic status may be greater than our current ability to adjust for it in epidemiologic studies. The fact that traditional risk factors were not associated with VLBW delivery in black women may be due to the very high prevalence of these risk factors among black women or to different or additional risks or stresses experienced by black women.     

Glutamine-enriched enteral nutrition in very low birthweight infants and allergic and infectious diseases at 6 years of age

In a previous randomised controlled trial, we found that glutamine-enriched enteral nutrition in 102 very low birthweight (VLBW) infants decreased both the incidence of serious infections in the neonatal period and the risk of atopic dermatitis during the first year of life. We hypothesised that glutamine-enriched enteral nutrition in VLBW infants in the neonatal period influences the risk of allergic and infectious disease at 6 years of age. Eighty-eight of the 102 infants were eligible for the follow-up study (13 died, 1 chromosomal abnormality). Doctor-diagnosed allergic and infectious diseases were assessed by means of validated questionnaires. The association between glutamine-enriched enteral nutrition in the neonatal period and allergic and infectious diseases at 6 years of age was based on univariable and multivariable logistic regression analyses. Seventy-six of the 89 (85%) infants participated, 38 in the original glutamine-supplemented group and 38 in the control group. After adjustment, we found a decreased risk of atopic dermatitis in the glutamine-supplemented group: adjusted odds ratio (aOR) 0.23 [95% CI 0.06, 0.95]. No association between glutamine supplementation and hay fever, recurrent wheeze and asthma was found. A decreased risk of gastrointestinal tract infections was found in the glutamine-supplemented group (aOR) 0.10 [95% CI 0.01, 0.93], but there was no association with upper respiratory, lower respiratory or urinary tract infections. We concluded that glutamine-enriched enteral nutrition in the neonatal period in VLBW infants decreased the risk of atopic dermatitis and gastrointestinal tract infections at 6 years of age.