Publications by authors named "José G B Derraik"

172 Publications

Maternal and Infant Factors Influencing Human Milk Oligosaccharide Composition: Beyond Maternal Genetics.

J Nutr 2021 Mar 24. Epub 2021 Mar 24.

Liggins Institute, The University of Auckland, Auckland, New Zealand.

Maternal genetics is a key determinant of human milk oligosaccharide (HMO) composition in human milk. Beyond genetic status, other factors influencing the HMO profile are poorly defined. Thus, we aimed to review the existing evidence on the associations between nongenetic maternal and infant factors and HMO composition. A systematic search was performed on PubMed and Web of Science (without a time restriction) to identify any relevant studies published. In total, 1056 results were obtained, of which 29 articles were selected to be included in this review. The range of factors investigated include lactation stage, maternal pre-pregnancy BMI (ppBMI), maternal age, parity, maternal diet, mode of delivery, infant gestational age, and infant sex. The data suggest that, beyond maternal genetics, HMO composition seems to be influenced by all these factors, but the underlining mechanisms remain speculative. The published evidence is discussed in this review, along with potential implications for infant growth and development. For example, 2'-fucosyllactose, which was reportedly increased in mothers with higher ppBMIs, was also associated with increased infant weight and height. In addition, greater levels of sialylated HMOs after preterm birth may support brain development in these infants.
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http://dx.doi.org/10.1093/jn/nxab028DOI Listing
March 2021

Caregiver perceptions of weight in preschool children, and determinants of engagement in a multidisciplinary intervention service for weight issues.

Obes Res Clin Pract 2021 Mar 17. Epub 2021 Mar 17.

Liggins Institute, University of Auckland, Auckland, New Zealand; Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand; Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand. Electronic address:

Aims: To explore the perceptions and experiences of caregivers of preschool children with weight issues referred from New Zealand's preschool check (the B4 School Check) to a healthy lifestyle programme. Second, to understand determinants of engagement with the programme for families post referral.

Methods: Semi-structured focus groups and interviews were conducted with caregivers of preschool children referred from the national preschool check (the B4 School Check) to the Whānau Pakari healthy lifestyle programme. A purposeful sampling approach ensured the opinions of Māori (New Zealand's indigenous population) and non-Māori caregivers were included. Those who engaged and did not engage with the programme were included from across Taranaki (a semi-rural region of New Zealand). Focus groups and interviews were run separately for Māori and non-Māori participants.

Results: Thematic analysis yielded one sub-theme related to caregiver perceptions of weight: societal beliefs about childhood weight, and three sub-themes related to determinants of engagement: referral experience, competing life demands, and caregiver resistance to and motivation for accepting external support. A negative referral experience to Whānau Pakari often resulted in caregivers declining to engage with the programme. Themes were similar across both Māori and non-Māori caregivers.

Conclusions: This study confirmed that caregiver perceptions influence their acceptance and management of their child's weight issues. The experience of the referral to a healthy lifestyle programme is important for determining future engagement, and is likely to be facilitated by providing improved training and support to health professionals around discussing childhood weight issues with caregivers of young children.
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http://dx.doi.org/10.1016/j.orcp.2021.03.002DOI Listing
March 2021

A prediction model for childhood obesity in New Zealand.

Sci Rep 2021 Mar 18;11(1):6380. Epub 2021 Mar 18.

A Better Start-National Science Challenge, Auckland, New Zealand.

Several early childhood obesity prediction models have been developed, but none for New Zealand's diverse population. We aimed to develop and validate a model for predicting obesity in 4-5-year-old New Zealand children, using parental and infant data from the Growing Up in New Zealand (GUiNZ) cohort. Obesity was defined as body mass index (BMI) for age and sex ≥ 95th percentile. Data on GUiNZ children were used for derivation (n = 1731) and internal validation (n = 713). External validation was performed using data from the Prevention of Overweight in Infancy Study (POI, n = 383) and Pacific Islands Families Study (PIF, n = 135) cohorts. The final model included: birth weight, maternal smoking during pregnancy, maternal pre-pregnancy BMI, paternal BMI, and infant weight gain. Discrimination accuracy was adequate [AUROC = 0.74 (0.71-0.77)], remained so when validated internally [AUROC = 0.73 (0.68-0.78)] and externally on PIF [AUROC = 0.74 [0.66-0.82)] and POI [AUROC = 0.80 (0.71-0.90)]. Positive predictive values were variable but low across the risk threshold range (GUiNZ derivation 19-54%; GUiNZ validation 19-48%; and POI 8-24%), although more consistent in the PIF cohort (52-61%), all indicating high rates of false positives. Although this early childhood obesity prediction model could inform early obesity prevention, high rates of false positives might create unwarranted anxiety for families.
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http://dx.doi.org/10.1038/s41598-021-85557-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973754PMC
March 2021

Correspondence: systematic reviews do not always capture context of real-world intervention programmes for childhood obesity (response to Littlewood, et al., 2020 in BMC Public Health).

BMC Public Health 2021 Mar 15;21(1):501. Epub 2021 Mar 15.

Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

In a recent issue of the BMC Public Health journal, Littlewood et al. described the results of a systematic review of interventions to prevent or treat childhood obesity in Māori or Pacific Island peoples. They found that studies to date have had limited impact on improving health outcomes for Māori and Pacific Island peoples, and suggest this may be due to a lack of co-design principles in the conception of the various studies. Ensuring that interventions are appropriate for groups most affected by obesity is critical; however, some inaccuracies should be noted in the explanation of these findings. There is a risk with systematic reviews that the context of intervention trials is lost without acknowledging the associated body of literature for programmes that refer to the ongoing commitment to communities and groups most affected by obesity.
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http://dx.doi.org/10.1186/s12889-021-10486-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958484PMC
March 2021

Exercise Cardiac Magnetic Resonance Imaging in Boys With Duchenne Muscular Dystrophy Without Cardiac Disease.

Pediatr Neurol 2021 Apr 30;117:35-43. Epub 2020 Dec 30.

Paediatric Neurology Department, Starship Children's Hospital, Auckland, New Zealand. Electronic address:

Background: Duchenne muscular dystrophy is caused by mutations in the DMD gene, resulting in cardiomyopathy in all affected children by 18 years. Although cardiomyopathy is now the leading cause of mortality in these children, there is ongoing debate regarding timely diagnosis, secondary prevention, and treatment of this condition. The purpose of this study was to use exercise cardiac magnetic resonance imaging in asymptomatic young boys with Duchenne muscular dystrophy to describe their heart function and compare this with healthy controls.

Methods: We studied 11 boys with Duchenne muscular dystrophy aged 8.6 to 13.9 years and 11 healthy age- and sex-matched controls.

Results: Compared with the controls, boys with Duchenne muscular dystrophy had lower ejection fraction at rest (57% versus 63%; P = 0.004). During submaximal exercise, they reached similar peak tachycardia but increased their heart rate and cardiac output only half as much as controls (P = 0.003 and P = 0.014, respectively). End-systolic volume remained higher in boys with Duchenne muscular dystrophy both at rest and during exercise. When transthoracic echocardiography was compared with cardiac magnetic resonance imaging, 45% of the echocardiograms had suboptimal or poor views in the Duchenne muscular dystrophy group.

Conclusions: Boys with Duchenne muscular dystrophy had abnormalities in left ventricular systolic function that were exaggerated by exercise stress. Exercise cardiac magnetic resonance imaging is feasible in a select population of children with Duchenne muscular dystrophy, and it has the potential to unmask early signs of cardiomyopathy.
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http://dx.doi.org/10.1016/j.pediatrneurol.2020.12.011DOI Listing
April 2021

Supplementation with milk enriched with complex lipids during pregnancy: A double-blind randomized controlled trial.

PLoS One 2021 24;16(2):e0244916. Epub 2021 Feb 24.

College of Life Sciences, University of Leicester, Leicester, United Kingdom.

Background: Gangliosides are a class of sphingolipids that are present in the cell membranes of vertebrates. Gangliosides influence a broad range of cellular processes through effects on signal transduction, being found abundantly in the brain, and having a role in neurodevelopment.

Objective: We aimed to assess the effects of maternal daily consumption of ganglioside-enriched milk vs non-enriched milk and a non-supplemented group of pregnant women on maternal ganglioside levels and pregnancy outcomes.

Design: Double-blind parallel randomized controlled trial.

Methods: 1,500 women aged 20-40 years were recruited in Chongqing (China) between 11 and 14 weeks of a singleton pregnancy, and randomized into three groups: Control-received standard powdered milk formulation (≥4 mg gangliosides/day); Complex milk lipid-enhanced (CML-E) group-same formulation enriched with complex milk lipids (≥8 mg gangliosides/day) from milk fat globule membrane; Reference-received no milk. Serum ganglioside levels were measured in a randomly selected subsample of 250 women per group.

Results: CML-E milk was associated with marginally greater total gangliosides levels in maternal serum compared to Control (13.02 vs 12.69 μg/ml; p = 0.034) but not to Reference group. CML-E milk did not affect cord blood ganglioside levels. Among the 1500 women, CML-E milk consumption was associated with a lower rate of gestational diabetes mellitus than control milk [relative risk 0.80 (95% CI 0.64, 0.99)], but which was not different to the Reference group. CML-E milk supplementation had no other effects on maternal or newborn health.

Conclusions: Maternal supplementation with milk fat globule membrane, as a source of gangliosides, was not associated with any adverse health outcomes, and did not increase serum gangliosides compared with the non-supplemented reference group.

Trial Registration: Chinese Clinical Trial Register (ChiCTR-IOR-16007700).

Clinical Trial Registration: ChiCTR-IOR-16007700; www.chictr.org.cn/showprojen.aspx?proj=12972.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244916PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904220PMC
February 2021

Bioelectrical impedance analysis for assessment of body composition in infants and young children-A systematic literature review.

Clin Obes 2021 Feb 9:e12441. Epub 2021 Feb 9.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Bioelectrical impedance analysis (BIA) is an easy to use, portable tool, but the accuracy of the technique in infants and young children (<24 months) remains unclear. A systematic literature review was conducted to identify studies that have developed and validated BIA equations in this age group. MEDLINE, Scopus, EMBASE, and CENTRAL were searched for relevant literature published up until June 30, 2020, using terms related to bioelectrical impedance, body composition, and paediatrics. Two reviewers independently screened studies for eligibility, resulting in 15 studies that had developed and/or validated equations. Forty-six equations were developed and 34 validations were conducted. Most equations were developed in young infants (≤6 months), whereas only seven were developed among older infants and children (6-24 months). Most studies were identified as having a high risk of bias, and only a few included predominantly healthy children born at term. Using the best available evidence, BIA appears to predict body composition at least as well as other body composition tools; however, among younger infants BIA may provide little benefit over anthropometry-based prediction equations. Currently, none of the available equations can be recommended for use in research or in clinical practice.
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http://dx.doi.org/10.1111/cob.12441DOI Listing
February 2021

The views of pregnant women in New Zealand on vaginal seeding: a mixed-methods study.

BMC Pregnancy Childbirth 2021 Jan 12;21(1):49. Epub 2021 Jan 12.

Liggins Institute, University of Auckland, Private Bag, Auckland, 92019, New Zealand.

Background: Vaginal seeding is the administration of maternal vaginal bacteria to babies following birth by caesarean section (CS), intended to mimic the microbial exposure that occurs during vaginal birth. Appropriate development of the infant gut microbiome assists early immune development and might help reduce the risk of certain health conditions later in life, such as obesity and asthma. We aimed to explore the views of pregnant women on this practice.

Methods: We conducted a sequential mixed-methods study on the views of pregnant women in New Zealand (NZ) on vaginal seeding. Phase one: brief semi-structured interviews with pregnant women participating in a clinical trial of vaginal seeding (n = 15); and phase two: online questionnaire of pregnant women throughout NZ (not in the trial) (n = 264). Reflexive thematic analysis was applied to interview and open-ended questionnaire data. Closed-ended questionnaire responses were analysed using descriptive statistics.

Results: Six themes were produced through analysis of the open-ended data: "seeding replicates a natural process", "microbiome is in the media", "seeding may have potential benefits", "seeking validation by a maternity caregiver", "seeding could help reduce CS guilt", and "the unknowns of seeding". The idea that vaginal seeding replicates a natural process was suggested by some as an explanation to help overcome any initial negative perceptions of it. Many considered vaginal seeding to have potential benefit for the gut microbiome, while comparatively fewer considered it to be potentially beneficial for specific conditions such as obesity. Just under 30% of questionnaire respondents (n = 78; 29.5%) had prior knowledge of vaginal seeding, while most (n = 133; 82.6%) had an initially positive or neutral reaction to it. Few respondents changed their initial views on the practice after reading provided evidence-based information (n = 60; 22.7%), but of those who did, most became more positive (n = 51; 86.4%).

Conclusions: Given its apparent acceptability, and if shown to be safe and effective for the prevention of early childhood obesity, vaginal seeding could be a non-stigmatising approach to prevention of this condition among children born by CS. Our findings also highlight the importance of lead maternity carers in NZ remaining current in their knowledge of vaginal seeding research.
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http://dx.doi.org/10.1186/s12884-020-03500-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802193PMC
January 2021

Surrogate markers and predictors of endogenous insulin secretion in children and adolescents with type 1 diabetes.

World J Pediatr 2021 Feb 7;17(1):99-105. Epub 2021 Jan 7.

Department of Endocrinology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.

Background: No studies have examined endogenous insulin secretion in pediatric patients with type 1 diabetes in China using the gold-standard mixed-meal tolerance test. Because the latter is labor-intensive, we examined simpler surrogate markers of endogenous insulin secretion in Chinese youth, as previously reported for a European population.

Methods: Participants were 57 children and adolescents with type 1 diabetes aged 4.4-16.8 years (56% females). We performed 120-minute mixed-meal tolerance tests with serum C-peptide (CP) measurements every 30 minutes. Severe insulin deficiency (SID) was defined as CP peak < 0.2 nmol/L. Urine CP and creatinine levels were measured at 0 and 120 minutes.

Results: Twenty-five (44%) patients had SID. Fasting CP levels missed one case (96% sensitivity) with no false positives (100% specificity). While the 120-minute urine CP/creatinine had 100% sensitivity, it yielded markedly lower specificity (63%). Every 1-year increase in diabetes duration and 1-year decrease in age at diagnosis were associated with 37% (P < 0.001) and 20% (P = 0.005) reductions in serum CP area-under-the-curve, respectively. Thus, 86% of children aged < 5 years had SID compared to none among patients aged ≥ 11 years.

Conclusions: Simple fasting CP measurements could be used to detect most SID cases in Chinese youth with type 1 diabetes. Fasting CP is a far more reliable measure of endogenous insulin secretion than the more commonly used insulin dose. Therefore, it could more precisely determine insulin secretory capacity to target those who could benefit, if treatments to preserve residual insulin secretion are developed.
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http://dx.doi.org/10.1007/s12519-020-00382-0DOI Listing
February 2021

Effects of Fecal Microbiome Transfer in Adolescents With Obesity: The Gut Bugs Randomized Controlled Trial.

JAMA Netw Open 2020 12 1;3(12):e2030415. Epub 2020 Dec 1.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Importance: Treatment of pediatric obesity is challenging. Preclinical studies in mice indicated that weight and metabolism can be altered by gut microbiome manipulation.

Objective: To assess efficacy of fecal microbiome transfer (FMT) to treat adolescent obesity and improve metabolism.

Design, Setting, And Participants: This randomized, double-masked, placebo-controlled trial (October 2017-March 2019) with a 26-week follow-up was conducted among adolescents aged 14 to 18 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or more in Auckland, New Zealand. A total of 87 individuals took part-565 individuals responded to advertisements, 328 were ineligible, and 150 declined participation. Clinical data were analyzed from September 2019 to May 2020.

Interventions: Single course of oral encapsulated fecal microbiome from 4 healthy lean donors of the same sex or saline placebo.

Main Outcomes And Measures: Primary outcome was BMI standard deviation score at 6 weeks using intention-to-treat analysis. Secondary outcomes included body composition, cardiometabolic parameters, well-being, and gut microbiome composition.

Results: Eighty-seven participants (59% female adolescents, mean [SD] age 17.2 [1.4] years) were randomized 1:1, in groups stratified by sex, to FMT (42 participants) or placebo (45 participants). There was no effect of FMT on BMI standard deviation score at 6 weeks (adjusted mean difference [aMD] -0.026; 95% CI -0.074, 0.022). Reductions in android-to-gynoid-fat ratio in the FMT vs placebo group were observed at 6, 12, and 26 weeks, with aMDs of -0.021 (95% CI, -0.041 to -0.001), -0.023 (95% CI, -0.043 to -0.003), and -0.029 (95% CI, -0.049 to -0.008), respectively. There were no observed effects on insulin sensitivity, liver function, lipid profile, inflammatory markers, blood pressure, total body fat percentage, gut health, and health-related quality of life. Gut microbiome profiling revealed a shift in community composition among the FMT group, maintained up to 12 weeks. In post-hoc exploratory analyses among participants with metabolic syndrome at baseline, FMT led to greater resolution of this condition (18 to 4) compared with placebo (13 to 10) by 26 weeks (adjusted odds ratio, 0.06; 95% CI, 0.01-0.45; P = .007). There were no serious adverse events recorded throughout the trial.

Conclusions And Relevance: In this randomized clinical trial of adolescents with obesite, there was no effect of FMT on weight loss in adolescents with obesity, although a reduction in abdominal adiposity was observed. Post-hoc analyses indicated a resolution of undiagnosed metabolic syndrome with FMT among those with this condition. Further trials are needed to confirm these results and identify organisms and mechanisms responsible for mediating the observed benefits.

Trial Registration: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12615001351505.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.30415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753902PMC
December 2020

Double-blind RCT of fish oil supplementation in pregnancy and lactation to improve the metabolic health in children of mothers with overweight or obesity during pregnancy: study protocol.

BMJ Open 2020 12 15;10(12):e041015. Epub 2020 Dec 15.

Liggins Institute, University of Auckland, Auckland, New Zealand

Introduction: Maternal obesity during pregnancy is associated with adverse changes in body composition and metabolism in the offspring. We hypothesise that supplementation during pregnancy of overweight and obese women may help prevent the development of greater adiposity and metabolic dysfunction in children. Previous clinical trials investigating fish oil supplementation in pregnancy on metabolic outcomes and body composition of the children have not focused on the pregnancies of overweight or obese women.

Methods And Analysis: A double-blind randomised controlled trial of fish oil (providing 3 g/day of n-3 polyunsaturated fatty acids) versus an equal volume of olive oil (control) taken daily from recruitment until birth, and in breastfeeding mothers, further continued for 3 months post partum. Eligible women will have a singleton pregnancy at 12-20 weeks' gestation and be aged 18-40 years with body mass index ≥25 kg/m at baseline. We aim to recruit a minimum of 128 participants to be randomised 1:1. Clinical assessments will be performed at baseline and 30 weeks of pregnancy, including anthropometric measurements, fasting metabolic markers, measures of anxiety, physical activity, quality of life and dietary intake. Subsequent assessments will be performed when the infant is 2 weeks, 3 months and 12 months of age for anthropometry, body composition (dual-energy X-ray absorptiometry (DXA)) and blood sampling. The primary outcome of the study is a between-group difference in infant percentage body fatness, assessed by DXA, at 2 weeks of age. Secondary outcomes will include differences in anthropometric measures at each time point, percentage body fat at 3 and 12 months and homeostatic model assessment of insulin resistance at 3 months. Statistical analysis will be carried out on the principle of intention to treat.

Ethics And Dissemination: This trial was approved by the Northern A Health and Disabilities Ethics Committee, New Zealand Ministry of Health (17/NTA/154). Results will be published in a peer-reviewed journal.

Trial Registration Number: ACTRN12617001078347p; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2020-041015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745511PMC
December 2020

High prevalence of undiagnosed comorbidities among adolescents with obesity.

Sci Rep 2020 11 18;10(1):20101. Epub 2020 Nov 18.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Metabolic diseases are increasing among adolescents with obesity. Although the reported prevalence of metabolic syndrome is approximately 30% worldwide, its prevalence is largely unknown among New Zealand adolescents. Therefore, we assessed the health of adolescents with obesity (BMI ≥ 30 kg/m) enrolled in a randomised clinical trial (Gut Bugs Trial), to identify the prevalence of undiagnosed comorbidities. Assessments included anthropometry, 24-h ambulatory blood pressure monitoring, and insulin sensitivity. We report on baseline data (pre-randomisation) on 87 participants (14-18 years; 59% females), with mean BMI 36.9 ± 5.3 kg/m (BMI SDS 3.33 ± 0.79). Approximately 40% of participants had undiagnosed metabolic syndrome, which was twice as common among males. Half (53%) had pre-diabetes and 92% a reduction in insulin sensitivity. Moreover, 31% had pre-hypertension/hypertension, 69% dyslipidaemia, and 25% abnormal liver function. Participants with class III obesity had a greater risk of metabolic syndrome than those with classes I/II [relative risk 1.99 (95% CI 1.19, 3.34)]. Risks for pre-hypertension/hypertension and inflammation were also greater among those with class III obesity. We identified a high prevalence of undiagnosed comorbidities among adolescents with obesity in New Zealand. As adolescent obesity tracks into adulthood, early interventions are needed to prevent progression to overt cardiometabolic diseases.
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http://dx.doi.org/10.1038/s41598-020-76921-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674474PMC
November 2020

Birth order is associated with an increased risk of obesity in young adults in Thailand.

J Epidemiol Community Health 2021 Mar 4;75(3):305-308. Epub 2020 Nov 4.

NCD Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.

Background: There is a growing body of evidence showing that early life events are associated with increased risk of cardiovascular and metabolic diseases later in adult life. However, there is a paucity of data in this field from Asian populations. In this study, we examined the association of birth order with obesity risk and cardiometabolic outcomes in young adults in Thailand.

Methods: Participants were the offspring from a birth cohort study in Chiang Mai (northern Thailand), who were followed up at ~20.5 years of age. Clinical assessments included anthropometry, blood pressure, fasting blood samples and carotid intima-media thickness. Insulin sensitivity was estimated using homeostatic model assessment of insulin resistance (HOMA-IR). Participants were stratified into two groups: first-borns and later-borns. Health outcomes between groups were compared using multivariable models adjusting for important confounders, in particular maternal body mass index (BMI).

Results: A total of 559 participants were studied: 316 first-borns (46% males) and 243 later-borns (47% males). Adjusted models showed anthropometric differences, with first-borns being 2.3 kg heavier (p=0.023) with a BMI 0.86 kg/m greater (p=0.019) than later-borns. Thus, rates of obesity were higher in first-borns than in later-borns (6.6% vs 2.9%), so that first-borns had an adjusted relative risk of obesity 3.3 times greater than later-borns [95% CI 1.42 to 7.88; p=0.006]. There were no observed differences in cardiovascular or metabolic parameters assessed, including HOMA-IR.

Conclusion: As observed in other populations, first-borns in Thailand had greater BMI and an increased risk of obesity in young adulthood. However, we observed no other cardiometabolic differences between first- and later-borns.
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http://dx.doi.org/10.1136/jech-2019-213572DOI Listing
March 2021

Lower insulin sensitivity remains a feature of children born very preterm.

Pediatr Diabetes 2021 Mar 6;22(2):161-167. Epub 2020 Nov 6.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Background: The first report of children born very preterm (<32 weeks of gestation) having insulin resistance was made 16 years ago. However, neonatal care has improved since. Thus, we aimed to assess whether children born very preterm still have lower insulin sensitivity than term controls.

Methods: Participants were prepubertal children aged 5 to 11 years born very preterm (<32 weeks of gestation; n = 51; 61% boys) or at term (37-41 weeks; n = 50; 62% boys). Frequently sampled intravenous glucose tolerance tests were performed, and insulin sensitivity was calculated using Bergman's minimal model. Additional clinical assessments included anthropometry, body composition using whole-body dual-energy X-ray absorptiometry scans, clinic blood pressure, and 24-hour ambulatory blood pressure monitoring.

Results: Children born very preterm were 0.69 standard deviation score (SDS) lighter (P < .001), 0.53 SDS shorter (P = .003), and had body mass index 0.57 SDS lower (P = .003) than children born at term. Notably, children born very preterm had insulin sensitivity that was 25% lower than term controls (9.4 vs 12.6 × 10 minutes ·[mU/L]; P = .001). Other parameters of glucose metabolism, including fasting insulin levels, were similar in the two groups. The awake systolic blood pressure (from 24-hour monitoring) tended to be 3.1 mm Hg higher on average in children born very preterm (P = .054), while the clinic systolic blood pressure was 5.4 mm Hg higher (P = .002).

Conclusions: Lower insulin sensitivity remains a feature of children born very preterm, despite improvements in neonatal intensive care. As reported in our original study, our findings suggest the defect in insulin action in prepubertal children born very pretermis primarily peripheral and not hepatic.
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http://dx.doi.org/10.1111/pedi.13140DOI Listing
March 2021

Abdominal Adiposity and Total Body Fat as Predictors of Cardiometabolic Health in Children and Adolescents With Obesity.

Front Endocrinol (Lausanne) 2020 4;11:579. Epub 2020 Sep 4.

Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.

We aimed to assess the role of adipose tissue distribution in cardiometabolic risk (in particular insulin sensitivity) in a population of children and adolescents with obesity. In this cross-sectional study, participants were 479 children and adolescents with obesity (322 boys and 157 girls) aged 3 to 18 years attending the Children's Hospital at Zhejiang University School of Medicine (Hangzhou, China). Clinical assessments included anthropometry, body composition (DXA scans), carotid artery ultrasounds, and OGTT. Insulin sensitivity was assessed using the Matsuda index. Participants were stratified into groups by sex and pubertal stage. Key predictors were DXA-derived android-to-gynoid-fat ratio (A/G) and total body fat percentage (TBF%). Irrespective of sex and pubertal stage, there was a strong association between increasing A/G (i.e., greater abdominal adiposity) and lower insulin sensitivity. In multivariable models, every 0.1 increase in A/G was associated with a reduction in insulin sensitivity in prepubertal boys [-29% (95% CI -36%, -20%); < 0.0001], pubertal boys [-13% (95% CI -21%, -6%); = 0.001], and pubertal girls [-16% (95% CI -24%, -6%); = 0.002]. In contrast, TBF% was not associated with insulin sensitivity when A/G was adjusted for, irrespective of pubertal stage or sex. In addition, every 0.1 increase in A/G was associated with increased likelihood of dyslipidemia in prepubertal boys [adjusted odds ratio (aOR) 1.62 (95% CI 1.05, 2.49)], impaired glucose tolerance in pubertal boys [aOR 1.64 (95% CI 1.07, 2.51)] and pubertal girls [aOR 1.81 (95% CI 1.10, 2.98)], and odds of NAFLD in both prepubertal [aOR 2.57 (95% CI 1.56, 4.21)] and pubertal [aOR 1.69 (95% CI 1.18, 2.40)] boys. In contrast, higher TBF% was only associated with higher fasting insulin and ALT in pubertal boys, being also predictive of NAFLD in this group [aOR 1.15 per percentage point (95% CI 1.06, 1.26)], but was not associated with the likelihood of other cardiometabolic outcomes assessed in any group. A/G is a much stronger independent predictor of cardiometabolic risk factors in children and adolescents with obesity in China, particularly glucose metabolism.
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http://dx.doi.org/10.3389/fendo.2020.00579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498567PMC
September 2020

Two-year outcomes of Whānau Pakari, a multi-disciplinary assessment and intervention for children and adolescents with weight issues: A randomized clinical trial.

Pediatr Obes 2021 Jan 20;16(1):e12693. Epub 2020 Jul 20.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Objective: To determine whether 12-month BMI SDS reductions persisted at 24 months in a multi-disciplinary assessment and intervention program for children and adolescents with obesity, and whether secondary outcomes improved.

Methods: This was a community-based 12-month RCT in Aotearoa/New Zealand. Eligible participants were aged 5 to 16 years with BMI ≥98th centile or BMI >91st centile with weight-related comorbidities. The low-intensity control received comprehensive home-based baseline assessments and advice, and 6-monthly follow-up. The high-intensity intervention received the same assessments and advice, but also weekly multidisciplinary sessions. Primary outcome was BMI SDS at 12 months. Secondary outcomes included cardiovascular and metabolic markers.

Results: 121 participants (60% of participants at baseline) were assessed at 24 months. BMI SDS reduction at 12 months was lost at 24 months in the modified intention-to-treat analysis [Control -0.03 (95%CI -0.14, 0.09) and Intervention -0.02 (-0.12, 0.08); P = .93]. However, sweet drink intake was reduced, water intake increased, and there were improvements in cardiovascular fitness in the high-intensity intervention. ≥70% attendance in the high-intensity intervention resulted in a persistent BMI SDS reduction of -0.22 after 24 months (95%CI -0.38, -0.06).

Conclusions: This trial was negative in terms of primary outcome at 24 months. However, high engagement led to sustained treatment effect, and there were multiple improvements in health measures.
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http://dx.doi.org/10.1111/ijpo.12693DOI Listing
January 2021

Rapid Review of SARS-CoV-1 and SARS-CoV-2 Viability, Susceptibility to Treatment, and the Disinfection and Reuse of PPE, Particularly Filtering Facepiece Respirators.

Int J Environ Res Public Health 2020 Aug 22;17(17). Epub 2020 Aug 22.

Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.

In the COVID-19 pandemic caused by SARS-CoV-2, hospitals are often stretched beyond capacity. There are widespread reports of dwindling supplies of personal protective equipment (PPE), particularly N95-type filtering facepiece respirators (FFRs), which are paramount to protect frontline medical/nursing staff, and to minimize further spread of the virus. We carried out a rapid review to summarize the existing literature on the viability of SARS-CoV-2, the efficacy of key potential disinfection procedures against the virus (specifically ultraviolet light and heat), and the impact of these procedures on FFR performance, material integrity, and/or fit. In light of the recent discovery of SARS-CoV-2 and limited associated research, our review also focused on the closely related SARS-CoV-1. We propose a possible whole-of-PPE disinfection solution for potential reuse that could be rapidly instituted in many health care settings, without significant investments in equipment.
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http://dx.doi.org/10.3390/ijerph17176117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7504573PMC
August 2020

Maternal bacteria to correct abnormal gut microbiota in babies born by C-section.

Medicine (Baltimore) 2020 Jul;99(30):e21315

A Better Start - National Science Challenge.

Introduction: There is evidence that caesarean section (CS) is associated with increased risk of childhood obesity, asthma, and coeliac disease. The gut microbiota of CS-born babies differs to those born vaginally, possibly due to reduced exposure to maternal vaginal bacteria during birth. Vaginal seeding is a currently unproven practice intended to reduce such differences, so that the gut microbiota of CS-born babies is similar to that of babies born vaginally. Our pilot study, which uses oral administration as a novel form of vaginal seeding, will assess the degree of maternal strain transfer and overall efficacy of the procedure for establishing normal gut microbiota development.

Methods And Analysis: Protocol for a single-blinded, randomized, placebo-controlled pilot study of a previously untested method of vaginal seeding (oral administration) in 30 CS-born babies. A sample of maternal vaginal bacteria is obtained prior to CS, and mixed with 5 ml sterile water to obtain a supernatant. Healthy babies are randomized at 1:1 to receive active treatment (3 ml supernatant) or placebo (3 ml sterile water). A reference group of 15 non-randomized vaginal-born babies are also being recruited. Babies' stool samples will undergo whole metagenomic shotgun sequencing to identify potential differences in community structure between CS babies receiving active treatment compared to those receiving placebo at age 1 month (primary outcome). Secondary outcomes include differences in overall gut community between CS groups (24 hours, 3 months); similarity of CS-seeded and placebo gut profiles to vaginally-born babies (24 hours, 1 and 3 months); degree of maternal vaginal strain transfer in CS-born babies (24 hours, 1 and 3 months); anthropometry (1 and 3 months) and body composition (3 months).

Ethics And Dissemination: Ethics approval by the Northern A Health and Disability Ethics Committee (18/NTA/49). Results will be published in peer-reviewed journals and presented at international conferences.

Registration: Australian New Zealand Clinical Trials Registry (ACTRN12618000339257).
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http://dx.doi.org/10.1097/MD.0000000000021315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387037PMC
July 2020

Fundamentals of Data Collection in Clinical Studies: Simple Steps to Avoid "Garbage In, Garbage Out".

Int J Low Extrem Wounds 2020 Jul 31:1534734620938234. Epub 2020 Jul 31.

NCD Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.

Many fundamental steps underpin the delivery of high-quality clinical research. In this article, we provide a brief commentary on some important aspects associated with the collection and management of data during clinical studies, which, if overlooked, will lead to poor-quality research. In particular, we discuss the key aspects that should help early career researchers maximize the relevance and impact of their clinical research.
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http://dx.doi.org/10.1177/1534734620938234DOI Listing
July 2020

Differences in Compositions of Gut Bacterial Populations and Bacteriophages in 5-11 Year-Olds Born Preterm Compared to Full Term.

Front Cell Infect Microbiol 2020 16;10:276. Epub 2020 Jun 16.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Preterm infants are exposed to major perinatal, post-natal, and early infancy events that could impact on the gut microbiome. These events include infection, steroid and antibiotic exposure, parenteral nutrition, necrotizing enterocolitis, and stress. Studies have shown that there are differences in the gut microbiome during the early months of life in preterm infants. We hypothesized that differences in the gut microbial composition and metabolites in children born very preterm persist into mid-childhood. Participants were healthy prepubertal children aged 5-11 years who were born very preterm (≤32 weeks of gestation; = 51) or at term (37-41 weeks; = 50). We recorded the gestational age, birth weight, mode of feeding, mode of birth, age, sex, and the current height and weight of our cohort. We performed a multi'omics [i.e., 16S rRNA amplicon and shotgun metagenomic sequencing, SPME-GCMS (solid-phase microextraction followed by gas chromatography-mass spectrometry)] analysis to investigate the structure and function of the fecal microbiome (as a proxy of the gut microbiota) in our cross-sectional cohort. Children born very preterm were younger (7.8 vs. 8.3 years; = 0.034), shorter [height-standard deviation score (SDS) 0.31 vs. 0.92; = 0.0006) and leaner [BMI (body mass index) SDS -0.20 vs. 0.29; < 0.0001] than the term group. Children born very preterm had higher fecal calprotectin levels, decreased fecal phage richness, lower plasma arginine, lower fecal branched-chain amino acids and higher fecal volatile (i.e., 3-methyl-butanoic acid, butyrolactone, butanoic acid and pentanoic acid) profiles. The bacterial microbiomes did not differ between preterm and term groups. We speculate that the observed very preterm-specific changes were established in early infancy and may impact on the capacity of the very preterm children to respond to environmental changes.
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http://dx.doi.org/10.3389/fcimb.2020.00276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309444PMC
June 2020

Newborn Screening TSH Values Less Than 15 mIU/L Are Not Associated With Long-term Hypothyroidism or Cognitive Impairment.

J Clin Endocrinol Metab 2020 09;105(9)

Liggins Institute, University of Auckland, Auckland, New Zealand.

Background: It is unclear whether newborns with mild thyrotropin elevation (mTSHe) are at risk of neurocognitive impairment. We assessed whether mTSHe at birth persists during childhood and compared neurocognitive functioning to siblings.

Methods: This study encompassed children born in the Auckland region (New Zealand) with a newborn screen TSH level of 8 to 14 mIU/L blood, age 6.9 to 12.6 years at assessment, and their siblings. Thyroid function tests (serum TSH and free thyroxine) and neurocognitive assessments were performed, including IQ via the Wechsler Intelligence Scale for Children, fourth edition.

Results: Ninety-six mTSHe individuals were studied, including 67 children recruited with 75 sibling controls. Mean mTSHe newborn TSH level was 10.1 mIU/L blood and 2.4 mIU/L at assessment (range, 0.8-7.0 mIU/L, serum). Although higher newborn TSH levels in the mTSHe group correlated with lower full-scale IQ scores (r = 0.25; P = .040), they were not associated with the magnitude of the IQ difference within sibling pairs (P = .56). Cognitive scores were similar for mTSHe and controls (full-scale IQ 107 vs 109; P = .36), with a minor isolated difference in motor coordination scores.

Conclusions: Our data do not suggest long-term negative effects of neonatal mild TSH elevation. TSH elevation below the screen threshold appears largely transient, and midchildhood neurocognitive performance of these children was similar to their siblings. We propose that associations between neonatal mild TSH elevation and IQ are due to familial confounders. We caution against the practice of reducing screening CH cutoffs to levels at which the diagnosis may not offer long-term benefit for those detected.
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http://dx.doi.org/10.1210/clinem/dgaa415DOI Listing
September 2020

The Effects of 20 Weeks of Side-Alternating Vibration Therapy on Physical Function, Bone and Muscle Health in Adolescents with Down Syndrome.

Phys Occup Ther Pediatr 2021 28;41(1):44-55. Epub 2020 Apr 28.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Aims: To evaluate the effects of side-alternating vibration therapy on physical function and body composition in adolescents with Down syndrome.

Methods: Fourteen adolescents (8 males) with Down syndrome (mean ± SD age: 15.5 ± 2.3 years) performed vibration treatment nine minutes daily, four times per week, for 20 weeks on a Galileo vibration platform. Data were collected at baseline and after 20 weeks of intervention. Assessments included six-minute walk test, muscle function (force plate), whole-body dual-energy X-ray absorptiometry and peripheral quantitative computed tomography of the non-dominant tibia.

Results: After 20 weeks, participants increased their distance walked in the six-minute walk test ( = 0.009), 2-leg single jump efficiency ( = 0.024) and jump velocity ( = 0.046). Participants also increased their power ( = 0.034) and reduced the time taken during the chair rise test ( < 0.001). At the total body level, increases were seen in bone mineral density ( = 0.004), bone mineral content ( = 0.043), fat free mass ( = 0.013) and lean mass ( = 0.021).

Conclusion: Side-alternating vibration therapy was associated with increases in physical function and muscle mass with no effects on bone health in adolescents with Down syndrome.

Clinical Trial Registration Number: Australian New Zealand Clinical Trial Registry (ACTRN12615000092594) - registered on 4 February 2015.
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http://dx.doi.org/10.1080/01942638.2020.1758983DOI Listing
April 2020

Gut microbiome transfer-Finding the perfect fit.

Clin Endocrinol (Oxf) 2020 07 15;93(1):3-10. Epub 2020 Apr 15.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Gut microbiome transfer (GMT; also referred to as faecal microbiota transplantation or FMT) has been propelled from fringe therapy to mainstream science as a highly effective treatment for recurrent Clostridioides difficile infection. As a result, there has been great interest in the potential efficacy and safety of GMT in treating other medical conditions, for example inflammatory bowel disease, and more recently as a novel therapy for obesity and metabolic diseases. For these chronic conditions, the results from clinical trials have been mixed. Further, specifically in obesity and metabolic diseases, there are limited available data, with only a few published studies with a small number of participants and short duration of follow-up. Therefore, this review aims to explore the human, microbial and formulation factors that may affect the success of GMT. This includes various aspects in the preparation and administration of GMT, such as stool processing, modes of delivery, pretreatment with antibiotics and/or bowel lavage, frequency of GMT and possible use of precision bacteriotherapy. In addition, we examine the potential use of GMT in obesity, type 2 diabetes and metabolic diseases based on current available literature, highlighting some recent advances in GMT research in this area, as well as potential adverse effects after GMT therapy.
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http://dx.doi.org/10.1111/cen.14183DOI Listing
July 2020

Large-for-gestational-age phenotypes and obesity risk in adulthood: a study of 195,936 women.

Sci Rep 2020 02 7;10(1):2157. Epub 2020 Feb 7.

Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

While there is evidence that being born large-for-gestational-age (LGA) is associated with an increased risk of obesity later in life, the data are conflicting. Thus, we aimed to examine the associations between proportionality at birth and later obesity risk in adulthood. This was a retrospective study using data recorded in the Swedish Birth Register. Anthropometry in adulthood was assessed in 195,936 pregnant women at 10-12 weeks of gestation. All women were born at term (37-41 weeks of gestation). LGA was defined as birth weight and/or length ≥2.0 SDS. Women were separated into four groups: appropriate-for-gestational-age according to both weight and length (AGA - reference group; n = 183,662), LGA by weight only (n = 4,026), LGA by length only (n = 5,465), and LGA by both weight and length (n = 2,783). Women born LGA based on length, weight, or both had BMI 0.12, 1.16, and 1.08 kg/m greater than women born AGA, respectively. The adjusted relative risk (aRR) of obesity was 1.50 times higher for those born LGA by weight and 1.51 times for LGA by both weight and height. Length at birth was not associated with obesity risk. Similarly, women born LGA by ponderal index had BMI 1.0 kg/m greater and an aRR of obesity 1.39 times higher than those born AGA. Swedish women born LGA by weight or ponderal index had an increased risk of obesity in adulthood, irrespective of their birth length. Thus, increased risk of adult obesity seems to be identifiable from birth weight and ignoring proportionality.
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http://dx.doi.org/10.1038/s41598-020-58827-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005699PMC
February 2020

Associations of Prenatal and Childhood Antibiotic Exposure With Obesity at Age 4 Years.

JAMA Netw Open 2020 01 3;3(1):e1919681. Epub 2020 Jan 3.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Importance: Although antibiotics are associated with obesity in animal models, the evidence in humans is conflicting.

Objective: To assess whether antibiotic exposure during pregnancy and/or early childhood is associated with the development of childhood obesity, focusing particularly on siblings and twins.

Design, Setting, And Participants: This cross-sectional national study included 284 211 participants (132 852 mothers and 151 359 children) in New Zealand. Data analyses were performed for 150 699 children for whom data were available, 30 696 siblings, and 4188 twins using covariate-adjusted analyses, and for 6249 siblings and 522 twins with discordant outcomes using fixed-effects analyses. Data analysis was performed November 2017 to March 2019.

Exposure: Exposure to antibiotics during pregnancy and/or early childhood.

Main Outcomes And Measures: The main outcome is odds of obesity at age 4 years. Anthropometric data from children born between July 2008 and June 2011 were obtained from the B4 School Check, a national health screening program that records the height and weight of 4-year-old children in New Zealand. These data were linked to antibiotics (pharmaceutical records) dispensed to women before conception and during all 3 trimesters of pregnancy and to their children from birth until age 2 years.

Results: The overall study population consisted of 132 852 mothers and 151 359 children (77 610 [51.3%] boys) who were aged 4 to 5 years when their anthropometrical measurements were assessed. Antibiotic exposure was common, with at least 1 course dispensed to 35.7% of mothers during pregnancy and 82.3% of children during the first 2 years of life. Results from covariate-adjusted analyses showed that both prenatal and early childhood exposures to antibiotics were independently associated with obesity at age 4 years, in a dose-dependent manner. Every additional course of antibiotics dispensed to the mothers yielded an adjusted odds ratio (aOR) of obesity in their children (siblings) of 1.02 (95% CI, 0.99-1.06), which was similar to the odds across pregnancy for the whole population (aOR, 1.06; 95% CI, 1.04-1.07). For the child's exposure, the aOR for the association between antibiotic exposure and obesity was 1.04 (95% CI, 1.03-1.05) among siblings and 1.05 (95% CI, 1.02-1.09) among twins. However, fixed-effects analyses of siblings and twins showed no associations between antibiotic exposure and obesity, with aORs of 0.95 (95% CI, 0.90-1.00) for maternal exposure, 1.02 (95% CI, 0.99-1.04) for child's exposure, and 0.91 (95% CI, 0.81-1.02) for twins' exposure.

Conclusions And Relevance: Although covariate-adjusted analyses demonstrated an association between antibiotic exposure and odds of obesity, further analyses of siblings and twins with discordant outcomes showed no associations. Thus, these discordant results likely reflect unmeasured confounding factors.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.19681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991276PMC
January 2020

Lower insulin sensitivity in young adults born preterm in Thailand.

Pediatr Diabetes 2020 03 30;21(2):210-214. Epub 2019 Dec 30.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Background: Previous studies reported impaired glucose homeostasis among preterm survivors, but consisted almost exclusively of Caucasians. It is unknown whether Asians born preterm display similar impairments.

Aim: To assess glucose homeostasis and other cardiometabolic outcomes among young adults born preterm in Thailand.

Methods: Participants were 575 young adult offspring of mothers from the Chiang Mai Low Birth Weight Study, born in 1989 to 1990 and followed up in 2010: 54.1% females, median age 20.6 years, including 33 individuals (5.7%) born preterm. After an overnight fast, participants underwent clinical assessments, including blood sampling (glucose, insulin, and lipid profile). Insulin sensitivity was assessed using HOMA-IR and insulin secretion estimated using HOMA-β.

Results: In unadjusted analyses, young Thai adults born preterm were 3.2 cm shorter (P = .037), 6 kg lighter (P = .016), and had HOMA-β 34% higher (P = .026) than those born at term. Adjusted analyses accounting for important confounders showed marked impairments in glucose homeostasis among preterm survivors: fasting insulin levels were 32% greater (P = .011), with HOMA-IR and HOMA-β that were 31% (P = .020) and 43% higher (P = .005), respectively, compared to peers born at term. There were no other contrasting observations between groups, with anthropometric differences disappearing after adjustment for confounders.

Discussion: Young adults in Thailand born preterm were more insulin resistant than peers born at term. The observed impairments in glucose metabolism among young Thai adults born preterm corroborate findings reported mostly on Caucasians. The challenge for general practitioners and public health professionals is to encourage those born preterm to make healthier lifestyle choices early on.
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http://dx.doi.org/10.1111/pedi.12969DOI Listing
March 2020

Acceptability of early childhood obesity prediction models to New Zealand families.

PLoS One 2019 2;14(12):e0225212. Epub 2019 Dec 2.

A Better Start-National Science Challenge, Auckland, New Zealand.

Objective: While prediction models can estimate an infant's risk of developing obesity at a later point in early childhood, caregiver receptiveness to such information is largely unknown. We aimed to assess the acceptability of these models to New Zealand caregivers.

Methods: An anonymous questionnaire was distributed online. The questionnaire consisted of multiple choice and Likert scale questions. Respondents were parents, caregivers, and grandparents of children aged ≤5 years.

Results: 1,934 questionnaires were analysed. Responses were received from caregivers of various ethnicities and levels of education. Nearly two-thirds (62.1%) of respondents would "definitely" or "probably" want to hear if their infant was at risk of early childhood obesity, although "worried" (77.0%) and "upset" (53.0%) were the most frequently anticipated responses to such information. With lower mean scores reflecting higher levels of acceptance, grandparents (mean score = 1.67) were more receptive than parents (2.10; p = 0.0002) and other caregivers (2.13; p = 0.021); males (1.83) were more receptive than females (2.11; p = 0.005); and Asian respondents (1.68) were more receptive than those of European (2.05; p = 0.003), Māori (2.11; p = 0.002), or Pacific (2.03; p = 0.042) ethnicities. There were no differences in acceptance according to socioeconomic status, levels of education, or other ethnicities.

Conclusions: Almost two-thirds of respondents were receptive to communication regarding their infant's risk of childhood obesity. While our results must be interpreted with some caution due to their hypothetical nature, findings suggest that if delivered in a sensitive manner to minimise caregiver distress, early childhood obesity risk prediction could be a useful tool to inform interventions to reduce childhood obesity in New Zealand.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225212PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886750PMC
April 2020

Perspective: Human Milk Oligosaccharides: Fuel for Childhood Obesity Prevention?

Adv Nutr 2020 01;11(1):35-40

Liggins Institute, University of Auckland, Auckland, New Zealand.

Obesity begins early but has lifelong consequences for health and well-being. Breastfeeding is thought to be preventive against obesity, but the extent and cause of this association are not well understood. Human milk oligosaccharides (HMOs) are abundant in human milk and not present in commercially available infant formula. These complex sugars are thought to contribute to the development of the infant gut microbiome and immune system. Recently, they have been investigated as a potential link between breastfeeding and lower obesity risk. So far, only a few human studies have examined HMO composition of human milk in association with the infant's concurrent anthropometry or subsequent growth in infancy, with conflicting results. However, HMOs have been shown to modulate the gut microbiome profile by selectively promoting the growth of specific bacteria, such as bifidobacteria. Moreover, there are differences in the gut microbiome of lean and obese humans, and there is some evidence that the early composition of the gut microbiome can predict later obesity. Although it seems that HMOs might have a role in infant growth and adiposity, there is not enough consistent evidence to understand their potential role in obesity prevention. More data, particularly from large or longitudinal studies, are needed to clarify the functions of HMOs and other breast-milk components in determining long-term health.
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http://dx.doi.org/10.1093/advances/nmz093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442366PMC
January 2020

Ranked Importance of Childhood Obesity Determinants: Parents' Views across Ethnicities in New Zealand.

Nutrients 2019 Sep 7;11(9). Epub 2019 Sep 7.

A Better Start-National Science Challenge, Auckland 1142, New Zealand.

Māori, Pacific, Indian, and New Zealand European pre-school children's caregivers' views on determinants of childhood obesity are needed to inform strategies that will reduce disparities in prevalence. Nineteen focus groups were conducted to explore the relative influence of factors contributing to body weight in children. Predetermined and participant-suggested factors were ranked. Discussion data were inductively analysed. The cost of healthy foods was the highest ranked factor across all groups. Ranked similarly were ease of access to takeaways and lack of time for food preparation. Cultural factors followed by screen time induced sedentariness in children and lack of time to ensure children exercised was next. Participant-raised factors included lack of familial, social, and health promotion support, and others' behaviour and attitudes negatively impacting what children ate. All groups rejected stereotyping that blamed culture for higher obesity rates. Compared to the Māori and NZ European groups, the Pacific Island and Indian participants spoke of losing culture, missing extended family support, and not having access to culturally appropriate nutrition education or social support and services. Public health policies need to mitigate the negative effects of economic deprivation on food insecurity. Complementary interventions that increase access to healthier meal choices more often are needed.
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http://dx.doi.org/10.3390/nu11092145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769712PMC
September 2019

Publishing Without Perishing: A Guide to the Successful Reporting of Clinical Data.

Int J Low Extrem Wounds 2019 Sep 3;18(3):219-227. Epub 2019 Sep 3.

Chiang Mai University, Chiang Mai, Thailand.

Many researchers find writing a scientific manuscript a highly discouraging task. This problem may be partly responsible for the fact that approximately half of completed clinical studies worldwide remain unreported or unpublished. Therefore, we aimed to create a user-friendly guide with helpful recommendations, which are complementary to the many existing reporting guidelines for quantitative clinical data. This article has been prepared with clearly defined subheadings, to facilitate quick identification of any specific sections/topics. We encourage the use of the IMRaD model (ie, Introduction, Methods, Results, and Discussion), providing guidance on the key information required, as well as the dos and don'ts. We also comment briefly on feedback and rejection, proposing the I AM approach (Ignore, Address, and Move on).
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http://dx.doi.org/10.1177/1534734619865860DOI Listing
September 2019