Publications by authors named "Susanna Y Huh"

26 Publications

  • Page 1 of 1

Delivery by caesarean section and offspring adiposity and cardio-metabolic health at ages 6.5, 11.5 and 16 years: results from the PROBIT cohort in Belarus.

Pediatr Obes 2021 Mar 3:e12783. Epub 2021 Mar 3.

Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.

Background: Caesarean delivery has been associated with later adiposity, perhaps via early programming or perhaps because of residual confounding by maternal or birth characteristics.

Objectives: Examine associations of caesarean delivery with adiposity and cardio-metabolic biomarkers.

Methods: Observational analysis of 15 069 children in the PROBIT cohort in Belarus. We examined measures of child anthropometry and blood pressure at 6.5, 11.5 and 16 years and fasting blood (11.5 years).

Results: Caesarean-delivered children were slightly heavier at 6.5 (mean BMI 15.8 vs. 15.6 kg/m ), 11.5 (18.4 vs. 18.2) and 16 years (21.5 vs. 21.3). After adjustment for prenatal characteristics including maternal third trimester BMI, however, we observed no association of caesarean versus vaginal delivery with child BMI (β 0.05 kg/m ; 95%CI: -0.03, 0.14), sum of skinfolds (0.14 mm; -0.13, 0.42), waist circumference (-0.07 cm; -0.23, 0.10), obesity (OR 0.99; 0.76, 1.29), or systolic (-0.20 mmHg; -0.70, 0.30) or diastolic (-0.17 mmHg, -0.60, 0.26) blood pressure at 6.5 years; results were similar at 11.5 and 16 years. At 11.5 years, we observed a modest association of caesarean delivery with fasting insulin (0.33 mU/L; 0.00, 0.65).

Conclusions: Caesarean delivery had little or no association with adiposity or related cardio-metabolic biomarkers in childhood. Adjustment for maternal BMI attenuated all outcome effect estimates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijpo.12783DOI Listing
March 2021

Maternal Place of Birth, Socioeconomic Characteristics, and Child Health in US-Born Latinx Children in Boston.

Acad Pediatr 2020 03 18;20(2):225-233. Epub 2019 Sep 18.

Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital (SY Huh), Boston, Mass; Department of Pediatrics, Harvard Medical School (SY Huh), Boston, Mass.

Objective: Among US-born children of Latina US (USB) and Latina foreign-born mothers (FBM), to determine whether 1) household and child characteristics differ; 2) child health outcomes differ; 3) these differences diminish for children of FBM with longer duration of residence in the United States; and 4) these differences can be explained by food insecurity (FI) or by Supplemental Nutrition Assistance Program (SNAP) participation.

Methods: Cross-sectional survey of 2145 Latina mothers of publicly insured US-born children 0 to 48 months old in a Boston emergency department (ED) 2004 to 2013. Predictors were FBM versus USBM and duration of residence in the United States. Outcomes were mothers' report of child health, history of hospitalization, developmental risk, and hospital admission on the day of ED visit. Multivariable logistic regression adjusted for potential confounders and effect modification.

Results: FBM versus USBM households had more household (31% vs 26%) and child (19% vs 11%) FI and lower SNAP participation (44% vs 67%). Children of FBM versus USBM were more likely to be reported in fair/poor versus good/excellent health (adjusted odds ratios 1.9, 95% confidence interval [1.4, 2.6]), with highest odds for children of FBM with shortest duration of residence, and to be admitted to the hospital on the day of the ED visit (adjusted odds ratios 1.7, 95% confidence interval [1.3, 2.2]). SNAP and FI did not fully explain these outcomes.

Conclusion: When providing care and creating public policies, clinicians and policymakers should consider higher rates of food insecurity, lower SNAP participation, and risk for poor health outcomes in Latinx children of FBM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acap.2019.09.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081477PMC
March 2020

Macronutrient Analysis of Modified-Fat Breast Milk Produced by 3 Methods of Fat Removal.

JPEN J Parenter Enteral Nutr 2020 07 17;44(5):895-902. Epub 2019 Sep 17.

Harvard Medical School, Boston, Massachusetts, USA.

Background: Infants with chylothorax after congenital heart disease surgery are commonly treated using modified-fat breast milk. The effect of fat removal on breast milk macronutrients remains unclear. We compared macronutrient content of breast milk with breast milk skimmed using 3 methods, including a novel device, a cream separator.

Methods: Thawed frozen breast milk samples from 30 women were defatted using refrigerated centrifuge, cream separator, and manual separation after refrigeration. We used standard assays to measure energy, protein, and fat content of breast milk samples.

Results: All fat removal methods yielded skimmed breast milk with substantially lower fat and energy content. Mean energy content in breast milk skimmed by centrifuge (36.7 [SD 3.6] kcal/100 mL) was similar to that from cream separator (38.8 [3.5] kcal/100 mL). Both centrifuge and cream separator methods removed almost all fat and substantially more fat than the manual fat removal method. For unprocessed milk, energy and fat content estimated by creamatocrit was similar to reference method measurements; in skimmed milk, the creamatocrit significantly overestimated fat content. Mean protein content of skimmed breast milk was similar to unprocessed breast milk (mean 1.25 [0.31] g/100 mL).

Conclusion: Breast milk fat removal did not significantly alter protein levels. In skimmed breast milk, the overestimation of fat content using creamatocrit method suggests a need for more accurate bedside methods to assess macronutrient content. The similar macronutrient composition of breast milk skimmed by cream separator and centrifuge suggests the potential for cream separator use as a new, portable defatting method for hospitals and families.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jpen.1710DOI Listing
July 2020

Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework.

J Pediatr Gastroenterol Nutr 2019 01;68(1):124-129

Developmental-Behavioral Pediatrics University Health System, Uniformed Services University, San Antonio, TX.

Pediatric feeding disorders (PFDs) lack a universally accepted definition. Feeding disorders require comprehensive assessment and treatment of 4 closely related, complementary domains (medical, psychosocial, and feeding skill-based systems and associated nutritional complications). Previous diagnostic paradigms have, however, typically defined feeding disorders using the lens of a single professional discipline and fail to characterize associated functional limitations that are critical to plan appropriate interventions and improve quality of life. Using the framework of the World Health Organization International Classification of Functioning, Disability, and Health, a unifying diagnostic term is proposed: "Pediatric Feeding Disorder" (PFD), defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. By incorporating associated functional limitations, the proposed diagnostic criteria for PFD should enable practitioners and researchers to better characterize the needs of heterogeneous patient populations, facilitate inclusion of all relevant disciplines in treatment planning, and promote the use of common, precise, terminology necessary to advance clinical practice, research, and health-care policy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MPG.0000000000002188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314510PMC
January 2019

Impact of a Standardized Clinical Assessment and Management Plan (SCAMP®) on growth in infants with CHD.

Cardiol Young 2018 Oct 3;28(10):1093-1098. Epub 2018 Sep 3.

1Center for Applied Pediatric Quality Analytics,Boston Children's Hospital,Boston,MA,USA.

Background: Growth failure is prevalent among infants with CHD. A Standardized Clinical Assessment and Management Plan was introduced at Boston Children's Hospital's cardiac medical ward to identify patients with growth failure, evaluate relevant contributing conditions, and recommend a management plan including collaboration with nutrition physicians.

Objective: The objective of this study was to determine whether enrolled patients had improved growth compared with historical controls.

Methods: A total of 29 patients were enrolled in the period July, 2013-June, 2014. In all, 42 historical controls who met eligibility criteria for enrolment were selected for comparison from patients admitted to the same ward in the period June, 2010-June, 2011. Patients with CHD aged <1 year , with growth failure defined as weight-for-age z-score <-2, or failure to sustain adequate weight gain were eligible for participation. Primary outcome was change in weight-for-age z-score from enrolment to most recent weight measurement among patients with at least 6 months of follow-up.

Results: Control patients were older at baseline admission weight (118 versus 95 days, p=0.33), and had a higher weight-for-age z-score, -2.9 (-3.1, -2.6) versus -3.7 (-4.3, -3.0) (p=0.02), compared with enrolled patients. Enrolled patients had greater gain in weight-for-age z-score, 2.7 (2.0, 3.4) versus 1.8 (1.5, 2.2) (p=0.03), from baseline to most recent follow-up.

Conclusion: Patients enrolled in a nutrition-focused protocol had greater weight improvement than historical controls. Identification of growth failure and collaboration with a nutrition support team was associated with improved weight gain among CHD patients experiencing growth failure. CHD programmes should consider a structural approach, including nutrition expertise to address growth failure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1047951118000781DOI Listing
October 2018

Reducing time to initiation and advancement of enteral feeding in an all-referral neonatal intensive care unit.

J Perinatol 2018 07 8;38(7):936-943. Epub 2018 May 8.

Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, 02115, USA.

Objective: Decrease time to enteral feeding initiation and advancement.

Study Design: In our all-referral neonatal intensive care unit, we developed an evidence-based guideline addressing feeding initiation and advancement. During 6 months before and 7 months after guideline implementation, we measured time to initiate feeding, time to 100 ml/kg/day of feeding, gastric residual measurement frequency, and incidence of necrotizing enterocolitis (balancing measure).

Result: Two hundred twenty-three infants were studied. Time from admission to feeding initiation was shorter after guideline implementation (mean 0.5 days [95% CI: 0.4-0.7] vs. 1.1 days [95% CI: 0.7-1.5], p = 0.01). Time from admission to 100 ml/kg/day feeding was also shorter (3.6 days [95% CI: 2.8-4.4] vs. 6.2 days [95% CI: 4.4-8.1], p = 0.01). After guideline implementation, routine gastric residual measurements were discontinued.

Conclusion: After implementation of an enteral feeding guideline, which included discontinuation of routine gastric residual assessment, we observed a faster initiation of enteral feeding and shorter time to reach 100 ml/kg/day.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41372-018-0110-2DOI Listing
July 2018

Case 31-2017: A 19-Month-Old Girl with Failure to Thrive.

N Engl J Med 2018 02;378(7):685-6

Boston Children’s Hospital, Boston, MA

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1056/NEJMc1714806DOI Listing
February 2018

Risk Factors for Fractures in Children Hospitalized in Intensive and Intermediate Care Units.

Hosp Pediatr 2017 Jul 6;7(7):395-402. Epub 2017 Jun 6.

Department of Pediatrics, and

Background And Objectives: Fragility fractures are increasingly recognized in hospitalized children. Our study aim was to identify risk factors for fracture in children hospitalized in intensive and intermediate care units.

Methods: We conducted a retrospective, case-control study comparing the clinical characteristics of children with fractures (cases) to children without fractures (controls) matched for age, sex, hospital unit, admission quarter and year, ICU length of stay, severity of illness, and resource utilization. Bivariate comparisons and matched multivariable logistic regression modeling were used to determine associations between potential risk factors and fracture.

Results: Median age at fracture for the 35 patients was 5.0 months (interquartile range 2.0 to 10.0 months) and at a comparable interval for the 70 matched controls was 3.5 months (interquartile range 2.0 to 7.0 months). In bivariate analyses, factors associated with fracture included: primary diagnosis of tracheoesophageal fistula, esophageal atresia and stenosis; diagnosis of kidney disease; and per 5-day increase in median cumulative ICU days at risk. In the final model, a respiratory disease diagnosis (odds ratio 3.9, 95% confidence interval 1.1-13.7) and per 5-day increase in median cumulative ICU days at risk (odds ratio 1.3, 95% confidence interval 1.0-1.6) were significant independent risk factors for fracture.

Conclusions: Children prone to fracture in the hospital are young, medically complex patients who require extended periods of intensive level medical care and potentially life-sustaining treatment modalities. The children who would benefit most from fracture reduction efforts are those with respiratory disease and prolonged ICU stays.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/hpeds.2016-0213DOI Listing
July 2017

Unpasteurized Shared Human Milk Use in Pediatric Inpatients: Health and Ethical Implications.

Hosp Pediatr 2017 Jun 4;7(6):352-356. Epub 2017 May 4.

Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts.

Growing evidence supporting the health benefits of human milk, particularly in the preterm population, has led to rising demand for donor human milk in NICUs and pediatric hospitals. There are no previous reports describing the use of unpasteurized shared human milk (USHM) in the hospital setting, but the use of USHM solicited from community donors through social networks appears to be common. Many pediatric hospitals permit inpatients to receive breast milk that has been screened and pasteurized by a human milk banking organization and will provide pasteurized donor human milk (PDHM) only to infants who are preterm or have specific medical conditions. These policies are designed to minimize potential adverse effects from improperly handled or screened donor milk and to target patients who would experience the greatest benefit in health outcomes with donor milk use. We explore the ethical and health implications of 2 cases of medically complex infants who did not meet criteria in our tertiary care hospital for the use of PDHM from a regulated human milk bank and were incidentally found to be using USHM. These cases raise questions about how best to balance the ethical principles of beneficence, nonmaleficence, justice, and patient autonomy in the provision of PDHM, a limited resource. Health care staff should ask about USHM use to provide adequate counseling about the risks and benefits of various feeding options in the context of an infant's medical condition.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/hpeds.2016-0178DOI Listing
June 2017

Clinical Trial of the Protein Farnesylation Inhibitors Lonafarnib, Pravastatin, and Zoledronic Acid in Children With Hutchinson-Gilford Progeria Syndrome.

Circulation 2016 Jul;134(2):114-25

From Departments of Anesthesia (L.B.G., M.E.K., A.A.D., K.L., M.M.G.), Cardiology (L.B.S.), Radiology (R.H.C., V.M.S.), Orthopedics (B.D.S.), Neurology (N.J.U.), Dermatology (M.G.L.), Genetics and Genomics (D.T.M.), Gastroenterology and Nutrition (S.Y.H.), and Hematology Oncology (M.W.K.), and Clinical Translational Study Unit (N.Q.), Boston Children's Hospital and Harvard Medical School, MA; Department of Pediatrics, Hasbro Children's Hospital and Warren Alpert Medical School of Brown University, Providence, RI (L.B.G.); Department of Biostatistics, Boston University School of Public Health and Harvard Clinical Research Institute, MA (J.M., R.B.D., H.S.); Division of Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.G.-H.); Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, OH (C.M.G.); Center for Advanced Orthopaedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (A.N.); and Division of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (M.W.K.).

Background: Hutchinson-Gilford progeria syndrome is an extremely rare, fatal, segmental premature aging syndrome caused by a mutation in LMNA yielding the farnesylated aberrant protein progerin. Without progerin-specific treatment, death occurs at an average age of 14.6 years from an accelerated atherosclerosis. A previous single-arm clinical trial demonstrated that the protein farnesyltransferase inhibitor lonafarnib ameliorates some aspects of cardiovascular and bone disease. This present trial sought to further improve disease by additionally inhibiting progerin prenylation.

Methods: Thirty-seven participants with Hutchinson-Gilford progeria syndrome received pravastatin, zoledronic acid, and lonafarnib. This combination therapy was evaluated, in addition to descriptive comparisons with the prior lonafarnib monotherapy trial.

Results: No participants withdrew because of side effects. Primary outcome success was predefined by improved per-patient rate of weight gain or carotid artery echodensity; 71.0% of participants succeeded (P<0.0001). Key cardiovascular and skeletal secondary variables were predefined. Secondary improvements included increased areal (P=0.001) and volumetric (P<0.001-0.006) bone mineral density and 1.5- to 1.8-fold increases in radial bone structure (P<0.001). Median carotid artery wall echodensity and carotid-femoral pulse wave velocity demonstrated no significant changes. Percentages of participants with carotid (5% to 50%; P=0.001) and femoral (0% to 12%; P=0.13) artery plaques and extraskeletal calcifications (34.4% to 65.6%; P=0.006) increased. Other than increased bone mineral density, no improvement rates exceeded those of the prior lonafarnib monotherapy treatment trial.

Conclusions: Comparisons with lonafarnib monotherapy treatment reveal additional bone mineral density benefit but likely no added cardiovascular benefit with the addition of pravastatin and zoledronic acid.

Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00879034 and NCT00916747.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCULATIONAHA.116.022188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943677PMC
July 2016

Fractures Among Inpatients in a Pediatric Hospital.

Hosp Pediatr 2016 Mar 1;6(3):143-50. Epub 2016 Jan 1.

Harvard Medical School, Boston, Massachusetts Gastroenterology, Hepatology and Nutrition, and.

Objective: Fractures occurring in hospitalized children may be an underrecognized preventable harm with implications for current and future bone health, but few data exist regarding the clinical characteristics of these pediatric patients. We describe the clinical characteristics of patients who sustained fractures during hospitalization over a 4.5-year period at a single tertiary care center.

Methods: We retrospectively identified subjects who experienced inpatient fractures using a voluntary safety event reporting system and computer-assisted keyword search of the electronic medical record. We used the medical record to collect clinical characteristics, laboratory data, and survival status.

Results: The safety event reporting system and keyword search identified 57% and 43% of subjects, respectively. Fifty-six subjects sustained 128 fractures while hospitalized, most frequently at the femur (33 fractures) and humerus (30 fractures). Twenty-seven subjects sustained multiple fractures. Common clinical characteristics included age ≤1 year (64%); preterm birth (53%); admission to an ICU (90%); immobilization (88%); and weight-for-age z score less than or equal to -2.0 (52%). Sixteen (29%) subjects died, and the mortality rate varied by primary diagnosis.

Conclusions: Critically ill, immobilized infants under 1 year of age and who were often born preterm sustained the majority of fractures occurring during hospitalization. A voluntary reporting system was insufficient to identify all inpatient fractures. Future studies should explore optimal fracture screening strategies and the relationship among fractures, severity of illness and mortality in hospitalized children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/hpeds.2015-0074DOI Listing
March 2016

Cohort profile: project viva.

Int J Epidemiol 2015 Feb 16;44(1):37-48. Epub 2014 Mar 16.

Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Channing Laboratory, Brigham and Women's Hospital, Boston, MA, USA, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA, USA, Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA, Department of Nutrition, Harvard School of Public Health, Boston, MA, USA, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA, Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA, Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA, Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA, Division of Endocrinology, Beth Israel Deaconess Medical Center, Boston, MA, USA and Division of Neonatology, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Channing Laboratory, Brigham and Women's Hospital, Boston, MA, USA, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA, USA, Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA, Department of Nutrition, Harvard School of Public Health, Boston, MA, USA, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA, Division of Newborn Medicine, B

We established Project Viva to examine prenatal diet and other factors in relation to maternal and child health. We recruited pregnant women at their initial prenatal visit in eastern Massachusetts between 1999 and 2002. Exclusion criteria included multiple gestation, inability to answer questions in English, gestational age ≥22 weeks at recruitment and plans to move away before delivery. We completed in-person visits with mothers during pregnancy in the late first (median 9.9 weeks of gestation) and second (median 27.9 weeks) trimesters. We saw mothers and children in the hospital during the delivery admission and during infancy (median age 6.3 months), early childhood (median 3.2 years) and mid-childhood (median 7.7 years). We collected information from mothers via interviews and questionnaires, performed anthropometric and neurodevelopmental assessments and collected biosamples. We have collected additional information from medical records and from mailed questionnaires sent annually to mothers between in-person visits and to children beginning at age 9 years. From 2341 eligible women, there were 2128 live births; 1279 mother-child pairs provided data at the mid-childhood visit. Primary study outcomes include pregnancy outcomes, maternal mental and cardiometabolic health and child neurodevelopment, asthma/atopy and obesity/cardiometabolic health. Investigators interested in learning more about how to obtain Project Viva data can contact Project_Viva@hphc.org.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ije/dyu008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339753PMC
February 2015

Vitamin D status and hypertensive disorders in pregnancy.

Ann Epidemiol 2014 May 15;24(5):399-403.e1. Epub 2014 Feb 15.

Harvard Medical School, Boston, MA; Obesity Prevention Program, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA; Department of Nutrition, Harvard School of Public Health, Boston, MA.

Purpose: Several studies have reported increased risk of preeclampsia when 25-hyrdoxyvitamin D (25[OH]D) levels are low. The extent to which 25(OH)D may lower risk for hypertensive disorder during pregnancy remains unclear.

Methods: Among women enrolled in the Project Viva prenatal cohort in Massachusetts, we examined associations of 25(OH)D levels obtained at 16.4-36.9 weeks of gestation (mean 27.9 weeks) with hypertensive disorders of pregnancy, including preeclampsia (56/1591, 3.5%) and gestational hypertension (109/1591, 6.9%).

Results: We did not detect an association between plasma 25(OH)D concentration (mean 58, standard deviation 22 nmol/L) and preeclampsia. For each 25 nmol/L increase in 25(OH)D, the adjusted odds ratio for preeclampsia was 1.14 (95% confidence interval, 0.77-1.67). By contrast and contrary to hypothesis, higher 25(OH)D concentrations were associated with higher odds of gestational hypertension: adjusted odds ratio for gestational hypertension was 1.32 (95% confidence interval, 1.01-1.72) per each 25 nmol/L increment in 25(OH)D. Vitamin D intake patterns suggest that this association was not because of reverse causation. Although the elevated hypertension risk may be due to chance, randomized trials of vitamin D supplementation during pregnancy should monitor for gestational hypertension.

Conclusions: These data do not support the hypothesis that higher 25(OH)D levels lower the overall risk of hypertensive disorders of pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annepidem.2014.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011985PMC
May 2014

Clinical trial of a farnesyltransferase inhibitor in children with Hutchinson-Gilford progeria syndrome.

Proc Natl Acad Sci U S A 2012 Oct 24;109(41):16666-71. Epub 2012 Sep 24.

Department of Anesthesia, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.

Hutchinson-Gilford progeria syndrome (HGPS) is an extremely rare, fatal, segmental premature aging syndrome caused by a mutation in LMNA that produces the farnesylated aberrant lamin A protein, progerin. This multisystem disorder causes failure to thrive and accelerated atherosclerosis leading to early death. Farnesyltransferase inhibitors have ameliorated disease phenotypes in preclinical studies. Twenty-five patients with HGPS received the farnesyltransferase inhibitor lonafarnib for a minimum of 2 y. Primary outcome success was predefined as a 50% increase over pretherapy in estimated annual rate of weight gain, or change from pretherapy weight loss to statistically significant on-study weight gain. Nine patients experienced a ≥50% increase, six experienced a ≥50% decrease, and 10 remained stable with respect to rate of weight gain. Secondary outcomes included decreases in arterial pulse wave velocity and carotid artery echodensity and increases in skeletal rigidity and sensorineural hearing within patient subgroups. All patients improved in one or more of these outcomes. Results from this clinical treatment trial for children with HGPS provide preliminary evidence that lonafarnib may improve vascular stiffness, bone structure, and audiological status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1073/pnas.1202529109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3478615PMC
October 2012

Fractures in hospitalized children.

Metabolism 2013 Mar 6;62(3):315-25. Epub 2012 Sep 6.

Harvard Medical School, and the Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA 02115, USA.

Hospitalized children have multiple risk factors for fragility fractures, related to disease pathophysiology, treatments, nutritional status and immobilization. Recognition and treatment of these risk factors are important to prevent morbidity associated with fractures and to promote current and future bone health. Many knowledge gaps remain regarding the ideal nutrition, physical activity, and medication regimens needed to optimize bone health and reduce the risk of fractures over the life course. This article reviews the pathogenesis, risk factors, treatment and prevention strategies for fractures in hospitalized infants and children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.metabol.2012.07.018DOI Listing
March 2013

Vitamin D deficiency in pregnancy and gestational diabetes mellitus.

Am J Obstet Gynecol 2012 Sep 1;207(3):182.e1-8. Epub 2012 Jun 1.

Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Objective: We examined the association of second-trimester maternal plasma 25-hydroxyvitamin D (25[OH]D) during pregnancy with gestational diabetes mellitus (GDM).

Study Design: Among 1314 pregnant women who participated in Project Viva, a birth cohort study, we measured 25(OH)D levels at 26-28 weeks gestation during GDM screening using a 1-hour 50-g glucose challenge test.

Results: We found 25(OH)D levels of <25 nmol/L in 44 of 1087 women (4.0%) with normal glucose tolerance, 9 of 159 women (5.7%) with impaired glucose tolerance, and 9 of 68 women (13.2%) with GDM. Analyses that were adjusted for sociodemographics, season, maternal body mass index, gestational weight gain, and dietary factors suggested that women with 25(OH)D levels of <25 vs ≥25 nmol/L may have higher odds of experiencing GDM (odds ratio, 2.2; 95% confidence interval, 0.8-5.5). Glucose levels after the glucose challenge test were associated inversely with 25(OH)D levels (P < .01).

Conclusion: Second-trimester 25(OH)D levels were associated inversely with glucose levels after 1-hour 50-g glucose challenge test; low 25(OH)D levels may be associated with increased risk of GDM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajog.2012.05.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3432741PMC
September 2012

Plasma 25-hydroxyvitamin D during pregnancy and small-for-gestational age in black and white infants.

Ann Epidemiol 2012 Aug 1;22(8):581-6. Epub 2012 Jun 1.

Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Purpose: In a prospective prenatal cohort study, we examined associations of second trimester and cord plasma 25-hydroxyvitamin D (25[OH]D) with small-for-gestational age (SGA) and the extent to which vitamin D might explain black/white differences in SGA.

Methods: We studied 1067 white and 236 black mother-infant pairs recruited from eight obstetrical offices early in pregnancy in Massachusetts. We analyzed 25(OH)D levels using an immunoassay and performed multivariable logistic models to estimate the odds of SGA by category of 25(OH)D level.

Results: Mean (SD) second trimester 25(OH)D level was 60 nmol/L (SD, 21) and was lower for black (46 nmol/L [SD, 22]) than white (62 nmol/L [SD, 20]) women. Fifty-nine infants were SGA (4.5%), and more black than white infants were SGA (8.5% vs. 3.7%). The odds of SGA were higher with maternal 25(OH)D levels less than 25 versus 25 nmol/L or greater (adjusted odds ratio, 3.17; 95% confidence interval, 1.16-8.63). The increased odds of SGA among black versus white participants decreased from an odds ratio of 2.04(1.04, 4.04) to 1.68(0.82, 3.46) after adjusting for 25(OH)D.

Conclusions: Second trimester 25(OH)D levels less than 25 nmol/L were associated with higher odds of SGA. Our data raise the possibility that vitamin D status may contribute to racial disparities in SGA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annepidem.2012.04.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396717PMC
August 2012

Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study.

Arch Dis Child 2012 Jul 23;97(7):610-6. Epub 2012 May 23.

Division of Gastroenterology and Nutrition, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.

Objective: To examine whether delivery by caesarean section is a risk factor for childhood obesity.

Design: Prospective prebirth cohort study (Project Viva).

Setting: Eight outpatient multi-specialty practices based in the Boston, Massachusetts area.

Participants: We recruited women during early pregnancy between 1999 and 2002, and followed their children after birth. We included 1255 children with body composition measured at 3 years of age.

Main Outcome Measures: BMI score, obesity (BMI for age and sex ≥95th percentile), and sum of triceps plus subscapular skinfold thicknesses at 3 years of age.

Results: 284 children (22.6%) were delivered by caesarean section. At age 3, 15.7% of children delivered by caesarean section were obese compared with 7.5% of children born vaginally. In multivariable logistic and linear regression models adjusting for maternal prepregnancy BMI, birth weight, and other covariates, birth by caesarean section was associated with a higher odds of obesity at age 3 (OR 2.10, 95% CI 1.36 to 3.23), higher mean BMI z-score (0.20 units, 95% CI 0.07 to 0.33), and higher sum of triceps plus subscapular skinfold thicknesses (0.94 mm, 95% CI 0.36 to 1.51).

Conclusions: Infants delivered by caesarean section may be at increased risk of childhood obesity. Further studies are needed to confirm our findings and to explore mechanisms underlying this association.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/archdischild-2011-301141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784307PMC
July 2012

Timing of solid food introduction and risk of obesity in preschool-aged children.

Pediatrics 2011 Mar 7;127(3):e544-51. Epub 2011 Feb 7.

Division of Gastroenterology and Nutrition, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.

Objective: To examine the association between timing of introduction of solid foods during infancy and obesity at 3 years of age.

Methods: We studied 847 children in Project Viva, a prospective pre-birth cohort study. The primary outcome was obesity at 3 years of age (BMI for age and gender ≥ 95th percentile). The primary exposure was the timing of introduction of solid foods, categorized as <4, 4 to 5, and ≥ 6 months. We ran separate logistic regression models for infants who were breastfed for at least 4 months ("breastfed") and infants who were never breastfed or stopped breastfeeding before the age of four months ("formula-fed"), adjusting for child and maternal characteristics, which included change in weight-for-age z score from 0 to 4 months-a marker of early infant growth.

Results: In the first 4 months of life, 568 infants (67%) were breastfed and 279 (32%) were formula-fed. At age 3 years, 75 children (9%) were obese. Among breastfed infants, the timing of solid food introduction was not associated with odds of obesity (odds ratio: 1.1 [95% confidence interval: 0.3-4.4]). Among formula-fed infants, introduction of solid foods before 4 months was associated with a sixfold increase in odds of obesity at age 3 years; the association was not explained by rapid early growth (odds ratio after adjustment: 6.3 [95% confidence interval: 2.3-6.9]).

Conclusions: Among formula-fed infants or infants weaned before the age of 4 months, introduction of solid foods before the age of 4 months was associated with increased odds of obesity at age 3 years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2010-0740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065143PMC
March 2011

Prospective association between milk intake and adiposity in preschool-aged children.

J Am Diet Assoc 2010 Apr;110(4):563-70

Division of Gastroenterology and Nutrition, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.

Objective: To determine whether the quantity and type of milk (whole, reduced fat, or 1%/nonfat) consumed at age 2 years is associated with adiposity at age 3 years.

Design: We assessed milk and dairy intake at age 2 years with food frequency questionnaires completed by mothers. Our primary outcomes were body mass index (BMI; calculated as kg/m(2)), z score and overweight at age 3 years, defined as BMI for age and sex >or=85th percentile.

Subjects/setting: Eight-hundred and fifty-two preschool-aged children in the prospective US cohort Project Viva.

Statistical Analyses: Linear and logistic regression models, adjusting for maternal BMI and education, paternal BMI, and child age, sex, race/ethnicity, intake of energy, nondairy beverages, television viewing, and BMI z score at age 2 years were used.

Results: At age 2 years, mean milk intake was 2.6 (standard deviation 1.2) servings per day. Higher intake of whole milk at age 2, but not reduced-fat milk, was associated with a slightly lower BMI z score (-0.09 unit per daily serving [95% confidence interval: -0.16 to -0.01]) at age 3 years; when restricted to children with a normal BMI (5th to <85th percentile) at age 2 years, the association was null (-0.05 unit per daily serving [95% confidence interval: -0.13 to 0.02]). Intake of milk at age 2 years, whether full- or reduced-fat, was not associated with risk of incident overweight at age 3 years. Neither total milk nor total dairy intake at age 2 years was associated with BMI z score or incident overweight at age 3 years.

Conclusion: Neither consuming more dairy products, nor switching from whole milk to reduced-fat milk at age 2 years, appears likely to prevent overweight in early childhood.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jada.2009.12.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229928PMC
April 2010

Prevalence of transient hyperphosphatasemia among healthy infants and toddlers.

Pediatrics 2009 Aug 20;124(2):703-9. Epub 2009 Jul 20.

Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.

Objective: To describe the prevalence and clinical characteristics of transient hyperphosphatasemia (TH) in a cohort of healthy infants and toddlers.

Methods: We performed a secondary data analysis of healthy infants and toddlers enrolled in a study examining the epidemiology of vitamin D deficiency. From 2005 to 2007, children aged 8 to 24 months were enrolled during well-child visits at an urban primary care pediatric clinic. At enrollment, we collected data regarding sociodemographic and clinical characteristics. We measured serum levels of alkaline phosphatase (AP), 25-hydroxyvitamin D, parathyroid hormone (PTH), calcium, magnesium, and phosphorus. We placed participants into 1 of 3 categories on the basis of serum AP levels: normal (AP: 110-400 U/L), intermediate (AP: >400 to 1000 U/L), and TH (AP: >1000 U/L). We used Fisher's exact test and analysis of variance to evaluate differences in characteristics among the 3 groups.

Results: Nine (2.8%) of 316 children had an AP level of >1000 U/L (mean: 2165 U/L). Sixteen children (5.1%) had an intermediate serum AP level (mean: 544 U/L). Mean weight-for-age, length-for-age, and weight-for-length z scores were similar across all 3 AP groups. Compared with the 291 children without TH, children in the intermediate AP and TH groups had similar mean serum levels of 25-hydroxyvitamin D, PTH, calcium, magnesium, and phosphorus.

Conclusions: TH seems to be a relatively common condition among healthy infants and toddlers. TH was not associated with anthropometric measures, vitamin D status, PTH, or serum minerals. Recognition of this benign condition is important to avoid unnecessary investigations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2008-3093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886727PMC
August 2009

Association between umbilical cord glucocorticoids and blood pressure at age 3 years.

BMC Med 2008 Aug 28;6:25. Epub 2008 Aug 28.

Division of Gastroenterology and Nutrition, Children's Hospital Boston, Boston, MA, USA.

Background: Animal data show that decreased activity of placental 11-beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2), which potently inactivates glucocorticoids (e.g. cortisol) to inert forms (cortisone), allows increased access of maternal glucocorticoids to the fetus and 'programs' hypertension. Data in humans are limited. We examined in humans the association between venous umbilical cord blood glucocorticoids, a potential marker for placental 11beta-HSD2 enzyme activity, and blood pressure at age 3 years.

Methods: Among 286 newborns in Project Viva, a prospective pre-birth cohort study based in eastern Massachusetts, we measured cortisol (F) and cortisone (E) in venous cord blood and used the ratio of F/E as a marker for placental 11beta-HSD2 activity. We measured blood pressure (BP) when the offspring reached age 3 years. Using mixed effects regression models to control for BP measurement conditions, maternal and child characteristics, we examined the association between the F/E ratio and child BP.

Results: At age 3 years, each unit increase in the F/E ratio was associated with a 1.6 mm Hg increase in systolic BP (95% CI 0.0 to 3.1). The F/E ratio was not associated with diastolic blood pressure or birth weight for gestational age z-score.

Conclusion: A higher F/E ratio in umbilical venous cord blood, likely reflecting reduced placental 11beta-HSD2 activity, was associated with higher systolic blood pressure at age 3 years. Our data suggest that increased fetal exposure to active maternal glucocorticoids may program later systolic blood pressure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1741-7015-6-25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2533350PMC
August 2008

Vitamin D deficiency in children and adolescents: epidemiology, impact and treatment.

Rev Endocr Metab Disord 2008 Jun 4;9(2):161-70. Epub 2008 Jan 4.

Division of Gastroenterology and Nutrition, Children's Hospital Boston, Boston, MA 02115, USA.

Vitamin D deficiency is highly prevalent among children and adolescents worldwide. The high rates of vitamin D deficiency during childhood are of major public health relevance, given the growing evidence that vitamin D deficiency may play a key role in the pathophysiology of many chronic diseases beyond rickets, including autoimmune conditions, cardiovascular diseases, and cancer. Identification, treatment, and prevention of vitamin D deficiency in childhood may therefore have profound health effects throughout the life span. In this review, we discuss the definitions, epidemiology, clinical implications, and treatment of vitamin D deficiency in children and adolescents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11154-007-9072-yDOI Listing
June 2008

Associations of maternal prenatal smoking with child adiposity and blood pressure.

Obes Res 2005 Nov;13(11):2021-8

Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, Boston, MA 02215, USA.

Objective: To examine the extent to which maternal prenatal smoking is associated with adiposity, central adiposity, and blood pressure in 3-year-old children.

Research Methods And Procedures: We studied 746 mother-child pairs in Project Viva, a prospective cohort study, and categorized mothers as never, early pregnancy, or former smokers. Main outcome measures were overweight (BMI for age and sex > 85th percentile), BMI z-score, sum of subscapular (SS) and triceps (TR) skinfolds, SS:TR skinfold ratio, and systolic blood pressure (SBP).

Results: One hundred sixty-one (22%) mothers quit smoking before pregnancy, 71 (10%) smoked in early pregnancy, and 514 (69%) never smoked. At age 3 years, 204 (27%) children were overweight. On multivariable analysis, compared with children of never smokers, children of early pregnancy smokers had an elevated risk for overweight [odds ratio (OR), 2.2; 95% confidence interval (CI), 1.2, 3.9] and higher BMI z-score (0.30 units; 95% CI, 0.05, 0.55), SS + TR (2.0 mm; 95% CI, 0.9, 3.0), and SBP (2.4 mm Hg; 95% CI, -0.1, 4.9). Children of former smokers were not more overweight (BMI z-score, 0.02 units; 95% CI, -0.15, 0.19) but had higher SBP (1.5 mm Hg; 95% CI, -0.1, 3.2). We saw no relationship of smoking with central adiposity (SS:TR).

Discussion: Former and early pregnancy smokers had children with somewhat higher SBP, but only early pregnancy smokers had children who were more overweight. Mechanisms linking smoking with child adiposity and blood pressure may differ. A long-term impact of maternal smoking on offspring cardiovascular risk provides further reason to reduce smoking in women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/oby.2005.248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483219PMC
November 2005

Maternal protein intake is not associated with infant blood pressure.

Int J Epidemiol 2005 Apr 2;34(2):378-84. Epub 2004 Dec 2.

Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, MA 02215, USA.

Background: Animal data show that low protein intake in pregnancy programs higher offspring blood pressure, but similar data in humans are limited. We examined the associations of first and second trimester maternal protein intake with offspring blood pressure (BP) at the age of six months.

Methods: In a prospective US cohort study, called Project Viva, pregnant women completed validated semi-quantitative food-frequency questionnaires (FFQ) to measure gestational protein intake. Among 947 mother-offspring pairs with first trimester dietary data and 910 pairs with second trimester data, we measured systolic blood pressure (SBP) up to five times with an automated device in the offspring at the age of six months. Controlling for blood pressure measurement conditions, maternal and infant characteristics, we examined the effect of energy-adjusted maternal protein intake on infant SBP using multivariable mixed effects models.

Results: Mean daily second trimester maternal protein intake was 17.6% of energy (mean 2111 kcal/day). First trimester nutrient intakes were similar. Mean SBP at age 6 months was 90.0 mm Hg (SD 12.9). Consistent with prior reports, adjusted SBP was 1.94 mm Hg lower [95% confidence interval (CI) -3.45 to -0.42] for each kg increase in birth weight. However, we did not find an association between maternal protein intake and infant SBP. After adjusting for covariates, the effect estimates were 0.14 mm Hg (95% CI 20.12 to 20.40) for a 1% increase in energy from protein during the second trimester, and 20.01 mm Hg (95% CI 20.24 to -0.23) for a 1% increase in energy from protein in the first trimester.

Conclusions: Variation in maternal total protein intake during pregnancy does not appear to program offspring blood pressure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ije/dyh373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994913PMC
April 2005