Early Weight Gain Research Articles

Early weight gain trajectories in first episode anorexia: predictors of outcome for emerging adults in outpatient treatment

BackgroundEarly response to treatment has been shown to be a predictor of later clinical outcomes in eating disorders (EDs). Specifically, early weight gain trajectories in anorexia nervosa (AN) have been shown to predict higher rates of later remission in inpatient treatment. However, no study has, as of yet, examined this phenomenon within outpatient treatment of first episode cases of AN or in emerging adults.MethodsOne hundred seven patients with AN, all between the ages of 16 and 25 and with an illness duration of < 3 years, received treatment via the first episode rapid early intervention in eating disorders (FREED) service pathway. Weight was recorded routinely across early treatment sessions and recovery outcomes (BMI > 18.5 kg/m2 and eating psychopathology) were assessed up to 1 year later. Early weight gain across the first 12 treatment sessions was investigated using latent growth mixture modelling to determine distinct classes of change. Follow-up clinical outcomes and remission rates were compared between classes, and individual and clinical characteristics at baseline (treatment start) were tested as potential predictors.ResultsFour classes of early treatment trajectory were identified. Three of these classes (n = 95), though differing in their early change trajectories, showed substantial improvement in clinical outcomes at final follow-up. One smaller class (n = 12), characterised by a ‘higher’ start BMI (> 17) and no early weight gain, showed negligible improvement 1 year later. Of the three treatment responding groups, levels of purging, depression, and patient reported carer expressed emotion (in the form of high expectations and low tolerance of the patient) determined class membership, although these findings were not significant after correcting for multiple testing. A higher BMI at treatment start was not sufficient to predict optimal clinical outcomes.ConclusionFirst episode cases of AN treated via FREED fit into four distinct early response trajectory classes. These may represent subtypes of first episode AN patients. Three of these four trajectories included patients with substantial improvements 1 year later. For those in the non-response trajectory class, treatment adjustments or augmentations could be considered earlier, i.e., at treatment session 12.

Effects of barrier perch access and early dietary protein and energy dilution on some welfare parameters, tibiotarsus measurements, fear and mobility level in broiler chickens

ABSTRACT 1. This experiment determined the effect of increasing mobility in broiler chickens by placing barrier perches between feeders and drinkers. In addition, the limitation of early weight gain by dietary energy and protein dilution on some welfare parameters, tibiotarsus measurements, fear and mobility level was examined. 2. A total of 504 male, one-day-old broiler chickens (Ross 308) were randomly allocated to four treatments with three replicate pens per treatment and 42 broiler chickens per pen as a 2 × 2 factorial arrangement. Treatments included feeding the basal control diet between 0–42 days or a diet diluted by 10% energy and 20% crude protein fed between 0–21 d, with the control diet fed between 22–42 d. The second factor was the presence or absence of barrier perches. All treatments were allocated as a completely randomised design. Welfare parameters (foot pad dermatitis, hock burn, gait score, feather score, breast blister), tibiotarsus measurements (bone mineral content, bone mineral density, fluctuating asymmetry and relative fluctuating asymmetry), tonic immobility and mobility level were recorded. 3. Results showed that access to a barrier perch and the diluted diet increased the mobility in broiler chickens. However, access to a barrier perch had no significant effect on tibiotarsus and welfare parameters. Broiler chickens had better gait scores (P < 0.05) and lower foot pad dermatitis incidence (P < 0.01) in groups fed the diluted diet. The diluted diet had no significant effect on bone mineral density but reduced the tibiotarsus bone mineral content (P < 0.05). 4. In conclusion, the diluted diet provided positive effects in terms of leg health due to weight gain limitations in the early period, thus improving broiler chicken welfare.

Maternal obesity, pregnancy weight gain, and birth weight and risk of colorectal cancer

ObjectiveColorectal cancer (CRC) is a leading cause of cancer-related death worldwide. Obesity is a well-established risk factor for CRC, and fetal or developmental origins of obesity may underlie its effect...

Gestational weight gain in 4 low- and middle-income countries and associations with birth outcomes: a secondary analysis of the Women First Trial

ABSTRACTBackgroundAdequate gestational weight gain (GWG) is essential for healthy fetal growth. However, in low- and middle-income countries, where malnutrition is prevalent, little information is available about GWG and how it might be modified by nutritional status and interventions.ObjectiveWe describe GWG and its associations with fetal growth and birth outcomes. We also examined the extent to which prepregnancy BMI, and preconception and early weight gain modify GWG, and its effects on fetal growth.MethodsThis was a secondary analysis of the Women First Trial, including 2331 women within the Democratic Republic of Congo (DRC), Guatemala, India, and Pakistan, evaluating weight gain from enrollment to ∼12 weeks of gestation and GWG velocity (kg/wk) between ∼12 and 32 weeks of gestation. Adequacy of GWG velocity was compared with 2009 Institute of Medicine recommendations, according to maternal BMI. Early weight gain (EWG), GWG velocity, and adequacy of GWG were related to birth outcomes using linear and Poisson models.ResultsGWG velocity (mean ± SD) varied by site: 0.22 ± 0.15 kg/wk in DRC, 0.30 ± 0.23 in Pakistan, 0.31 ± 0.14 in Guatemala, and 0.39 ± 0.13 in India, (P <0.0001). An increase of 0.1 kg/wk in maternal GWG was associated with a 0.13 cm (95% CI: 0.07, 0.18, P <0.001) increase in birth length and a 0.032 kg (0.022, 0.042, P <0.001) increase in birth weight. Compared to women with inadequate GWG, women who had adequate GWG delivered newborns with a higher mean length and weight: 47.98 ± 2.04 cm compared with 47.40 ± 2.17 cm (P <0.001) and 2.864 ± 0.425 kg compared with 2.764 ± 0.418 kg (P <0.001). Baseline BMI, EWG, and GWG were all associated with birth length and weight.ConclusionsThese results underscore the importance of adequate maternal nutrition both before and during pregnancy as a potentially modifiable factor to improve fetal growth.

Associations between insulin resistance and adverse pregnancy outcomes in women with gestational diabetes mellitus: a retrospective study

BackgroundThis study aimed to explore the relationship between insulin resistance (IR) and adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM), and to determine the risk factors for IR in women with GDM.MethodsThis study employed a retrospective survey of 710 women diagnosed with GDM. Serum lipids, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), and serum protein were measured in the first trimester (6–12 weeks), and OGTT and fasting insulin tests were performed in the second trimester (24–28 weeks). These results were then used to evaluate IR by homeostasis model assessment (HOMA). When HOMA-IR ≥ 2.0, IR was diagnosed. The relationship between HOMA-IR and adverse pregnancy outcomes was analyzed by a logistic regression model, and multiple stepwise regression was used to analyze the risk factors of IR.ResultsIR significantly increasd the risk of the hypertensive disorders of pregnancy and large for gestational age (LGA) (OR = 5.31,95%CI:1.87,15.10; OR = 1.65,95%CI:1.10, 2.48, respectively) in women with GDM, but not for cesarean section, premature delivery, premature rupture of membranes, postpartum hemorrhage, macrosomia and SGA. Compared to normal groups, greater body mass index (BMI) before pregnancy category (overweight or obesity group) were associated with higher risk of IR in the second trimester, the OR (95% CI) were 4.09 (2.65, 6.30) and 6.52 (2.99, 14.20). And higher level of FPG (OR = 1.63, 95%CI: 1.11, 2.40), TG (OR = 1.32, 95%CI: 1.08, 1.63) and weight gain before diagnosis of GDM (OR = 1.08, 95%CI: 1.02, 1.15) were also associated with higher risk of IR in the second trimester in women with GDM, while age (OR = 0.94, 95%CI: 0.90, 0.98)was the weak protective factor for IR.ConclusionGDM with IR in the second trimester increased adverse pregnancy outcomes, especially the risk of hypertensive disorders of pregnancy and LGA. In addition, FPG, HbA1c, and TG in early pregnancy, pre-pregnant BMI and weight gain before diagnosis of GDM were all independent risk factors for IR.

Feasibility and acceptability of home treatment as an add-on to family based therapy for adolescents with anorexia nervosa. A case series.

ObjectiveThis study examines the feasibility, acceptability, and preliminary effect sizes on outcome measures of home treatment (HT) as an add‐on to family‐based therapy (FBT) in adolescents with anorexia nervosa (AN). The HT intervention is delivered by specialized nurses and aims at supporting patients and parents to re‐establish family meals in the home environment.MethodForty‐five (43 female, 2 male) adolescents meeting ICD 10 criteria for anorexia nervosa or atypical anorexia nervosa received FBT augmented with HT over 12 weeks. Eating disorder (ED) diagnosis, psychopathology and severity of clinical symptoms were assessed using the Eating Disorder Examination (EDE) interview, the Eating Disorders Inventory (EDI‐2) at baseline (BL) and after 3‐monthsResultsAll participants and parents were retained and found HT acceptable. At the end of Treatment (EOT) participants showed a significant early weight gain, a reduction in the AN psychopathology assessed with the EDE interview and a reduction in EDI‐2 total scores. None of the patients had to be admitted to hospital. Treatment satisfaction was high in both patients and parents.DiscussionFindings provide preliminary evidence that HT is feasible, acceptable and produces clinically significant improvements in targeted outcome.

Effects of imatinib on vascular insulin sensitivity and free fatty acid transport in early weight gain.

Vascular endothelial dysfunction is an essential part of the pathophysiology of type 2 diabetes and its complications. In type 2 diabetes, endothelial dysfunction is characterized by reduced insulin signaling and increased transendothelial transport of fatty acids (FA). As the Abl kinase inhibitor imatinib was previously shown to reverse type 2 diabetes and to inhibit VEGF signaling via Abl kinases, we studied the effect of imatinib on vascular insulin sensitivity and fatty acid transport in vivo and in vitro. C57/BL6J mice were fed a chow diet or Western diet (WD), and received daily imatinib injections for two weeks. Insulin-mediated vasoreactivity of resistance arteries was studied using intravital microscopy, and metabolic insulin sensitivity using the hyperinsulinemic-euglycemic clamp. The effect of imatinib on triglyceride content in skeletal muscle and heart in vivo was also determined. In vitro, the effect of imatinib on fatty acid transport was studied in human umbilical vein endothelial cells (HUVECs) by evaluating the effect of imatinib on fluorescently labeled FA uptake both under basal and VEGF-B-stimulated conditions. Imatinib prevented the WD-induced weight gain in mice, independently from food intake. In line with this, imatinib enhanced insulin-mediated vasoreactivity of resistance arteries in the WD-fed mice. However, imatinib did not affect triglyceride content in muscle. In cultured endothelial cells, VEGF-B stimulation resulted in a time-dependent uptake of fatty acids in parallel with increased phosphorylation of the Abl kinase substrate Crk-like protein (CrkL) at Tyr207. Although imatinib effectively prevented VEGF-B-mediated Abl kinase activation, it had no effect on VEGF-B mediated endothelial FA uptake. Imatinib prevents weight gain and preserves insulin-mediated vasodilation in WD-fed mice, but does not affect endothelial FA transport despite inhibiting VEGF-B signaling. The beneficial effect of imatinib on insulin-mediated vasodilation may contribute to the anti-diabetic effects of imatinib.

Interplay between Prepregnancy Body Mass Index, Early Childhood Negative Temperament, and Slowness in Eating on Early Childhood Rapid Weight Gain.

Background: Early childhood eating behaviors and temperament have been linked to excess weight gain in separate lines of research. However, the interplay among these variables along with maternal prepregnancy body mass index (BMI) in predicting rapid weight gain is poorly understood. Methods: This observational study tested superfactors of early childhood temperament using the Infant Behavior Questionnaire-Revised, and their relationships with eating behavior using the Baby Eating Behavior Questionnaire on rapid weight gain among 9-18 months children (n = 283). The bivariate relationships were evaluated using Pearson correlations. Two-way interactions assessed whether childhood temperament moderated the relationship between childhood eating behaviors and rapid weight gain, with prepregnancy BMI as a higher order moderator. Results: Food responsiveness positively correlated with Negativity [r = 0.256, adjusted (adj) p < 0.001] and inversely with Regulation (r = -0.203, adj p = 0.006). Slowness in eating positively correlated with Negativity (r = 0.196, p = 0.006) and inversely with Surgency (r = -0.188, adj p = 0.008) and Regulation (r = -0.181, p = 0.007). Slowness in eating was significantly correlated with rapid weight gain (r = -0.168, p = 0.005). Prepregnancy BMI was a moderator of slowness in eating and Negativity such that children of mothers with high prepregnancy BMI in conjunction with high Negativity and low in slowness in eating experienced the greatest rapid weight gain, whereas children of mothers with low prepregnancy BMI in conjunction with low Negativity and high in slowness in eating experienced the least rapid weight gain. Conclusions: Assessing early childhood temperament may bolster health care and parenting interventions to increase early eating regulation and to promote healthier weight trajectories.

Cause-Specific Stillbirth and Neonatal Death According to Prepregnancy Obesity and Early Gestational Weight Gain: A Study in the Danish National Birth Cohort.

Maternal obesity is associated with impaired fetal and neonatal survival, but underlying mechanisms are poorly understood. We examined how prepregnancy BMI and early gestational weight gain (GWG) were associated with cause-specific stillbirth and neonatal death. In 85,822 pregnancies in the Danish National Birth Cohort (1996–2002), we identified causes of death from medical records for 272 late stillbirths and 228 neonatal deaths. Prepregnancy BMI and early GWG derived from an early pregnancy interview and Cox regression were used to estimate associations with stillbirth or neonatal death as a combined outcome and nine specific cause-of-death categories. Compared to women with normal weight, risk of stillbirth or neonatal death was increased by 66% with overweight and 78% with obesity. Especially deaths due to placental dysfunction, umbilical cord complications, intrapartum events, and infections were increased in women with obesity. More stillbirths and neonatal deaths were observed in women with BMI < 25 and low GWG. Additionally, unexplained intrauterine death was increased with low GWG, while more early stillbirths were seen with both low and high GWG. In conclusion, causes of death that relate to vascular and metabolic disturbances were increased in women with obesity. Low early GWG in women of normal weight deserves more clinical attention.

Early childhood weight gain: Latent patterns and body composition outcomes.

Despite early childhood weight gain being a key indicator of obesity risk, we do not have a good understanding of the different patterns that exist. To identify and characterise distinct groups of children displaying similar early-life weight trajectories. A growth mixture model captured heterogeneity in weight trajectories between 0 and 60months in 1390 children in the Avon Longitudinal Study of Parents and Children. Differences between the classes in characteristics and body size/composition at 9years were investigated. The best model had five classes. The "Normal" (45%) and "Normal after initial catch-down" (24%) classes were close to the 50th centile of a growth standard between 24 and 60months. The "High-decreasing" (21%) and "Stable-high" (7%) classes peaked at the ~91st centile at 12-18months, but while the former declined to the ~75th centile and comprised constitutionally big children, the latter did not. The "Rapidly increasing" (3%) class gained weight from below the 50th centile at 4months to above the 91st centile at 60months. By 9years, their mean body mass index (BMI) placed them at the 98th centile. This class was characterised by the highest maternal BMI; highest parity; highest levels of gestational hypertension and diabetes; and the lowest socio-economic position. At 9years, the "Rapidly increasing" class was estimated to have 68.2% (95% confidence interval [CI] 48.3, 88.1) more fat mass than the "Normal" class, but only 14.0% (95% CI 9.1, 18.9) more lean mass. Criteria used in growth monitoring practice are unlikely to consistently distinguish between the different patterns of weight gain reported here.

Intrapartum group B Streptococcal prophylaxis and childhood weight gain

ObjectiveTo determine the difference in rate of weight gain from birth to 5 years based on exposure to maternal group B streptococcal (GBS) intrapartum antibiotic prophylaxis (IAP).DesignRetrospective cohort study of...

A Health-Literacy Intervention for Early Childhood Obesity Prevention: A Cluster-Randomized Controlled Trial.

Children who become overweight by age 2 have greater risk of long-term obesity and health problems. The study aim was to assess the effectiveness of a primary care-based intervention on the prevalence of overweight at age 24 months. In a cluster-randomized trial, sites were randomly assigned to the Greenlight intervention or an attention-control arm. Across 4 pediatric residency clinics, we enrolled infant-caregiver dyads at the 2-month well-child visit. Inclusion criteria included parent English- or Spanish-speaking and birth weight ≥1500 g. Designed with health-literacy principles, the intervention included a parent toolkit at each well-child visit, augmented by provider training in clear-health communication. The primary outcome was proportion of children overweight (BMI ≥85th percentile) at age 24 months. Secondary outcomes included weight status (BMI z score). A total of 459 intervention and 406 control dyads were enrolled. In total, 49% of all children were overweight at 24 months. Adjusted odds for overweight at 24 months (treatment versus control) was 1.02 (95% confidence interval [CI]: 0.63 to 1.64). Adjusted mean BMI z score differences (treatment minus control) were -0.04 (95% CI: -0.07 to -0.01), -0.09 (95% CI: -0.14 to -0.03), -0.19 (-0.33 to -0.05), -0.20 (-0.36 to -0.03), -0.16 (95% CI: -0.34 to 0.01), and 0.00 (95% CI -0.21 to 0.21) at 4, 6, 12, 15, 18, and 24 months, respectively. The intervention resulted in less weight gain through age 18 months, which was not sustained through 24 months. Clinic-based interventions may be beneficial for early weight gain, but greater intervention intensity may be needed to maintain positive effects.

Adolescent Eating Disorder Day Programme Treatment Models and Outcomes: A Systematic Scoping Review.

Background: Adolescent eating disorder day programmes (DP), or partial hospitalization programs, are becoming increasingly widespread worldwide. They typically function as an alternative to inpatient care and/or a step up or down in treatment intensity. There has been an increase in the number of publications within the last 5 years investigating DP outcomes. While there are now numerous programmes operating internationally, there is large variability in the content, structure and theoretical underpinnings of each programme. This makes it difficult to compare programme outcomes, and the impact the therapeutic model may have.Aims: To review existing literature on adolescent eating disorder DP treatment models and outcomes.Methods: A systematic scoping review was conducted. Four databases (PsychInfo, EMBASE, Medline, CENTRAL) were searched for relevant peer-reviewed journal articles and book chapters investigating adolescent eating disorder DPs that function as alternatives to inpatient treatment. No restrictions on study methodology were imposed. Studies were first mapped by location, study characteristics and day programme treatment characteristics, then narratively synthesized.Results: Forty nine studies were included in this review. All used a quantitative methodology. One study also included qualitative methods. The majority of studies included describe DPs in the USA (69%). Seventy-six percent of the studies described DPs that operate 5-days per week and most (57%) either only admit or only report on outcomes for restrictive eating disorders. Two-thirds (69%) reported on DPs that had a family focused treatment model, the remainder had a more integrated treatment model informed mostly by individual psychotherapeutic models. Generally, DP treatment is associated with weight gain and improvements in eating disorder and comorbid psychopathology. The studies that include follow-up data (27%) reveal improvements are usually maintained from 3 months to 2 years post-treatment. Early weight gain, early psychological change and early therapeutic alliance are associated with improved end of treatment outcomes. Findings regarding other potential predictors of outcome are mixed.Conclusions: Current evidence suggests day programmes are an effective alternative to inpatient treatment that lead to sustained improvements. DPs tend to either be young-person-only with a family-focused treatment model or all age with a more integrative model. Controlled, empirical investigations into the impact of the therapeutic model on outcomes are needed, as are investigations into treatment mechanisms and the individual and parent experience of day programme treatment.

Home treatment for adolescents with eating disorders as an add-on to family based therapy

IntroductionFamily-based therapy (FBT) has been proven effective in treating eating disorders among children and adolescents. However, many families have difficulties implementing the measures recommended in outpatient therapy.ObjectivesThis study examines the effectiveness of add-on home treatment (HT) to family based therapy (FBT) in adolescents with anorexia nervosa (AN). The HT intervention is delivered by specialized nurses and aims at supporting patients and parents to re-establish family meals in the home environment.MethodsWe performed an case-control study in AN patients comparing 44 (42 female, 2 male) adolescents receiving FBT augmented with HT compared to 22 (22 female, 1 male) participants receiving FBT alone. Eating disorder diagnosis, psychopathology and severity of clinical symptoms were assessed using (EDE, EDI-2) and clinical parameters (BMI, menstrual status, level of over-exercising) at baseline and after 3-months.ResultsAfter 3 months both treatment groups showed a significant early weight gain, a reduction in the rate of AN diagnoses assessed with the EDE interview and a reduction in EDI-2 total scores. The combined HT/FBT group showed a significantly greater increase in BMI than the FBT-only group. In the combined HT/FBT group none of the patients had to be admitted to hospital while 13.6% of the FBT-only group had to be referred to inpatient treatment. Treatment satisfaction in the combined HT/FBT group was high in both patients and parents.ConclusionsOur results suggest that HT augmented FBT is superior compared to FBT alone in terms of early weight gain and might reduce the risk of hospital admission in adolescent AN.DisclosureNo significant relationships.

Real-Time Lung Weight Measurement during Ex Vivo Lung Perfusion: Clinical Importance of Early Weight Gain

<h3>Purpose</h3> Lung weight gain during ex vivo lung perfusion (EVLP) can reduce lung transplant suitability. Therefore, real-time weight measurement can enhance donor lung evaluation. We sought to 1) develop/validate a real-time EVLP weight measurement system, and 2) define the time course of lung weight change during EVLP. <h3>Methods</h3> In our clinical acellular EVLP system, from 6/2019-9/2020, real-time lung weight was measured in 36 cases. Weights were recorded with a scale under the organ chamber, and back table static weights measured after EVLP. Lungs were classified as unfavorable (n = 13) if declined after EVLP (n = 8) or PGD grade ≥ 2 at 72 hrs if transplanted (n = 5). Favorable group lungs were transplanted, with PGD ≤ 1 at 72 hrs (n = 23). <h3>Results</h3> Real-time lung weights correlated well with static/back table weights (r = 0.69, p < 0.01, Figure A). Unfavorable group lungs gained significantly more weight (mean 38 g, range -59 to 135 g) during the 1^st hour of EVLP vs. favorable group lungs (mean -51 g, range -155 to +53 g) (p < 0.01, Figure B). In fact, this effect was most pronounced in the first 10 minutes of EVLP (Figure C), and correlated with an increased pulmonary artery (PA) pressures (7.0 ± 2.2 vs 5.4 ± 1.3 mmHg, p = 0.03). In contrast, lung weight gain was similar between groups during EVLP hours 2 and 3. For the 28 lungs suitable for transplant, 30-day recipient survival was 100%. <h3>Conclusion</h3> Real-time lung weight measurement during EVLP is feasible. Our data suggest that donor lung weight gain in the earliest phase of EVLP correlates with decreased lung transplant suitability and PGD. Further studies are needed to define the significance of lung weight gain early during EVLP.

Systemic inflammation is negatively associated with early post discharge growth following acute illness among severely malnourished children - a pilot study.

Background: Rapid growth should occur among children with severe malnutrition (SM) with medical and nutritional management. Systemic inflammation (SI) is associated with death among children with SM and is negatively associated with linear growth. However, the relationship between SI and weight gain during therapeutic feeding following acute illness is unknown. We hypothesised that growth post-hospital discharge is associated with SI among children with SM. Methods: We conducted secondary analysis of data from HIV-uninfected children with SM (n=98) who survived and were not readmitted to hospital during one year of follow-up. We examined the relationship between changes in absolute deficits in weight and mid-upper-arm circumference (MUAC) from enrolment at stabilisation to 60 days and one year later, and untargeted plasma proteome, targeted cytokines/chemokines, leptin, and soluble CD14 using multivariate regularized linear regression. Results: The mean change in absolute deficit in weight and MUAC was -0.50kg (standard deviation; SD±0.69) and -1.20cm (SD±0.89), respectively, from enrolment to 60 days later. During the same period, mean weight and MUAC gain was 3.3g/kg/day (SD±2.4) and 0.22mm/day (SD±0.2), respectively. Enrolment interleukins; IL17-alpha and IL-2, and serum amyloid P were negatively associated with weight and MUAC gain during 60 days. Lipopolysaccharide binding protein and complement component 2 were negatively associated with weight gain only. Leptin was positively associated with weight gain. Soluble CD14, beta-2 microglobulin, and macrophage inflammatory protein 1 beta were negatively associated with MUAC gain only. Glutathione peroxidase 3 was positively associated with weight and MUAC gain during one year. Conclusions: Early post-hospital discharge weight and MUAC gain were rapid and comparable to children with uncomplicated SM treated in the community. Higher concentrations of SI markers were associated with less weight and MUAC gain, suggesting inflammation negatively impacts recovery from wasting. This finding warrants further research on reducing inflammation on growth among children with SM.

Systemic inflammation is negatively associated with early post discharge growth following acute illness among severely malnourished children - a pilot study

Background: Rapid growth should occur among children with severe malnutrition (SM) with medical and nutritional management. Systemic inflammation (SI) is associated with death among children with SM and is negatively associated with linear growth. However, the relationship between SI and weight gain during therapeutic feeding following acute illness is unknown. We hypothesised that growth post-hospital discharge is associated with SI among children with SM. Methods: We conducted secondary analysis of data from HIV-uninfected children with SM (n=98) who survived and were not readmitted to hospital during one year of follow-up. We examined the relationship between changes in absolute deficits in weight and mid-upper-arm circumference (MUAC) from enrolment at stabilisation to 60 days and one year later, and untargeted plasma proteome, targeted cytokines/chemokines, leptin, and soluble CD14 using multivariate regularized linear regression. Results: The mean change in absolute deficit in weight and MUAC was -0.50kg (standard deviation; SD±0.69) and -1.20cm (SD±0.89), respectively, from enrolment to 60 days later. During the same period, mean weight and MUAC gain was 3.3g/kg/day (SD±2.4) and 0.22mm/day (SD±0.2), respectively. Enrolment interleukins; IL17-alpha and IL-2, and serum amyloid P were negatively associated with weight and MUAC gain during 60 days. Lipopolysaccharide binding protein and complement component 2 were negatively associated with weight gain only. Leptin was positively associated with weight gain. Soluble CD14, beta-2 microglobulin, and macrophage inflammatory protein 1 beta were negatively associated with MUAC gain only. Glutathione peroxidase 3 was positively associated with weight and MUAC gain during one year. Conclusions: Early post-hospital discharge weight and MUAC gain were rapid and comparable to children with uncomplicated SM treated in the community. Higher concentrations of SI markers were associated with less weight and MUAC gain, suggesting inflammation negatively impacts recovery from wasting. This finding warrants further research on reducing inflammation on growth among children with SM.

Do Infants With Robin Sequence Have Improved Feeding and Weight Gain After Mandibular Distraction?

Infants with Robin sequence (RS) typically have impaired weight gain, presumed to result primarily from upper airway obstruction. Operations that improve airway obstruction are therefore theorized to facilitate feeding and weight gain, but the relationship between airway intervention and feeding improvement remains unclear. The aim of this study was to evaluate weight gain over the first 3 years of life in patients with RS. This is a retrospective cohort study of patients with RS treated at Boston Children's Hospital from 1995 to 2016. The primary predictor variable was type of intervention (no operation, tongue-lip adhesion, mandibular distraction osteogenesis [MDO]). The primary outcome measure was weight-for-age Z-score. A control group of patients with isolated cleft palate without RS was also included. Individuals with tracheostomy or insufficient growth data were excluded. Descriptive statistics were calculated, and statistical significance was set at P<.05. A total of 222 subjects were included: no operation, n=61 (27.5%); tongue-lip adhesion, n=78 (35.1%); MDO, n=22 (9.9%); and control, n=61 (27.5%). Mean age at tongue-lip adhesion was 37±99days compared with 247±312days for MDO (P<.05). At 6 months of age, the MDO group had the lowest mean weight (Z=-2.34±1.88, P<.05) and both surgical groups were underweight compared with controls (P<.05). By 24 months of age, there were no weight differences between any study group. Individuals that had MDO at <3 months of age had significantly faster weight gain than those that had later operations (P<.05). Patients with RS who had an airway operation in the first year of life demonstrated poorer early weight gain but caught up to controls by 2 years of age. Patients that had MDO before 3 months of age had faster weight gain than those that had later operations. Neither age at operation nor type of intervention affected growth outcomes by 3 years of age, which were comparable with controls.

Does kangaroo mother care have an impact on morbidity, mortality and duration of hospital stay of newly born low birth weight babies?

Background: Preterm and low birth weight infants are more likely to experience neonatal morbidity including acute respiratory, gastrointestinal, central nervous system, immunologic, hearing and vision problems than both term and normal weight infants who survive the neonatal period. The present study was aimed to evaluate the impact of Kangaroo Mother Care (KMC) on morbidity and mortality of new-borns and duration of hospital stay.Methods: A prospective case control study over a 12 month period was conducted from August 2013 to August 2014 on 50 new-borns weighing less than 1.8 kg. The primary outcome variable was “weight gain”. Secondary measures included morbidity, mortality and duration of hospitalization. Observations were recorded in a proforma specially designed for the study. The results were subjected to statistical analysis.Results: The hospital stay was less amongst neonates who received KMC. Twenty four (48%) out of 50 were discharged within 10 days, another 24 within 11 to 20 days. Neonates who did not received KMC, majority i.e. 27 of the neonates were in the ICU for 11-20 days. There were 3 neonates who stayed beyond 1 month.Conclusions: The study showed that KMC is useful method of caring VLBW baby in respect of early weight gain and decrease morbidity, mortality and hospital stay in our set up. However, there are still insufficient evidences to recommend its routine use in VLBW babies in our country. Well-designed large randomized controlled trail of this intervention are needed.

Childhood DNA methylation as a marker of early life rapid weight gain and subsequent overweight

BackgroundHigh early postnatal weight gain has been associated with childhood adiposity; however, the mechanism remains unknown. DNA methylation is a hypothesised mechanism linking early life exposures and subsequent disease. However, epigenetic changes associated with high early weight gain have not previously been investigated. Our aim was to investigate the associations between early weight gain, peripheral blood DNA methylation, and subsequent overweight/obese. Data from the UK Avon Longitudinal study of Parents and Children (ALSPAC) cohort were used to estimate associations between early postnatal weight gain and epigenome-wide DNA CpG site methylation (Illumina 450 K Methylation Beadchip) in blood in childhood (n = 125) and late adolescence (n = 96). High weight gain in the first year (a change in weight z‐scores > 0.67), both unconditional (rapid weight gain) and conditional on birthweight (rapid thrive), was related to individual CpG site methylation and across regions using the meffil pipeline, with and without adjustment for cell type proportions, and with 5% false discovery rate correction. Variation in methylation at high weight gain-associated CpG sites was then examined with regard to body composition measures in childhood and adolescence. Replication of the differentially methylated CpG sites was sought using whole-blood DNA samples from 104 children from the UK Southampton Women’s Survey.ResultsRapid infant weight gain was associated with small (+ 1% change) increases in childhood methylation (age 7) for two distinct CpG sites (cg01379158 (NT5M) and cg11531579 (CHFR)). Childhood methylation at one of these CpGs (cg11531579) was also higher in those who experienced rapid weight gain and were subsequently overweight/obese in adolescence (age 17). Rapid weight gain was not associated with differential DNA methylation in adolescence. Childhood methylation at the cg11531579 site was also suggestively associated with rapid weight gain in the replication cohort.ConclusionsThis study identified associations between rapid weight gain in infancy and small increases in childhood methylation at two CpG sites, one of which was replicated and was also associated with subsequent overweight/obese. It will be important to determine whether loci are markers of early rapid weight gain across different, larger populations. The mechanistic relevance of these differentially methylated sites requires further investigation.