Gastric Flora in Gastrostomy Fed Children with Neurological Impairment on Antacid Medication

This prospective cohort study aimed to: (1) describe types, concentrations and sensitivity profiles of bacteria found in gastric aspirates of neurologically impaired children; (2) compare flora between outpatients and those admitted with aspiration pneumonia; and (3) examine predictors of bacterial colonization. Gastric aspirates from gastrostomy fed, neurologically impaired children on antacid medication were measured for pH and sent for microbiological testing. The outpatient arm included 26 children at their baseline; the inpatient arm included 31 children with a clinical diagnosis of aspiration pneumonia. Descriptive statistics summarized the ecology and resistance patterns of microbial flora. Predictors of total bacterial colonization were explored with linear regression. High concentrations of potentially pathogenic fecal-type bacteria were detected in 50/57 (88%) gastric aspirates. pH was found to be the only predictor of bacterial growth; children with gastric pH ≥ 4 had significantly higher concentrations of aerobic growth, while those with no bacterial growth had a pH < 4. Further studies to evaluate optimal gastric pH, the role of gastric bacteria in causing aspiration pneumonia, and the optimal empiric therapy for aspiration pneumonia are recommended

Severe Obesity, Obesity, and Cardiometabolic Risk in Children 0 to 6 Years of Age

Background: The prevalence of obesity in children has been shown to be plateauing or decreasing in some countries. However the burden of severe obesity is often not assessed. Children with severe obesity may be at increased risk for cardiovascular disease and diabetes. The objective is to determine the prevalence of severe obesity in young children and to examine the association with cardiometabolic risk factors. Methods: A longitudinal study was conducted through The Applied Research Group for Kids! (TARGet Kids!), a practice-based research network in Toronto, Canada. Healthy children from birth to 6 years of age were recruited and followed through middle childhood. The main outcomes of the study were; total cholesterol, HDL, LDL, and non-HDL cholesterol, triglycerides, glucose, systolic blood pressure (SBP) and diastolic blood pressure (DBP). BMI was age and sex-standardized based on the WHO growth standards. A BMI z score > 3 was used to define obesity for children under 5 years of age, and severe obesity for children ≥5 years of age. Results: Among 5738 children less than 5 years, 0.8% had a zBMI>3. In 626 children 5 and 6 years, 2.1% has a zBMI>3. In the multivariable analysis adjusted for age, sex, maternal ethnicity, and family history, using repeated measures, children with a zBMI>3 had significantly higher odds of having abnormal SBP (OR 6.4, 95% CI 1.5-27.9; p=0.01) and DBP (OR, 3.6 95% CI 1.2-10.6; p=0.02), respectively, as compared to healthy weight children. Trends demonstrating an association between zBMI>3 and abnormal lipid levels were also identified. Conclusion: Young children with zBMI greater than 3 have significantly higher blood pressure measures and trends towards worse lipid profiles than children at lower zBMIs

Severe Obesity, Obesity, and Cardiometabolic Risk in Children 0 to 6 Years of Age

Background: The prevalence of obesity in children has been shown to be plateauing or decreasing in some countries. However the burden of severe obesity is often not assessed. Children with severe obesity may be at increased risk for cardiovascular disease and diabetes. The objective is to determine the prevalence of severe obesity in young children and to examine the association with cardiometabolic risk factors. Methods: A longitudinal study was conducted through The Applied Research Group for Kids! (TARGet Kids!), a practice-based research network in Toronto, Canada. Healthy children from birth to 6 years of age were recruited and followed through middle childhood. The main outcomes of the study were; total cholesterol, HDL, LDL, and non-HDL cholesterol, triglycerides, glucose, systolic blood pressure (SBP) and diastolic blood pressure (DBP). BMI was age and sex-standardized based on the WHO growth standards. A BMI z score > 3 was used to define obesity for children under 5 years of age, and severe obesity for children ≥5 years of age. Results: Among 5738 children less than 5 years, 0.8% had a zBMI>3. In 626 children 5 and 6 years, 2.1% has a zBMI>3. In the multivariable analysis adjusted for age, sex, maternal ethnicity, and family history, using repeated measures, children with a zBMI>3 had significantly higher odds of having abnormal SBP (OR 6.4, 95% CI 1.5-27.9; p=0.01) and DBP (OR, 3.6 95% CI 1.2-10.6; p=0.02), respectively, as compared to healthy weight children. Trends demonstrating an association between zBMI>3 and abnormal lipid levels were also identified. Conclusion: Young children with zBMI greater than 3 have significantly higher blood pressure measures and trends towards worse lipid profiles than children at lower zBMIs

Severe obesity in children 17 to 24 months of age: a cross-sectional study of TARGet Kids! and Better Outcomes Registry & Network (BORN) Ontario

OBJECTIVES: International data suggests the prevalence of severe obesity in young children may be increasing, yet no Canadian data are available. The objectives of this study were to examine definitions of severe obesity and to evaluate associated risk factors among young children in Ontario. METHODS: A cross-sectional study was conducted in children 17 to 24 months of age using two Ontario data sources: TARGet Kids! (n=3713) and BORN Ontario (n=768). Body mass index z-score (zBMI) definitions were adapted from the World Health Organization (WHO) (z-score > 3) and the US Centers for Disease Control (CDC) (>120% of the 95th percentile) and applied to define severe obesity in young children. Multinomial logistic regression was used to evaluate associations between demographic and pregnancy risk factors and zBMI categories. RESULTS: 1.1% (95% CI: 0.8-1.4) of children met the adapted WHO definition of severe obesity compared to 0.3% (95% CI: 0.2-0.6) using the CDC definition. Median neighborhood household income (OR=0.80, 95%CI 0.69-0.93) and maternal pre-pregnancy BMI (OR=1.08, 95% CI: 1.01-1.15) were associated with severe obesity in unadjusted analyses. After adjustment for potential confounders, the OR for the association between maternal pre-pregnancy and severe obesity was 1.04 (95% CI: 0.94-1.15). CONCLUSION: More than 1% of Ontario children met the WHO definition of severe obesity in very early childhood. Modifiable risk factors were identified. Future studies are needed to understand the terminology, prevalence and risk factors for severe obesity in young children across Canada.Funding for this study was received from the Canadian Institutes of Health Research

Non-Western immigrant children have lower 25-hydroxyvitamin D than children from Western families

Objective: To determine if children aged 1-6 years from non-Western immigrant families have lower serum 25-hydroxyvitamin D (25(OH)D) levels than children from Western-born families and examine which factors influence this relationship. Design: Cross-sectional study. Setting: Toronto, Canada. Subjects: Healthy children (n 1540) recruited through the TARGet Kids! practice-based research network. Serum 25(OH)D concentrations of non-Western immigrants were compared with those of children from Western-born families. Children from non-Western immigrant families were defined as those born, or their parents were born, outside a Western country. Univariate and multiple linear regression analyses were used to identify factors which might influence this relationship. Results: Median age was 36 months, 51 % were male, 86 % had 'light' skin pigmentation, 55 % took vitamin D supplements, mean cow's milk intake was 1·8 cups/d and 27 % were non-Western immigrants. Median serum 25(OH)D concentration was 83 nmol/l, with 5 % having 25(OH)D Conclusions: There is an association between non-Western immigration and lower 25(OH)D in early childhood. This difference appears related to known vitamin D determinants, primarily vitamin D supplementation, representing opportunities for intervention.</p

The Association between Early Childhood and Later Childhood Sugar-Containing Beverage Intake: A Prospective Cohort Study

Sugar-containing beverages (SCBs) are a major source of sugar intake in children. Early life intake of SCBs may be a strong predictor of SCB intake later in life. The primary objective of this study was to evaluate if SCB intake (defined as 100% fruit juice, soda, and sweetened drinks) in early childhood (≤2.5 years of age) was associated with SCB intake in later childhood (5-9 years of age). A prospective cohort study was conducted using data from the TARGet Kids! primary care practice network (n = 999). Typical daily SCB intake was measured by parent-completed questionnaires. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression. A total of 43% of children consumed ≥0.5 cups/day of SCBs at ≤2.5 years and this increased to 64% by 5-9 years. Daily SCB intake, compared to no daily intake, at ≤2.5 years was significantly associated with SCB intake at 5-9 years (adjusted OR: 4.03; 95% CI: 2.92-5.55) and this association was much stronger for soda/sweetened drinks (adjusted OR: 12.83; 95% CI: 4.98, 33.0) than 100% fruit juice (OR: 3.61; 95% CI: 2.63-4.95). Other early life risk factors for SCB intake at 5-9 years were presence of older siblings, low household income, and shorter breastfeeding duration. Daily intake of SCBs in early childhood was strongly associated with greater SCB intake in later childhood. Early life may be an important period to target for population prevention strategies. </p