Age at Weaning and Infant Growth: Primary Analysis and Systematic Review.

OBJECTIVE: To test whether earlier age at weaning (age 3-6 months) may promote faster growth during infancy. STUDY DESIGN: Weaning at age 3.0-7.0 months was reported by 571 mothers of term singletons in a prospective birth cohort study conducted in Cambridge, UK. Infant weight and length were measured at birth and at age 3 months and 12 months. Anthropometric values were transformed into age- and sex-adjusted z-scores. Three linear regression models were performed, including adjustment for confounders in a stepwise manner. Measurements at age 3 months, before weaning, were used to consider reverse causality. RESULTS: Almost three-quarters (72.9%) of infants were weaned before age 6 months. Age at weaning of 3.0-7.0 months was inversely associated with weight and length (but not with body mass index) at 12 months (both P ≤ .01, adjusted for maternal and demographic factors). These associations were attenuated after adjustment for type of milk feeding and weight or length at age 3 months (before weaning). Rapid weight gain between 0 and 3 months predicted subsequent earlier age at weaning (P = .01). Our systematic review identified 2 trials, both reporting null effects of age at weaning on growth, and 15 observational studies, with 10 reporting an inverse association between age at weaning and infant growth and 4 reporting evidence of reverse causality. CONCLUSION: In high-income countries, weaning between 3 and 6 months appears to have a neutral effect on infant growth. Inverse associations are likely related to reverse causality.European Union, World Cancer Research Foundation International, Medical Research Council, Newlife Foundation, NIHR Cambridge Comprehensive Biomedical Research Center, and University of California San Francisco Pathways Explore GrantThis is the final version. It first appeared at http://www.sciencedirect.com/science/article/pii/S0022347615004710

Breast milk nutrient content and infancy growth.

AIM: Benefits of human breast milk (HM) in avoiding rapid infancy weight gain and later obesity could relate to its nutrient content. We tested the hypothesis that differential HM total calorie content (TCC) or macronutrient contents may be associated with infancy growth. METHODS: HM hindmilk samples were collected at ages 4-8 weeks from 614 mothers participating in a representative birth cohort, with repeated infancy anthropometry. HM triglyceride (fat), lipid analytes and lactose (carbohydrate) were measured by (1) H-NMR, and protein content by the Dumas method. TCC and %macronutrients were determined. RESULTS: In 614 HM samples, fat content was as follows: [median(IQR)]: 2.6 (1.7-3.6) g/100 mL, carbohydrate: 8.6 (8.2-8.8) g/100 mL, protein: 1.2 (1.1-1.2) g/100 mL; TCC: 61.8 (53.7-71.3) kcal/100 mL. HM of mothers exclusively breast feeding vs. mixed feeding was more calorific with higher %fat, lower %carbohydrate and lower %protein. Higher HM TCC was associated with lower 12-months body mass index (BMI)/adiposity, and lower 3-12 months gains in weight/BMI. HM %fat was inversely related to 3-12 months gains in weight, BMI and adiposity, whereas %carbohydrate was positively related to these measures. HM %protein was positively related to 12-months BMI. CONCLUSION: HM analysis showed wide variation in %macronutrients. Although data on milk intakes were unavailable, our findings suggest functional relevance of HM milk composition to infant growth.PP was supported by a MRC Clinical Training Fellowship (G1001995). The Cambridge Baby Growth Study has been supported by the European Union, the World Cancer Research Foundation International, the Medical Research Council, the NIHR Cambridge Comprehensive Biomedical Research Centre, the Newlife Foundation for disabled children, the Mothercare Group Foundation, and Mead Johnson Nutrition.This is the final version of the article. It first appeared from Wiley via https://doi.org/ 10.1111/apa.1336

Unintended Consequences: institutional artifacts, closure mechanisms and the performance gap

Renewable technologies often feature in policies to improve the energy efficiency of buildings. Designers introduce predicted energy values for specific technologies, but are surprised when the technologies fail to perform as expected. Three building projects are used to explore the effect of construction processes on the energy performance of building-integrated photovoltaic (BIPV) technology. In two cases BIPV failed to deliver expected energy generation, while in the third, dramatic changes in project processes and technical specifications were needed to achieve the specified output. A social construction of technology (SCOT) analysis documents how the energy generation of BIPV disappeared from view at certain points as actors focused on building features. A contribution is made to the theoretical development of SCOT by responding to two issues: privileging of cognitive closure mechanisms and the neglect of institutional analysis. The concept of inflection mechanisms is introduced as a second type of closure mechanism. More specifically, the role of institutional artefacts (e.g. planning requirements and schedules) in the construction process is found to contribute to the performance gap. To reduce the ‘performance gap’, practitioners need to focus on the distribution of design responsibility, sequencing of work and the location of expertise

Evidence from 3-month-old infants shows that a combination of postnatal feeding and exposures in utero shape lipid metabolism

Abstract: We tested the hypothesis that both postnatal feeding and conditions in utero affect lipid metabolism in infants. Infants who experienced restrictive growth conditions in utero and others exposed to maternal hyperglycaemia were compared to a control group with respect to feeding mode. Dried blood spots were collected from a pilot subset of infant participants of the Cambridge Baby Growth Study at 3mo. Groups: (a) a normal gestation (control, n = 40), (b) small for gestational age (SGA, n = 34) and (c) whose mothers developed hyperglycaemia (n = 59). These groups were further stratified by feeding mode; breastfed, formula-fed or received a mixed intake. Their phospholipid, glyceride and sterol fractions were profiled using direct infusion mass spectrometry. Statistical tests were used to identify molecular species that indicated differences in lipid metabolism. The abundance of several phospholipids identified by multivariate analysis, PC(34:1), PC(34:2) and PC-O(34:1), was 30–100% higher across all experimental groups. SM(39:1) was around half as abundant in in utero groups among breastfed infants only. The evidence from this pilot study shows that phospholipid metabolism is modulated by both conditions in utero and postnatal feeding in a cohort of 133 Caucasian infants, three months post partum

Reduced size at birth and persisting reductions in adiposity in recent, compared with earlier, cohorts of infants born to mothers with gestational diabetes mellitus

Funder: National Institute for Health Research Cambridge Biomedical Research CentreFunder: Medical Research Council; doi: http://dx.doi.org/10.13039/501100000265; Grant(s): Unit programme: MC_UU_12015/2Abstract: Aims/hypothesis: This study aimed to explore the infancy growth trajectories of ‘recent’ and ‘earlier’ offspring of mothers with gestational diabetes mellitus (OGDM), each compared with the same control infants, and investigate whether ‘recent’ OGDM still exhibit a classical phenotype, with macrosomia and increased adiposity. Methods: Within a prospective observational birth cohort, 98 ‘earlier’ OGDM born between 2001 and 2009 were identified using 75 g oral glucose tolerance testing at 28 weeks gestation, 122 recent OGDM born between 2011 and 2013 were recruited postnatally through antenatal diabetes clinics, and 876 normal birthweight infants of mothers with no history of diabetes were recruited across the full study period as the control group. All infants followed the same study protocol (measurements at birth, 3, 12 and 24 months, including weight, length and skinfold thickness indicating adiposity, and detailed demographic data). In all cases, GDM was defined using the International Association of Diabetes and Pregnancy Study Group criteria. Results: Earlier OGDM had higher birthweight SD scores (SDS) than control infants. Conversely, recent OGDM had similar birthweight- and length SDS to control infants (mean ± SD, 0.1 ± 1.0 and− 0.1 ± 0.9, respectively), but lower mean skinfold thickness SDS (−0.4 ± 0.6 vs 0.0 ± 0.9; p < 0.001). After birth, earlier OGDM showed reduced gains in weight and length between 3 and 12 months. In contrast, recent OGDM had increased weight and skinfold thickness gains until 3 months, followed by reduced gains in those variables from 3 to 12 months, compared with control infants. At 24 months, recent OGDM had lower adiposity than control infants (mean skinfold thickness SDS −0.3 ± 0.7 vs 0.0 ± 0.8; p < 0.001). At all time points recent OGDM had lower growth measurements than earlier OGDM. Conclusions/interpretation: Recent OGDM showed different growth trajectories to the earlier group, namely normalisation of birthweight and reduced adiposity at birth, followed by initial rapid weight gain but subsequent reduced adiposity postnatally. While avoidance of macrosomia at birth may be advantageous, the longer-term health implications of these changing growth trajectories are uncertain

Extensive Study of Breast Milk and Infant Growth: Protocol of the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF).

Funder: Medical Research Council; Grant(s): Unit programmes: MC_UU_12015/2 and MC_UU_00006/2Funder: Wellcome TrustGrowth and nutrition during early life have been strongly linked to future health and metabolic risks. The Cambridge Baby Growth Study (CBGS), a longitudinal birth cohort of 2229 mother-infant pairs, was set up in 2001 to investigate early life determinant factors of infant growth and body composition in the UK setting. To carry out extensive profiling of breastmilk intakes and composition in relation to infancy growth, the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF) was established upon the original CBGS. The strict inclusion criteria were applied, focusing on a normal birth weight vaginally delivered infant cohort born of healthy and non-obese mothers. Crucially, only infants who were exclusively breastfed for the first 6 weeks of life were retained in the analysed study sample. At each visit from birth, 2 weeks, 6 weeks, and then at 3, 6, 12, 24, and 36 months, longitudinal anthropometric measurements and blood spot collections were conducted. Infant body composition was assessed using air displacement plethysmography (ADP) at 6 weeks and 3 months of age. Breast milk was collected for macronutrients and human milk oligosaccharides (HMO) measurements. Breast milk intake volume was also estimated, as well as sterile breastmilk and infant stool collection for microbiome study

Reduced Recombination in High Efficiency Molecular Nematic Liquid Crystalline: Fullerene Solar Cells

Bimolecular recombination in bulk heterojunction organic solar cells is theprocess by which nongeminate photogenerated free carriers encounter eachother, and combine to form a charge transfer (CT) state which subsequentlyrelaxes to the ground state. It is governed by the diffusion of the slower andfaster carriers toward the electron donor–acceptor interface. In an increasingnumber of systems, the recombination rate constant is measured to be lowerthan that predicted by Langevin’s model for relative Brownian motion and thecapture of opposite charges. This study investigates the dynamics of chargegeneration, transport, and recombination in a nematic liquid crystallinedonor:fullerene acceptor system that gives solar cells with initial power conversionefficiencies of >9.5%. Unusually, and advantageously from a manufacturingperspective, these efficiencies are maintained in junctions thickerthan 300 nm. Despite finding imbalanced and moderate carrier mobilitiesin this blend, strongly suppressed bimolecular recombination is observed,which is ≈150 times less than predicted by Langevin theory, or indeed, morerecent and advanced models that take into account the domain size andthe spatial separation of electrons and holes. The suppressed bimolecularrecombination arises from the fact that ground-state decay of the CT state issignificantly slower than dissociation

Genotypic and phenotypic spectrum of pyridoxine-dependent epilepsy (ALDH7A1 deficiency)

Pyridoxine-dependent epilepsy was recently shown to be due to mutations in the ALDH7A1 gene, which encodes antiquitin, an enzyme that catalyses the nicotinamide adenine dinucleotide-dependent dehydrogenation of L-{alpha}-aminoadipic semialdehyde/L-{Delta}1-piperideine 6-carboxylate. However, whilst this is a highly treatable disorder, there is general uncertainty about when to consider this diagnosis and how to test for it. This study aimed to evaluate the use of measurement of urine L-{alpha}-aminoadipic semialdehyde/creatinine ratio and mutation analysis of ALDH7A1 (antiquitin) in investigation of patients with suspected or clinically proven pyridoxine-dependent epilepsy and to characterize further the phenotypic spectrum of antiquitin deficiency. Urinary L-{alpha}-aminoadipic semialdehyde concentration was determined by liquid chromatography tandem mass spectrometry. When this was above the normal range, DNA sequencing of the ALDH7A1 gene was performed. Clinicians were asked to complete questionnaires on clinical, biochemical, magnetic resonance imaging and electroencephalography features of patients. The clinical spectrum of antiquitin deficiency extended from ventriculomegaly detected on foetal ultrasound, through abnormal foetal movements and a multisystem neonatal disorder, to the onset of seizures and autistic features after the first year of life. Our relatively large series suggested that clinical diagnosis of pyridoxine dependent epilepsy can be challenging because: (i) there may be some response to antiepileptic drugs; (ii) in infants with multisystem pathology, the response to pyridoxine may not be instant and obvious; and (iii) structural brain abnormalities may co-exist and be considered sufficient cause of epilepsy, whereas the fits may be a consequence of antiquitin deficiency and are then responsive to pyridoxine. These findings support the use of biochemical and DNA tests for antiquitin deficiency and a clinical trial of pyridoxine in infants and children with epilepsy across a broad range of clinical scenarios

Human Milk Short-Chain Fatty Acid Composition is Associated with Adiposity Outcomes in Infants.

BACKGROUND: Presumed benefits of human milk (HM) in avoiding rapid infancy weight gain and later obesity could relate to its nutrient composition. However, data on breast milk composition and its relation with growth are sparse. OBJECTIVE: We investigated whether short-chain fatty acids (SCFAs), known to be present in HM and linked to energy metabolism, are associated with infancy anthropometrics. METHODS: In a prospective birth cohort, HM hindmilk samples were collected from 619 lactating mothers at 4-8 wk postnatally [median (IQR) age: 33.9 (31.3-36.5) y, body mass index (BMI) (kg/m2): 22.8 (20.9-25.2)]. Their offspring, born at 40.1 (39.1-41.0) wk gestation with weight 3.56 (3.22-3.87) kg and 51% male, were assessed with measurement of weight, length, and skinfold thickness at ages 3, 12, and 24 mo, and transformed to age- and sex-adjusted z scores. HM SCFAs were measured by 1H-nuclear magnetic resonance spectroscopy (NMR) and GC-MS. Multivariable linear regression models were conducted to analyze the relations between NMR HM SCFAs and infancy growth parameters with adjustment for potential confounders. RESULTS: NMR peaks for HM butyrate, acetate, and formic acid, but not propionate, were detected. Butyrate peaks were 17.8% higher in HM from exclusively breastfeeding mothers than mixed-feeding mothers (P = 0.003). HM butyrate peak values were negatively associated with changes in infant weight (standardized B  = -0.10, P = 0.019) and BMI (B = -0.10, P = 0.018) between 3 and 12 mo, and negatively associated with BMI (B = -0.10, P = 0.018) and mean skinfold thickness (B = -0.10, P = 0.049) at age 12 mo. HM formic acid peak values showed a consistent negative association with infant BMI at all time points (B < = -0.10, P < = 0.014), whereas HM acetate was negatively associated with skinfold thickness at 3 mo (B = -0.10, P = 0.028) and 24 mo (B = -0.10, P = 0.036). CONCLUSIONS: These results suggest that HM SCFAs play a beneficial role in weight gain and adiposity during infancy. Further knowledge of HM SCFA function may inform future strategies to support healthy growth.PP was supported by a Medical Research Council Clinical Training Fellowship (G1001995). The Cambridge Baby Growth Study has been supported by the European Union (QLK4-1999-01422), the World Cancer Research Foundation International (2004/03), the Medical Research Council (7500001180), the NIHR Cambridge Comprehensive Biomedical Research Centre, Newlife - The Charity for Disabled Children (07/20), Mothercare Foundation (RG54608), and Mead Johnson Nutrition. KKO is supported by the Medical Research Council (MC_UU_12015/2)

Securing a just space for small-scale fisheries in the blue economy

The vast developmental opportunities offered by the world\u27s coasts and oceans have attracted the attention of governments, private enterprises, philanthropic organizations, and international conservation organizations. High-profile dialogue and policy decisions on the future of the ocean are informed largely by economic and ecological research. Key insights from the social sciences raise concerns for food and nutrition security, livelihoods and social justice, but these have yet to gain traction with investors and the policy discourse on transforming ocean governance. The largest group of ocean-users - women and men who service, fish and trade from small-scale fisheries (SSF) - argue that they have been marginalized from the dialogue between international environmental and economic actors that is determining strategies for the future of the ocean. Blue Economy or Blue Growth initiatives see the ocean as the new economic frontier and imply an alignment with social objectives and SSF concerns. Deeper analysis reveals fundamental differences in ideologies, priorities and approaches. We argue that SSF are being subtly and overtly squeezed for geographic, political and economic space by larger scale economic and environmental conservation interests, jeopardizing the substantial benefits SSF provide through the livelihoods of millions of women and men, for the food security of around four billion consumers globally, and in the developing world, as a key source of micro-nutrients and protein for over a billion low-income consumers. Here, we bring insights from social science and SSF to explore how ocean governance might better account for social dimensions of fisheries