Long-chain polyunsaturated fatty acids in breast milk and infant formula, maternal perinatal mental health, and infant development

This study examined the associations between maternal perinatal mental health or exposure to long-chain polyunsaturated fatty acids (LCPUFAs) in relation to infant development in the Pregnancy, Infection, and Nutrition Study (2002-2006) (n=358). Certain LCPUFAs have been shown to benefit visual acuity, while maternal mental health may negatively affect child development. Women completed questionnaires during pregnancy to assess trait anxiety and depressive symptoms. A home visit in the fourth postpartum month assessed perceived stress and depressive symptoms, collected infant feeding data, and obtained breast milk samples. Infant development was assessed at 12 months using the Mullen Scales of Early Learning. Multivariable linear regression was used to examine the associations between trait anxiety, perceived stress, and depressive symptoms in relation to Mullen scores. Similar techniques were used to examine LCPUFA exposure in relation to Mullen scores and whether women with elevated depressive symptoms had lower breast milk docosahexaenoic acid (DHA) concentration. High levels of trait anxiety were associated with lower Receptive Language (adjusted [beta]=-2.9, 95% confidence interval: -5.6, -0.3) and Early Learning Composite (adjusted [beta] =-4.5, CI: -8.9, 0.0) scores. No associations were observed between anxiety and other sub-scale scores or between perceived stress or depressive symptoms and Mullen scores. Mean DHA content of breast milk samples was 0.28% of fatty acids (standard deviation=0.22); mean arachidonic acid (AA) content 0.57% (SD=0.20). Women with elevated depressive symptoms before 20 weeks gestation had 25% lower breast milk DHA than women with few symptoms. Upon adjustment for preterm birth, smoking, race and ethnicity, and education, no differences in development were observed in relation to breastfeeding exclusivity. No association was observed between the LCPUFA content of breast milk and formula and development. Maternal anxiety may influence overall infant cognitive development and the ability to process verbal input. Women who experienced elevated depressive symptoms in early pregnancy may have less DHA available to their infants. However, this study found no evidence of enhanced development related to LCPUFAs. Given the conflicting results among previous studies and this study's limitations, no actions are currently warranted to change infant feeding practices except to note that infant LCPUFA supplementation deserves further study

Self-Compassion and Depressive Symptoms as Determinants of Sensitive Parenting: Associations with Sociodemographic Characteristics in a Sample of Mothers and Toddlers

Parenting that is sensitive and responsive to children’s needs has been shown to support children’s optimal growth and development in many cultural contexts. Numerous studies suggest that self-compassion is positively related to sensitive parenting. Despite growing research interest linking self-compassion to responsive parenting, there are considerable gaps in the literature. The current study examined the associations between self-compassion, depressive symptoms, socioeconomic status, and sensitive parenting. Data was obtained from a cohort study of 300 families in central Ohio enrolled when children were a mean (SD) calendar age of 18.2 (0.7) months. Children of all gestational ages at birth are included, and 37% were born preterm (<37 weeks’ gestation). Observational protocols were used to determine maternal sensitivity in a semi-structured play setting. Self-compassion was assessed with the Self-Compassion Scale when children were 24 months old. Self-compassion was not associated with sociodemographic characteristics including maternal education, household income, child sex and gestational age. In unadjusted regression models, depressive symptoms were related to sensitive parenting (B = −0.036, SE = 0.016, p = 0.03), but self-compassion was not a statistically significant predictor (p = 0.35) of sensitivity, and neither self-compassion nor depressive symptoms were statistically significant predictors of sensitive parenting after adjustment for covariates. Considerations for future studies are discussed

Maternal Body Mass Index and Daughters’ Age at Menarche

The role of inter-generational influences on age at menarche has not been explored far beyond the association between mothers’ and daughters’ menarcheal ages. Small size at birth and childhood obesity have been associated with younger age at menarche, but the influence of maternal overweight or obesity on daughters’ age at menarche has not been thoroughly examined

Breastfeeding and long-chain polyunsaturated fatty acid intake in the first 4 post-natal months and infant cognitive development: an observational study

The aim of this study was to examine infant feeding and the long-chain polyunsaturated fatty acid (LCPUFA) concentration of breast milk and formulas in relation to infant development. The prospective Pregnancy, Infection and Nutrition Study (n = 358) collected data on breastfeeding, breast milk samples and the formulas fed through 4 months post-partum. At 12 months of age, infants’ development was assessed (Mullen Scales of Early Learning). Linear regression was used to examine development in relation to breastfeeding, breast milk docosahexaenoic acid (DHA) and arachidonic acid (AA) concentration, and DHA and AA concentration from the combination of breast milk and formula. The median breast milk DHA concentration was 0.20% of total fatty acids [interquartile range (IQR) = 0.14, 0.34]; median AA concentration was 0.52% (IQR = 0.44, 0.63). Upon adjustment for preterm birth, sex, smoking, race and ethnicity and education, breastfeeding exclusivity was unrelated to development. Among infants exclusively breastfed, breast milk LCPUFA concentration was not associated with development (Mullen composite, DHA: adjusted β = −1.3, 95% confidence interval: −10.3, 7.7). Variables combining DHA and AA concentrations from breast milk and formula, weighted by their contribution to diet, were unassociated with development. We found no evidence of enhanced infant development related to the LCPUFA content of breast milk or formula consumed during the first four post-natal months

Depressive Symptoms during Pregnancy and the Concentration of Fatty Acids in Breast Milk

The aim of the present study was to examine the association between depressive symptoms in pregnancy and the concentration of long-chain polyunsaturated fatty acids (LCPUFAs) in breast milk. Women (n =287) enrolled in the Pregnancy, Infection, and Nutrition Study completed the Center for Epidemiologic Studies Depression Scale in pregnancy (<20 and 24–29 weeks) and had LCPUFAs measured in breast milk (4 months postpartum). Multiple linear regression was used to examine associations between depressive symptoms and breast milk LCPUFAs. Increasing depressive symptoms at <20 weeks were associated with lower docosahexaenoic acid concentrations (adjusted β=−1.15, 95% confidence interval =−2.12, −0.19). No similar associations were observed with other fatty acids nor between symptoms at 24–29 weeks and LCPUFAs. Depressive symptoms, even in the subclinical range, early in pregnancy are inversely associated with breast milk docosahexaenoic acid. This may have implications for the timing of screening and interventions for perinatal depression and the nutritional value of breast milk

A prospective study of maternal anxiety, perceived stress, and depressive symptoms in relation to infant cognitive development

Our objective was to examine the associations between maternal psychological health (trait anxiety, perceived stress, depressive symptoms) during pregnancy or postpartum and infant visual, language, motor, and overall cognitive development

Comparative Genomic Characterization of Francisella tularensis Strains Belonging to Low and High Virulence Subspecies

Tularemia is a geographically widespread, severely debilitating, and occasionally lethal disease in humans. It is caused by infection by a gram-negative bacterium, Francisella tularensis. In order to better understand its potency as an etiological agent as well as its potential as a biological weapon, we have completed draft assemblies and report the first complete genomic characterization of five strains belonging to the following different Francisella subspecies (subsp.): the F. tularensis subsp. tularensis FSC033, F. tularensis subsp. holarctica FSC257 and FSC022, and F. tularensis subsp. novicida GA99-3548 and GA99-3549 strains. Here, we report the sequencing of these strains and comparative genomic analysis with recently available public Francisella sequences, including the rare F. tularensis subsp. mediasiatica FSC147 strain isolate from the Central Asian Region. We report evidence for the occurrence of large-scale rearrangement events in strains of the holarctica subspecies, supporting previous proposals that further phylogenetic subdivisions of the Type B clade are likely. We also find a significant enrichment of disrupted or absent ORFs proximal to predicted breakpoints in the FSC022 strain, including a genetic component of the Type I restriction-modification defense system. Many of the pseudogenes identified are also disrupted in the closely related rarely human pathogenic F. tularensis subsp. mediasiatica FSC147 strain, including modulator of drug activity B (mdaB) (FTT0961), which encodes a known NADPH quinone reductase involved in oxidative stress resistance. We have also identified genes exhibiting sequence similarity to effectors of the Type III (T3SS) and components of the Type IV secretion systems (T4SS). One of the genes, msrA2 (FTT1797c), is disrupted in F. tularensis subsp. mediasiatica and has recently been shown to mediate bacterial pathogen survival in host organisms. Our findings suggest that in addition to the duplication of the Francisella Pathogenicity Island, and acquisition of individual loci, adaptation by gene loss in the more recently emerged tularensis, holarctica, and mediasiatica subspecies occurred and was distinct from evolutionary events that differentiated these subspecies, and the novicida subspecies, from a common ancestor. Our findings are applicable to future studies focused on variations in Francisella subspecies pathogenesis, and of broader interest to studies of genomic pathoadaptation in bacteria

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years