Idiosyncratic food preferences of children with autism spectrum disorder in England

Objectives: To obtain a better understanding of feeding difficulties experienced by children with autism spectrum disorder (ASD).Methodology: Parents/caregivers (n = 325) of children (3–16 years) diagnosed with ASD living in England participated in an online questionnaire investigating early feeding history, food preferences and mealtime environment.Results: The most common feeding problem was the transition from weaning foods to textured food. Food appearance mainly determined food acceptance with over half the children (n = 152) being specific about the colour of their food. Nearly 65% (n = 191) were particular about food presentation, including specific brands and food packaging. Sensory attributes and texture of food affected food acceptance. There were clear preferences for crunchy or dry foods, followed by food with a smooth consistency. Nearly 80% (n = 223) repeatedly chose the same foods from a limited range. For specific food groups, the clear favourite among the study population was refined carbohydrates (64.4%, n = 186). A large proportion of children had tactile sensitivity, where 60% (n = 176) disliked having their hands/face dirty. Over 70% (n = 205) of children disliked strong odours, indicating the importance of the sensory attributes to food and the mealtime environment. Less than 40% (n = 108) of children were seen by a dietitian and the most common concern was the limited variety of foods and dietary intake.Conclusion: The study highlighted the need for nutritional monitoring and intervention where long-term idiosyncratic feeding behaviour may contribute to nutritional deficiencie

Impact of a Multi-Strain Probiotic on Healthcare-Associated Bloodstream Infection Incidence and Severity in Preterm Neonates

Aim:Hospital acquired bloodstream infection (HA-BSI) is a major contributor to morbidity and mortality in preterm, very low birthweight infants, especially in low-to-middle- income countries.Materials and Methods:We conducted a double-blind, placebo-controlled, randomized clinical trial to investigate the effect of a multi-strain probiotic formulation (LabinicTM) on the incidence and severity of HA-BSI in preterm neonates.Results:Two hundred neonates (100 per arm) were included in this trial. Fifteen neonates developed HA-BSI events (2 in the probiotic arm and 13 in the placebo arm). The median day of life at HA-BSI onset for the probiotic group was 10.5±3.5, and for the placebo group, it was 11.2±6.4. The incidence of HA-BSI in neonates receiving the probiotic was significantly lower compared to those receiving the placebo [0.93 versus 5.99 HA-BSI events/1,000 neonate-days; incidence rate ratio (IRR) of 0.156 [95% confidence interval (CI): 0.017 to 0.691], p=0.0046]. Calculating the incidence rate of the combined outcome (sepsis/death) was also lower in the probiotic group versus the placebo group [2.34 versus 6.45 events/1,000 neonate days; IRR 0.33 (95% CI: 0.11 to 0.97), p=0.043].Conclusion:The use of a multi-strain probiotic significantly reduced HA-BSI incidence in this cohort of preterm neonates

The use of probiotics in the management of necrotising enterocolitis in HIV exposed premature and very-low birth weight infants

Thesis (PhD)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Introduction: An association between maternal human immunodeficiency virus (HIV) infection and Necrotizing Enterocolitis (NEC) in preterm infants has been reported. The impact of probiotics in an HIV-exposed very low birth weight (VLBW) infant on the occurrence of NEC is uncertain at present; however it is known that probiotics have protective effects against inflammation and prevent NEC. Postnatal growth restriction is a major issue in preterm, especially extremely-low-birth-weight (ELBW) infants and probiotics have been found to improve feeding tolerance in preterm infants. Human milk oligosaccharides (HMO) also known as the prebiotics of human milk, are known to have bifidogenic and anti-adhesive effects. Infants that receive human milk show a reduced incidence of NEC compared to those who receive infant formula. Very little is known about the composition of breast milk in the HIV-infected mother. Objective: The primary objective of the study was to assess the effect of probiotics on the incidence and severity of NEC in high-risk infants born to HIV-positive and HIV-negative women. The secondary objectives were to assess the effect of probiotic administration on feeding tolerance and growth outcomes of HIV-exposed but uninfected preterm infants, to describe the HMO composition of HIV-infected mothers breast milk and lastly to determine if HMO composition affects the incidence of NEC in HIV-exposed preterm very low birth weight infants. Patients and Methods: A randomized, double blind, placebo controlled trial was conducted for the period July 2011 to August 2012. HIV-exposed and HIV-unexposed premature (<34 weeks gestation) infants with a birth weight of ≥500g and ≤1250g were randomized to receive either a probiotic or a placebo. The probiotic consisted of 1x109 CFU, L. rhamnosus GG and B. infantis per day and was administered for 28 days. NEC was graded according to Bell’s criteria. Anthropometrical parameters and daily intakes were monitored. Breats milk samples were analysed for oligosaccharide content. Results: 74 HIV-exposed and 110 HIV-unexposed infants were enrolled and randomized (mean birth-weight, 987g; mean gestational 28.7 weeks). The incidence of death and NEC did not differ significantly between the HIV-exposed and unexposed groups but a significantly higher NEC incidence was found in the control group. There was no difference in the average daily weight gain for treatment groups or HIV exposure. The HIV-exposed group achieved significantly higher z-scores for length and head circumference at day 28 than the unexposed group (p<0.01 and p=0.03, respectively). There were no differences in the incidence of any signs of feeding intolerance and abdominal distension between the groups. Our results show significantly higher absolute concentrations of 2’-fucosyllactose, laco-N-tetraose and lacto-N-fucopentaose 1 and higher relative abundance of 3’-sialyllactose, difucosyl-lacto-N-tetraose and fucosyl-disialyllacto-N-hexaose in HIV-infected compared to -uninfected Secretor women. DSLNT concentrations were significantly lower in the breast milk of mothers whose infants developed NEC compared to infants without NEC. Conclusion: Probiotic supplementation reduced the incidence of NEC in the premature infants; however results failed to show a lower incidence of NEC in HIV-exposed premature infants. Probiotic supplementation did not affect growth outcomes or the incidence of any signs of feeding intolerance in HIV-exposure. The data confirms previous reports that HIV-infected mothers have higher 3’sialyllactose milk concentrations. Most intriguing though, the data also indicates that low levels of DSLNT in the mother’s milk increase the infant’s risk for NEC, which is in accordance with results from previously published animal studies and warrants further investigation.AFRIKAANSE OPSOMMING: Inleiding: ʼn Verwantskap tussen moederlike menslike immuniteitsgebreksvirus (MIV) en nekrotiserende enterokolitis (NEK) in premature babas is aangemeld. Die impak van probiotika in ʼn MIV-blootgestelde baie lae geboortemassa (BLGM) baba op die voorkoms van NEK is tans nog onseker, maar dit is wel bekend dat probiotika ʼn beskermende effek het teen inflammasie en die voorkoms van NEK. Nageboortelike groei beperkings is ʼn groot probleem in premature, veral ekstreme lae geboortemassa (ELGM) babas. Daar is gevind dat probiotika voeding toleransie in premature babas kan verbeter. Menslike melk oligosakkariede (MMO), ook bekend as die prebiotika van menslike melk, is bekend om bifidogeniese en anti-kleef effekte te hê. Babas wat moedersmelk ontvang toon ʼn verlaagde voorkoms van NEK in vergelyking met diegene wat baba formule melk ontvang. Baie min inligting is bekend oor die samestelling van borsmelk in die MIV-positiewe moeder. Doel: Die primêre doel van die studie was om die effek van probiotika op die voorkoms en die graad van NEK in hoë risiko babas van MIV-positiewe en MIV-negatiewe vroue te bepaal. Die sekondêre doelwitte was om die effek van probiotika op voeding verdraagsaamheid en groei uitkomste van MIV-blootgestelde, maar nie- geinfekteerde premature babas te evalueer sowel as die MMO samestelling van MIV-positiewe moeders se borsmelk te beskryf en laastens om die invloed van die MMO samestelling op die voorkoms van NEK in baie lae geboortegewig MIV-blootgestelde premature babas te beskryf. Pasiënte en Metodes: ʼn Gerandomiseerde, dubbelblinde, plasebo-beheerde studie is vir die tydperk Julie 2011 tot Augustus 2012 onderneem. MIV-blootgestelde en nie-blootgestelde premature (<34 weke) babas met 'n geboorte gewig van ≥500g en ≤1250g was ewekansig verdeel om probiotika of plasebo te ontvang. Die probiotika het bestaan uit 1x109 kolonie vormende eenhede, L. rhamnosus GG en B. infantis per dag en is toegedien vir 28 dae. NEK is gegradeer volgens Bell se kriteria. Antropometriese parameters en daaglikse inname is gemonitor. Borsmelk monsters is geanaliseer vir oligosakkaried inhoud. Resultate: 74 MIV-blootgestelde en 110 MIV-nie-blootgestelde babas is ingesluit en ewekansig ingedeel (gemiddelde geboorte gewig, 987g, gemiddelde gestasie 28,7 weke). Die voorkoms van die sterftes en NEK het nie beduidend verskil tussen die MIV-blootgestelde en nie-blootgestelde groepe nie, maar 'n beduidende verskil is gevind vir NEK voorkoms tussen die studie en die kontrole groep. Daar was geen verskil in die gemiddelde daaglikse gewigstoename tussen die behandelings groepe of MIV-blootstelling nie. Die MIV-blootgestelde groep het beduidend hoër z-tellings vir lengte en kopomtrek op dag 28 getoon teenoor die nie-blootgestelde groep (p <0.01 en p = 0,03, onderskeidelik). Daar was geen verskille in die voorkoms van voeding onverdraagsaamheid en abdominale distensie tussen die twee groepe nie. Ons resultate dui op aansienlik hoër absolute konsentrasies van 2'-fucosyllactose, laco-N-tetraose en lakto-N-fucopentaose 1 en hoër relatiewe voorkoms van 3'-sialyllactose, difucosyl-lakto-N-tetraose en fucosyl-disialyllacto-N-hexaose in MIV-positiewe vroue in vergelyking met-negatiewe Sekretor vroue. DSLNT konsentrasies was aansienlik laer in die melk van moeders wie se babas NEK ontwikkel het in vergelyking met babas sonder NEK. Gevolgtrekking: Probiotika aanvullings verminder die voorkoms van NEK in premature babas, maar die resultate kon nie ʼn laer voorkoms van NEK in MIV-blootgestelde premature babas bewys nie. Probiotiese aanvulling het geen invloed op groei uitkomste of die voorkoms van voeding onverdraagsaamheid in MIV-blootstelling getoon nie. Die data bevestig vorige verslae wat aandui dat MIV-besmette moeders hoër 3'sialyllactose borsmelk konsentrasies het. ʼn Interessante aspek is dat lae vlakke van DSLNT in die moeder se melk beduidend is van ʼn verhoogde risiko vir NEK, wat in ooreenstemming is met die resultate uit voorheen gepubliseerde dier studies en regverdig verdere ondersoeke

Diet and childhood asthma : review

CITATION: Labuschagne, I. L. & Van Niekerk, E. 2016. Diet and childhood asthma : review. South African Family Practice, 58(1):S9-S11, doi:10.1080/20786190.2014.978098.The original publication is available at http://www.tandfonline.comChildhood asthma is the most common chronic inflammatory childhood disease with almost 20% children and adolescents reporting asthma symptoms in South Africa. Associations between asthma and dietary antioxidants (vitamin E, vitamin C, carotenoids, selenium, polyphenols, and fruit), polyunsaturated fatty acids (PUFA), and vitamin D have been found. Adherence to the Mediterranean diet seems protective. This condensed review briefly reports on available data of possible protective dietary patters and practices.http://www.tandfonline.com/doi/full/10.1080/20786190.2014.978098Publisher's versio

Idiosyncratic food preferences of children with autism spectrum disorder in England

Objectives: To obtain a better understanding of feeding difficulties experienced by children with autism spectrum disorder (ASD). Methodology: Parents/caregivers (n = 325) of children (3–16 years) diagnosed with ASD living in England participated in an online questionnaire investigating early feeding history, food preferences and mealtime environment. Results: The most common feeding problem was the transition from weaning foods to textured food. Food appearance mainly determined food acceptance with over half the children (n = 152) being specific about the colour of their food. Nearly 65% (n = 191) were particular about food presentation, including specific brands and food packaging. Sensory attributes and texture of food affected food acceptance. There were clear preferences for crunchy or dry foods, followed by food with a smooth consistency. Nearly 80% (n = 223) repeatedly chose the same foods from a limited range. For specific food groups, the clear favourite among the study population was refined carbohydrates (64.4%, n = 186). A large proportion of children had tactile sensitivity, where 60% (n = 176) disliked having their hands/face dirty. Over 70% (n = 205) of children disliked strong odours, indicating the importance of the sensory attributes to food and the mealtime environment. Less than 40% (n = 108) of children were seen by a dietitian and the most common concern was the limited variety of foods and dietary intake. Conclusion: The study highlighted the need for nutritional monitoring and intervention where long-term idiosyncratic feeding behaviour may contribute to nutritional deficiencies

Acidified infant formula explained

CITATION: Labuschagne, I., Van Niekerk, E. & Lombard, M. J. 2013. Acidified infant formula explained. South African Family Practice, 55(3):354-356.The original publication is available at http://www.safpj.co.zaThe development of effective methods to prevent acute gastroenteritis is an important goal for infant health. Exclusive breastfeeding and postponement of complementary foods until the age of six months is recommended for healthy infants. However, at times, infant formula is required. Various types are commercially available. Acidified cow’s milk formula has been found to prevent the growth of pathogenic bacteria and concurring diarrhoeal disease.http://www.safpj.co.za/index.php/safpj/article/view/3729Publisher's versio

The role of human milk oligosaccharides in preventing necrotising enterocolitis and human immunodeficiency virus transmission

CITATION: Van Niekerk, E., Blaauw, R. & Kirsten, G. F. 2014. The role of human milk oligosaccharides in preventing necrotising enterocolitis and human immunodeficiency virus transmission. South African Journal of Clinical Nutrition, 27(2):51-55.The original publication is available at http://www.sajcn.co.zaThe heavy burden of maternal human immunodeficiency virus (HIV) infection has resulted in a high prevalence of premature births, with an associated increase in the incidence of necrotising enterocolitis (NEC). NEC is a life-threatening inflammatory disease of the gastrointestinal tract that predominantly occurs in preterm infants. Human milk oligosaccharides (HMOs) are carbohydrate compounds which have been shown to have health-promoting effects through their bifidogenic and antiadhesive properties. There is a reduced incidence of NEC in infants who receive human milk, compared to those receiving infant formula. It is suggested that the oligosaccharides found within human milk may act as specific substrates in assisting the growth of selected beneficial bacteria, called probiotics. Probiotics are live microbial food ingredients which have been shown to have health-promoting effects. Lactobacillus rhamnosus GG and Bifidobacterium infantis have been used as probiotics to reduce the incidence of NEC. Furthermore, HMOs have been associated with protection against postnatal HIV transmission. HMOs may hold key responsibility for the prevention of NEC, and possibly the transmission of HIV, to infants in resource-limited settings and in a developing country, such as South Africa, where HIV plays a major role in the outcomes of preterm neonates.http://sajcn.co.za/index.php/SAJCN/article/view/790Publisher's versio

Fish Consumption Improved Head Circumference and Mid-Upper Arm Circumference among Infants in Zambia: A Randomised Controlled Trial

Fish is a good source of Animal Source Proteins (ASP). Families from low-income countries with limited access to other animal source proteins can utilize it to improve the nutrition status of infants and young children. The objective of the study was to assess if fish fed during the early complementary feeding period had an effect on improved head circumference (HC) and mid-upper arm circumference (MUAC) among infants aged 6–7 months. A randomised controlled trial was conducted from April 2019 to January 2020 in the Samfya district, Luapula Province, Zambia. The infants (238) were randomised to either the fish group (intervention) or the sorghum group (control). Every week for a period of 6 months, infants received seven sachets of fish powder and sorghum powder, respectively. Compliance was also monitored during the fish powder distribution. The head circumference measurements were conducted at baseline and once each follow-up month for a period of six months while the MUAC measurements were conducted twice (at baseline and endline). Using statistical software for data science (STATA) (version 16), a linear mixed effect model was used to analyse the data. The results showed that fish improved head circumference for age z score (HCZ) by 0.53 (95% CI: 0.23–0.82), p-value p-value < 0.002. Therefore, fish can be used as the main source of protein in complementary foods for infants and young children in low-income communities with limited access to meat

The Efficacy of Fish as an Early Complementary Food on the Linear Growth of Infants Aged 6&ndash;7 Months: A Randomised Controlled Trial

Fish is a good animal-source protein for growth and development. The main objective of the study was to assess the efficacy of fish during the early complementary feeding period on infants&rsquo; linear growth in the Samfya district of the Luapula Province of Zambia in 6 months randomised controlled trial. The study was conducted from April 2019 to January 2020. Infants aged 6&ndash;7 months (N = 238) were assigned to either the intervention (treatment) group or control (placebo) group to receive fish powder or sorghum powder, respectively. Participants were followed on a weekly basis to distribute the powder and record compliance/usage and any morbidities. Anthropometric measurements were taken monthly. A linear mixed-effects model showed that fish powder improved linear growth among infants over all the 6 months of the intervention period. The fish powder increased length-for-age z scores by 1.26 (95% CI: 0.94&ndash;1.57) and weight-for-age z score by 0.95 (95% CI 0.6&ndash;1.23). The addition of fish powder to the infant&rsquo;s usual food during the early complementary feeding improves the infant&rsquo;s linear growth outcome

Effect of a Multi-Strain Probiotic on Growth and Time to Reach Full Feeds in Preterm Neonates

Background: The main nutritional goal for premature neonates is to achieve a postnatal growth rate that the neonate would have experienced in utero. Postnatal growth failure is, however, very common in very and extremely low birth weight neonates. The use of probiotics shows promising results in reducing the time for full feeds, as well as in increased weight gain. The optimal probiotic strain has, however, not been elucidated. The aim of the present study was to evaluate the difference in the growth and time to reach full feeds between the two treatment arms, using LabinicTM as a multi-strain probiotic and a placebo. Methods: We conducted a double-blind, placebo-controlled, randomized clinical trial investigating the effect of a multi strain probiotic (LabinicTM) on various outcomes in preterm neonates. The results on the time to reach full feeds and the growth will be discussed in this paper. A probiotic or placebo was given once daily to the neonates for 28 days. Weight and feeding volume were measured daily, and length and head circumference were measured weekly. Results: The probiotic group reached full feeds earlier 8.7 days; &plusmn; 2.0 than the placebo group 9.7 days; &plusmn;4.3 (p = 0.04) and regained their birthweight earlier than the placebo group 11.5 days &plusmn; 6.3 vs. 13.3 days &plusmn; 6.3 (p = 0.06). From day 21 onwards, the probiotic group showed a significantly greater crude gain in weight (p &lt; 0.001) than the placebo group (estimated difference between the two groups day 21: 56.7 g and at day 28: 83.7 g. There was a significant improvement observed in the weight Z-score change in the probiotic group over the 28-day period. Conclusion: The use of a multi-strain probiotic (LabinicTM) shows great potential as a low-cost, low-risk intervention in reducing the time to reach full feeds as well as shortening the time to regain birthweight. The probiotic had an additional beneficial impact on Z-score change in weight potentially decreasing post-natal growth restriction