Breastfeeding and infant eczema in the first year of life in the KOALA birth cohort study: a risk period-specific analysis

OBJECTIVE: We studied the association between breastfeeding and eczema, taking into account the possible influence of reverse causation, with risk period-specific analyses. METHODS: Information on breastfeeding, determinants, and outcomes at 1 year of age was collected with repeated questionnaires for 2405 mother-infant pairs participating in the KOALA (Child, Parent and Health: Lifestyle and Genetic Constitution [in Dutch]) birth cohort study. By using multivariate logistic regression analysis, we compared an overall analysis with risk period-specific analyses. RESULTS: By the age of 1 year, 535 infants (22.2%) had developed eczema. In an overall analysis, we found a weak nonsignificant trend toward a reduced risk of eczema in the first year of life with increasing duration of breastfeeding (lowest risk for those breastfed for > or = 7 months versus never breastfed). In the risk period-specific analysis (confined to infants "at risk" for eczema onset after 3 months of age), no indication for reverse causation was found (results were not very different, compared with the overall analysis). Infants who were breastfed from birth on had a slightly (although not statistically significantly) increased risk for eczema in the first 3 months of life, compared with infants who were formula fed from birth on. CONCLUSIONS: Our results indicated that no strong effect of breastfeeding on eczema in the first year of life was present. This conclusion was strengthened by risk period-specific analysis, which made the influence of reverse causation unlikely

Cytokines and soluble CD14 in breast milk in relation with atopic manifestations in mother and infant (KOALA Study)

BACKGROUND: Conflicting evidence exists concerning the protective role of breastfeeding in allergy and atopic disease aetiology. Breast milk contains biologically active molecules influencing the innate immune system of newborns. OBJECTIVE: We aim to assess whether cytokines (TGF-beta1, IL-10 and IL-12) and soluble CD14 (sCD14) in breast milk are influenced by maternal atopic constitution and modify the development of atopic manifestations in infants. METHODS: Milk samples were collected at 1 month post-partum of 315 lactating mothers participating in the ongoing KOALA Birth Cohort Study. The cytokines and sCD14 were analysed by ELISA in the aqueous fraction. We compared the concentrations of cytokines and sCD14 in breast milk between mothers with and without an allergic history and also with and without allergic sensitization (specific IgE). Associations of cytokines and sCD14 with the development of eczema, wheezing in the first 2 years of life and allergic sensitization of infants at the age of 2 years were analysed by multivariate logistic regression analyses to correct for confounders. RESULTS: We found higher sCD14 levels in mothers with a positive vs. negative allergic history (7.6 vs. 7.0 microg/mL; P = 0.04) and in mothers who were sensitized vs. non-sensitized (7.8 vs. 7.1 microg/mL; P = 0.03). None of the studied immune factors were associated with infant's atopic outcomes. IL-10 was not detected above the detection limit of 0.2 pg/mL. CONCLUSION: Taking together the results of the present and previous studies, we conclude that there is no convincing evidence for a relation between TGF-beta1, sCD14, IL-10 or IL-12 in breast milk and atopic manifestations in infant

Breast-feeding duration and infant atopic manifestations, by maternal allergic status, in the first 2 years of life (KOALA study).

Objective To investigate the potential effect of modification by maternal allergic status on the relationship between breast-feeding duration and infant atopic manifestations in the first 2 years of life. Study design Data from 2705 infants of the KOALA Birth Cohort Study (The Netherlands) were analyzed. The data were collected by repeated questionnaires at 34 weeks of gestation and 3, 7, 12, and 24 months postpartum. Total and specific immunoglobulin E measurements were performed on venous blood samples collected during ionic visits at age 2 years. Relationships were analyzed using logistic regression analyses. Results Longer duration of breast-feeding was associated with a lower risk for eczema in infants of mothers without allergy or asthma (P-trend = .01) and slightly lower risk in those of mothers with allergy but noasthma(P-trend =.14). There was no such association for asthmatic mothers (P-trend =.87). Longer breast-feeding duration decreased the risk of recurrent wheeze independent of maternal allergy (P-trend =.02) or asthma status See editorial, p 331 and (P-trend =.06). related articles, p 352 Conclusions Our findings show that the relationship between breast-feeding and and p 359 infant eczema in the first 2 years of life is modified by maternal allergic status. The protective effect of breast-feeding on recurrent wheeze may be associated with protection against respiratory infection

Do intensive care data on respiratory infections reflect influenza epidemics?

Objectives Severe influenza can lead to Intensive Care Unit (ICU) admission. We explored whether ICU data reflect influenza like illness (ILI) activity in the general population, and whether ICU respiratory infections can predict influenza epidemics. Methods We calculated the time lag and correlation between ILI incidence (from ILI sentinel surveillance, based on general practitioners (GP) consultations) and percentages of ICU admissions with a respiratory infection (from the Dutch National Intensive Care Registry) over the years 2003–2011. In addition, ICU data of the first three years was used to build three regression models to predict the start and end of influenza epidemics in the years thereafter, one to three weeks ahead. The predicted start and end of influenza epidemics were compared with observed start and end of such epidemics according to the incidence of ILI. Results Peaks in respiratory ICU admissions lasted longer than peaks in ILI incidence rates. Increases in ICU admissions occurred on average two days earlier compared to ILI. Predicting influenza epidemics one, two, or three weeks ahead yielded positive predictive values ranging from 0.52 to 0.78, and sensitivities from 0.34 to 0.51. Conclusions ICU data was associated with ILI activity, with increases in ICU data often occurring earlier and for a longer time period. However, in the Netherlands, predicting influenza epidemics in the general population using ICU data was imprecise, with low positive predictive values and sensitivities

Skeletal Muscle Adaptive Responses to Different Types of Short-Term Exercise Training and Detraining in Middle-Age Men

Introduction Whether short-term, single-mode exercise training can improve physical fitness prior to a period of reduced physical activity (e.g. post-surgery recovery) is not well characterized in clinical populations nor middle-age adults. We investigated skeletal muscle adaptive responses following endurance exercise training (ENT), high-intensity interval training (HIIT) or resistance exercise training (RET), and a subsequent period of detraining, in sedentary, middle-age men. Methods Thirty-five sedentary, males (39±3 yr) were randomized to parallel groups and undertook six weeks of either ENT (n=12), HIIT (n=12) or RET (n=11) followed by 2.5 weeks of detraining. Skeletal muscle fiber characteristics, body composition, muscle thickness, muscle strength, aerobic capacity, resting energy expenditure and glucose homeostasis were assessed at baseline, and after exercise training and detraining. Results Lean mass increased after RET and HIIT (+3.2±1.6% and +1.6±2.1%, P<0.05). Muscle strength (sum of leg press, leg extension and bench press 1RMs) increased after all training interventions (RET: +25±5%; HIIT: +10±5%; ENT: +7±7%, P<0.05). Aerobic capacity increased only after HIIT and ENT (+14±7% and +11±11%, P<0.05). Type I and II muscle fiber size increased for all groups post-training (main effect of time, P<0.05). Following a period of detraining, the gains in lean mass and maximal muscle strength were maintained in RET and HIIT groups, but maximal aerobic capacity declined below post-training levels in HIIT and ENT (P<0.05). Conclusion Six weeks of HIIT induced widespread adaptations prior to detraining in middle-age men. Exercise training-induced increases in aerobic capacity declined during 2.5 weeks of detraining but gains in lean mass and muscle strength were maintained

Early life exposure to antibiotics and the subsequent development of eczema, wheeze, and allergic sensitization in the first 2 years of life: the KOALA Birth Cohort Study

OBJECTIVES: Antibiotic exposure in early life may be associated with atopic disease development either by interfering with bacterial commensal flora or by modifying the course of bacterial infections. We evaluated early life exposure to antibiotics and the subsequent development of eczema, wheeze, and allergic sensitization in infancy. METHODS: Information on antibiotic use in the first 6 months and eczema and wheeze until age 2 was collected by repeated questionnaires in 2764 families participating in the KOALA (Child, Parent and Health: Lifestyle and Genetic Constitution [in Dutch]) Birth Cohort Study in The Netherlands. Antibiotic intake was evaluated both as maternal antibiotic use during breastfeeding and infant oral medication. Venous blood samples taken from 815 infants at 2 years of age were analyzed for total and specific immunoglobulin E against common food and inhalant allergens using a radioallergosorbent test. Multivariate logistic regression analysis was used to adjust for confounding factors. RESULTS: During the first 2 years, eczema was present in 32% of all infants, recurrent wheeze in 11%, and prolonged wheezing in 5%. At 2 years old, 27% of children were sensitized against > or = 1 allergen. At 6 months old, 11% had been exposed to antibiotics through breast milk and 20% directly through medication. The risk for recurrent wheeze, and prolonged wheeze was higher in infants directly exposed to antibiotics through medication, also after excluding from the analyses children who wheezed in the same period as an antibiotic had been used (avoiding reverse causation). Antibiotic use through breastfeeding was associated with recurrent wheeze, but prolonged wheeze was not. Eczema and sensitization were not associated with antibiotic exposure. CONCLUSIONS: We demonstrated that early antibiotic use preceded the manifestation of wheeze but not eczema or allergic sensitization during the first 2 years of life. Different biological mechanisms may underlie the etiology of wheeze compared with eczema or sensitization. Antibiotic exposure through breastfeeding enhanced the risk for recurrent wheeze, but this needs further confirmation

Mumps epidemic in orthodox religious low-vaccination communities in the Netherlands and Canada, 2007 to 2009.

Item does not contain fulltextWe assessed the epidemiological characteristics of a mumps virus epidemic (genotype D) that occurred in the Netherlands between August 2007 and May 2009 and its association with a subsequent mumps outbreak in Canada. In the Netherlands, five data sources were used: notifications (only mandatory since the end of 2008) (56 cases), laboratory confirmation data (177 cases), a sentinel general practitioner (GP) database (275 cases), hospitalisation data (29 cases) and weekly virological reports (96 cases). The median age of cases in the notification, laboratory and GP databases ranged from 13 to 15 years. The proportion of cases that were unvaccinated ranged from 65% to 85% in the notification, laboratory and GP databases. Having orthodox Protestant beliefs was the main reason for not being vaccinated. In Canada, a mumps virus strain indistinguishable from the Dutch epidemic strain was detected between February and October 2008 in an orthodox Protestant community with historical and family links to the affected community in the Netherlands, suggesting that spread to Canada had occurred. Prevention and control of vaccine-preventable diseases among population subgroups with low vaccination coverage remains a priority

Consumption of organic foods and risk of atopic disease during the first 2 years of life in the Netherlands

We prospectively investigated whether organic food consumption by infants was associated with developing atopic manifestations in the first 2 years of life. The KOALA Birth Cohort Study in the Netherlands (n 2764) measured organic food consumption, eczema and wheeze in infants until age 2 years using repeated questionnaires. Diet was defined as conventional ( 90 % organic). Venous blood samples taken from 815 infants at 2 years of age were analysed for total and specific IgE. Multivariate logistic regression models were fitted to control for potential confounding factors. Eczema was present in 32 % of infants, recurrent wheeze in 11 % and prolonged wheezing in 5 %. At 2 years of age, 27 % of children were sensitised against at least one allergen. Of all the children, 10 % had consumed a moderately organic diet and 6 % a strictly organic diet. Consumption of organic dairy products was associated with lower eczema risk (OR 0.64 (95 % CI 0.44, 0.93)), but there was no association of organic meat, fruit, vegetables or eggs, or the proportion of organic products within the total diet with the development of eczema, wheeze or atopic sensitisation. Further studies to substantiate these results are warranted. AD - Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College London, London, UK