International Journal of Child Health and Nutrition

67-77

Authors: Keith E. Williams, Maria Blanques Petty, Maria Arlete M. Schimith-Escrivão, Kyong-Mee Chung, Woo Hyun Jung, Helen M. Hendy

The present study considered three samples of mothers from Brazil, South Korea, and the United States to determine whether mothers demonstrate a consistent pattern of feeding practices associated with child overweight. Participants included 1204 mothers of children 6-10 years old. Mothers completed questionnaires to report their children's demographics and their feeding practices with the Parent Mealtime Action Scale (PMAS). The South Korean children showed significantly less obesity (10.4%) than children from Brazil (17.0%) or the United States (19.6%). Confirmatory factor analysis for mothers from all three samples revealed good fit for the same nine PMAS dimensions of feeding practice. Hierarchical multiple regression revealed that after taking into account child age and gender, heavier child weight was found associated with more Fat Reduction and less Insistence on Eating by mothers from all three samples. Results from past experimental research suggest that these two maternal feeding practices would be counter-productive for teaching children's self-regulation of diet and weight management. Alternative maternal feeding practices are suggested.

84-92

Authors: Susanne Georgsson Öhman, Christina Sandberg

Background: Premature infants are at increased risk of developing Gastroesophageal Reflux Disease (GERD), which for these children is associated with a number of severe symptoms. There is great need for effective instruments and clear symptom criteria to assess the presence and degree of severity of GERD. Aim: To develop and pilot test an observation instrument for early detection of symptoms of GERD in premature infants. Method: A combination of three research methods was used – systematic literature review, observation instrument development and a pilot test. Results: The systematic review identified specific symptoms of GERD. The development of the observational instrument started with the establishment of concordance between the criteria of symptoms according to the literature review and to NIDCAP, “Newborn Individualized Developmental Care and Assessment Program”. In the pilot test the criteria of symptoms were revised by comparing the result and the criteria between infants that clinically were estimated to have had a reflux problem and the ones who did not. Conclusion: An observation instrument was developed. The clinical evaluation by a pilot test showed that the instrument could be useful to record significant symptoms and combinations of symptoms that may occur in premature infants assessed as having reflux problems.

99-107

Authors: Shahzad Akram, Eleni Simatou, Jan-Bernd Stukenborg, Lars Hagenäs, Olle Söder, Zulfiqar A. Bhutta

Background: Foeto-placental growth is regulated by a complex balance of growth promoting and growth inhibiting factors and hormones, namely the insulin-like growth factors (IGF) and the intracellular caspase proteins. Changes in the IGF-axis appear to affect this balance, with deficiencies possibly triggering apoptosis. Aim: To ascertain levels of apoptosis in the placenta of infants born small for gestational age (SGA) and appropriate for gestational age (AGA), comparing samples from two population groups, Pakistani and Swedish, in an attempt to better understand the mechanism behind foetal-placental growth restriction. Methods: Placental samples were taken immediately following delivery in both Karachi and Stockholm. In total 36 samples were included for further analysis (Pakistani: SGA n = 12, AGA n = 12; Swedish: SGA n = 7, AGA n = 5). Protein extraction was conducted for cell-death ELISA, and the remaining tissue samples were then paraffin embedded for further immunohistochemical and immunoflourescent analysis, looking at the apoptotic proteins, p53, caspase 8, and caspase 3. Furthermore, we compared maternal and newborn anthropometry between populations. Results: A higher apoptotic index, for caspase 8 and caspase 3, was seen in the Pakistani samples, as compared to the Swedish samples (p<0.01). TUNEL assays showed higher levels of apoptosis in the Pakistani population as compared to the Swedish population (p<0.01). Cell death ELISA analysis showed greater apoptotic activity in placenta from the Pakistani population as compared to the Swedish groups (p<0.05) as well as increased apoptotic activity in the SGA groups as compared to the AGA groups within each population (ELISA, p<0.05). No differences were seen in p53 levels as assessed by immunohistochemistry. Pakistani mothers were, on average, shorter than their Swedish counterparts (p<0.01).Conclusion: Increased apoptotic activity in placenta of the Pakistani population, as compared to their Swedish counterparts, may be associated with decreased foetal-placental growth seen in this population, particularly in babies born SGA. These findings, along with previously published results of the IGF-axis, and birth weight outcomes, suggests that lower IGF levels may be involved in the extracellular triggering of apoptosis, through caspase 8. This may further suggest a possible mechanism of foetal-placental growth restriction.