Category: Prior Clinic Blog
STUDY: Mothers Milk Best
JOURNAL: Pediatrics 2003;111:1017-1023.
AUTHORS: Dr. Koo
ABSTRACT: Use of palm oil and its more liquid fraction, palm olein, to supplement infant formula may adversely affect skeletal development.
COMMENTARY: Optimization of bone mass can begin during infancy with appropriate nutritional intake," but "infant formulas with similar contents can have different biological outcomes, depending on the ingredients added.
Dr. Koo of Wayne State University, Detroit, and colleagues point out that palm oil and olein "are used in some infant formula fat blends to match the fatty acid profile of human milk." Nevertheless, there is evidence that such additives lower calcium and fat absorption.
To investigate, the researchers conducted a double-blind study of 128 infants who were randomized to receive cow milk-based formulas with or without palm olein. The palm olein-containing formula was Enfamil with iron (Bristol Myers); the palm olein-free was Similac with iron (Abbott Laboratories).
Measurements taken at baseline (2 weeks of age) and at 3 and 6 months showed no significant differences between groups in factors such as weight and formula intake. However, infants fed the palm-containing formula showed significantly lower bone mineral content and bone mineral density at 3 and 6 months.
Matching the fatty acid profile of human milk by using palm olein, the researchers conclude, "may result in an unintended depression of bone mass accretion and may potentially be detrimental to optimal bone health."
JOURNAL: Pediatrics 2003;111:1113-1116.
AUTHORS: Dr. Weiss
ABSTRACT: By the time they reach 6 months of age, all infants should be examined by a pediatrician to determine their risk of developing dental caries.
COMMENTARY: Children who appear most likely to develop caries should perhaps have their first visit with a dentist before the recommended age of 12 months.
More than 40% of US children show signs of tooth decay when they enroll in kindergarten, making the condition many times more common than either asthma or hay fever.
Pediatricians need to be aware of the risk factors for dental caries in young children and, if indicated, make a referral to the dentist, the authors emphasize.
Although tooth decay is a general problem in children, some risk factors have been identified. For example, low socioeconomic status and consumption of sugary foods are known to increase the risk of dental caries.
Still, the direct cause of such disease is generally the overgrowth of certain bacterial types. Dr. Weiss explained that the types of bacteria a person carries in his or her mouth is essentially set by the age of 2 years old. This makes intervening early in life especially important.
Infants are likely get their first dose of these bacteria from their mothers or other close caretakers--often from sharing utensils--so risk assessments involve checking a mother's oral health, which can help determine her child's risk of also inheriting her cavities.
STUDY: Physiotherapy and local steroid injections were of similar effectiveness for treating new episodes of unilateral shoulder pain
JOURNAL: Ann Rheum Dis. 2003;62:385-387, 394-399
ABSTRACT: Steroid injection or physical therapy offers similar outcomes for the treatment of acute unilateral shoulder pain.
COMMENTARY: Community physiotherapy and local steroid injections were of similar effectiveness for treating new episodes of unilateral shoulder pain in primary care, but those receiving physiotherapy had fewer co-interventions.
Although the reasons for lower reconsultation rate during follow-up in the physical therapy group are unclear, the authors noted that it reduced their workload with no change in overall patient outcome.
They recommend that patients and clinicians deciding on acute treatment for shoulder problems consider personal preference, availability of physical therapy and/or of doctors trained in injection, need for cointerventions, and concerns about the long-term effectiveness of steroid injections.
STUDY: Careful with Sunbeds
JOURNAL: BMA's Board of Science and Education
AUTHORS: British Medical Association
ABSTRACT: People should stop using sun beds because of the dangers of ultra-violet radiation.
COMMENTARY: The "Sunbeds" report, from the BMA's Board of Science and Education, calls on the Government to regulate sunbed use after research has shown that some people are having more than 100 sunbed sessions a year.
It's ironic, people use sunbeds because they think they'll look better and yet they will probably end up looking old prematurely and possibly getting skin cancer.
The report said the risk of skin cancer appeared to be greatest for the young, with the chances of developing a tumour increasing by up to 20% per decade of sunbed use before the age of 56.
Other health risks include premature ageing of the skin and damage to the cornea, as people often do not wear protective goggles. There is also increasing evidence that sunbeds have an immunosuppressive effect.
The BMA noted that ultra-violet radiation is sometimes used to treat psoriasis and eczema. However in these circumstances a dermatologist records every dose after each treatment and a lifetime total is recorded as a safety measure. This careful dosing does not happen with tanning salons or when people have sunbeds in their home.
JOURNAL: ARVO 2003 Annual Meeting: Abstract 811/B786, presented May 4, 2003; abstracts 2111 and 2112, presented May 6, 2003.
AUTHORS: J. P. SanGiovanni,K. A. Trivedi
ABSTRACT: Dietary omega-3 fatty acids but not beta-carotene supplementation is associated with a reduced risk of age-related macular degeneration (AMD).
COMMENTARY: Higher intake of omega n-3 long-chain polyunsaturated fatty acid (LCPUFA) and fish was associated with decreased risk of having neovascular AMD after adjusting for nutrient- and nonnutrient-based predictors and correlates of AMD.
Total fish consumption of more than two servings per week was associated with a decreased risk for neovascular AMD compared with no fish in the diet (OR, 0.49; 95% CI, 0.28 - 0.84). Having more than one four-ounce weekly serving of broiled or baked fish (OR, 0.64; 95% CI, 0.44 - 0.94) or tuna (OR, 0.66; 95% CI, 0.45 - 0.98) also protected against neovascular AMD.
A second study, by W. G. Christen, from Brigham and Women's Hospital in Boston, Massachusetts, and colleagues, showed no protective effect of beta-carotene against AMD.
In the third study, by K. A. Trivedi and colleagues from Harvard Medical School in Boston, Massachusetts, women with a higher dietary intake of omega-3 fatty acids were at decreased risk of developing dry eye syndrome (DES).
Of 39,876 women participating in the Women's Health Study, 32,470 female health professionals aged between 45 and 84 years provided information on diet and DES. The highest versus the lowest dietary intake of omega-3 fatty acids was associated with decreased risk of DES (OR, 0.83; 95% CI, 0.70 - 0.98; P for trend = 0.04), after adjustments for age, other demographic factors, postmenopausal hormone therapy, and total fat intake.