Maternal & Child Health Links:
Research, Education, Extension & Technology
Volume I
This newsletter is written by and transmitted electronically from
Karen
L. Konzelmann, National Program Leader--Maternal and Child Health,
Cooperative State Research, Education and Extension Service, USDA.
It is intended for Cooperative Extension System educators in the
fields of nutrition, human health and nutrition research.
TABLE OF CONTENTS
Introductions: Dr. Alma C. Hobbs,
Dr. Dennis M. Bier
Research News: Is Iron Better Absorbed with
Juice or Milk?
Did You Know?: Research Methods--Use
of Stable Isotopes
What's New in Lactation, Teen Pregnancy, Infant
Feeding
Cultural Issues
Trends in Maternal & Child Health:
Early Hospital Release; HIV Testing; Lead
Still An Issue; Child Health Study
Resources Available
Electronic Connections, World Wide Web sites
Journal References Worth Noting
Subscribe Online for the electronic version
of MCH LINKS
Introductions:
It is my pleasure to welcome you to the first edition of Maternal
& Child Health Links. The purpose of this electronic communication
is to strengthen the research foundation for our educational programs
by highlighting current research and available resources in the
fields of maternal and child health. We have a unique partnership
with the Agricultural Research Service and Baylor College of Medicine,
which operates the Children's Nutrition Research Center (CNRC) in
Houston, Texas. By locating one of our national program leaders
at the CNRC, we have the opportunity to forge linkages between the
medical, research and education communities and our units' nutrition
team.
Dr. Alma C. Hobbs,
Deputy Administrator
Families, 4-H & Nutrition, CSREES-USDA
The Children's Nutrition Research Center is one of the five ARS
Human Nutrition Research Centers. Our Center is unique because
it is the only HNRC that operates under a Cooperative Agreement,
in this case with Baylor College of Medicine. The Mission
of the CNRC is "to define the dietary needs which will assure
health in pregnant and lactating women and in children from conception
through adolescence." This rather simple mission statement
directs a diverse scientific program, conducted by more than 30
faculty scientists, that encompasses basic and applied research
in botany, animal sciences, and human nutrition. None of this
research will ultimately "assure health" unless the investigational
outcomes are communicated to individuals who can implement them.
For this reason, the CNRC is delighted to participate in our partnership
with the CSREES and, thus, link our research with its application
through the educational activities necessary to translate and disseminate
this information.
Dr. Dennis M. Bier, Director--Children's Nutrition Research
Center
Is Iron Better Absorbed with Juice or Cow's
Milk?
One-year-old children absorb iron supplements better when given
with apple juice than when given with cow's milk, according to a
recent study at the Children's Nutrition Research Center, published
in the January issue of Pediatric Research. Steven Abrams,
M.D., associate professor of pediatrics at Baylor College of Medicine,
conducted the research to evaluate both the absorption of supplemental
iron and the different methods of providing the supplement.
BACKGROUND: Although iron-deficiency anemia has decreased in recent
years in the United States, making sure infants and toddlers get
an adequate amount of the mineral remains an important nutritional
concern--particularly at the time of weaning from formula or breast
milk to cow's milk. Cow's milk is known to be low in iron
and high in calcium. Large amounts of calcium have been shown
to inhibit iron absorption. Ferrous sulfate is widely used
to provide supplemental iron for infants and toddlers. Prior
studies have shown that iron absorption is enhanced by ascorbic
acid, but there were no studies of absorption on this age group,
nor had any evaluation been done of different methods of administering
the iron.
STUDY METHOD: Dr. Abrams used a two-tracer stable isotope
technique to determine iron absorption from a 5-mg dose of stable
isotopically enriched ferrous sulfate given with a typical cow's
milk containing meal including a small amount of ascorbic acid compared
to the same dose given with apple juice containing 42 mg of ascorbic
acid. The study subjects were 10 children who had recently
discontinued formula feeding and had begun cow's milk. Red
blood cell iron incorporation of the isotope was determined 14 days
after dosing and the iron absorption calculated based on the assumption
that 90% of absorbed iron is incorporated into the red blood cells.
RESULTS: Iron absorption was significantly greater when given with
juice than with milk. Iron absorption was negatively correlated
with serum ferritin levels, leading to the conclusion that a small
supplement of iron is better absorbed when given with juice, than
with milk. Also there was a large variability in iron absorption
in healthy 1-year-old infants which was related to their existing
iron stores. (Pediatric Research 39:1- 5, 1996)
Did You Know? Research Methods: Use of
Stable Isotopes
Researchers are often asked about the safety of their studies,
especially on infants and children. Very stringent rules are in
place for obtaining approval of the studies and for securing the
informed consent of the families. One current method used
for clinical trials studying metabolism involves the use of stable
isotopes. Stable isotopes are naturally occurring, nonradioactive
minor isotopes of elements that are completely safe for human beings
of all ages, including premature infants. Use of these isotopes
allows a scientist to "trace" a precisely measured and
administered dose of the specific substance being studied and then
determine, after analysis by mass spectrometry and other methods,
the amount that is absorbed or utilized. For example, calcium
stable isotopes can be fed and given intravenously to determine
how fast bone is being formed. The use of stable isotopes
requires very sophisticated analytical techniques. CNRC scientists
use a wide variety of stable isotopes to measure energy utilization,
iron metabolism and protein and cholesterol metabolism.
What's New In...
Lactation:This is the most energy-demanding
phase of a woman's reproductive cycle. Dr. Nancy Butte, associate
professor of pediatrics, CNRC, has an ongoing study to look at the
specific energy costs of nursing a baby in order to further define
the caloric requirements to adequately nourish an infant and also
assure a healthy weight range for the mother postpartum. Interesting
findings to date show that 24-hour sedentary energy expenditure
and sleeping metabolic rates of lactating women are actually higher
than those of postpartum, non-lactating women, possibly due to the
cost of synthesizing milk. When the level of free-living physical
activity was measured it did not differ significantly between groups
of lactating and non-lactating women, nor did the level of activity
affect the lactation performance. More as this study progresses.
Teen Pregnancy:Significance
of iron-deficiency anemia. Both pregnancy and adolescent growth
are associated with increased iron requirements. Pregnant
adolescents, particularly those who enter pregnancy with depleted
iron stores due to recent growth, are at high risk for iron-deficiency
anemia. According to the 1990 Pregnancy Nutrition Surveillance
System data, the prevalence of iron-deficiency anemia in pregnant
adolescents was 11% during the first trimester, 16% during the second,
and 37% during the third trimester. Iron-deficiency anemia
in early gestation has been associated with a 2-to 3-fold increased
risk for prematurity and low-birth-weight infants. This is
another reason to urge the pregnant teens in your classes to seek
early prenatal care and also to take any medication prescribed by
their health-care provider. (Story, Nutrition Issues & Adolescent
Pregnancy, Nutrition Today, July-August, 1995).
Infant Feeding: Experts recommend only 1-2 servings
of juice each day for children under 4--a serving size being 2-4
ounces. Fruit juice has become a childhood staple in recent
years and the concern pediatricians have is that excess juice can
replace more nutrient-dense foods like milk. Children under the
age of 5 drink more juice than any other age group. (Tufts
University Diet and Nutrition Letter, Vol.13 No.3. May, 1995).
Cultural Issues: The new census
report on the foreign-born population: 1994 provides a demographic
snapshot of changes in the U.S. and underscores our need for multicultural
teaching materials. Highlights of the report include:
- More immigrants have come in the last 5 years than at any time
since the end of WWII
- About 25% of the most recent immigrants were from Mexico, with
large numbers also from Russia, Vietnam, Cuba, the Dominican Republic
and the Philippines
- Vast majority settled in 6 states--California, Florida, New
York, Texas, Illinois, and New Jersey (U.S. News & World Report,
September 11, 1995)
Trends Related to Maternal & Child Health
Early Hospital Dismissal for New Mothers: Many health plans
are requiring new mothers to be discharged within 24 hours after
an "uncomplicated delivery." Some hospitals are
even offering cash incentives of $100 to women who agree to leave
the hospital early. Medical concerns with this practice are
numerous for both the new mother and the baby. In such a short
time, bleeding or infection may not show up in the mom and the lack
of time may prevent or interfere with complete newborn screening.
Important practices as the establishment of lactation and the detection
of jaundice do not occur in such short hospital stays. The
human concerns of time and energy to learn how to care for a newborn
and the ability to detect future problems such as dehydration are
all at issue. Health care professionals agree that good home-care
follow-up is critical and a plan needs to be in place before the
new family leaves the hospital. An indication of the concern
and emotion involved in this issue is the fact that 50,000 letters
were sent to a congressman in support of his bill to allow 48-hour
maternity stays after an article entitled "Home Too Soon"
ran in the October, 1995 issue of Good Housekeeping. In an
effort to safeguard new mothers, the American Academy of Pediatrics
and the American College of Obstetricians and Gynecologists are
planning to issue new guidelines in the spring.
For additional details see Pediatrics, Vol.96 No.4 Oct. 95
HIV Home Testing: Watch for Food and Drug
Administration approval of a kit to use at home to test for HIV,
the virus that causes AIDS. This could be especially important
for pregnant women who could take the test privately and, if HIV-positive,
could then receive treatment to diminish the risk of transmittal
to their unborn child.
Lead Still An Issue: At least 10% of
preschoolers have lead poisoning, according to the National Safe
Kids Campaign. Sponsors recommend having a child tested for lead
between 9 months and 1 year and then again at age 2. This is especially
critical if the child lives in a dwelling built before 1978.
Children's Health Study - 1995
The American Health Foundation and Scholastic, Inc. surveyed 3,112
students in grades 2 through 6 in 175 public, private schools in
United States Survey highlights include:
- 90% agreed it is important to exercise regularly
- 85% know they should eat fruits and vegetables at least 3 times
daily
- 50% said they had eaten only one fruit or one vegetable or
none "yesterday"
- 55% knew whole-wheat bread had fiber
- 25% thought cheese had fiber, 14% thought butter had fiber
- 79% knew eating foods high in fat could make you gain weight
- 47% drank regular milk, 36% low fat/skim milk
- 33% wore a helmet the last time they rode a bicycle
- 81% wore a seat belt in their last car ride
- 21% believed AIDS could not be passed from one person to another
- 45% live in a household where a gun is kept
- 45% of 6th graders reported they drank beer, liquor or wine
in the past
Full document IFAN # 121011714 accessed via PEN pages
- Note: percentages are rounded
Folate-Folic Acid:
Good for All Ages A vitamin that reduces the
risk for neural tube defect in newborn babies may also prevent heart
attack and stroke. The vitamin is folic acid--a B-vitamin
that is essential for DNA synthesis, cell proliferation and replication,
tissue growth and the production of red blood cells. Studies
have shown conclusively that consumption of supplemental folic acid
in addition to folates contained in the diet can prevent significant
numbers of cases of spina bifida and anencephaly, two of the most
common and severe birth defects. The defects occur when the
neural tube which develops into the spinal cord fails to close--18-26
days after conception. If the error occurs at the top of the
tube, the child is born with anencephaly (no brain) and dies soon
after birth. If the error occurs further down the spinal cord,
the child is born with spina bifida--an open spine. In 1992
the U.S. Public Health Service published the recommendation that
all women capable of becoming pregnant should consume 400 micrograms
of folic acid daily. More recently, scientists have found
evidence that a deficiency of folic acid may promote the development
of atherosclerotic plaque, which can lead to heart attack or stroke.
Folic acid is involved in regulating homocysteine. A deficiency
or an inability to metabolize folic acid can cause the blood levels
of homocysteine to rise. This can then lead to an increased
expression of the clotting enzymes and tissue factors affecting
the development of blood clots and plaque. Currently decisions
are being made regarding the best way to increase the consumption
of folic acid. Options include recommending a supplement for
specific high-risk individuals or taking the population-based approach
of fortifying the common food supply by enriching a cereal-grain
product such as flour. Meantime, the best advice is to eat
plenty of fresh fruits and vegetables.
See Journal of the American Medical Association, Dec.6, 1995,
1717-18 & 1698-1702 for further information.
Resources Available
Nutrition Information Service at CNRC 1-713-798-7017
Center for Disease Control AIDS Hotline 1-800-342-2437
National Hispanic Immunization Hotline 1-800-232-0233
Lead Information Center 1-800-424-5323
Two educational courses for pregnant teens have recently been revised.
-
Title: Today's Mom, Alabama Cooperative Extension Service
Target Audience: pregnant teens, adults & women with
infants to age 1
Includes: leader's guide, 6 one-hour lessons covering
prenatal nutrition, food safety and infant feeding--flip charts
& templates for 14 posters.
Cost: $30. Check only, no purchase orders
Order from: Extension Asst. Director-Communications,
222 Duncan Hall Annex
Auburn University, AL 36849-5623.
Info Contact: Barbara Struempler,
e-mail bstruemp@acenet.auburn.edu
-
Title: Have A Healthy Baby, Purdue University Cooperative Extension
Service
Target Audience: pregnant teens and limited resource adults
Includes: leader's guide, five lessons on prenatal nutrition
and life-style choices, participant workbook, camera-ready evaluation
forms, fetus model & graduation
certificate.
Cost: Teen version
$40
Adult version,
including video
$50
Order from: Agricultural Communications Service
Media Distribution Center
301 S. Second Street
Lafayette, Indiana 47905-1092
More Info: Contact Donna Vandergraff,
e-mail Donna_Vandergraff@acn.purdue.edu
Electronic Connections
References Worth Noting
American Academy of Pediatrics. Healthy Parenting. Prevention,
October 1995,75-78. Article discusses strategies for children's
preventive health care and violence prevention
Williams M, Parker, Baker D, Parikh N, Pitkin K, Coates W &
Nurss J. Inadequate functional health literacy among patients
at two public hospitals. JAMA, December 5, 1995 Vol 274 No
21:1677-1682
Editorial: Patients who can't read: Implications for the health
care system. JAMA, December 6, 1995 Vol 274 No 21:1719-1720.
Discusses relationship between health and socioeconomic class and
the importance of education.
Rosenbaum J. Beat the clock: new treatments for infertility.
American Health, December 1995: 71-90. Article discusses the
issues involved in dealing with infertility including some of the
current controversies and contains diagrams of procedures and a
definition of terms.
Kennedy E, Goldberg J. What are American children eating?
Implications for public policy. Nutrition Reviews, May 1995
Vol 53, No 5:111-126. This is a detailed review of policy
issues looking at new food consumption patterns and their relationship
to the Dietary Guidelines.
The purpose of this communication is to provide updates on relevant
research and resources for education programming. Please let
me know if this meets your needs or if you have ideas for topics
to include. In order to facilitate sharing materials across
the states, information about new materials will be included if
details are forwarded to me. A specific electronic mail address
has been established by Baylor College of Medicine
for responses. It is MCHLINKS@bcm.tmc.edu
The Cooperative State Research, Education, and Extension Service,
USDA, is the Federal partner of the state and territory land grant
universities in their research, education, and extension missions.
The USDA prohibits discrimination in its programs on the basis of
race, color, national origin, sex, religion, age, disability, political
beliefs, marital or family status. Mention of a product,
service, or curriculum does not constitute endorsement by USDA or
CES unless the curriculum citation specifically says "recommended
for use in all States and Territories".
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