Maternal & Child Health Links:
Research, Education, Extension & Technology
Volume II

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

Responses to Volume I:  Quotes from Readers Across the Country
Research News:  Applying Plant Nutrition to Human Nutrient Needs
Did You Know? Research Methods--Hydroponic Growth - System Protocols
Lactation:  Storing Breast Milk
Teen Pregnancy:  Retrospective Analysis of Trends
Infant Feeding:  Bottled Water for Babies
Immunization Perspectives:  Parent Survey & Hispanic Focus Group Results
Smoking Parents Linked to Children's Poor Diets
Summer Safety for Kids:  Trampoline Risks--Pet Choices
First Year Findings of USDA's  "What We Eat in America" Survey
Resources Available
Electronic Connections:  World Wide Web Sites
Journal References Worth Noting
Subscribe Online for the electronic version of MCH LINKS

Responses to Volume I 

A sample of responses: "Bravo!  The first issue was excellent!"...a state specialist from  Michigan.  "Just a note to tell you this kind of research-based information is well received"... a nutrition faculty member from Texas.  "It is immediately useable for my regular radio and news columns"...an Extension educator from Minnesota.  "Lots of useful information for us non-Extension folks, thanks"...a National Agricultural Library staffer from Maryland.  "I'll use this journal to assist me in preparing a newsletter for our state public health nutritionists and will retain a hard copy in our Nutrition Research Library"...a nutrition training specialist in the New York State Department of Health.

Applying Plant Nutrition to Human Nutrition Needs

At the USDA/ARS Children's Nutrition Research Center, scientists are determining the dietary requirements of individual nutrients from foods, as normally consumed, for children and pregnant and lactating women.  The daily requirement for each nutrient varies among individuals depending on their developmental age and/or physiological state, plus the bioavailability of that nutrient.  For instance, a 12-year-old adolescent has a higher calcium requirement than a 45-year-old adult (per kg body mass), because of the active bone growth and mineral deposition which occurs at this earlier developmental age.  Similarly, because of menstrual iron loss, a 30-year-old female will have a higher iron requirement than a 30-year-old male.

The CNRC is unique in that it combines plant research and human research under one roof.  This multidisciplinary effort is led by Michael Grusak, PhD, USDA/ARS Plant Physiologist and adjunct assistant professor of pediatrics at Baylor College of Medicine.  The Plant Physiology Laboratory, equipped with a greenhouse, growth chambers and hydroponic facilities, allows the study of plant nutrient transport in important food crops.  This research enables Grusak's group to develop methodologies to study human nutrient requirements and additionally offers answers to how plants could be modified or manipulated to provide more nutrients in the foods adults and children regularly eat and enjoy.

Current efforts focus on determining the calcium bioavailability from green beans when fed to adolescent males and females.  Adolescents have a high requirement for calcium.  While the optimal source is milk and other dairy products, consumption of these products appears to be declining in many adolescents-especially females.  Little is known about the ability of children to absorb calcium from vegetables.  While green beans are not the richest vegetable source of calcium, they are more popular than calcium-dense vegetables such as broccoli or mustard greens.  Dr. Grusak has developed an efficient and economical hydroponic growth procedure that allows the intrinsic labeling of green beans with a stable calcium isotope.  These labeled vegetables can then be harvested and safely fed to humans--both children and adults--to investigate the biological availability of calcium from this food source.  This determination is essential before recommendations can be made regarding the amount of the daily calcium intake requirement that can be met by eating green beans.

In addition to these human investigations, efforts are underway to determine the plant processes responsible for calcium deposition in the green bean pod.  Recent studies have indicated broad differences in calcium concentration between green bean varieties.  Differences in  pod physical characteristics have been identified between varieties that correlate with calcium concentrations.  The knowledge gained in these studies can lead to significant improvements in the nutritional quality not only of green beans, but also can be applied to other food crops. Eventually, improved plant varieties can then be assessed in human bioavailability investigations.  

(J. Sci. Food Agric. 70: 11-15, 1996 & J. Amer. Soc. Hort. Sci. 121: 656-659, 1996)

Did You Know?  Research Methods:  Hydroponic Growth - System Protocols

- Growing and labeling plants in a hydroponic medium rather than a soil matrix allows a scientist to control the elements that the plants have available for absorption and also to generate nearly-uniform enrichments when necessary.   When expensive stable isotopes are used in a study, the use of hydroponics eliminates the isotope loss that would occur via adsorption onto soil particles.  Labeled plant foods can be used to study nutrient absorption and metabolism in humans.

The unique arrangement that Dr. Grusak and his group have designed for the CNRC is a recirculating hydroponic system for administering stable isotopes of all nutrients which are normally absorbed by the root system of the plant.  It is comprised of 10 interconnected growth containers and a reservoir tank, for recirculating the nutrient solution.  Elevated nutrient solution refill tanks, connected to a mechanical float in the reservoir tank, serve to maintain a constant volume in the reservoir tank and a pH meter/controller activates acid or base additions as required.  In order to grow and label a crop, three phases are involved:  1) selection of an appropriate crop plant which will incorporate the nutrient of interest; 2) preliminary growth of the crop without label, to determine harvest yield and net nutrient influx dynamics; and 3) the actual labeling of the crop with the stable isotope(s).

The result of these processes is the ability to generate safe, traceable plant foods that can help answer questions about the absorption and utilization of specific nutrients in human nutrition studies and also provide information for use by agronomists interested in ways that plants can be manipulated to enhance their nutritional quality.  (J. Sci. Food Agric. 64: 223230, 1994)

Lactation:  Storing Breast Milk

Storing human milk for home or day care use requires a few precautions.  Judy Hopkinson, PhD, lactation physiologist and assistant professor of pediatrics at the Children's Nutrition Research Center (CNRC), Baylor College of Medicine, has these recommendations.  First, wash hands with soap, then express the milk into clean glass or plastic bottles.  Bottles should contain a single serving--usually 2-3 ounces for a very small infant and 3-4 ounces for an older one.  Be sure to leave 1/2-1 inch room at the top for expansion.  Label and date the bottle.  Dr. Hopkinson suggests storing the bottles in the back of the refrigerator if the milk is to be used within 5- 7 days.  For longer periods, place in the back of the freezer.  Avoid putting bottles in the door of either the refrigerator or the freezer as the temperature is less stable there.  Transport milk on ice or in a cooler. Collection and storage equipment should be sterilized periodically and after episodes of mastitis or yeast infection.

Use frozen milk within 3 months.  To thaw, put the bottle in a bowl of hot water or hold under running tap water.  Test a drop on the inside of the wrist to make sure it is body temperature.

Boiling human milk or heating it in the microwave is not advised. Frozen milk does not look the same as fresh--it separates and may look lumpy--but it is perfectly safe to use.  Storing milk for hospitalized infants requires greater care and individual hospital guidelines should be followed.

Teen Pregnancy Report

A recent retrospective analysis of trends in data on pregnancies, abortions and birth rates of United States adolescent girls ages 13 to 19 years was done for the years 1980, 1985, and 1990.  Pregnancy rates among 15-to 19-year-old teenagers remained fairly stable from 1980 to 1985 but increased by 9% during the last half of the decade, reaching 95.9 pregnancies per 1000 teens by 1990.

Despite the increase in the pregnancy rate, there was a decline in the total number of pregnancies among 15-to 19-year old girls, primarily due to the decline in the population of that age group between 1980 and 1990.  In 1980 there were 10.4 million 15-to 19-year-old girls and by 1990 the number had decreased to 8.7 million.  In 1990 the pregnancy rate for girls 13 and 14 years old was 7.1 per 1000 girls--a 13% increase in ten years. Pregnancies in that age group account for about 3% of all adolescent pregnancies.

Despite similar rates of sexual experience, rates of adolescent pregnancies and births are higher in the United States than in other developed countries.  National health objectives for the year 2000 include reducing the pregnancy rate for adolescent girls ages 17 or younger to no more than 50 pregnancies per 1000.  The 1990  rate for15-to 17- year old girls is about 26% higher than this goal.  (Journal of the American Medical Association  275 (13) 1996).

Bottled Water for Babies

The popularity of bottled water for adults has led some baby-food manufacturers to produce bottled water for babies.  The new products are being test-marketed in both grocery and drugstore chains.  According to the American Academy of Pediatrics, babies get all the water they need from breast milk or formula during the first 6 months of life.  The only time an infant might need a little extra water is during extremely hot weather.  Then no more than about 4 ounces of water (apart from feedings) is recommended in a 24-hour period.

Since the bottled water is often stocked in infant care sections of stores, new parents may confuse it with more expensive electrolyte solutions, which are typically recommended for diarrhea sufferers and used under a physician's guidance.  In addition, some bottled waters contain fluoride.  The American Academy of Pediatric Dentistry recently recommended that fluoride, a mineral which helps prevent cavities, should not be provided in any form to infants in areas with inadequate tapwater fluoridation until the babies are 6 months old, when they are customarily given inexpensive fluoride supplements.

If consumers choose to buy bottled water for other uses, they do not need to buy a brand specifically for babies.  (Tufts University Diet and Nutrition Letter 13 (1) 6-8, 1995).  

Immunization Issues--Parent Survey Results & Hispanic Focus Groups Identify Barriers

A recent survey entitled "Vaccine Report: Parents Speak Out on Immunization" provides insight into the lack of understanding and awareness among some parents about the importance of immunizations.  Survey findings include:

• 59% of respondents did not know that children should receive their first immunization against pertussis by 2 months of age
  

• 20% believed pertussis was not contagious, 47% were not aware that polio was contagious, and 32% did not know that measles could be fatal

• Many parents were not aware that multiple doses of vaccine are required to provide adequate protection, 26% thought one dose of diphtheria, tetanus and pertussis (DTP) was adequate and 36% believed one dose of haemophilus influenza type b (Hib) was adequate.
• Only 1 percent had any idea of the increase of measles cases in the last decade, and the vast majority thought the increase had been 50% when the actual increase was 1000%

These findings underscore the critical need for education and the importance of repeating the messages frequently to reach new parents.

Hispanic consumers reported the following barriers to immunization:

• Inconvenient clinic hours and locations
• Seldom, or never, finding materials available in languages other than English
• Lack or scarcity of bilingual/bicultural health clinic staff
• Having reservations about the confidentiality of public health clinics and thus being reluctant to go to them for services

Research conducted by the National Coalition of Hispanic Health and Human Services

Smoking Parents Linked to Children's Poor Diet

A recent study analyzed the diets of 515 children between the ages of 2 and 17 to assess the association between parental smoking and the diet quality of the children residing in lowincome households. The chief finding was that low-income children of parents who smoked had significant differences in their diets when compared with children of nonsmokers.

Children whose parents smoked 11 or more cigarettes a day had lower vitamin A intakes, higher total calorie and sodium intakes and the highest cholesterol intakes compared to the rest of the sample.  Total fiber intake also correlated with parental smoking;  the children of smokers had lower fiber intakes than children of nonsmokers.  All the adverse outcomes increased the smoker's children's risk of chronic disease.

Parents with the heaviest cigarette habit spent a smaller proportion of their grocery-store money on food.  The findings suggest that in low-income households, the poor dietary habits of adults who smoke are transferred to their children.  The findings also emphasize the importance of the role pediatricians, other health practitioners, and educators play in nutrition counseling with low-income children of smoking parents.  (Pediatrics 97:312317,1996)

Summer Safety for Kids 

Trampolines are fun, but children need supervision when using them.  According to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, more than 40,000 children under age 15 were treated in hospital emergency rooms in 1994 for injuries related to trampolines.  The most common injuries included fractured forearms, tibias, elbows & hands.

Iguanas, turtles and other reptiles pose serious health risks for young children, babies and even fetuses, according to a recent report form U.S. Centers for Disease Control and Prevention (CDC).  Many reptiles carry salmonella bacteria which can spread from the animal's fecal matter to a person's hands-typically after the person has handled the animal or its cage. Salmonella, which causes food poisoning can lead to meningitis or other ailments.  The CDC studied 13 state health department reports from 1994 and 1995 linking salmonella infections to pet reptiles.  Often the children involved were less than six months of age.  The CDC recommends:

• Pregnant women and children younger than 5 should not have contact with reptiles
• Reptiles should not be kept in day-care centers
• Owners should always wash their hands after handling the animals or their cages

First Year Findings of USDA's  "What We Eat in America" Survey

American diets are changing, according to data based on personal interviews with about 5,500 Americans of all ages across the country, including low-income individuals, children, and the elderly.

On any given day in 1994...

Food consumed outside the home contributed about 20% total calories for 3-5 year olds and

Increased to 25% for 6-11 year olds

Reached 33% for 12-19 year olds

1 of 3 school-age children get more than 40% of their total days calories away from home

The number of women and young children eating away from home has increased 50% since the late 1970s

Where are we eating besides home?

• 3-5 year olds, #1 someone else's house, #2 fast food  restaurants, #3 day care units
• Grade school ages, #1 school cafeteria, #2 someone else's house, #3 fast food restaurants
• Teen boys, #1 fast food restaurants
• Teen girls, #1 school cafeteria, #2 fast food restaurants

( Findings reinforce the importance of the School Lunch Program and USDA's Team Nutrition)

Overall consumption trends compared to 1977-1978:

Decrease - fat, 5-7% milk, 16% for children under 5

Increase - grain mixtures, 115% (especially ethnic ones such as  Mexican) snacks, 200%    calories, 6% body weight, 11-12 lbs. non-citrus juices (grape, apple), 300% fruit, 20% - primarily due to juices

Comparison to Recommended Dietary Allowances:

• Children and teen-aged males meet RDAs for most nutrients
• Teen-aged girls averaged 85% or less of the RDA for calcium, magnesium, zinc and      vitamin E
• Women fell short for intakes of iron, zinc, magnesium, vitamin B6 , calcium, and vit. E
• Males did not meet the RDA for zinc or magnesium

(Agricultural Research Service Food & Nutrition Research Briefs, January, 1996) 

Resources Available

1. National Information Center for Children and Youth with Disabilities (NICCYD).  A clearing-house that provides free information on children's disabilities and disabilityrelated issues. 1-800-695-0285
    

2. Independent Study Course for Child Care Providers
   Title:  Caregivers Manual, Univ. of  Nebraska, NE Research & Extension Center Target Audience:  Child care providers in center based  facilities & family child care providers
   Includes:  11 chapters providing 1 hour training each,  ending with a quiz, 350 pages  Topics include nutrition, food preparation, how children ages 3-5 develop and more
   Cost:  $20--Check, Visa, or Mastercard.
   Order from:    Caregiver Manual
                       P.O. Box 830918
                       Lincoln, Nebraska 68583-0918
   Info Contact:  Darlene Martin, Internet nerc010@unlvm.unl.edu
    

3. Charting A Positive Future for Teen Parents ( CHOICES)
   Title: Choices, Univ. of  Florida Cooperative Extension Service
   Target Audience: Pregnant teens
   Includes:  Curriculum and Videos--experiential learning activities related to prenatal care,parenting, nutrition resource management and confidence skills.
   Cost: 3 volume curriculum @ $50 each, plus postage  Set of 4 videos $20
   Order from: IFAS Publications
                    P.O. Box 110011 Univ. of Florida Gainesville, FL 32611-0011
   Info Contact:  Extension Home Economics Faculty 352-392-2090

Electronic  Connections

Journal Articles Worth Noting

1. Krebs-Smith S, Cook A, Subar A, Cleveland L, Friday J, Kahle L.  Fruit and vegetable intakes of children.  Archives of Pediatric Adolescent Medicine 150: 81-86, 1996.  Article contains an analysis of 3 days of dietary data from respondents in the USDA's 1989-1991  Continuing Survey of Food Intakes by Individuals.  Intakes of all fruits and dark-green and deep-yellow vegetables were very low compared to recommendations.

2. Sells C, Blum R.  Morbidity and mortality among U.S. adolescents: an overview of data and trends.  American Journal of Public Health Vol 86 (4): 513-519, 1996.  This synthesis of data illustrates the significant shifts that have occurred over the last decade.
3. Hingley A.  Preventing childhood poisoning.  FDA Consumer Vol 30 (2): 7-11, 1996.  Article contains detailed information on lead- and iron-containing products.
4. Bucher H, Guyatt G, Cook R, Hatala R, Cook D, Lang J,  Hunt D.  Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia.  JAMA Vol 275  (14): 11131117, 1996.  This is a meta-analysis of randomized controlled trials indicating that calcium supplementation during pregnancy leads to an important reduction in systolic and diastolic blood pressure and preeclampsia.
5. Shaw G, Velie E, Schaffer D.  Risk of neural tube defect-affected pregnancies among obese women.  JAMA Vol 275 (14) 1093-1096, 1996.  Authors conclude as many as 10% of women may be obese periconceptionally and they have a twofold increased risk of having babies with NTDs--even when consuming recommended amounts of folic acid.

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".