Maternal & Child Health Links:
Research, Education, Extension & Technology
Volume III
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
Research News: Body Composition Differs Among
Ethnic Groups
Did you Know? Research Methods: Dual-Energy X-ray
Absortiometry (DXA)
Lactation: Teen Moms Lactation Differs from
Adult Moms
Infant Feeding: AAP Recommends Boiling Water for
Formula
Cultural Issues: Second Largest Group of Kids
are Hispanic
Women's Health Initiative Recruiting
Eight Medical Tests Women Should Not Ignore
Pacifiers and Ear Infections
Resources Available
Electronic Connections
Journal Articles Worth Noting
Subscribe Online for the electronic version
of MCH LINKS
Research News: Body Composition Differs
Among Ethnic Groups
In order to understand differences in growth and body composition,
scientists are studying children and teens from different ethnic/racial
groups. Findings from an on-going study at the Children's Nutrition
Research Center show African-American girls and boys tend to grow
taller and heavier sooner than white or Hispanic children.
Hispanic boys and girls have significantly more body fat than white
or black children. Hispanic girls averaged 32 percent body fat;
boys averaged 24 percent. Among females in general, white girls
had the lowest average body fat at 26 percent. Black boys
average the lowest body fat for males at 19 percent. The study is
being conducted by Kenneth Ellis, a research biophysicist and professor
of pediatrics at Baylor College of Medicine.
BACKGROUND:Body composition studies have been conducted over the
last 40 years, but principally on white children. The former
studies focused on just three age groups--birth, 6 months, and 9
to 10 years. U.S. children today weigh more and are taller
and bigger than in previous generations. One in three girls
and one in four boys today has body fat levels considered to be
obese for adults. This is double the frequency seen only 20
years ago.
Dr. Ellis wants to determine when the extra weight becomes mainly
fat, compared to muscle or bone and also to measure the different
rates among various ethnic groups. He also wants to provide
data on normal bone growth for use by health professionals.
STUDY METHOD: The study objective was to establish the range of
normal body composition values for a multiethnic population (ages
3-18) using dual-energy x-ray absorptiometry -- a state of the art
technique (see following article). The study participants are equally
divided among boys and girls and white, black, and Mexican-American
populations. Current data reflect results on more than 800 children
and teens out of approximately 1,200 total study subjects. Bone
mineral content (BMC), lean tissue mass, body fat mass, and percent
of fatness are being examined as a function of age and sexual maturity.
For participants to qualify for this study both parents had to be
of the same ethnic group and be at least second-generation U.S.
residents.
RESULTS: In general, the average values for the bone mineral
content (BMC) and lean mass compartments for the black children
are higher than those observed for the age-matched white or Hispanic
children. The differences became statistically evident for
the bone mineral content by age 3-5 years and by 6-8 years for the
total body lean tissue compartment, which is mainly muscle mass.
Hispanic girls are found not to be different from the white girls
in terms of the BMC and lean compartments. Thus, reference BMC and
lean values developed for a white population may be adequate for
Hispanics, but not black children. Data from this study have shown
African-American girls and boys mature sexually about three years
sooner than white or Hispanic children--a finding consistent with
other studies.
Did You Know? Research Methods:
Dual-Energy X-ray Absorptiometry (DXA)
Dual-energy x-ray absorptiometry, often referred to as DXA, is
one of the most sophisticated techniques in measuring growth.
It provides information for a three-compartment model of body composition;
bone mineral content, non-bone lean tissue mass, and body fat mass.
The DXA instruments have the capability of measuring both total
body and regional bone content with good precision, very low radiation
dose, and minimal measurement time. Typically, a study subject
lies quietly for 10-15 minutes while an imager scans his or her
body. There is no discomfort. These characteristics allow
DXA to be used with infants and children, as well as adults, and
also allows persons with bone problems to be scanned more often
than was possible with previous methods such as neutron activation.
Scientists at the Children's Nutrition Research Center have pioneered
the use of DXA with infants and children and also compared DXA with
other methods for accuracy and safety.
DXA is the same process used in hospitals and clinics across
the country to measure the density of intact bone in the diagnosis
of osteoporosis.(Journal of Bone & Mineral Research , Vol 11
(6):843-848,1996).
Lactation: Teen Moms' Lactation Differs
from Adult Moms
A recent study completed by Dr. Kathleen Motil, assistant professor,
Baylor College of Medicine, examined the adequacy of milk production,
milk composition, and lactational behavior of adolescent mothers,
and compared their lactational performance with that of adult mothers.
There were no significant differences in the nutrient composition
of the milk between the two groups, with the exception of higher
sodium concentrations in the adolescents' milk during early lactation.
The teens' lactational performance differed from the adult moms
in that they tended to nurse their infants less often and for a
shorter duration. In this particular study, begun at six weeks postpartum,
the teens produced less milk than the adult mothers.
BACKGROUND: Even though about 675,000 adolescents in the U.S. give
birth annually and approximately 30% of them breast-feed their infants,
there are little scientific data on the lactational capacity of
the adolescent mother. Some evidence suggests the adolescent is
incapable of producing the volume of milk necessary to nourish the
infant while other opinions suggest the composition of the adolescent
mother's milk may be altered to compensate for the reduced volume.
STUDY METHOD: In order to characterize the differences in
milk production, milk composition, and the lactational behavior
between adolescents and adults, twenty-two lactating mothers, 11
adolescents and 11 adults, were studied at 6 week intervals between
6 and 24 weeks postpartum. The age range of the adolescents was
14 to 18 years. Not all adolescents continued to nurse their babies
throughout the entire study. All study participants were healthy,
well-nourished, nonsmokers, had an uncomplicated pregnancy, and
delivered healthy, term infants. Milk production was determined
by the test-weighing procedure. The milk samples were analyzed for
total nitrogen, protein nitrogen, nonprotein nitrogen, lactose,
fat, energy, sodium, potassium, calcium, and phosphorous content.
Lactational behavior including the frequency of nursing, the duration
of feeding, and the frequency with which supplemental formula and/or
complementary food were given to the infants were recorded.
RESULTS: Besides nursing their babies less often and for shorter
periods of time, the teens offered supplemental formula more frequently
and earlier than did the adult moms. The quantity of supplemental
formula was about six ounces per day. What is not known, because
lactational performance was not assessed prior to six weeks, is
whether milk production was insufficient to meet the infants' needs
thus necessitating formula supplementation or whether formula supplementation
was instituted early on as a matter of social practice, thereby
lessening the reliance of the infant on the mothers' milk supply.
Even the adolescents who nursed during the entire 24 week study,
maintained a level of milk production that was two-thirds of the
adult mothers. The nutrient composition of the teens' milk, however,
was preserved throughout lactation.
Additional studies of adolescent lacatational performance which
begin immediately after birth need to be conducted. Meantime, strategies
aimed at increasing milk volume such as increasing the frequency
and duration of nursing and subsequently decreasing the use of formula
may improve the lactational performance of adolescent mothers.
Infant Feeding: AAP Recommends Boiling Water
for Formula
Whether new parents who have decided to formula feed their infants
choose the powder, liquid concentrate or ready-to-feed forms, proper
preparation and refrigeration are critical to safety. For
many years, the American Academy of Pediatrics (AAP) felt municipal
water supplies were safe enough to make boiling water before mixing
with formula unnecessary. After problems with contamination
in major cities water supplies, that advice has changed. The
recommendation now is to heat the water until it reaches a rolling
boil and then to continue to boil it for one -two minutes.
Let the water cool before using.
Adding the exact amounts of water called for on the label is important.
Under-diluted formula can cause problems for the infants' digestive
system. Over-diluted formula will not provide adequate nutrition
for the baby. All forms of formula need to be refrigerated
after opening or mixing and used within the time specified.
Note: Educators working with limited resource families may want
to be certain an infants' care provider can read and understand
the instructions for the type of formula being used. (FDA Consumer
Vol 30(5)17-20, 1996)
Cultural Issues: Second Largest Group of
Kids are Hispanic
As of July 1, 1996 the number of Hispanic Children is exceeded
only by non-Hispanic white children according to the most recent
Census Bureau data. Data for the 50 states, the District of
Columbia and Puerto Rico indicate there are now 12 million Hispanic
children in the United States, compared to 50.8 million non-Hispanic
white and 11.4 million non-Hispanic black children.
Highlights from the Growing Up Hispanic report include the following:
- 94% of the increase is a result of fertility rates and legal
immigration
- 31% of the children of Hispanic working adults had no health
insurance, compared to only 12% of white children
- 40% of Hispanic children are estimated to live in poverty
- 64% of Hispanic families with children are headed by two parents
- Hispanics are the group least likely to see a physician
- Hispanic adolescents are the group most likely to attempt suicide:
are more likely to report fear of attack going to and from school;
and are targeted for recruitment by tobacco and alcohol industries.
(The Coalition of Hispanic Health & Human Services Organization
Reporter Vol 21 (1), 1996)
Women's Health Initiative Recruiting
Experts are still recruiting women ages 50-79 for the largest
prevention study in women's health ever undertaken. Called the Women's
Health Initiative (WHI), it is a 15 year project sponsored by the
National Institutes of Health and coordinated by the Fred Hutchinson
Cancer Research Center in Seattle. The study should provide answers
to questions about the benefits of hormone-replacement therapy,
a low-fat diet and calcium-vitamin D supplements. There are
40 WHI sites nationwide. For information, call 800-549-6636.
The call is automatically transferred to the nearest study site.
Eight Medical Tests Women Should Not Ignore
A recent report on preventive care from researchers at the University
of California, Los Angeles, found that 40% of women over the age
of 40 had not had a professional breast exam during the previous
year--despite the fact that this inexpensive procedure is commonly
recommended as a way to detect cancer in its early stages. Their
study found that women without health insurance were the most likely
to go without preventive care. However, even women with health insurance
were struggling to keep up with widely recommended screening tests.
Health plans continually change and the extent of their coverage
also changes making it difficult to know exactly which preventive
measures are covered by the plan. The following medical tests are
recommended for women who are healthy and want to remain so.
There is broad consensus that the first five tests should be part
of every women's standard medical care; the last three are recommended
for women with specific risk factors.
-
Cholesterol
-
Mammogram and Clinical Breast Exam
-
Blood in Stool (Colon Cancer)
-
Pap Smear
-
Blood Pressure
-
Bone Density
-
HIV
-
Skin Cancer
(Health, May, June, 1996)
Pacifiers and Ear Infections
After studying a large number of children (845), researchers are
suggesting that pacifiers be given to children only during the first
10 months of life, when the need for sucking is the strongest and
acute otitis media is uncommon. Acute otitis media (AOM) is
an inflammation of the middle ear with symptoms of infection, such
as fever. It affects about two-thirds of all children under
age three. The study found that more than 3 attacks of AOM occurred
in 29.5% of the children younger than 2 years using pacifiers and
in 20.6% of those not doing so. In children 2 to 3 years of
age, the figures were 30.6% and 13.2%, respectively. The use of
the pacifier seemed to increase the number of annual ear infection
from 3.6 to 5.4 episodes in children ages 10 months to two years
and from 1.9 to 2.7 episodes in children 2 to 3 years of age.
The use of a pacifier did not influence the incidence of AOM in
children four years of age or older. (Healthy Kids, American Academy
of Pediatrics, April, May 1996)
Resources Available
- The Progress of Nations, 1996 is the annual report issued by
the United Nations Children's Fund (UNICEF). It ranks nations
according to their achievements in child health, nutrition education,
family planning and progress for women. It contains sobering
statistics for American children. Available at no cost from
the United Nations Committees in major cities or by writing UNICEF
House, 3 United Nations Plaza, N.Y., N.Y., 10017.
- The Kids Count Data on Asian, Native American, and Hispanic
Children provides a state-by-state economic and social profile
using the 1990 census data. It is available at no cost from
the Annie E. Casey Foundation, 701 St. Paul Street, Baltimore
MD 21202, phone 410-547-6600.
- Kids Having Kids--A Robin Hood Foundation Special Report on
the Cost of Adolescent Childbearing is a new, comprehensive publication
listing the consequences of adolescent childbearing for the mothers
themselves, their children, the fathers of their children and
for the nation. It is available at no cost from the Robin
Hood Foundation, 111 Broadway, 19th Floor, N.Y., N.Y. 10006, phone
212-227-6601.
- Food Safety Education Materials from Purdue University Cooperative
Extension Service. Twenty-two different publications, curriculum
packages, videos for children and adults are available.
One example: The Future of Food Preservation-- Irradiation, a
10 minute video for $15.00 and lesson plans for $25.00.
Info contact: Willie Burgess, Internet, willie@cfs.purdue.edu
Order from: Agricultural Communications Service
Media Distribution Center
301 S. Second Street
Lafayette, IN 47901-1232
Electronic Connections
Journal Articles Worth Noting
- NIH Consensus Development Panel on Physical Activity and Cardiovascular
Health. JAMA, Vol 276 (3):241-246, 1996. This article
contains the latest advice on fitness and cites the benefits and
importance of even moderate amounts of activity.
- Anding JD, Kubena KS, McIntosh WA, O'Brien B. Blood lipids,
cardiovascular fitness, obesity, and blood pressure: The presence
of potential coronary heart disease risk factors in adolescents.
J Am Diet Assoc Vol 96 (3):238-242, 1996. The authors cite
evidence that young people may be at risk for CAD earlier than
previously believed. They urge health professionals to take
an aggressive role in identifying, reducing and eliminating the
modifiable risk factors.
- Bassuk EL, Weinreb LF, Buckner JC, Browne A, Salomon A, and
Basic SS. The characteristics and needs of sheltered homeless
and low-income housed mothers. JAMA Vol 276 (8):640-646,
1996. The findings of this recent, comprehensive study warrant
close attention by anyone working with low income audiences.
The authors examined physical health and habits, mental health
and substance abuse, life events, support networks and physical
and sexual assault.
- Silberstein LE, Jefferies LC. Placental-blood banking--a
new frontier in transfusion medicine. N Engl J of Med Vol
335 (3):199-200, 1996. This issue has 3 articles on umbilical
cord- blood. Fetal cord-blood discarded after the delivery
of a newborn is being found to be a useful source of cells needed
in the treatment of leukemia and other serious blood diseases.
Cord blood transplantation appears to be as effective as bone
marrow transplantation even though there is not a perfect match
between the donor of the cells and the person receiving them.
- Tofler IR, Stryer BK, Micheli LJ, Herman LR. Physical
and emotional problems of elite female gymnasts. N Engl
J of Med Vol 335 (4):281-283, 1996. This article is the
one that received a lot of notoriety during the recent Olympics.
It discusses the physical injuries, the potential for abuse and
the need for coaching standards in competitive gymnastics.
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,
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beliefs, marital or family status. Mention of a product,
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