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

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: Impact of Heredity on Bone Turnover Response to Changes in Calcium Intake
Research News: Hormones Can Improve Bone Health in Amenorrheic Young Women
Cultural Issues: Focus on Hispanics
Profile of an Hispanic Preschooler
Teen Mothers: GAO Report
America's Children: Key National Indicators of Well-Being
Infant Mortality Rates Among Industrialized Nations
Nasal Spray Flu Vaccine
New Resources and Events
Electronic Connections
Journal Articles Worth Noting
Subscribe Online for the electronic version of MCH LINKS

Research News: Impact of Heredity on Bone Turnover Response to
Changes in Calcium Intake

Girls and women from families with a history of osteoporosis have a significantly altered bone turnover response to acute changes in calcium intake, according to a study conducted at the Children's Nutrition Research Center.  Dr. Steven Abrams, associate professor, and Dr. Kenneth Ellis, professor, Department of Pediatrics, Baylor College of Medicine, and others, compared the bone turnover response to changes in calcium intake between members of families with a history of osteoporosis and those without a history of the disease.

Background:  The development of osteoporosis is directed by both environmental and genetic factors.  Genetic factors, however, have a greater impact on the development of premenopausal bone mass. Daughters of women with a maternal history of osteoporosis have reduced bone mineral content compared to women with no family history of the disease.  Since calcium is the major mineral in bone matrix and girls attain about the same bone mass as their premenopausal mothers by age 16, it was hypothesized that calcium metabolism is altered in families with a history of low bone mass and osteoporosis.  Prior studies had not specifically examined the role of  heredity  on calcium kinetics.  The aim of this study was to measure calcium absorption and bone calcium deposition and resorption rates during both low-and high-calcium intakes in three generations of family members with and without a history of osteoporosis.

Study Method:  Ten Caucasian families were recruited and grouped according to bone status as either control or osteoporotic. Each family was represented by the maternal grandmother, (age range 56-81 years), the mother (age range 32-47 years), and granddaughter (age range 8-15 years). In five of the families the mother and/or grandmother had osteoporosis.  To examine active and passive calcium absorption, both groups of families consumed low-and high-calcium diets for 10 days prior to administration of oral (46 Ca) and intravenous (42 Ca) stable isotopes.  Calcium intake during the high-calcium period was increased by consumption of calcium rich foods only.  Both blood and urine samples were collected following the isotope administration. Total calcium was measured in the 24-hour urine pool using atomic absorption spectroscopy. Bone mineral content and bone mineral density of the total body and lumbar spine were measured by dual-energy X-ray absorptiometry.

Results: Bone turnover response was significantly altered in girls and women from families with a history of osteoporosis.  Fractional calcium absorption, bone calcium deposition, and the balance in bone calcium turnover were all significantly affected by diet.  Females from nonosteoporotic families had decreased bone calcium resorption with little change in bone calcium deposition during the high-calcium study.  In contrast, girls and adult women from osteoporotic families had both increased bone calcium deposition and resorption during the high-calcium period, leading to a less positive balance in bone calcium turnover.  A significant interaction between bone status and diet was found for bone calcium resorption and approached significance for bone calcium deposition, effects which were independent of generation.  The study illustrates that females in families with a history of osteoporosis utilize calcium differently than females from families who do not have a history of the disease.

J Bone Miner Res 1998: 13: 491-499

Research News: Hormones Can Improve Bone Health in Amenorrheic
Young Women

One of every six white women will have an osteoporotic hip fracture during her lifetime. Peak bone mass acquired during adolescence and early adulthood is a major determinant in the development of osteoporosis later in life.  Some young women with hypothalamic amenorrhea--cessation of menstruation due to excessive exercise or eating disorders, for example, run an increased risk of developing osteoporosis due to reduced mineralization of bone. These young women also have very low amounts of body fat, which depress the levels of the female hormone, estrogen.  Estrogen is essential for utilizing calcium and other minerals in the development of optimal bone density.

Evidence exists that bone mineral density is increased in young women with hypothalamic amenorrhea who have used oral contraceptives--synthetic female hormones, estrogen and progesterone. There has also been some evidence that progesterone alone could improve bone health in athletes 21-45 years old with amenorrhea, defined as no menstrual bleeding in the past 6 months, or oligomenorrhea, defined as 6 or fewer menstrual periods in the previous 12 months. Scientific investigations had not been done on a population younger than 21 years of age.

In a randomized, controlled clinical trial conducted at Texas Children's Hospital and the USDA/ARS Children's Nutrition Research Center at Baylor College of Medicine, 24 white females, ages 14-28 with amenorrhea, were studied for a period of one year.  Study subjects were randomized to receive  oral contraceptives, medroxyprogesterone alone or with oral contraceptives or a placebo. Bone mineral density was measured by dual-energy x-ray absorptiometry at baseline, 6 and 12 months.  The study was conducted by Dr. Albert C. Hergenroeder, Chief of Adolescent and Sports Medicine at Baylor and Texas Children's Hospital, and the bone mineral analysis was conducted by Dr. Kenneth Ellis, Professor of Pediatrics at Baylor and a CNRC scientist.

At the end of the study the women taking the combined estrogen and progesterone preparation had significantly more bone mineral in their total skeletons and in the lower spine compared to the other two groups.  There was no evidence that oral medroxyprogesterone therapy alone improves bone mineral in women of 14-28 years of age with hypothalamic amenorrhea or oligomenorrhea.

If these findings are replicated in other studies, they could provide the basis for an inexpensive treatment for bone loss for the approximately 15 percent of female athletes and 3 to 5 percent of all young women in the United States who suffer from hypothalamic amenorrhea and thus are at risk for developing osteoporosis.

Am J Obstet Gynecol 1997: 176; 1017-25.

Cultural Issues: Focus on Hispanics

The US Census defines Hispanics as  "persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race."  Hispanics currently comprise about 10 percent of the U.S. population and the numbers are increasing rapidly due to immigration and a high birth rate.

Key Health Statistics for the U.S.:

• Though only approximately 10 percent of the population, Hispanics had 18 percent of the babies born in 1995.
• In 1996 the number of Hispanic children surpassed the number of black children
• 75 percent of Hispanic births occur in 6 states CA,TX, NY, FL, IL, & AZ
• 71 percent of Hispanic females received prenatal care in the first trimester compared to 83 percent of non-Hispanic whites
• Breastfeeding rates 84 percent initiated breastfeeding, the highest of any ethnic group, according to a 1997 WIC Infant Feeding Practices Study Immunization-- coverage levels for all individual vaccines (except HebB) were lower for Hispanics and non-Hispanic blacks than among non-Hispanic whites in 1997.
• Diabetes one in ten adult Hispanics have the disease and the incidence of type 2 diabetes, which typically occurs in adults, is increasing among Hispanic children and adolescents.
• Cancer leading cancer sites are the same as for whites: prostate, breast, lung, and colon and rectum. Incidence however is 30 percent lower than rates for whites.
• HIV/AIDS representing 10 percent of the population, Hispanics account for 18 percent of all AIDS cases up from 15 percent in 1995.  Hispanic males represent 11 percent of the males in US and have 17.3 percent of the reported cases.

References:  U.S. Census, Pediatrics Vol 2, No 6, Immunization Technical Assistance Net Work, American Cancer Society, Diabetes Fact Sheet & HIV/AIDS Impact on Hispanics.

Profile of an Hispanic Preschooler

Compared to children of other racial/ethnic groups Hispanic children are:

• Less likely to have health insurance

• Less likely to have access to pediatric services
• More likely to face preventable illness such as measles and AIDS
• More likely to suffer from chronic illness, including asthma
• More likely to live in a neighborhood exposed to toxins and contaminants, including lead air pollution

Reference: Vacunas desde la cuna, February 1998.

Teen Mothers: U.S. General Accounting Office Report

In order to provide a better understanding of the characteristics that could help in the development and implementation of preventive strategies  Congress requested the General Accounting Office to prepare a detailed report of social and demographic information about teen mothers.  They used national birth certificate data and current analyses of four national surveys: the National Longitudinal Survey of Youth, the National Education Longitudinal Study of 1988, the National Survey of Family Growth, and the National Household Survey on Drug Abuse. Highlights include the following:

• Although the birth rate for teenage women decreased 41 percent from the late 1950s to 1995, the number of babies born is still high--about 512,000 in 1995.
• Births to unmarried teenage mothers more than quintupled as a proportion of total teen births over the same period.
• In 1995, nearly half of teen mothers were white and most were aged 18 to 19 and unmarried.
• About two-thirds of recent teen mothers did not intend to get pregnant or have a child.
• About 20 percent who gave birth already had one child.
• Sixty-four percent of teen mothers complete high school compared with about 90 percent of all teen women.
• Teen mothers reported drug use in the past month that was similar to that of other women their age.
• About 28 percent of white teen mothers reported smoking tobacco during their pregnancy, compared with 5 percent of black and Hispanic mothers.

GAO/HEHS Teen Mothers, Selected Socio-Demographic Characteristics and Risk Factors.

America's Children: Key National Indicators of Well-Being  

This report, issued by the Federal Interagency Forum on Child and Family Statistics, measures 23 indicators of important aspects of children's lives including their economic security, health, behavior, social environment and education.  This is the second annual effort to monitor the overall status of the nation's children.  Highlights include the following:

In 1997, children under age 18 numbered 69.5 million, or 26 percent of the population, down from 36 percent at the end of the baby boom.

Ethnic diversity among children continues to increase.  The proportion of Hispanic children is increasing rapidly and they now slightly outnumber black, non-Hispanic children.

Children under 18 continue to represent 40 percent of the poor population though they are only about one-fourth of the total population.

The number of children with no health insurance grew to 10.6 million, or 15 percent of all children.

In 1996, low birthweight rates were the highest in two decades. Infant mortality, however, has declined due primarily to survival rates which have increased for the highest-risk infants.

In 1996, 77 percent of children ages 19-35 months were up to date with their immunizations.

Children ages 1 to 5 with measurable blood lead levels declined from 88 percent in the late 1970's to 6 percent in 1994.  The decline resulted from legislation banning lead from paint and plumbing supplies and from the phasing out of lead in gasoline.

More young children are being read to by their families and participating in early childhood education.

The high school completion rate has increased slightly from 84 percent in 1983 to 86 percent in 1996.

The percentages of 8th, 10th, and 12th graders who smoked daily, drank heavily or used illicit drugs have increased. The report shows that 25 percent of 12th graders smoke on a regular basis.

The complete report is available at http://nces.ed.gov/childstat/

Infant Mortality Rates Among Industrialized Nations

Source: IMR Rates; UNICEF, State of the World's Children, 1998; rankings calculated by the Children's Defense Fund, 7/98.

Nasal Spray Flu Vaccine   

The results of a multi-center national trial show that a new nasal spray flu vaccine is effective at preventing both the flu and flu-related ear infections in children. Ten clinical sites, including Baylor College of Medicine, studied a total of 1602 children from 15 months of age up to 6 years during the 1996-97 flu season.  The vaccine was administered to 1,070 children and 532 received a placebo.  Of those given the vaccine, only 14 (1 percent) developed influenza and only one child in that group of 14 presented with a related ear infection. Of the placebo group, 95 of the 532 (18 percent) developed influenza while 20 of the 95 cases of influenza also had a related earache.

The nasal spray is made from live but weakened influenza viruses.  The vaccine has been developed under a cooperative research agreement between the National Institute of Allergy and Infectious Diseases (NIAID) and a biopharmaceutical company.  Pending FDA approval, the vaccine is expected to be available for the fall 1999 flu season.

Texas Medical Center News, Vol 20, No 10. June 1, 1998

New Resources and Events

The Future of Children Journal and Executive Summary is published three times a year by the David and Lucile Packard Foundation.  Each issue contains in-depth coverage of a specific topic related to the well-being of children.  Order from Circulation Department, Center for the Future of Children, The David and Lucile Packard Foundation, 300 Second Street, Suite 102, Los Altos, CA 94022.  There is no cost for these publications.
 

Childhood and Adolescent Obesity in America: What's a Parent To Do?--a 12 page publication written by Betty Holmes, MS,RD at University of Wyoming. It contains very practical information on helping children make healthy food choices, the importance of physical activity and strategies for parents of overweight children.  It can be downloaded from http://west.uwy.edu/food. Scroll down to University of Wyoming "Publications on Line" for the publication.  Order hard copies from University of Wyoming Bulletin Room, PO Box 3313, Laramie, WY 82071.
 

If My Child is Overweight What Should I Do About It? is written by Joanne Ikeda, MA,RD at the University of California, Berkeley.  It is a 16 page booklet which offers practical advice about the prevention and treatment of overweight children by encouraging size acceptance, a healthy diet and physical exercise. For information on Publication # 21455, call 1-800-994-8849. Single copies are $3.00 plus $1.00 s/h and 8.25% tax  E-mail inquiries may be sent to danrcs@ucdavis.edu.

HIV/AIDS: The Impact on Hispanics--published by the National Coalition of Hispanic Health and Human Services Organizations.  This 56 page report provides the newest findings and basic facts about HIV transmission, replication, treatment and prevention and contains surveillance information regarding the impact on 10 states.  Order from COSSMHO, Attention Odell Jackson, 1501 Sixteenth Street NW, Washington, DC 20036.  The cost is $12.00 by check only.

A satellite program entitled "From Farm to Table: Safe Food for America--Shared Responsibility" from Ohio State University is to be broadcast on September 22, 1998. For details and coordinates go to Ohio State's web site at  http://www.ag.ohio-state.edu/~nutrext.

Electronic Connections

Journal Articles Worth Noting

1. Kleinman RE, JM Murphy, M Little, M Pagano, CA Wehler, K Regal, MS Jellinek. 1998. Hunger in children in the United States: Potential behavioral and emotional correlates. Pediatrics Vol. 101, p. e3. http://www.pediatrics.org/. Article reports that children who were defined as "hungry" were more likely to show behavioral, emotional and academic problems than those from families who do not report experiences of hunger.
2. Jemmott, JB III. Abstinence and safer sex HIV risk-reduction interventions for African American adolescents. JAMA 279(19):1529-36. Article reports the results of a study designed to gauge the effects of various interventions with sexually experienced adolescents.
3. McBride, CM, P Lozano, SJ Curry, D Rosner, LC Grothaus. Use of health services by children of smokers and nonsmokers in a health maintenance organization. Am J Pub Health. 1998, Vol. 88(6):897-902. Article discusses findings regarding the use of primary care, emergency room visits and preventive care visits for the two groups.
4. Henkel, J. Irradiation: A safe measure for safer food. FDA Consumer, May/June 1998:12-17. Article provides a good overview of the issues  involved in consumer acceptance of irradiated foods.
5. Yates, et al. Dietary reference intakes: The new basis for recommendations for calcium and related nutrients, B vitamins and choline. J Am Diet Assoc 1998:699-706.

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".