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Indian Pediatr 2014;51: 676
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Gaurav Gupta
Email:
[email protected]
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Is Vitamin D intake in pregnancy linked to asthma and
allergies in children? (PLoS One. 2014;9:e99856)
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Epidemiological studies suggest an association between vitamin D intake
during pregnancy and risk of asthma and allergy in the offspring. To
investigate the interdependence of cord blood 25-hydroxy-vitamin D
[25(OH)-Vitamin D] levels and investigator-diagnosed asthma and
allergy-related conditions during preschool age, the cord blood
25(OH)-Vitamin D levels were measured in 257 children from the
Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) at-risk
mother-child cohort. Troublesome lung symptoms, asthma, respiratory
infections, allergic rhinitis and eczema, at age 0-7 yrs were diagnosed
exclusively by the COPSAC pediatricians strictly adhering to predefined
algorithms. Objective assessments of lung function and sensitization
were performed repeatedly from birth. After adjusting for season of
birth, deficient cord blood 25(OH)-Vitamin D level (<50 nmol/L) was
associated with a 2.7-fold increased risk of recurrent troublesome lung
symptoms, but showed no association with respiratory infections or
asthma. There was no association between cord blood 25(OH)-Vitamin D
level and lung function, sensitization, rhinitis or eczema.
Given the high rates of Vitamin D Deficiency in Indian
population and the increasing incidence of allergies and asthma in
children, this may be a potential way to reduce morbidity. However, the
results need to be replicated in interventional studies.
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Is fast food/Western diet really bad for us?
(Nutr J. 2014;13:61.doi: 10.1186/1475-2891-13-61)
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While numerous changes in human lifestyle constitute modern life, our
diet has been gaining attention as a potential contributor to the
increase in immune-mediated diseases. The Western diet is characterized
by an over consumption and reduced variety of refined sugars, salt and
saturated fat. The objective of this Review article was to detail the
mechanisms for the Western diet’s impact on immune function. The author
reviewed the impacts and mechanisms of harm for our over-indulgence in
sugar, salt, and fat, as well as the data outlining the impacts of
artificial sweeteners, gluten, and genetically modified foods; attention
was given to revealing where the literature on the immune impacts of
macronutrients was limited to either animal or in-vitro models
versus where human trials existed. Detailed attention was given to
the dietary impact on the gut microbiome and the mechanisms by which our
poor dietary choices were encoded into our gut, our genes, and were
passed to our offspring. While today’s modern diet may provide
beneficial protection from micro- and macronutrient deficiencies,
abundance of macronutrients that compose our diet may all lead to
increased inflammation, reduced control of infection, increased rates of
cancer, and increased risk for allergic and auto-inflammatory diseases.
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Do probiotics help prevent eczema? (Arch Dis
Child. 2014;pii: archdischild-2013-305799]
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This randomized controlled trial evaluated a multistrain, high-dose
probiotic in the prevention of eczema. Women from 36 weeks gestation and
their infants younger than 6 months received daily, either the probiotic
mix or placebo. The main outcome measured was physician-diagnosed eczema
at age of 2 years. Infants were followed up by questionnaire. Clinical
examination and skin prick tests to common allergens were done at 6
months and 2 years. The cumulative frequency of diagnosed eczema at 2
years was similar in the probiotic (34.1%) and placebo arms (32.4). The
cumulative frequency of skin prick sensitivity at 2 years was reduced in
the probiotic (10.5%) compared with the placebo arm (18.5%). The
statistically significant differences between the arms were mainly in
sensitization to cow’s milk and hen’s egg proteins at 6 months. Atopic
eczema occurred in 9 out of 171 children in the probiotic arm and 21 out
of 173 in the placebo arm. The study did not provide evidence that the
probiotic either prevented eczema or reduced its severity. However, the
probiotic seemed to prevent atopic sensitization to common food
allergens, and so potentially reduce the incidence of atopic eczema in
early childhood.
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Does frenotomy improve breastfeeding
difficulties in Infants with tongue tie? (Pediatr
Int. 2014;Jun 30:doi: 10.1111/ped.12429)
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The aim of this systematic review was to critically examine the existing
literature regarding the efficacy of tongue-tie division in infants with
ankyloglossia. An electronic literature search was systematically
conducted from usual databases. The literature search yielded 4
randomized clinical trials and 12 observational studies for analysis.
The quality of the literature was rated in regard to the two most
important outcomes (sucking/latching and nipple pain) and five less
important outcomes (milk supply/milk production, continuation of
breastfeeding, weight gain, adverse events, and dyad distress). There
was an overall moderate quality of evidence for the efficacy of
frenotomy for the treatment of breastfeeding difficulties in infants
with ankyloglossia. No major complications from frenotomy were reported.
These results need to be interpreted with caution in
the Indian context where parents suspect tongue tie in virtually every
child with speech delay or poor feeding. Here, in most cases there is no
evidence of ankyloglossia. Many a times, frenotomy is done ‘rountinely’
in children with feeding problems/ delayed speech, and this practice
needs to be discouraged in favor of a moderate approach wherein only
children with clinically significant tongue tie and feeding problems are
operated.
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