Daily Breakfast is Associated With a Lower Type 2 Diabetes Risk Profile in Children

Bottom Line:

 Regular consumption of a healthy breakfast may help children lower their risk of developing type 2 diabetes, according to a study published in this week’s PLOS Medicine. The study, conducted by Angela Donin of St. George’s University of London and colleagues, found an association between children who reported skipping breakfast most days and higher levels of known diabetes risk factors.

Full Study:

The researchers reached these conclusions after conducting a cross-sectional study of 4,116 primary school children 9-10 years old in the UK. The children responded to questions about how often and what they ate for breakfast, and blood tests measured diabetes risk markers such as fasting insulin, glucose, and glycated hemoglobin (HbA1c). Twenty-six percent of children reported not having breakfast every day.

 Children who reported usually not having breakfast had higher fasting insulin (percent difference

26.4%, 95% confidence interval [CI] 16.6%–37.0%), higher insulin resistance (percent difference 26.7%, 95% CI 17.0%–37.2%), slightly higher HbA1c (percent difference 1.2%, 95% CI 0.4%–2.0%), and slightly higher glucose (percent difference 1.0%, 95% CI 0.0%–2.0%),) than those who reported always eating breakfast. Additionally, among children who completed a 24 hour dietary recall, those who reported eating a high fiber, cereal breakfast had lower insulin resistance than those eating other types of food, such as biscuit-based breakfasts.

"Breakfast for Children"

 Though a limitation of cross-sectional studies is the risk of identifying false associations as a result of confounding factors, the associations identified in this study remained significant even after adjusting for potentially confounding factors such as socioeconomic status, physical activity, and body fat. Still, the authors note the need for future studies to demonstrate whether increasing breakfast consumption among children leads to improvements in their diabetes risk profile.

 The authors say: “The observed associations suggest that regular breakfast consumption, particularly involving consumption of a high fibre cereal, could protect against the early development of type 2 diabetes risk….”

Funding: 

This research is supported by a Diabetes UK research grant (grant reference BDA 11/0004317). Data collection in the CHASE Study was supported by grants from the Wellcome Trust (grant reference 068362/Z/02/Z) and the National Prevention Research Initiative (NPRI) (grant reference G0501295). The Funding Partners for this NPRI award were: British Heart Foundation; Cancer Research UK; Department of Health; Diabetes UK; Economic and Social Research Council; Medical Research Council; Research and Development Office for the Northern Ireland Health and Social Services; Chief Scientist Office, Scottish Executive Health Department; and Welsh Assembly Government. Diabetes prevention research at St George’s, University of London is supported by the NIHR CLAHRC South London. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Reference:

Donin AS, Nightingale CM, Owen CG, Rudnicka AR, Perkin MR, et al. (2014) Regular Breakfast Consumption and Type 2 Diabetes Risk Markers in 9- to 10-Year-Old Children in the Child Heart and Health Study in England (CHASE): A Cross-Sectional Analysis. PLoS Med 11(8): e1001703. doi:10.1371/journal.pmed.1001703

Author Affiliations:

St. George’s University of London, UNITED KINGDOM, University of Oxford, UNITED KINGDOM, Medical Research Council Human Nutrition Research, UNITED KINGDOM, University of Glasgow School of Medicine, UNITED KINGDOM

Contact:

Angela Donin, St. George’s University of London, UNITED KINGDOM, +44 (0)208 725 2793, adonin@sgul.ac.uk.

Barriers to HIV Testing in Older Children

Bottom Line:

 Concerns about guardianship and privacy can discourage clinics from testing children for HIV, according to new research from Zimbabwe published this week in PLOS Medicine.  The results of the study, by Rashida A. Ferrand of the London School of Hygiene & Tropical Medicine and colleagues, provide much-needed information on how to improve care of this vulnerable population.

Background Information:

More than three million children globally are living with HIV (90% in sub-Saharan Africa) and in 2011 an estimated 1000 infant infections occurred every day. HIV acquired through mother-to-child transmission around the time of birth is often unsuspected in older children, and the benefits of treatment are diminished in children who develop symptoms of immune system failure before infection is discovered.

Methodology:

Provider-initiated HIV testing and counseling (PITC) involves health care providers routinely recommending HIV testing and counseling when people attend health care facilities. To investigate the provision and uptake of PITC among children between 6 and 15 years old, the researchers collected and analyzed data from staff at 6 clinics in Harare, Zimbabwe.

Among 2,831 eligible children, about three-quarters were offered PITC, of whom 1,534 (54.2%) consented to HIV testing. The researchers diagnosed HIV infection in about 1 in 20 (5.3%) of the children tested, highlighting the need for more effective PITC. HIV infection was also found in 1 out of 5 guardians who tested with a child.

HIV

Results and Discussion:

The main reasons that health-care workers gave for not offering PITC were perceived unsuitability of the accompanying guardian to provide consent for HIV testing on behalf of the child, and lack of availability of staff or HIV testing kits.  Children who were asymptomatic, older, or attending with a male or a younger guardian were less likely to be offered HIV testing. Male guardians were less likely to consent to their child being tested.

 In interviews, health-care workers raised concerns that a child might experience maltreatment if he or she tested positive, and showed uncertainty around whether testing of the guardian was mandatory and whether only a parent (if one was living) could legally provide consent.  When parents were alive but not present, seeking consent from another adult raised ethical concerns that a positive HIV test in a child would disclose the HIV status of a parent who hadn’t provided consent.

 The study, which was funded by the Wellcome Trust, did not explore the reasons for refusal of HIV testing by clients. Also, because the relationship of the child to the accompanying adult was not available, the appropriateness of the guardian could not be independently ascertained.

 Lead author Dr. Rashida Ferrand from the London School of Hygiene & Tropical Medicine said: “The fear of the stigma faced by the child and their family seems to be discouraging caregivers from testing children for HIV. However, with improved clarity of guidelines, engagement with staff, and organisational adjustments within clinics, it should be possible to harness the commitment of health-care workers and properly implement HIV testing and counseling.”

 In an accompanying Perspective, Mary-Ann Davies and Emma Kalk of the University of Cape Town, who were uninvolved in the study, point out that “The fact that >90% of infected children had a previous missed opportunity for testing indicates suboptimal pediatric PITC coverage in most routine settings,” and call for “clear HIV testing policies for children and guidance on guardianship, together with training of [health-care workers] on such policies.”

Funding:

The study was funded by the Wellcome Trust through an Intermediate Fellowship to RAF (Grant No: 095878/Z/11Z). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Reference:

Kranzer K, Meghji J, Bandason T, Dauya E, Mungofa S, et al. (2014) Barriers to Provider-Initiated Testing and Counselling for Children in a High HIV Prevalence Setting: A Mixed Methods Study. PLoS Med 11(5): e1001649. doi:10.1371/journal.pmed.1001649

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001649

Author Affiliations:

  • London School of Hygiene and Tropical Medicine, United Kingdom
  • Biomedical Research and Training Institute, Zimbabwe
  • Harare City Health Department, Zimbabwe
  • Population Services International, Zimbabwe
  • University of Zimbabwe, Zimbabwe

Contact:

Press Office at the London School of Hygiene & Tropical Medicine, UNITED KINGDOM, +44 (0) 207 927 2802, press@lshtm.ac.uk

Perspective Article

 Funding:

MAD receives funding from the National Institutes of Allergy and Infectious Diseases (Grant 2U01AI069924) and both authors receive funding from the National Institute of Child Health and Human Development (R01HD075156). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Reference:

Davies M-A, Kalk E (2014) Provider-Initiated HIV Testing and Counselling for Children. PLoS Med 11(5):e1001650. doi:10.1371/journal.pmed.1001650

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001650

Author Affiliations:

University of Cape Town, South Africa

 Contact:

Mary-Ann Davies

Infectious Disease Epidemiology Unit

School of Public Health

University of Cape Town

3 Buxton Ave.

Cape Town, Western Cape 8001

SOUTH AFRICA

27 21 406 6487

Mary-ann.Davies@uct.ac.za

Violent Video Games Associated With Increased Aggression in Children

Bottom Line:

 Habitually playing violent video games appears to increase aggression in children, regardless of parental involvement and other factors.

Author:

 Douglas A. Gentile, Ph.D., of Iowa State University, Ames, and colleagues.

Background:

 More than 90 percent of American youths play video games, and many of these games depict violence, which is often portrayed as fun, justified and without negative consequences.

How the Study Was Conducted:

 The authors tracked children and adolescents in Singapore over three years on self-reported measures of gaming habits, aggressive behavior, aggressive cognition (AC, such as aggressive fantasies, beliefs about aggression, and attaching motives of hostility to ambiguous provocations) and empathy. The researchers also examined the effects of age, sex, parental monitoring and other traits.

"Video games and aggression in children"

Results:

 Among 3,034 children, a habit of playing violent video games was associated with long-term, self-reported aggressive behavior through increases in AC, regardless of parental involvement, age, sex and initial aggressiveness. Empathy did not appear to mediate the effects of playing violent video games on aggression. However, the authors suggest more investigation is needed before concluding the effects are entirely the result of changes in AC.

Discussion:

“Because of the large number of youths and adults who play violent video games, improving our understanding of the effects is a significant research goal that has important implications for theory, public health and intervention strategies designed to reduce negative effects or to enhance potential positive effects.”

Reference:

Douglas A. Gentile PhD, Dongdong Li PhD, Angeline Khoo PhD, Sara Prot MA, Craig A. Anderson PhD. Mediators and Moderators of Long-term Effects of Violent Video Games on Aggressive Behavior: Practice, Thinking, and Action. JAMA Pediatr. 2014;168(5):-. doi:10.1001/jamapediatrics.2014.63

Editor’s Note:

 This work was supported by grants from the Ministry of Education and the Media Development Authority of Singapore. Please see article for additional information, including other authors, author contributions and affiliations, etc.

Electronic Media Associated With Poorer Well-Being in Children

Bottom Line:

 The use of electronic media, such as watching television, using computers and playing electronic games, was associated with poorer well-being in children.

Author:

 Trina Hinkley, Ph.D., of Deakin University, Melbourne, Australia, and colleagues.

Background:

Using electronic media can be a sedentary behavior and sedentary behavior is associated with adverse health outcomes and may be detrimental at a very young age.

How the Study Was Conducted:

 The authors used data from the European Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS) study to examine the association of using electronic media between ages 2 and 6 years and the well-being of children two years later. Questionnaires were used to measure six indicators of well-being, including emotional and peer problems, self-esteem, emotional well-being, family functioning and social networks.

Results:

 Among 3,604 children, electronic media use appeared to be associated with poorer well-being. Watching television appeared to be associated with poorer outcomes more than playing electronic games or using computers. The risk of emotional problems and poorer family functioning increased with each additional hour of watching TV or electronic game and computer use.

"Electronic media for children"

Discussion:

 “Higher levels of early childhood electronic media use are associated with children being at risk for poorer outcomes with some indicators of well-being. … Further research is required to identify potential mechanisms of this association.”

Reference:

 Trina Hinkley PhD, Vera Verbestel MSc, Wolfgang Ahrens PhD, Lauren Lissner PhD, Dénes Molnár PhD, Luis A. Moreno PhD, Iris Pigeot PhD, Hermann Pohlabeln PhD, Lucia A. Reisch PhD, Paola Russo BSc, Toomas Veidebaum PhD, Michael Tornaritis PhD, Garrath Williams PhD, Stefaan De Henauw PhD, Ilse De Bourdeaudhuij PhD. Early Childhood Electronic Media Use as a Predictor of Poorer Well-being: A Prospective Cohort Study. JAMA Pediatr. 2014;168(5):-. doi:10.1001/jamapediatrics.2014.94

Editor’s Note:

 The authors made funding/support disclosures. Please see article for additional information, including other authors, author contributions and affiliations, etc.

Children Who Watch More Television Sleep Less

Bottom Line:

 Pre-school and school-aged children who spent more time watching television got less sleep.

Author:

 Marcella Marinelli, M.Sc., Ph.D., of the Center for Research in Environmental Epidemiology, Barcelona, Spain, and colleagues. 

Background:

 Sleep is important and prior research has suggested that television viewing can cause irregular sleep habits. The American Academy of Pediatrics recommended in 2009 that children under 2 years avoid exposure to any media and that for older children time be limited to one to two hours per day.

"Children and TV "

How the Study Was Conducted:

 The authors examined the association between hours of television viewing and sleep in 1,713 children in Spain through parent-reported sleep duration.

Results: Children who watched TV for 1.5 hours or more a day had shorter sleep duration at baseline. Children who reported increased TV viewing over time (from less than 1.5 hours per day to 1.5 or more hours per day) reported a reduction in sleep at follow-up visits. 

Discussion:

 “Further prospective studies are required to confirm these findings and to investigate the mechanisms that may underline the possible association.”

Reference:

Marcella Marinelli MSc, PhD, Jordi Sunyer MD, PhD, Mar Alvarez-Pedrerol PhD, Carmen Iñiguez PhD, Maties Torrent MD, PhD, Jesús Vioque , Michelle C. Turner PhD, Jordi Julvez PhD. Hours of Television Viewing and Sleep Duration in Children: A Multicenter Birth Cohort Study. JAMA Pediatr. 2014;168(5):-. doi:10.1001/jamapediatrics.2013.3861

Editor’s Note: Please see article for additional information, including other authors, author contributions and affiliations, etc. 

Opening or Expanding a Casino Associated With Lower Rate of Overweight Children in that Community

The opening or expansion of a casino in a community is associated with increased family income, decreased poverty rates and a decreased risk of childhood overweight or obesity, according to a study in the March 5 issue of JAMA.

Obesity disproportionately affects children with low economic resources at the family and community levels. Few studies have evaluated whether this association is a direct effect of economic resources. “American Indian-owned casinos have resulted in increased economic resources for some tribes and provide an opportunity to test whether these resources are associated with overweight/obesity,” according to background information in the article.

Jessica C. Jones-Smith, Ph.D., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues assessed whether openings or expansions of American Indian-owned casinos were associated with childhood overweight/obesity risk. The authors hypothesized that casinos could alter individual, family, or community resources, reducing barriers to healthful eating and physical activity and decreasing the risk of overweight/obesity. “These resources could include increased income, either via employment or per capita payments, and health-promoting community resources, such as housing, recreation and community centers, and health clinics.”

"Casino and obesity"

The researchers used body mass index (BMI) measurements from American Indian children (ages 7-18 years) from 117 school districts that encompassed tribal lands in California between 2001 and 2012 and compared children in districts with tribal lands that either did or did not gain or expand a casino. Besides BMI, other measures included in the analysis were per capita annual income, median (midpoint) annual household income, percentage of population in poverty and total population.

Of the 117 school districts, 57 either opened or expanded a casino, 24 had a preexisting casino but did not undergo expansion, and 36 did not have a casino at any time during the study period. Forty-eight percent of the measurements of the children (n = 11,048) were classified as overweight/obese. The researchers found that every 1 casino slot per capita gained was associated with an increase in average per capita annual income, a decrease in the percentage of the population living in poverty, and a decrease in the percentage of overweight/obesity.

The authors speculate that the association found in this study between casinos and childhood overweight/obesity may be from both increased family/individual and community economic resources, but emphasize that further research is needed to better understand the mechanisms underlying this association.

Reference:

Jessica C. Jones-Smith, PhD; William H. Dow, PhD; Kristal Chichlowska, PhD. Association Between Casino Opening or Expansion and Risk of Childhood Overweight and Obesity. JAMA. 2014;311(9):929-936. doi:10.1001/jama.2014.604

Editor’s Note:

Funding for this project was provided by a grant from the National Institute of Child Health and Human Development. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Editorial: Socioeconomic Influences on Child Health – Building New Ladders of Social Opportunity

Regarding the two studies in this issue of JAMA that examine socioeconomic influences on child health, Neal Halfon, M.D., M.P.H., of the University of California, Los Angeles, writes in an accompanying editorial that “an enormous loss of human potential results from unsafe, uncertain, stressful childhood environments that do not have the basic scaffolding that all children need to thrive.”

“A casino in every neighborhood is not the answer, but increasing family income and removing other pressures that reduce the capacity of families to invest in their children should be part of the solution. While incremental improvements like expanding preschool and extending health insurance may help add new rungs to the existing ladder of social opportunity, the fact is that these ladders are broken, outdated, and designed for a different era and need to be redesigned and transformed from the bottom up.”

Reference:

doi:10.1001/jama.2014.608

Editor’s Note:

Please see the article for additional information, including financial disclosures, funding and support, etc.

Avoid Use Of Codeine In Children Less Than 12 Years, Confirmed By MHRA

Children having age less than 12 years should not use codeine containing products for the treatment of sleep apnoea due to increased risk of breathing problems as confirmed by Medicines and Healthcare Products Regulatory Authority (MHRA) UK.

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Behavioral Problems Are Associated With Loud Snoring Among Young Children

Latest study has indicated that behavioral problems could be associated with loud and persistent snoring in young children. This study was published in journal of Pediatrics. These behavioral problems include depression and hyperactivity as suggested by Dean Beebe, PhD, director of the neuropsychology program at Cincinnati Children’s Hospital Medical Center and lead author of the study.

Continue reading Behavioral Problems Are Associated With Loud Snoring Among Young Children

Promising New Treatment For Kids Having Egg Allergy

Latest study which has been published in New England Journal of Medicine has suggested that egg allergy in children could be eradicated by giving them small amount of egg white powder for a duration of 10 months. According to this research there are approximately 4% of US children who are suffering allergy from different foods.  Symptoms of food allergy could be as mild as rashes and as severe as death.

Continue reading Promising New Treatment For Kids Having Egg Allergy