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Background: Bariatric surgery (BS) results in major and sustained weight loss and improves comorbidities in patients with obesity but can also lead to malnutrition, especially through severe malabsorption and/or surgical complications. Little is known about the efficacy of artificial nutrition (AN) in this setting. Methods: In this case series, we describe data from consecutive severely malnourished patients after BS (resectional and non-resectional), managed by AN at our hospital unit over a 4-year period. Results: Between January 2018 and June 2022, 18 patients (mean ± SD age 42.2 ± 10.4 years, 94% women) required AN following BS complications. At the time of AN initiation, more than half of the patients (53%) had multiple revisional surgeries (up to four). Mean BMI was 49.7 ± 11.3 kg/m2 before BS and 29.6 ± 9.6 kg/m2 when AN was initiated. Most patients (n=16, 90%) received enteral nutrition. AN management resulted in weight regain (+4.7kg ± 8.0, p=0.034), increased serum albumin (+28%, p=0.02), pre-albumin (+88%, p=0.002), and handgrip strength (+38%, p=0.078). No major AN complication nor death was observed. Median total AN duration was 4.5 months [1-12]. During follow-up, the cumulative duration of hospitalization was 33 days [4-88] with a median of 2.5 hospitalizations [1-8] per patient. Conclusion: Malnutrition can occur after any BS procedure, and AN when required in this setting appears safe and effective on nutritional parameters. It is important to recognize the potential risk factors for malnutrition, which include excessive weight loss resulting from surgical complications, eating disorders, multiple revisional BS, and pregnancy. [ABSTRACT FROM AUTHOR]

Ticks are blood-sucking ectoparasites and can transmit various pathogens of medical and veterinary relevance. The life cycle of ticks can be completed under laboratory conditions on experimental animals, but the artificial feeding of ticks has attracted increased interest as an alternative method. This study represents the first report on the successful in vitro feeding of all life stages of two-host tick species, Hyalomma scupense and Hyalomma excavatum, and the three-host tick Hyalomma dromedarii. The attachment and engorgement rates of adults were 84% (21/25) and 76% (19/25) for H. scupense females. For adult H. excavatum and H. dromedarii, 70% (21/30) and 34.4% (11/32) of the females attached and all attached females successfully fed to repletion. The oviposition rates of the artificially fed females were 36.4%, 57.1% and 63.1% for H. dromedarii, H. excavatum and H. scupense, respectively, with a reproductive efficiency index varying between 44.3 and 60.7%. For the larvae, the attachment and engorgement rates were 44.2% (313/708) and 42.8% (303/708) for H. dromedarii, 70.5% (129/183) and 56.8% (104/183) for H. excavatum and 92.6% (113/122) and 55.7% (68/122) for H. scupense. The attachment and engorgement rates for the nymphs were 90.2% (129/143) and 47.6% (68/143) for H. dromedarii, 66.7% (34/51) and 41.2% (21/51) for H. excavatum, and 44.1% (30/68) and 36.8% (25/68) for H. scupense. Molting rates of the immature stages varied between 71.3% (216/303) and 100% (68/68) for the larvae and between 61.9% (13/21) and 96% (24/25) for the nymphs. The successful in vitro feeding of all stages of the three Hyalomma species makes this method a valuable tool for tick research, with potential applications in studies on the pathogens transmitted by these tick species such as Theileria annulata. [ABSTRACT FROM AUTHOR]

Coccinella septempunctata (Linnaeus) and Hippodamia convergens (Guérin Méneville) are important predators of many pests of agricultural crop importance. Feeding these predators with artificial diets (ADs) is an important means to achieve large-scale production. In this study, the effects of five different artificial diets on the development, survival and reproduction of the two predators were evaluated under laboratory conditions (26 ± 2 °C, 60% RH, and 12:12 (L:D) h). The artificial diets consisted of various main ingredients, including barley flour (BF-AD), soybean flour (SF-AD), potato flour (PF-AD), frozen aphids (FA-AD), and milk powder (MP-AD). Both predators successfully underwent their entire development on all of these formulated artificial diets. The results of this study show that the black bean aphid (Aphis fabae (Scopoli)) and artificial diets SF-AD and PF-AD appear to be the most suitable for mass rearing of the predators. These diets decreased the total pre-adult development period, increased female and male longevity, significantly increased larval and pupal survival rates, adult emergence and weight, oviposition period, and fecundity, and significantly decreased the pre-oviposition period compared to the other artificial diets tested. Similarly, the data showed that the highest values of growth index and success index were obtained with the predators fed the black bean aphid diet (9.6–15.0 and 1.0–1.0, respectively), followed by artificial diets SF-AD (9.1–13.5 and 0.9-1.0, respectively) and PF-AD (8.3–10.7 and 0.8–0.9, respectively). The artificial diets, particularly SF-AD and PF-AD, can be used for mass rearing of C. septempunctata and H. convergens for biological control applications and adult rearing during aphids scarcity. [ABSTRACT FROM AUTHOR]

The article focuses on the evolution of gastrostomy feeding in children with chronic kidney disease (CKD) and its role in improving nutrition and growth outcomes. Topics include the historical challenges of achieving adequate nutritional intake in CKD patients, the shift from nasogastric to gastrostomy feeding over the past 25 years, and recent evidence supporting the effectiveness of gastrostomy devices in promoting normal growth in infants and children with CKD.

Autism spectrum disorder (ASD) is a pervasive neurodevelopmental disorder that brings heavy burdens to families and the society. This case-control study explored risk factors for ASD based on 74,252 children aged 3–12 years who were recruited from general education kindergartens, primary schools, and special education schools in Shanghai, China. One hundred ninety-two children were identified with ASD according to the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition. Male sex, the presence of anoxia or asphyxia at birth, artificial feeding, adverse maternal psychological status, complications during pregnancy and higher paternal education were associated with ASD even after controlling for age, residential district, family history of mental disorders, parental personality, and amount of daily TV viewing. [ABSTRACT FROM AUTHOR]

The rearing of ticks is an important technique for studies aiming to elucidate the course and pathogenesis of tick-borne diseases (TBDs). TBDs caused by protozoans (Theileria, Babesia) and bacteria (Anaplasma/Ehrlichia) impose a serious constraint upon livestock health and production in tropical and sub-tropical regions where the distributions of host, pathogen, and vector overlap. This study focuses on Hyalomma marginatum, one of the most important Hyalomma species in the Mediterranean region, being a vector of the virus that causes Crimean-Congo haemorrhagic fever in humans, together with H. excavatum, a vector of Theileria annulata, an important protozoan of cattle. The adaptation of ticks to feeding on artificial membranes allows the creation of model systems that can be put to use examining the underlying mechanisms of pathogen transmission by ticks. Silicone membranes, in particular, offer researchers the flexibility to adjust membrane thickness and content during artificial feeding. The aim of the present study was to develop an artificial feeding technique using silicone-based membranes for all developmental stages of H. excavatum and H. marginatum ticks. Attachment rates after feeding on silicone membranes for females H. marginatum and H. excavatum were 8.33% (8/96) and 7.95% (7/88), respectively. The use of cow hair as a stimulant increased the attachment rate of H. marginatum adults in comparison to other stimulants. The engorgement of H. marginatum and H. excavatum females took 20.5 and 23 days with average weights of 307.85 and 260.64 mg, respectively. Although both tick species could complete egg-laying, and this was followed by hatching of larvae; their larvae and nymphs could not be fed artificially. Taken together, the results of the present study clearly indicate that silicone membranes are suitable for feeding of H. excavatum and H. marginatum adult ticks, supporting engorgement, laying of eggs, and hatching of the larvae. They thus represent a versatile tool for studying transmission mechanisms of tick-borne pathogens. Further studies are warranted to examine attachment and feeding behaviours in order to increase the success of artificial feeding of larvae and nymphal stages. [ABSTRACT FROM AUTHOR]

The in vitro feeding of ticks facilitates the conduction of studies involving the intrinsic vector-pathogen relationship, susceptibility tests, and resistance to acaricides, in addition to mimicking the use of experimental hosts. The objective of this study was to establish an in vitro feeding system using silicone membranes to supply various diets to the species Ornithodoros rostratus. Each experimental group included 130 first-instar O. rostratus nymphs. The groups were divided according to the diet provided: citrated rabbit blood, citrated bovine blood, bovine blood with antibiotics, and defibrinated bovine blood. The control group was fed directly on rabbits. Ticks were weighed before and after the feeding and monitored individually according to their biological parameters. The results of the experiment demonstrated that the proposed system was efficient in terms of fixation stimulus and satisfactory in terms of tick engorgement, which would allow the maintenance of O. rostratus colonies by using artificial feeding through silicone membranes. All diets provided were efficient for the maintenance of colonies, but the ticks that received citrated rabbit blood displayed similar biological parameters to those observed under in vivo feeding conditions. [ABSTRACT FROM AUTHOR]

To date, the feeding and oral-motor abilities of patients with CHARGE syndrome (CS) have not been longitudinally assessed. This study aims to investigate the level of these abilities at different ages and evaluate how they evolve during growth. We retrospectively analysed oral-motor features of 16 patients with molecularly confirmed CS (age range 4–21 years old; mean 11 years; SD 6 years; median 10 years). Nearly 100% of CS new-borns had weak sucking at birth, and half of them demonstrated poor coordination between breathing and swallowing. Over time, the percentages of children with tube feeding dependence (60% at birth) faced a slow but steady decrease (from 33% at 6 months, 25% at 12 months, to 13% at school age) in tandem with the decreasing risk of aspiration. The ability of eating foods requiring chewing was achieved at school age, after the acquisition of an adequate oral sensory processing. A mature chewing pattern with a variety of food textures was not achieved by more than half of patients, including those requiring artificial enteral nutrition. Most patients started prolonged oral-motor treatments with speech language therapists in early childhood. Conclusions: Although feeding and swallowing disorders are constant features in CS patients, a slow and gradual development of feeding abilities occurs in most cases. Rehabilitation plays a key role in overcoming structural and functional difficulties and attaining appropriate eating skills. What is Known: • Feeding problems and swallowing dysfunction have been noted in CHARGE syndrome. • The involvement of multiple factors, including structural problems in the mouth, throat, or esophagus, and neurological impairment, make feeding a complicated task in CHARGE individuals. What is New: • Dysphagia gradually improves in most CHARGE children over time, though with a wide interindividual variability. • The percentages of children with tube feeding dependence decrease over time from 60% at birth to 33% at 6 months and 13% at school age. [ABSTRACT FROM AUTHOR]

Purpose: To determine the stability of appetitive traits during infancy and their association with early life exposures. Methods: Participants were from the BiTwin birth cohort (longitudinal study of Portuguese infants). Appetitive traits at 3 months were measured using the Baby Eating Behaviour Questionnaire (n = 347) and at 12 months with the Children's Eating Behaviour Questionnaire for toddlers (n = 325). Stability was assessed with multi-level models. The association of early life exposures (weight for gestational age, mode of feeding, prematurity, smoking during pregnancy, maternal pre-pregnancy BMI, gestational weight gain, and diabetes mellitus diagnosis) with infant appetitive traits was estimated by multivariable linear regression models. Results: Appetite traits showed limited stability (ICCs: 0.25–0.34). Associations with early life exposures varied by age. At 3 months, infants of mothers with higher pre-pregnancy BMI and excessive gestational weight gain had low Satiety Responsiveness. In contrast, infants small for gestational age scored high in this trait (β̂ = 0.241; 95% CI 0.056–0.425). Exclusively formula-fed infants presented weak food approach traits at this age, namely low Enjoyment of Food (β̂ = − 0.145; 95% CI − 0.270 to − 0.019) and Food Responsiveness (β̂ = − 0.415; 95% CI − 0.618 to − 0.212). At 12 months, infants who were small for gestational age had low Food Responsiveness (β̂ = − 0.297; 95% CI − 0.523 to − 0.072), in contrast, infants of mothers who gained excessive gestational weight had high scores in this trait. Formula feeding was related to rapid eating (Slowness in Eating: β̂ = − 0.252; 95% CI 0.451 to − 0.054). Conclusion: Early life exposures may play a role in the development of infants' appetitive traits, which then change during the first year of life. Interventions focussed on maternal and infant health may have the potential to shape appetite in infancy. [ABSTRACT FROM AUTHOR]

To perform its propagative and circulative cycle into its insect vector, the flavescence dorée phytoplasma invades different cell types. Clathrin-mediated endocytosis is used by a wide range of bacteria to infect eukaryote cells. Among the insect proteins interacting with the phytoplasma adhesin VmpA, we identified the adaptor protein complex AP-1 and AP-2 suggesting that phytoplasmas could enter the insect cells via clathrin-mediated endocytosis. By infection assays of insect cells in culture, we showed that phytoplasmas entry into Drosophila S2 cells was more efficient than infection of the Euva cell line developed from the insect vector Euscelidius variegatus. Chlorpromazine, cytochalasin D and knockdown of clathrin heavy chain (chc) gene expression using RNA interference inhibited entry of phytoplasmas into S2 cells. During invasion of S2 cells, phytoplasmas were observed very closed to recombinant GFP-labelled clathrin light chain. To verify the role of clathrin in the insect colonization by phytoplasmas, RNAi was performed via artificial feeding of chc dsRNA by the vector E. variegatus. This decreased the expression of chc gene in the midgut and heads of E. variegatus. The chc lower expression correlated to a decreased of midgut and salivary gland cells colonization after the insects had ingested phytoplasmas from infected plants. In conclusion, results indicate that clathrin is important for the FD phytoplasma to enter insect cells and colonize its insect vector. [ABSTRACT FROM AUTHOR]

Artificial feeding of fish enriches water mass with particulate organic matter, which serves as a feed for zooplankton. Phytoplankton was present in the pond in small amounts with the predominance of green, euglena, and yellow-green algae. Digging the ground, fish mix silt and waste products. Bacteria living on the bottom and in water release gas bubbles, which bring into the surface layers bacteria and fine detritus particles serving there as a feed for zooplankton. [ABSTRACT FROM AUTHOR]

Introduction: Food inadequacies in the first 6 months of life are considered a global problem, with an emphasis on early complementary feeding introduction (CFI). This study aimed to identify the determinants of CFI. Methods: A birth cohort study (N = 641). Data on infant feeding was collected before 30 days, and at 2, 4, and 6 months of age and, at baseline, data regarding socioeconomic status, demographics, maternal and infant health, obstetric history, and infant care. The hypothesis was that the risk determinants for early CFI vary according to the type of food and the age range of this introduction. Twelve Cox regression models were fit with four outcomes (formula; other types of milk; other beverages; and solid/semi-solid foods) considering three different age ranges of the infant at their introduction (< 2 months, 2–4 months, and 4–6 months). Results: The introduction of the four food groups analyzed was early (median ages of introduction: formulas = 45 days; other milks = 135 days; other beverages = 120 days; solids and semi-solids = 135 days). The determinants that increased the risk of introducing formulas before 2 months were: primiparity, employed without maternity leave, mothers with unsatisfactory prenatal counseling and those who had cesarean sections. Not living with a partner, infant pacifier use at 2 months of age had a higher risk of introducing formula between 2 and 4 months of age. Non-white skin color, more than 35 years old, low maternal education, and lower family income increased the risk of introducing other types of milk between 2 and 4 months of age. Between 4 and 6 months of age, adolescent and low education level mothers had a higher risk of introducing other types of milk, unemployed was a protective factor against the introduction of other foods and beverages in this age group. Conclusions: The determinants of early CFI varied according to the type of food and the age of introduction. [ABSTRACT FROM AUTHOR]

Purpose: Nutrition education andcounseling is the first-line approach in nutritional support for adult cancer patients; however, it is not well implemented in many clinical settings. This study aims to determine the effect of an evidence-based nutrition education and counseling (NEC) program on nutrition status among cancer patients receiving radiotherapy. Subjects/methods: This cluster-randomized clinical trial enrolled cancer patients receiving radiotherapy from ten radiotherapy units in three hospitals. Randomization was conducted at the unit level (five units into the NEC group and five units into the usual care group). The primary outcome was nutrition status after radiotherapy measured by the Patient-Generated Subjective Global Assessment (PG-SGA). Secondary outcomes included nutrition-related blood biomarkers after radiotherapy and the use of artificial nutrition and treatment interruption during radiotherapy. Results: A total of 468 patients were enrolled (241 in the NEC and 227 in the usual care group); 196 patients were female with a mean age (SD) of 59.8 (11.9). No difference was found between the NEC and usual care groups in nutrition status and blood biomarkers at baseline. After radiotherapy, patients in the NEC group had lower PG-SGA scores (5.6 vs 6.9; MD = −1.3, p < 0.001) and lower malnutrition rate (56.0% vs 70.5%; OR = 0.5; p = 0.004) compared with the usual care group. The usages of artificial nutrition and treatment interruption during radiotherapy and the level of blood biomarkers after radiotherapy did not differ between groups. Conclusions: Nutrition education and counseling is an effective approach in reducing malnutrition and can be generalized to multiple radiotherapy settings. Registered under ClinicalTrails.gov Identifier no.: None. [ABSTRACT FROM AUTHOR]

Objectives: Human milk expression has become an increasingly common means for providing milk to an infant, with women expressing to address breastfeeding problems or to allow for flexible feeding options. This study explored the experiences and recommendations of mothers who expressed human milk, with this paper reporting on the advice mothers would offer to other mothers to address common challenges. Methods: Interpretive description was used in this qualitative project. Using purposive sampling, mothers of infants aged 0–24 months who expressed human milk were recruited to participate from two health regions in western Canada. Individual, audio-taped interviews were completed with 35 women. NVIVO™ software was used for data analysis. Results: Mothers reported the desire to offer experiential advice to other mothers navigating milk expression and encouraged other mothers to seek guidance from health care professionals such as lactation consultants, peer support online, and from family and friends. Experiential knowledge shared included: (a) product recommendations, (b) expression tips, (c) support for workplace expression, (d) encouragement to seek help, and (e) moral support. Conclusions: Healthcare professionals should include evidence-based expression information as part of routine lactation support, while recognizing the importance of mother-to-mother knowledge transfer and emotional support. Services that assist mothers to determine and access pumps appropriate to their unique breastfeeding needs and goals should be offered, and the opportunity for peer support through creation of, or referral to, appropriate in-person or online support groups should be made available. [ABSTRACT FROM AUTHOR]

In this paper, I describe my 62 years in primatology focusing on some of the key findings from fieldwork conducted in Japan, India, and Africa. My first study on nonhuman primates described in detail the division of a troop of Japanese macaques at Takasakiyama. After that, I had an opportunity to work on Hanuman langurs at Dharwar, India. These langurs lived in one-male, multi-female groups. This type of group structure was maintained through takeovers by all-male parties. The adult male and all juvenile males were chased out of the group. By this process, the one-male, multi-female group system was maintained. The incoming adult male bit and killed all infants in the group. Mothers who lost their infants went into estrus and mated with the newly arrived male. For many years, scientists ignored these events or ruled them out as abnormal behavior. My work on Japanese macaques suggested that concentrated resources created by artificial feeding exaggerated dominance rank hierarchies among individuals, whereas it is comparatively relaxed in the natural environment. I also investigated the population dynamics of a troop and the life histories of individuals. From these studies, I documented the frequency of twin births, the carrying of dead infants by mothers, and the occurrence of physical malformations. These observations were made possible through artificial feeding, revealing the merits and demerits of this approach. I pointed out that authors and journal editors must be careful to acknowledge important elements of the environment where studies are conducted, and these should be described when reporting results in scientific articles. My studies of chimpanzees were conducted at Bossou, Guinea. I suggested that there are males who lived outside of bisexual groups. Chimpanzees in this population made and used many kinds of tools. Some of them were observed only at Bossou, and a few were only discovered 20 years after the establishment of Bossou as a research site. After decades of research on tool use in this species, I also suggested that there are cultural zones throughout the geographic distribution of chimpanzees. [ABSTRACT FROM AUTHOR]

Background: People with emotional eating (EE) may experience weight gain and obesity, eating disorder psychopathology, and emotion dysregulation. Limited research has examined experiences in childhood that may be associated with EE in adulthood. Perceived parental feeding practices and emotion regulation difficulties were examined as correlates of negative and positive EE in adulthood. Methods: A cross-sectional study using an online community sample of adults (N = 258) examined self-reported negative (Emotional Eating Scale-Revised; EE-anger/anxiety, EE-boredom, and EE-depression) and positive (Emotion Appetite Questionnaire; EE-positive) EE, perceived parental feeding practices (Child Feeding Questionnaire), and emotion regulation difficulties (Difficulties in Emotion Regulation Scale). Results: Moderation analyses calculated in PROCESS macro examined emotion regulation difficulties as a moderator of relationships between perceived parental feeding practices and EE. Across all models tested, age, BMI, and gender were entered as covariates. Higher perceptions of parental control (monitoring and restriction) of unhealthy eating behaviors and pressure to eat were more strongly associated with EE-anger/anxiety and EE-positive when emotion regulation difficulties were high. Higher perceptions of parental restriction of unhealthy eating behaviors and pressure to eat were more strongly associated with higher EE-boredom when emotion regulation difficulties were high. No significant interactions between perceived parental feeding practices and emotion regulation difficulties emerged in relation to EE-depression. Conclusions: Perceived controlling parental feeding practices and emotion regulation difficulties may explain meaningful variance in negative and positive EE in adulthood. [ABSTRACT FROM AUTHOR]

This article poses a response to one argument supporting the force feeding of political prisoners. This argument assumes that prisoners have moral autonomy and thus cannot be force fed in the early stages of their hunger strike. However, as their fasting progresses, their cognitive competence declines, and they are no longer autonomous. Since they are no longer autonomous, force feeding becomes justified. This article questions the recurrent citation of a paper in empirical support of the claim that hunger strike causes mental disorders or cognitive impairments. The paper, written by Daniel Fessler, partially relies on the Minnesota Starvation Experiment conducted in 1944 to 1945 for scientific support. Using widely accepted criteria for assessing the ethical acceptability of clinical research, we argue that the Minnesota Starvation Experiment had significant scientific shortcomings and is a case of unethical research. From this, we question the appropriateness of citing the Minnesota Starvation Experiment and consequently Fessler's paper. If Citing Fessler's paper becomes problematic, this particular argument for the force feeding of prisoners loses much of its strength. [ABSTRACT FROM AUTHOR]

This case report details how occupational therapy treatment in an outpatient setting successfully guided the parents of a child with autism spectrum disorder and a history of prematurity from restrained syringe feedings to the acceptance of spoon feedings. Occupational therapy practitioners are qualified, needed and available to assess and treat feeding disorders in children with autism spectrum disorder and a history of prematurity. Family-centered practice must be utilized for successful outcomes in an outpatient service delivery model. [ABSTRACT FROM AUTHOR]

To explore parenting style, child effortful control, parenting stress, and their associations with maternal use of pressure to eat among Asian U.S. immigrant families with preschoolers. One hundred and nine Asian immigrant mothers with 3-to-5-year-old children in Maryland, United States rated their authoritative and authoritarian parenting styles, frequency of pressuring their child to eat, perceived parenting stress, and child's effortful control. Two proposed moderated mediation models were tested using conditional process modeling. Effortful control mediated the association between authoritative parenting style and pressure to eat practices, αβ = −0.07, p < 0.05, and the association between authoritarian style and pressure to eat, αβ = 0.12, p < 0.05. Moreover, parenting stress moderated the association between child effortful control and maternal pressure to eat in the authoritarian style model, but not in the authoritative style model. Specifically, higher effortful control was associated with less use of pressure to eat at low and mean levels of parenting stress. Our findings revealed potential mechanisms underlying the associations between parenting styles and controlling feeding practices. Importantly, information learned from the present study may guide transdisciplinary efforts to design and implement culturally sensitive and family-based interventions targeting Asian immigrants' wellbeing and obesity in the United States. Highlights: This study examined the underlying mechanisms associated with the use of controlling feeding practices in Asian U.S. immigrant families with preschoolers. Child effortful control mediated the associations between parenting styles and pressure to eat. Parenting stress moderated the association between child effortful control and maternal pressure to eat in the authoritarian style model only. [ABSTRACT FROM AUTHOR]

Purpose: From September 2010 until November 2019, Ireland's infant vitamin D supplementation policy recommended administration of 5 μg/day of vitamin D3 from birth to 12 months to all infants, regardless of feeding method. This study aims to examine policy adherence. Methods: In the prospective COMBINE birth cohort study (recruited 2015–2017), detailed longitudinal supplement data were examined in 364 infants across the first year of life, according to product type, dose, frequency, and duration. Vitamin D supplement use at 2, 6, and 12 months in COMBINE was compared with the BASELINE cohort (recruited 2008–2011, n = 1949). Results: In COMBINE, 92% of infants initiated supplementation at birth. The median supplementation duration was 51 (40, 52) weeks, with a range of 3–52 weeks. While supplementing, most parents (92%) used an exclusive vitamin D supplement as recommended and 88% gave 5 µg/day. Half (51%) gave vitamin D daily and a further 33% supplemented at least 3–6 times/week. Overall, 30% adhered fully to the policy, providing 5 µg vitamin D3 daily from birth to 12 months. A further 16% were broadly compliant, giving 5 µg frequently for the full 12 months. Vitamin D supplement use at 2, 6, and 12 months in COMBINE was 93%, 89%, and 72%, considerably higher than our earlier BASELINE cohort at 49%, 64%, and 44% at the same time points (all P < 0.001). Conclusions: We report a high level of vitamin D supplementation initiation at birth, with full to broad policy adherence among more than half of infants. There is scope to improve overall compliance by focusing on supplementation frequency. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to explore association between maternal depressive symptoms and infant feeding practice at hospital discharge. Methods: Data were obtained from a birth cohort study based in Australia that linked to health administrative records. Maternal demographic data, mental health status derived from the Edinburgh Postnatal Depression Scale (EPDS), feeding practices of livebirths of at least 400 g or gestation periods of at least 20 weeks recorded during July–December 2015 were included (n = 14,658). Logistic regression models were performed to test association between presence of depressive symptoms and exclusive breast or formula feeding within 24 h prior to hospital discharge while adjusting for covariates known to be associated with breastfeeding. Results: About 12% of women self-reported having depressive symptoms (EPDS score ≥ 10). Although only 7% of women (n = 1012) exclusively formula fed their babies, having depressive symptoms was associated with a 51% higher likelihood of exclusive formula feeding at hospital discharge. The association remains significant after adjustment for maternal age, gestational weeks, number of previous pregnancies, socioeconomic and partner status (p < 0.001) and all other covariates (p = 0.009). Conclusions for Practice: Having depressive symptoms was associated with increased likelihood of exclusive formula feeding. Routine measurement post-delivery and early management of maternal depressive symptoms may influence infant feeding practice and reduce prevalence of exclusive formula feeding at hospital discharge. [ABSTRACT FROM AUTHOR]

Previous research suggests a deleterious impact on dietary quality when people immigrate to the United States and that children influence immigrant parent's decisions to serve traditional and/or non-traditional foods. Interviews (n = 75) were conducted with Hmong, Somali, and Latino parents of 5–7 year old children about the foods they serve to their children and how the child influences these food decisions. A racially/ethnically diverse team coded interviews using a mixed inductive/deductive approach. Most Latino and Somali parents reported serving mostly traditional foods at home. Regarding feeding decisions, parents reported: (1) allowing children non-traditional foods when requested; (2) "Americanizing" traditional foods; and (3) that children prefer traditional foods. Some Hmong parents reported serving their children non-traditional foods at meals while parents ate traditional foods. Results offer guidance to providers working with immigrant parents of young children regarding maintaining healthful diets when children request potentially unhealthy non-traditional foods. [ABSTRACT FROM AUTHOR]

Objective: Many children with chronic kidney disease (CKD) exhibiting symptoms of poor appetite, gastro-oesophageal reflux and vomiting are reliant on enteral tube feeds (ETF) to achieve adequate nutritional intake. Following a successful renal transplant (RT), some of these symptoms may resolve and ETF then discontinued. There are only a few studies reporting the time taken to transition from ETF to complete oral feeding after transplantation. This study aimed to investigate the time taken to discontinue ETF following RT in children attending a large tertiary nephrology unit. Methods: A retrospective review of medical and dietetic records between 1 January 2014 and 31 December 2017. Results: The study included 20 paediatric renal transplant recipients (70% male) aged 1 to 17 years. Seventy percent discontinued ETF at a median of 6 (0–70) weeks post-transplantation. Patients had ETF from a median of 0.45 (0–10.8) years of age, for a median of 3.9 (1.1–10.9) years prior to receiving a transplant. Four (20%) were referred to the Feeding and Eating Disorder team at a median of 20 (2–44) months post-renal transplantation. Mean body mass index (BMI) Z-score of 0.43 at 12 months pre-transplant was found to be significantly associated with shorter duration of ETF post-transplant (r = 0.8, p = 0.001). Conclusions: Seventy percent of children stopped ETF by a median of 6 weeks post-renal transplant. A good nutritional status pre-transplant may reduce the duration of ETF following transplantation. Four children experienced behavioural feeding issues post-transplant and required further specialist support. Future multi-centre research is required to support these findings to provide a more robust indication of time to achieve full oral feeding. [ABSTRACT FROM AUTHOR]

Objectives: To describe the prevalence of overweight and obesity among children under 5 years old, assess the indicators of breastfeeding practices, and explore the associations between breastfeeding practices and early childhood overweight/obesity. Methods: The survey was conducted in 20 counties in central and western China in 2016. All children under 5 years old were physically measured for anthropometric data and their breastfeeding practices were obtained through a face-to-face questionnaire interview. We performed logistic regressions to assess the associations of different breastfeeding practices with overweight/obesity. Results: The prevalence of overweight and obesity among children under 5 years old were 8.7% and 2.6%, respectively. Overall, 93.6% of children were breastfed, while only 20.7% had exclusive breastfeeding under 6 months of age and about half of the children under 5 years old were weaned at 12 months. Compared with children with a duration of breastfeeding ≥ 12 months, children who have been breastfed for < 6 months were significantly associated with a 97% increased risk of overweight/obesity (OR 1.97, 95% CI 1.34–2.88, P = 0.001). Conclusions for Practice: The present study showed that overweight and obesity among children under 5 years old in central and western China remained an important childhood health concern. The rates of most indicators of breastfeeding practices were low, which needed more public attention. Moreover, we found that a shorter duration of breastfeeding was associated with an increased risk of overweight/obesity among children in central and western China. [ABSTRACT FROM AUTHOR]

Dementia is reported to be the overall fourth leading non-communicable cause of death, and accounted for almost two million deaths worldwide (3.5% of the total number) in 2016. Dysphagia and aspiration pneumonia secondary to dementia are the two most serious comorbidities. As the dementia progresses and the severity of an individual's dysphagia increases, the question of whether to commence an artificial nutrition or allow a person to continue to eat and drink orally is raised, both having associated risks. The purpose of this study was to establish current perspectives regarding the method(s) of feeding being used or preferred, once an individual with dementia has reached the end stages of the disease and is unable to swallow safely and efficiently, and ascertain the reasons for the choice made. An online search was completed, and articles published in English available up to April 2018 were considered for inclusion. Hand searching inclusive of the grey literature was also completed to obtain the maximum amount of relevant information. The total yield numbered 1888 studies, and following exclusions, full text studies deemed suitable for review amounted to 18. Themes were generated during the review process, relevant information was extracted, and six main themes emerged: feeding method; aspiration pneumonia; mortality; malnutrition; ethical considerations, and religion. The review indicated that the preferred method of feeding in end-stage dementia was artificial nutrition, in most cases via percutaneous endoscopic gastrostomy. However, despite the perceived advantage of providing artificial nutrition, no convincing evidence was found to support the use of tube feeding in end-stage dementia. In fact, initiating tube feeding was considered to have adverse effects such as aspiration pneumonia, malnutrition and expedited death. Longitudinal research regarding current practice is therefore indicated to establish an optimal procedure for individuals with end-stage dementia and dysphagia. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of water-soluble dietary fibers (pectin, soybean fiber, and guar gum) on the bioavailability of quercetin glucoside mixture (Q3GM) comprising quercetin-3-O-glucoside (Q3G, 31.8%) and its glucose adducts. Methods: Male Wistar/ST rats were fed test diet containing 0.7% Q3GM with or without 5% of each dietary fiber for 8 weeks. Total quercetin derivatives were evaluated with liquid chromatograph tandem mass spectrometry (LC–MS/MS) as total quercetin derivatives after enzymatic deconjugation in plasma, urine, and fecal samples on week 2, 4, 6 and 8. Quercetin glucuronides excreted in feces were also measured. Results: Fiber feeding elevated cecal weight and reduced cecal pH, indicative of cecal fermentation promotion. Changes in plasma and urinary quercetin levels revealed three phases of quercetin metabolism, including cumulative, transient, and stable phases. On week 2, total quercetin derivatives were higher in plasma samples from three fiber-fed groups than those control groups; however, urinary excretion increased in fiber-fed groups on week 4. Soybean fiber upregulated plasma and urinary quercetin levels on week 6 and 8. Intestinal degradation of quercetin by bacteria, calculated from differences between aglycone ingestion and sum of urinary and fecal excretion, was suppressed after dietary fiber supplementation especially in pectin fiber, which may partly contribute to the increase in quercetin bioavailability. Fecal quercetin glucuronide excretion was high in soybean fiber-fed rats, suggestive of the reduction of β-glucuronidase in colon. Conclusion: Water-soluble dietary fibers, especially soybean fiber, enhanced quercetin bioavailability after chronic feeding and may promote beneficial effects of quercetin on disease prevention. [ABSTRACT FROM AUTHOR]

Purpose: To explore the associations between type of milk feeding (the "nutrients") and mode of breast milk feeding (the "nursing") with child cognition. Methods: Healthy children from the GUSTO (Growing Up in Singapore Toward healthy Outcomes) cohort participated in repeated neurodevelopmental assessments between 6 and 54 months. For "nutrients", we compared children exclusively bottle-fed according to type of milk received: formula only (n = 296) vs some/all breast milk (n = 73). For "nursing", we included only children who were fully fed breast milk, comparing those fed directly at the breast (n = 59) vs those fed partially/completely by bottle (n = 63). Results: Compared to infants fed formula only, those who were bottle-fed breast milk demonstrated significantly better cognitive performance on both the Bayley Scales of Infant and Toddler Development (Third Edition) at 2 years [adjusted mean difference (95% CI) 1.36 (0.32, 2.40)], and on the Kaufman Brief Intelligence Test (Second Edition) at 4.5 years [7.59 (1.20, 13.99)]. Children bottle-fed breast milk also demonstrated better gross motor skills at 2 years than those fed formula [1.60 (0.09, 3.10)]. Among infants fully fed breast milk, those fed directly at the breast scored higher on several memory tasks compared to children bottle-fed breast milk, including the deferred imitation task at 6 months [0.67 (0.02, 1.32)] and relational binding tasks at 6 [0.41 (0.07, 0.74)], 41 [0.67 (0.04, 1.29)] and 54 [0.12 (0.01, 0.22)] months. Conclusions: Our findings suggest that nutrients in breast milk may improve general child cognition, while nursing infants directly at the breast may influence memory. [ABSTRACT FROM AUTHOR]

Background: Studies on forgoing treatment often ignore treatments that are continued until death.Objective: To investigate how often specific treatments are withdrawn or withheld before death and to describe the associated patient, physician, and care characteristics.Design: National mortality follow-back study in Switzerland in 2013/2014 using a standardized survey to collect information on the patient's end of life and demographics on the physician.Participants: A random sample of adults who died non-suddenly without an external cause and who had met the physician completing the survey (N = 3051).Main Measures: Any of nine specific treatments was continued until death, withdrawn, or withheld.Key Results: In 2242 cases (84%), at least one treatment was either continued until death or withheld or withdrawn. The most common treatment was artificial hydration, which was continued in 23%, withdrawn in 4%, and withheld in 22% of all cases. The other eight treatments were withdrawn or withheld in 70-94% of applicable cases. The impact of physician characteristics was limited, but artificial hydration, antibiotics, artificial nutrition, and ventilator therapy were more likely to be withheld at home and in nursing homes than in the hospitals.Conclusions: Large differences exist between care settings in whether treatments are continued, withdrawn, or withheld, indicating the different availability of treatment options or different philosophies of care. While certain patient groups are more likely to have treatment withheld rather than attempted, neither patient nor physician characteristics impact the decision to continue or withdraw treatment. [ABSTRACT FROM AUTHOR]

Objectives: This study was performed to determine the use of technological devices among 0–3 year old children and the attitudes and behaviours of their parents for the use of technological devices. Methods: This cross-sectional study was conducted in five family health centers located in Zonguldak City Center. Study group was composed of a total of 500 parents who admitted to five family health centers between April 04-June 01, 2018, who had a child of 0–3 years old and who approved to participate in the study. Data of the study were collected through face-to-face interview technique by using Data Collection Form. Results: In this study, the majority of the parents (82.4%) and children (81.8%) were using at least one of the technological devices. Smartphones (40.8%) were the most commonly used technological devices among the children; and it was followed by television (39.6%) and tablet/computer (19.6%), respectively. Nearly half of the children were using at least one of the technological devices for an average of 2–5 h per day. Parents allowed their children to use technological devices in order to do housework, silence the child when cried, to feed the child, to be able to make him/her sleep, to entertain her/him when he/she spoiled and to spend some time with friends, respectively. Conclusions: The results of this study reveal the necessity for the parents to get counseling service about the health risks that may occur in children due to long-term use of technological devices and about spending effective time with children. [ABSTRACT FROM AUTHOR]

Background: Critically ill children have a high prevalence of malnutrition. Children with acute kidney injury experience high rates of protein debt. Previous research has indicated that protein provision is positively associated with survival. Methods: This was a prospective observational study of all patients receiving CRRT for greater than 48 h at our tertiary care institution. Patients with inborn errors of metabolism were excluded. Data collection included energy, protein, and fluid volume intakes, anthropometrics, feeding modality, and route of nutrition intake. Results: Forty-one patients 9 ± 6.8 years of age, 66% male, received CRRT over a 10-month time period. CRRT treatment was 17.3 ± 25 days. Forty-one percent were malnourished via anthropometric criteria at CRRT start. Median protein delivery was 2 g/kg/day (IQR 1.4–2.5). Fifty-one percent received a combination of parenteral nutrition (PN) and enteral/oral feedings (EN), 34% received only PN, and 12% received only EN. Percentage of time meeting protein goals by modality was 27.6%, 34.6%, and 65.3% for those patients receiving solely EN, PN, and EN + PN combination, respectively. When weaned to only EN support from combination PN + EN, the average percentage of time protein goals were met decreased to 20.5% (p < 0.01). Conclusions: Without PN, patients on enteral/oral nutrition support fail to meet appropriate protein prescription. Transition of parenteral to enteral feeds was identified as a period of nutritional risk in children receiving CRRT. [ABSTRACT FROM AUTHOR]

Childhood obesity is increasing especially in Latinos and early intervention is essential to prevent later obesity complications. Latino children (n = 201) recruited at two San Francisco hospitals were assessed at birth including infant anthropometrics and feeding practices and followed to age 9 with annual anthropometric assessments. We evaluated the relationship between perinatal risk factors and obesity at age 9 and chronic obesity (obesity at both 5 and 9 years). Higher birthweight [odds ratio (OR) 2.48, 95% confidence interval (CI) 1.06-5.81] and maternal pre-pregnancy body mass index (BMI) (OR 1.09, 95% CI 1.00-1.18) were associated with increased risk for obesity at 9 years. Higher maternal pre-pregnancy BMI (OR 1.10, 95% CI 1.01-1.20) was associated with chronic obesity. Additionally, prenatal depression symptoms were protective (OR 0.33, 95% CI 0.11-0.94) against chronic obesity. We found no association between maternal age and education, exclusive breastfeeding at 4-6 weeks, rapid infant weight gain, and obesity or chronic obesity. Perinatal risk factors for obesity including higher birthweight and maternal pre-pregnancy BMI persisted until age 9, whereas, other variables significant at age 5 in our cohort and other populations including exclusive breastfeeding and rapid infant weight gain were no longer associated with increased risk. [ABSTRACT FROM AUTHOR]

The purpose of this prospectively collected database is to evaluate the safety of placement of a feeding jejunostomy (FJ) in patients undergoing upper gastrointestinal surgery and evaluating the gastrointestinal (GI) and mechanical complications. A total of 46 consecutive patients who underwent upper gastrointestinal surgery for various benign and malignant diseases were included. All of these patients underwent Witzel feeding jejunostomy at the time of laparotomy. The patients were followed postoperatively to record the gastrointestinal and/or mechanical complications that occurred during the hospital stay of the patients. Feeding jejunostomy could be performed in 100% of the patients and postoperatively, jejunostomy feeds could be started in 97.8% of the patients. 34.8% of the patients underwent an emergency laparotomy; 81.25% of the patients in the emergency group developed a significant postoperative FJ related complications with significant mechanical complications in the emergency group. GI complications were 82.14%; diarrhea was the most frequently encountered (69.5%). GI complications were more frequent and significant in patients with a low preoperative serum albumin (< 3.5 g/dl). No mortalities were recorded as a direct consequence of a FJ. Jejunostomy feeding is an excellent method of providing enteral nutritional support in patients undergoing major abdominal surgery and in patients with upper aero digestive tract pathologies who cannot be fed by mouth. Tube feeding is associated with complications which are minor and self-limiting or can be managed by simple bedside maneuvers. Feeding jejunostomy should be considered in all patients who may require short- or long-term enteral nutrition. [ABSTRACT FROM AUTHOR]

Objectives: To examine the ability of different elements of the Self-Feeding Assessment Tool for Elderly with Dementia (SFED) to predict mortality risk in nursing home residents.Design and Setting: Data from 387 residents in five nursing homes for the elderly in Japan were obtained using a baseline survey. This measure's ability to predict mortality risk was examined over a two-year observation period.Participants and Measurement: Demographic information (sex, age, height, weight, medical history) on 387 initial participants was gathered. A total of 10 individuals were excluded from the analysis because of the inability to eat by mouth at baseline, while 36 were excluded owing to missing mortality data during the observation period. The resulting 341 residents were divided into a death group or survival group according to whether they were still alive after two-year observation period. In addition to basic information and the SFED, the baseline survey included the Barthel Index (BI), Clinical Dementia Rating (CDR), and Mini Nutritional Assessment-Short Form (MNA®-SF). The ability of SFED to predict time-to-event mortality was examined using Cox proportional hazards regression analysis, including other measures associated with mortality as confounding variables.Results: In total, 129 participants (37.8%) died during the observation period, and their mean SFED score was significantly lower than that of surviving ones (11.1 ± 6.7 vs. 15.0 ± 5.6, P<0.001). SFED score was significantly associated with two-year mortality in the Cox proportional hazards regression analysis after adjusting for sex, age, medical history, BI, CDR, and MNA®-SF (hazard ratio = 0.941, 95% confidence interval = 0.898-0.985, P = 0.010). Additionally, three SFED categories were significantly associated with mortality risk: movement ("able to eat without dropping food"), concentration ("able to maintain attention to meal"), and safety ("able to swallow without choking, with no change in vocal quality after eating").Conclusions: Self-feeding ability as measured by SFED score was associated with long-term mortality in elderly living in nursing homes. Accordingly, adjusting feeding assistance based on regular SFED-based assessments may help maintain self-feeding ability and enhance quality of life in this population, as well as providing evidence for end-of-life care options and greatly improving care quality. [ABSTRACT FROM AUTHOR]

Objectives High birth weight (HBW ≥ 4000 g) infants are at increased risk for obesity, but research has yet to identify the mechanism for this increased risk and whether certain subsets of HBW infants are at greater risk. Methods This exploratory study examined child eating behaviors and maternal feeding practices and beliefs across 21 HBW and 20 normal birth weight (NBW, 2500-3999 g) infants at 7-8 months of age using maternal-report measures (n = 41) and a bottle feeding task (n = 16). Results HBW infants were at increased risk for high weight-for-length at 7-8 months (F (2, 38) = 6.03, p = .02) compared to NBW infants, but no statistically significance differences on weight gained per day since birth, child eating behaviors, or most maternal feeding practices and beliefs were found between HBW and NBW infants. However, HBW infants who maintained a high weight-for-length (≥ 85th percentile) at 7-8 months had a higher birth weight, gained more weight per day, and had lower maternal-reported satiety responsiveness and maternal social interactions during feedings than their HBW counterparts who were currently below the 85th percentile. Conclusions for Practice HBW infants did not differ from NBW infants on eating behaviors and feeding practices, but children born at HBW who maintain excess weight during infancy do differ from those infants who fall below the 85th percentile for weight-for-length. Future research should identify risk factors that longitudinally differentiate HBW infants at greatest risk for maintaining excess weight and develop early screening and intervention efforts for this subset of at-risk infants. [ABSTRACT FROM AUTHOR]

Objectives The present study investigates the influence of joint feeding preferences of both the mother and father on initiation and duration of breastfeeding. Methods Data from the Infant Feeding Practices Study II was analyzed. Female participants in a national consumer opinion panel were followed from pregnancy through 1 year postpartum, and were asked about infant feeding practices. We examined the association between maternal prenatal perception of the expectant father’s breastfeeding preferences and breastfeeding outcomes (initiation, duration of exclusive breastfeeding and any breastfeeding) and whether concordance between the parents’ infant feeding preferences influenced breastfeeding. Results Mothers who perceived that the father preferred exclusive breastfeeding (vs. no preference) were more likely to initiate breastfeeding [adjusted odds ratio (aOR) = 1.9; 95% confidence interval (95% CI) 1.0-3.7], and they had a lower hazard of stopping exclusive and any breastfeeding at any given time [exclusive breastfeeding: adjusted hazard ratio (aHR) = 0.8; 95% CI 0.6-0.9; any breastfeeding: aHR = 0.6; 95% CI 0.5-0.7]. When both the mother and the father preferred exclusive breastfeeding, the hazard of breastfeeding cessation at any given time was lowest (exclusive breastfeeding: aHR = 0.4; 95% CI 0.3-0.5; any breastfeeding: aHR = 0.4; 95% CI 0.3-0.5). The risk of breastfeeding cessation remained lower even when only the father preferred exclusive breastfeeding. Conclusions for Practice Mothers tend to breastfeed for a longer duration when they perceive that the expectant father prefers exclusive breastfeeding and, even more so, when both parental preferences for exclusive breastfeeding concur. Efforts are needed to involve expectant fathers in breastfeeding decision-making and education to achieve breastfeeding success. [ABSTRACT FROM AUTHOR]

Purpose: During the first years of life, food preferences are shaped that might last throughout a person’s entire life affecting his/her health in the long term. However, knowledge on early feeding habits is still limited for toddlers. Therefore, the goal of the present study was to: (1) assess toddlers’ nutrient intake; (2) compare the findings to past studies as well as to national feeding recommendations and (3) identify major food sources for energy and macronutrients.Methods: A food survey using a 4-day diary was conducted. The dietary software nut.s® was used to analyse the data.Results: A cohort of 188 healthy toddlers (aged 1-3 years) was analysed. The energy intake of most toddlers was below the recommended daily intake (RDI) but in accordance with earlier studies. Protein intake was three- to fourfold higher than the RDI and reached the proposed upper limit of 15% of total energy intake. Fat intake was in accordance with the RDI, but the balance of saturated and unsaturated fatty acids should be improved. Carbohydrate intake met the RDI. For the micronutrients, iron and vitamin D intakes showed critical values.Conclusion: As in other European countries, the diet of Swiss toddlers in general seems adequate but does not meet all nutritional requirements. In particular, the quality of the fats and vitamin D supplementation should be improved. For proteins and iron, additional research is needed to gain more confidence in the recommendations. [ABSTRACT FROM AUTHOR]

This study compared a behavioral feeding intervention with and without pre-meal sensory integration therapy (SIT) in two boys with autism spectrum disorder and severe food selectivity. For both participants, child bite and drink consumption and total intake increased to similar levels with corresponding decreases in inappropriate mealtime behavior (IMB) in both conditions. The SIT condition was then discontinued and both participants continued to exhibit high levels of bite and drink consumption with corresponding low levels of IMB during a non-SIT phase. Caregivers of both participants were then trained in the behavioral feeding intervention. Follow-up data were collected for one participant for two months following intervention and showed maintenance of treatment gains over time. Limitations of the current study and directions for future research comparing the effects of behavioral feeding interventions with and without SIT are discussed. [ABSTRACT FROM AUTHOR]

Purpose: The present study was designed to determine the effects of both choline form and availability on maternal immune function during lactation.Methods: Sprague-Dawley rats were randomized to one of the three diets 24-48 h before parturition and fed ad libitum until 21 days postnatal: 1 g/kg choline as free choline (C, n = 11), the current form, and amount of choline in commercial diets; 1 g/kg choline as phosphatidylcholine (PC1, n = 11); or 2.5 g/kg choline as PC (PC2.5, n = 8). Choline metabolites in offspring stomach contents were quantified. At 21 days, lymphocytes from mothers’ mesenteric lymph nodes and spleens were isolated and phenotypes and ex vivo cytokine production after mitogen exposure were determined.Results: There was a higher proportion of choline and a lower proportion of lyso-PC in stomach contents (representing dam’s milk) of C pups compared to PC1. In the mesenteric lymph nodes, feeding PC1 compared to C led to a higher IL-2 production after Concanavalin A (ConA) stimulation and a higher proportion of T cells (CD3+) and a lower proportion of B cells [immunoglobulin (Ig)κ, CD45RA+, and IgM+; P < 0.05]. Splenocytes from the PC1 group produced more IL-6 and TNF-α after lipopolysaccharides stimulation compared to C (P < 0.05). Splenocytes from the PC2.5 group produced more IL-2 and IL-6 after ConA stimulation compared to PC1 (P < 0.05).Conclusions: Feeding choline as PC in the maternal diet improved the ability of immune cells to respond ex vivo to mitogens and increasing the amount of PC in the diet further improved T cell proliferation. [ABSTRACT FROM AUTHOR]

Purpose: Consumption of Western diet high in fat and fructose has been attributed to the recent epidemic of nonalcoholic fatty liver disease (NAFLD). However, the impact of specific fatty acids on the progression of NAFLD to nonalcoholic steatohepatitis (NASH) is poorly understood. In the present study, we investigated the chronic effects of consumption of fructose in combination with saturated fatty acids (SFA) or trans fatty acids (TFA) on the development of NAFLD.Methods: Male Sprague-Dawley rats were randomly assigned to six isocaloric starch/high fructose (44% of calories), high fat (39% calories) diet containing either starch-peanut oil, fructose-peanut oil, fructose-palmolein, fructose-clarified butter, fructose-coconut oil or fructose-partially hydrogenated vegetable oil and fed for 24 weeks. Palmolein, clarified butter and coconut oil were used as the source of SFA whereas partially hydrogenated vegetable oil was used as the source of TFA. Peanut oil was used as the reference oil.Results: Long-term feeding of fructose in combination with SFA or TFA induced hepatic steatosis of similar extent associated with upregulation of stearoyl CoA desaturase-1. In contrast, fructose in combination with TFA induced NASH with fibrosis as evidenced by upregulation of hepatic proinflammatory cytokine and fibrogenic gene expression, increased hepatic oxidative stress and adipocytokine imbalance. Histopathological analysis revealed the presence of NASH with fibrosis. Further, peanut oil prevented the development of NAFLD in fructose-fed rats.Conclusion: Fructose in combination with TFA caused NASH with fibrosis by inducing oxidative stress and inflammation, whereas, fructose in combination with SFA caused simple steatosis, suggesting that the type of fatty acid is more important for the progression of NAFLD. [ABSTRACT FROM AUTHOR]

In dieser Übersicht werden auf der Basis eines literaturgestützten Expertenprozesses die für den klinischen Alltag relevanten Grundsätze der Palliativversorgung von Menschen mit fortgeschrittener Demenz dargestellt. Insbesondere wird auf Indikation, Bedeutung und Ziele der Palliativversorgung bei fortgeschrittener Demenz, auf lebensverlängernde Maßnahmen und auf Möglichkeiten der Beschwerdelinderung in der letzten Lebensphase eingegangen. Ein besonderer Schwerpunkt liegt auf den rechtlichen Grundlagen der Entscheidungsfindung. [ABSTRACT FROM AUTHOR]

The long feeding duration of ixodid ticks and need for regular blood changes turns the artificial feeding of ticks into a tedious process. To reduce the number of blood changes, a semi-automated system (SAS) for the artificial feeding of hard ticks was developed and evaluated. It consisted of a glass feeding reservoir that can accommodate six tick feeding chambers. A peristaltic pump was used to pump blood through the feeding reservoir, which was changed once daily. Groups of Dermacentor reticulatus and Ixodes ricinus adults were fed simultaneously in both the SAS and a conventional in vitro feeding system. In the conventional system, feeding chambers were hung inside a glass beaker filled with blood that was replaced twice daily. Dermacentor reticulatus adults fed in the SAS obtained significantly higher engorgement weights. Although engorgement rates between both systems were comparable, significantly more SAS-fed females laid fertile egg batches. The egg batch weight of SAS-fed females was also significantly higher. In contrast, the engorgement rate and fecundity of SAS-fed I. ricinus were significantly reduced in comparison to ticks fed in the conventional system. This reduction was likely to be caused by fungal infestation, which could spread between feeding chambers in the SAS. Although the SAS reduced the workload compared to the conventional feeding system and showed promising results for the in vitro feeding of D. reticulatus adults, measures to prevent fungal infestations in the SAS should be considered in future studies. [ABSTRACT FROM AUTHOR]

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Background: Nasoduodenal tube (NDT) placement is typically performed at the bedside and two-view abdominal radiographs are usually used to confirm tube position. Anecdotally, in most instances the lateral view is unnecessary and utilizes more than twice the radiation than an anteroposterior (AP) view alone.Objective: We hypothesize that NDT location can be determined using only the AP view, with the NDT position determined on two views utilized as the gold standard.Materials and Methods: A search was performed for all two- or three-view abdominal radiographs from September 2012 to September 2013 with the phrase "ND tube" in the reason field of the requisition. These studies were independently reviewed by two radiologists and scored for anatomical tube position in three different scenarios: AP view alone, the lateral view alone, and both views together, with the latter serving as the gold standard. The anatomical scores were subsequently grouped to reflect clinically significant scenarios. Comparative analysis was performed with the original and clinically grouped scores.Results: A total of 102 patients and 306 separate two-view exams were evaluated. Of the 102 patients, 55 had at least two separate exams. Across raters, concordances of AP and lateral scores relative to the gold standard assessment were 88% and 73% for anatomical scores, and 91.5% and 86.4% for clinically grouped data. Trend differences for fewer errors were found with the AP compared to the lateral view. There were statistically significant group differences with a greater number of false-negative errors in the lateral data set. No clear differences were found when comparing AP and lateral ratings for false-positive errors. Upon review of the common errors, we determined a few imaging findings on AP radiographs that can help assess the need for an additional lateral view.Conclusion: A single AP view is sufficient to determine the NDT position in most cases. Two views should be reserved for cases where the NDT position cannot be definitively assessed. Transitioning toward the single AP view to evaluate the NDT position could have immediate consequences for dose reduction. [ABSTRACT FROM AUTHOR]

In vitro feeding of ticks (Acari: Ixodidae) is an important means to study the biology of ticks and their vectorial capacity. Here, we have adapted the tick Hyalomma lusitanicum Koch to previously published silicone-based membranes for in vitro feeding. For comparison purposes data on pre-oviposition, oviposition and hatching from females engorged on animals were used. A total of 68 engorged females out of 169 were obtained; feeding duration and feeding behaviour were similar to that of ticks on live host animals, although the final weight achieved for membrane-fed ticks was lower than that of their animal-fed counterparts. Comparison of the time taken for egg production and hatching showed that pre-oviposition was faster for membrane-fed ticks (16 days) than for animal-fed ticks (36 days), whereas the duration of oviposition-hatching was the same for the two feeding methods (34 days). We also observed that seasonality has an influence on tick feeding success: the conditions in Spring/Summer accelerated the tick life cycle. It is concluded that relatively large numbers of homogeneous laboratory-raised Hyalomma ticks can be produced without feeding them on experimental animals. [ABSTRACT FROM AUTHOR]

This contribution analyzes end-of-life decisions in Italy. Its aim is to report the complex situation in end-of-life decisions. The scientific work applies an interdisciplinary approach by taking into consideration the position of the medical and biomedical communities. In addition, it examines the perspective of the jurisprudence and of the parliament. The investigation of all these parties is fundamental since Italy is one of the few Western European countries that does not have an ad hoc law ruling advance directives. After a complete and comprehensive study of the standpoint taken by the medical and biomedical communities, in addition to the position taken by the Italian law-maker, this contribution underlines the significance of the role of the jurisprudence. In the conclusions, the author underlines the significance of a specific law governing advance directives since it will end the contrasts between these different communities in addition to provide legal certainty. [ABSTRACT FROM AUTHOR]

Background Length of residence in the United States (US), changes in dietary and physical activity behaviors, and economic and social barriers contribute to high childhood obesity rates among children from immigrant families in the US. Brazilians comprise a fast-growing immigrant population group in the US, yet little research has focused on health issues affecting Brazilian children in immigrant families. Understanding sociocultural and environmental influences on parents' beliefs and practices related to child feeding and weight status is essential to altering obesity trends in this group. Methods Qualitative study consisting of five focus groups with a convenience sample of 29 Brazilian immigrant mothers. Results Analyses revealed that the sociocultural and environment transitions faced by Brazilian immigrant mothers' influence their beliefs and practices related to child feeding and weight status. Additionally, acculturation emerged as a factor affecting mothers' feeding practices and their children's eating habits, with mothers preferring Brazilian food environments and that their children preferring American food environments. Mothers viewed themselves as being responsible for promoting and maintaining their children's healthy eating and feeding behaviors, but changes in their social and cultural environments due to immigration and the pressures and demands of raising a family in a new country make this difficult. Conclusions Health promotion interventions to improve healthful eating and feeding practices of Brazilian children in immigrant families must account for social and cultural changes and daily life demands due to immigration as well as potential variation in the levels of acculturation between mothers and their children. [ABSTRACT FROM AUTHOR]

Parent perception of weight and feeding styles are associated with obesity in other racial groups but have not been explored in-depth in Chinese-American preschoolers. Cross-sectional survey of 253 Chinese-American parents with preschoolers was performed in a community clinic. Regression analysis was used to assess relationships between parental perception of weight and feeding styles. Parent under-perception of weight was common but more likely in boys than girls (χ = 4.91, p = 0.03). Pressuring was also greater in boys [adjusted mean difference (95% CI) 0.24 (0.004, 0.49)]. In girls, pressuring was lower for children perceived as overweight [adjusted mean difference in CFQ scores −0.75 (−1.27, −0.23)]; in boys, pressuring was high regardless of perceived child weight. Weight perceptions and feeding styles related to childhood obesity in other groups were identified in Chinese-American families. Parent under-perception of child weight and pressure to eat were more common in boys. These factors should be addressed in Chinese-American preschooler obesity prevention programs. [ABSTRACT FROM AUTHOR]

This study evaluated the effectiveness of a family-centered feeding intervention, Easing Anxiety Together with Understanding and Perseverance (EAT-UP™), for promoting food acceptance of children with autism spectrum disorder at home. A concurrent multiple-baseline design was used with systematic replication across three families. Baseline was followed by an 'Intervention-Coaching' phase and then an 'Intervention-Independent' phase. Using direct observation and pre- and post-intervention questionnaires, data on acceptance of less preferred foods and challenging mealtime behaviors were collected. Procedural fidelity was monitored throughout all study phases. Data were analyzed using visual analysis and measures of effect size. All children demonstrated increases in food acceptance (effect size >0.90) and dietary diversity and decreased challenging behaviors. Implications for practice and research are discussed. [ABSTRACT FROM AUTHOR]

Objective WHO and UNICEF recommend cup feeding for neonates unable to breastfeed in low-resource settings. In developed countries, cup feeding in lieu of bottle feeding in the neonatal period is hypothesized to improve breastfeeding outcomes for those initially unable to breastfeed. Our aim was to synthesize the entire body of evidence on cup feeding. Methods We searched domestic and international databases for original research. Our search criteria required original data on cup feeding in neonates published in English between January 1990 and December 2014. Results We identified 28 original research papers. Ten were randomized clinical trials, 7 non-randomized intervention studies, and 11 observational studies; 11 were conducted in developing country. Outcomes evaluated included physiologic stability, safety, intake, duration, spillage, weight gain, any and exclusive breastfeeding, length of hospital stay, compliance, and acceptability. Cup feeding appears to be safe though intake may be less and spillage greater relative to bottle or tube feeding. Overall, slightly higher proportions of cup fed versus bottle fed infants report any breastfeeding; a greater proportion of cup fed infants reported exclusive breastfeeding at discharge and beyond. Cup feeding increases breastfeeding in subgroups (e.g. those who intend to breastfeed or women who had a Caesarean section). Compliance and acceptability is problematic in certain settings. Conclusions Further research on long-term breastfeeding outcomes and in low-resource settings would be helpful. Research data on high risk infants (e.g. those with cleft palates) would be informative. Innovative cup feeding approaches to minimize spillage, optimize compliance, and increase breastfeeding feeding are needed. [ABSTRACT FROM AUTHOR]

Background: Although the literature on nursing home (NH) patients with tube feeding (TF) has focused primarily on the continuation vs. discontinuation of TF, the reassessment of these patients for oral feeding has been understudied. Re-assessing patients for oral feeding may be better received by families and NH staff than approaches focused on stopping TF, and may provide an opportunity to address TF in less cognitively impaired patients as well as those with end-stage conditions. However, the literature contains little guidance on a systematic interdisciplinary team approach to the oral feeding reassessment of patients with TF, who are admitted to NHs. Methods: This project had two parts that were conducted in one 170-bed intermediate/skilled, Medicare-certified NH in Honolulu, Hawai'i. Part 1 consisted of a retrospective observational study of characteristics of TF patients versus non-tube fed patients at NH admission (2003-2006) and longitudinal follow-up (through death or 6/30/2011) with usual care of the TF patients for outcomes of: feeding and swallowing reassessment, goals of care reassessment, feeding status (TF and/or per oral (PO) feedings), and hospice status. Part 2 involved the development of an interdisciplinary TF reassessment protocol through working group discussions and a pilot test of the protocol on a new set of patients admitted with TF from 2011-2014. Results: Part 1: Of 238 admitted patients, 13.4% (32/238) had TF. Prior stroke and lack of DNR status was associated with increased likelihood of TF. Of the 32 patients with TF at NH admission, 15 could communicate and interact (mild, moderate or no cognitive impairment with prior stroke or pneumonia); while 17 were nonverbal and/or bedbound patients (advanced cognitive impairment or terminal disease). In the more cognitively intact group, 9/15 (60%) were never reassessed for tolerance of oral diets and 10/15 (66.7%) remained with TF without any oral feeding until death. Of the end-stage group, 13/17 (76.5%) did not have goals of care reassessed and remained with TF without oral feeding until death. Part 2: The protocol pilot project included all TF patients admitted to the facility in 2011-2014 (N=33). Of those who were more cognitively intact (n=22), 21/22 (95.5%) had swallowing reassessed, 11/22 (50%) resumed oral feedings but 11 (50%) failed reassessment and continued exclusive TF. Of those with end-stage disease (n=11), 100% had goals of care reassessed and 9 (81.8%) families elected individualized oral feeding (with or without TF). Conclusion: Using findings from our retrospective study of usual care, our NH's interdisciplinary team developed and pilot-tested a protocol that successfully reintroduced oral feedings to tube-fed NH patients who previously would not have resumed oral feeding. [ABSTRACT FROM AUTHOR]