Methodological Development of an Exploratory Randomised Controlled Trial of an Early Years’ Nutrition Intervention: The CHERRY Programme (Choosing Healthy Eating When Really Young).

Methodological development of an exploratory randomised controlled trial of an early years’ nutrition intervention: the CHERRY programme (Choosing Healthy Eating when Really Young).

Matern Child Nutr. 2013 Jun 25;
Watt RG, Draper AK, Ohly HR, Rees G, Pikhart H, Cooke L, Moore L, Crawley H, Pettinger C, McGlone P, Hayter AK

Good nutrition in the early years of life is vitally important for a child’s development, growth and health. Children’s diets in the United Kingdom are known to be poor, particularly among socially disadvantaged groups, and there is a need for timely and appropriate interventions that support parents to improve the diets of young children. The Medical Research Council has highlighted the importance of conducting developmental and exploratory research prior to undertaking full-scale trials to evaluate complex interventions, but have provided very limited detailed guidance on the conduct of these initial phases of research. This paper describes the initial developmental stage and the conduct of an exploratory randomised controlled trial undertaken to determine the feasibility and acceptability of a family-centred early years’ nutrition intervention. Choosing Healthy Eating when Really Young (CHERRY) is a programme for families with children aged 18 months to 5 years, delivered in children’s centres in one urban (Islington) and one rural (Cornwall) location in the United Kingdom. In the development stage, a mixed-methods approach was used to investigate the nature of the problem and options for support. A detailed review of the evidence informed the theoretical basis of the study and the creation of a logic model. In the feasibility and pilot testing stage of the exploratory trial, 16 children’s centres, with a sample of 394 families were recruited onto the study. We hope that the methodology, which we present in this paper, will inform and assist other researchers in conducting community-based, exploratory nutrition research in early years settings. HubMed – eating

Advanced paternal age at birth: phenotypic and etiologic associations with eating pathology in offspring.

Psychol Med. 2013 Jun 24; 1-13
Racine SE, Culbert KM, Burt SA, Klump KL

Advanced paternal age at birth has been linked to several psychiatric disorders in offspring (e.g. schizophrenia) and genetic mechanisms are thought to underlie these associations. This study is the first to investigate whether advanced paternal age at birth is associated with eating disorder risk using a twin study design capable of examining both phenotypic and genetic associations. Method In a large, population-based sample of female twins aged 8-17 years in mid-puberty or beyond (n = 1722), we investigated whether advanced paternal age was positively associated with disordered eating symptoms and an eating disorder history [i.e. anorexia nervosa (AN), bulimia nervosa (BN) or binge eating disorder (BED)] in offspring. Biometric twin models examined whether genetic and/or environmental factors underlie paternal age effects for disordered eating symptoms.Advanced paternal age was positively associated with disordered eating symptoms and an eating disorder history, where the highest level of pathology was observed in offspring born to fathers ?40 years old. The results were not accounted for by maternal age at birth, body mass index (BMI), socio-economic status (SES), fertility treatment or parental psychiatric history. Twin models indicated decreased genetic, and increased environmental, effects on disordered eating with advanced paternal age.Advanced paternal age increased risk for the full spectrum of eating pathology, independent of several important covariates. However, contrary to leading hypotheses, environmental rather than genetic factors accounted for paternal age-disordered eating associations. These data highlight the need to explore novel (potentially environmental) mechanisms underlying the effects of advanced paternal age on offspring eating disorder risk. HubMed – eating

Areca nut chewing and risk of atrial fibrillation in taiwanese men: a nationwide ecological study.

Int J Med Sci. 2013; 10(7): 804-11
Tsai WC, Chen CY, Kuo HF, Wu MT, Tang WH, Chu CS, Lin TH, Su HM, Hsu PC, Jhuo SJ, Lin MY, Lee KT, Sheu SH, Lai WT

Background: Areca nut chewing is associated with the risk of obesity, metabolic syndrome, hypertension, and cardiovascular mortality. Although a few case reports or case series have suggested the link between areca nut chewing and cardiac arrhythmias, information about the relationship between areca nut chewing and atrial fibrillation (AF) is lacking. Thus, a nationwide ecological study was conducted to investigate this. Methods: Two national datasets, the nationwide population-based 2005 Taiwan National Health Insurance Research dataset (NHIRD) and the 2005 National Health Interview Survey (NHIS), were used for analyses. The clinical characteristics, inhabited area and medical histories for 375,360 eligible males were retrieved from the 2005 NHIRD. Health related behaviors including areca nut chewing, cigarette smoking, infrequent vegetable eating, and exercise habit were collected from the 2005 NHIS. The prevalence of AF and the areca nut chewing rate were evaluated by multivariate analysis. Results: Of the 375,360 males (mean age, 44 years old), 1,326 (0.35%) were diagnosed with AF. The higher areca nut chewing rate, the higher prevalence rate of AF in Taiwan (Spearman correlation coefficient r = 0.558, p = 0.007). After adjusting for other covariates, the current areca nut chewing rate was found to be independently associated with the prevalence of AF. The adjusted odd ratio for areca nut chewing was 1.02 (95% CI = 1.00-1.04) in risk of AF prevalence. Conclusions: Areca nut chewing is independently associated with the prevalence of AF in Taiwanese men. However, further exploration of the underlying mechanisms is necessary. HubMed – eating

Dental findings of gastroesophageal reflux disease and treatment planning.

Turk J Gastroenterol. 2013 Feb; 24(1): 70-1
Gül P

Gastroesophageal reflux (GER) is one of the most common digestive disorders known, and it effects approximately 40% of the general population (1). Excess amounts of gastric juice reflux into the esophagus, which subsequently induces symptoms with or without associated esophageal mucosal injury (esophagitis). Vomiting, heartburn or retrosternal burning discomfort, and oral regurgitation of bitter gastric contents are the most common symptoms of GER. Other than these symptoms, GER also has harmful effects on oral health (1). Long-term gastric reflux can bring about dental erosion, in particular, erosion of the posterior teeth, and the severity of which is related to the duration of GER, frequency of reflux, pH, type of acid, and the quality/quantity of saliva. Saliva protects the teeth because of its diluting and buffering role (2). A 23 year old female who complained about sensitive gums and dental caries was seen at our clinic. According to patient’s past medical history, it was noted that she was suffered from painful breasts, stomach problems, and a significant cough at night. Upon oral examination, there was noted demineralized places on the vestibule cervical region of her teeth (Figure 1A-C). Panoramic radiography showed that some restorations needed to be renewed, and dental caries was also diagnosed. Moreover, in several teeth, initial carious lesions were determined and at that time it was decided to follow these teeth until the beginning of restoration process. Before the restorative process, saliva flow rate, buffering capacity, and Streptococci mutans and/or Lactobacilli bacterial load counts were determined using an appropriate kit. During restorative treatment, older restorations in the lower molars were restored with amalgam. Older composite restorations were changed with amalgam. Restorations were completed in three weeks time. Finally, fluoride application were performed on sensitive areas. Before releasing the patient to follow up, oral hygiene education was given to patient and necessary changes noted for her diet (limitations regarding fatty and spicy meals, avoidance of bedtime eating, avoidance of alcohol, caffeine, soft drinks, citrus and hard candy) were told. GER, especially its effect on dental erosions as well as the diseases slightly effect dental caries, is significant (3). Insufficient amounts of saliva may cause both dental caries and erosion. Protection of the oral cavity depends on a needed sufficient amount of saliva (4,5). The buffering capability of saliva may also be very important for preventing dental caries. In addition, salivary flow rate is accepted as an important factor for preventing both dental caries and erosion (4,6). According to the results of our analysis, stimulated salivary flow rate was found to be low, however buffering capacity was normal. Salivary streptococci mutans and Lactobacilli levels were measured, and both were noted to be higher than 105 CFU/ml. If the salivary flow rate of the patient is diminished and regurgitation of gastric contents occurs at night time, the potential for damage to the teeth increases significantly (7). It is claimed that risk for development of cervical lesions is significantly elevated in patients with low unstimulated flow rates of saliva. Because saliva has a capability to buffer the acids on tooth surfaces, low salivary flow rates bring about initiation of dental erosion (7). It is proved by observing low salivary flow rates and cervical erosion regions in our patient. We followed and applied all the needed treatments necessary for our patient of three years who was suffered from GER. After six months, symptoms of GER was reduced related to the treatment which was recommended by her gastroenterologist. Panoramic radiography was again taken and it was determined that there were no problems in regards to her fillings except for an unimportant dental erosion, however initial caries lesions were seriously expanded. Six months later after the continuing to follow this patient, it was reported that there were no problems with her fillings, whereas caries was expanded and new initial caries lesions appeared. During the one year follow up period, although we continued to apply preventative treatment, there were suprisingly no problems with the observed surfaces of the amalgam fillings, whereas we found caries in surfaces of teeth which were not applied any restoration. Nevertheless, both the dental and medical treatments were performed succesfully and as a result both reflux symptoms as well as the new caries problems were nearly resolved. In the treatment of GER, the primary reason of the illness must be eliminated, and in order to accomplish this there needs to be close cooperation with a gastroenterologist. Furthermore, the patient’s mouth must be followed closely, and development of damage must be prevented by using appropriate restorative materials. Successful treatment of this medical condition is necessary before the initation of the dental rehabilitation. Acknowledgments: This study was presented in poster format at the XV. Departments of Restorative Dentistry Meeting in Trabzon, Turkey: Gul P, Akgul N (2010). HubMed – eating