Wellness check: Nutrition

 Maternal milk may be associated with better long-term cognitive outcomes in pre-term infants

1. Longer and more maternal milk intake was associated with better academic performance and reduced symptoms of attention-deficit/hyperactivity disorder (ADHD) in premature infants.

2. Benefits of maternal milk were greater in infants born at lowest gestational ages.

 Evidence Rating Level: 2 (Good)

 Infants born pre-term have increased mortality and morbidity and are at risk for long-term neurodevelopmental sequelae. Although maternal milk has been shown to positively affect neurodevelopment in full-term infants, this same benefit is less clear for pre-term infants.

This prospective cohort study included 586 preterm infants (53.6% male) to evaluate the association between maternal milk feeding on cognitive and behavioral outcomes.  Infants born less than 33-week gestation across 5 different Australian hospitals were included from January 2001 to December 2005. The primary exposure was mean volume of maternal milk ingested during hospitalization and duration of maternal milk feeding determined at follow-up visits at 4, 12, and 18 months. Neurodevelopment outcomes including 1) IQ, 2) academic achievement, 3) symptoms of attention-deficit/hyperactivity disorder (ADHD), 4) executive function, and 5) behavior were measured when infants reached 7 years of age. The association was adjusted for potential confounding covariates such as income, education level, occupation, race, alcohol use, and number of people living in the home.

Both higher maternal milk intake and longer duration of maternal milk intake during hospitalization were independently associated with higher cognitive performance, better academic achievements, and fewer symptoms of ADHD. Maternal milk exposure was not associated with executive function or behavior. Despite this, the study was limited due to the exclusion of donor human milk as a potential substitute for maternal milk. As a result, whether breast milk in general could provide similar benefits in preterm infants with no access to maternal milk remains to be determined. However, this large cohort study offers preliminary evidence that maternal milk could provide long-term benefits for pre-term infants.

Supplemental Nutrition Assistant Programs may help prevent child maltreatment

1. States with more generous SNAP policies had decreased number of reported child maltreatment.

2. States with more generous SNAP policies had decreased number of foster care placements.

 Evidence Rating Level: 2 (Good)

 In the US, approximately one third of children experience a Child Protective Service (CPS) investigation for potential mistreatment before the age of 18. Public assistance policies such as Supplemental Nutritional Assistance Program (SNAP) may help prevent child maltreatment by improving household resources among low income families. However, whether differences in SNAP policy play a role in child maltreatment has not been directly examined.

This prospective cohort study examined the association between generosity of state policies on SNAP with level of CPS involvement and foster care placement across all 50 states and the District of Columbia from 2004 to 2016. Generosity was measured by adoption of policies that improved or stabilized household resources for SNAP participants. The main outcome measured was reports of child maltreatment in CPS and children receiving foster care services. Statistical analysis was performed using a 2-way fixed-effects regression model..

This study found that states that adopted SNAP income generosity policy options had lower rates of CPS and foster care outcomes for all forms of child maltreatment and specifically for neglect even after controlling for important variables. However, the study was limited due the fact that the authors could not access all the policy and administrative options that states implemented during the study period. Nonetheless, the results of this study helped to provide initial evidence for further studies that examine how policies targeting food insecurity help play a role in the complex systems that impact child maltreatment.

Early peanut introduction was not associated with lower prevalence of peanut allergy

1. Introduction of a guideline recommending early peanut introduction to all infants was not associated with significant reduction in prevalence of peanut allergy.

2. Earlier peanut introduction was associated with lower odds of peanut allergy in infants born of Australian but not East Asian ancestry.

 Evidence Rating Level: 2 (Good)

 In children at-risk for food allergies, randomized clinical trials have shown that earlier peanut introduction can help lower the prevalence of peanut allergies. These results led to guideline changes in 2016 for early peanut introduction for all infants. However, whether early introduction of peanuts decrease the prevalence of peanut allergies in the general population is not known. As a result, the objective of the present study was to measure the change in prevalence of peanut allergy in the general population and in predetermined subgroups of high-risk infants.

This cross-sectional cohort study examined the prevalence of peanut allergy in two groups of Australian infants between the age of 11-15 months. One group consisted of 5276 infants tested between 2007-2011 prior to introduction of guideline changes and the other group consisted of 1933 infants tested in 2018-2019. Age of peanut introduction was evaluated using researcher-administered questionnaires. The primary outcome was prevalence of peanut allergy, which was detected via skin prick tests and confirmed by subsequent oral challenge if positive.

The prevalence of peanut allergy in 2018-2019 cohort was not significantly lower than the 2007-2011 cohort. However, within the 2018-2019 cohort, peanut introduction at 6 months or younger was associated with decreased odds of peanut allergy compared to infants exposed at 12 months or older. Despite these findings, the study was limited by the self-reported nature of peanut exposure as well as unaccounted population differences between these two cohorts. However, this study provided an effective framework for studies aimed at evaluating the efficacy of general dietary guideline changes in the US.

 Image: PD

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