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Nutrition

Global Health, Microbiology, Nutrition, Pediatrics, Research

Malnourished children have young guts

Malnourished children have young guts

Bangladeshi_childrenChildren who grow up malnourished lag behind healthy kids in terms of their height and weight. But a new study finds that they also fall behind in the bacteria in their guts. The findings may explain why weight gains are often temporary, and malnourished children remain underweight compared to healthy children in the long-term.

Babies get their first gut bacteria from their mothers during birth. As they eat new foods, the community that live in the intestines changes and matures throughout the first few years of life. By age three, an “adult” community has taken up residence in the gut, and helps the body to break down food and boost the immune system. But in malnourished children, scarce or low-quality food and infections from poor sanitation result in an underdeveloped bacterial community that looks more like the inhabitants of a young child.

A study by Sathish Subramanian and colleagues published yesterday in Nature finds that children living in a slum in Dhaka, Bangladesh who were treated for malnutrition with nutrient-dense foods, have a temporary improvement in their gut bacteria. But the community will regress back to a younger state months after the therapy stops. The results correlate with observations that nutritional therapy saves lives, but cannot correct problems such as stunted growth, learning disabilities and a weakened immune system.

Initially, the researchers took stool samples from healthy children of a range of ages from the same slum. By looking at the identity of the bacteria from their intestines, the researchers could figure out what types of bacteria live in the gut at different times. They then looked at the bacterial communities from children receiving therapeutic foods to treat malnutrition to determine the “age” of their communities throughout the course of their treatment.

In a commentary on the study, Elizabeth Costello, PhD, and David Relman, MD, researchers in the Department of Microbiology and Immunology at Stanford, compare the gut communities of malnourished children to a degraded environment, such as a clear-cut rainforest that becomes choked with weeds. Just as it is difficult to clear the weeds and restore the original rainforest trees, it is challenging to rehabilitate the gut communities of chronically malnourished children.

“Degraded communities can be resistant or resilient to change, and although host health can be restored, youth cannot,” write Costello and Relman. “Thus, an ounce of prevention is likely to be worth a pound of cure and, as with other types of developmental delays, early intervention may be crucial.”

The study’s authors suggest that monitoring the gut communities of impoverished children may be one way to kept tabs on their health, and to measure if experimental nutritional treatments are working. Just like height or weight, the age of the gut bacterial community may be one way to track a child’s growth and development.

Patricia Waldron is a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Malnourished infants grow into impoverished adults, study shows and Who’s hungry? You can’t tell by looking
Photo by Mark Knobil

Genetics, Nutrition, Obesity, Research

Early findings show nutrigenomics could make weight loss more efficient

Early findings show nutrigenomics could make weight loss more efficient

Bieler2“Food is your best medicine,” a wise saying and a book by the late Henry Bieler, MD, holistic doctor to the stars, includes testimonials by Gloria Swanson and Greta Garbo and a recipe for an alkalizing broth comprising four green vegetables to which he attributes all kinds of health benefits. My former ballet teacher (1919-2012) used to eat the broth according to his instructions whenever she was sick, almost sick, or feeling “toxic” for any reason, and I make it now and then just in case it works.

Well, science is moving toward grounding some beliefs about the healing power of certain foods for certain people and the effectiveness of diets tailored to a person’s genetic makeup. A New Scientist piece reports that last week at the European Society of Human Genetics meeting in Milan, University of Trieste researcher Nicola Pirastu, PhD, and colleagues presented findings on nutrigenomics showing that diets shaped according to a person’s metabolism may be more effective than non-specialized calorie reduction in helping him or her lose weight.

From the piece:

The team used the results of a genetic test to design specific diets for 100 obese people that also provided them with 600 fewer calories than usual. A control group was placed on a 600-calorie deficit, untailored diet.

After two years, both groups had lost weight, but those in the nutrigenetic group lost 33 per cent more. They also took only a year to lose as much weight as the group on the untailored diet lost in two years.

I’ll keep eating four green vegetables in their cooking water (and adding Bieler-taboo salt and pepper) until a larger, randomized trial tells me otherwise, but it’s worth considering that “healthy” isn’t one-size-fits-all. The piece continues:

[John Mathers, PhD, director of the Human Nutrition Research Centre at Newcastle University, UK] says the effects of even a healthy diet can vary according to someone’s genetics. For instance, the APOE gene is linked to the breakdown of fat, and one variant of it confers a higher risk of getting cardiovascular disease and dementia. “People with that variant respond differently to certain fats in the diet,” he says. Another gene affects how much vitamin B9 people need.

Previously: Stanford geneticist talks tracking biological data points and personalized medicine, Ask Stanford Med: Genetics chair answers your questions on genomics and personalized medicine and How genome testing can help guide preventative medicine
Photo by Emily Hite

Global Health, Nutrition, Parenting, Pediatrics, Research, Rural Health, Stanford News

Seeking solutions to childhood anemia in China

Seeking solutions to childhood anemia in China

Chinese boyHow can health and nutrition education needs in rural China be addressed? Start by examining infant-feeding practices.

Scott Rozelle, PhD, director of the Rural Education Action Program, part of the Freeman Spogli Institute for International Studies (FSI) Center on Food Security and the Environment at Stanford, conducted a study on 1,800 babies in China’s Shaanxi province to address high rates of anemia and cognitive delays in children owing to poor nutrition, though not necessarily lack of funds for healthy food.

A recent piece on the FSI website describes the ongoing study:

One third of households were given a free daily supply of nutritional supplements for their children. Another third were given the same free supplements, and were enrolled in a text message reminder program. A final third of households served as a control group. The study is ongoing through April, 2015, but 12 months into the program, the researchers have found that the supplements have reduced anemia rates by 28 percent, although cognitive delays have persisted.

Text message reminders appear to have been modestly effective in improving program compliance. Caregivers who received the reminders gave their baby the micronutrient supplements, on average, 10 percent more often over the course of the first six months of the study. So far, however, this improved compliance has not led to a corresponding fall in anemia rates.

Rozelle commented in the piece, “To reach all of China’s at-risk babies – that’s our ultimate objective. And to do that, we need an effective government program.”

Previously: Who’s hungry? You can’t tell by lookingFeeding practices and activity patterns for babies vary with families’ race and ethnicity, study shows and Student inventors create device to help reduce anemia in the developing world
Photo by Kris Krüg

Nutrition, Public Health, Research

How the body’s natural defenses help protect cells from toxins in everyday foods and flavorings

How the body's natural defenses help protect cells from toxins in everyday foods and flavorings

Here’s some interesting findings to ponder as you reach for your afternoon caffeine fix: Compounds in your saliva may protect human cells from powerful plant-based chemicals, called pyrogallol-like polyphenols (PLPs) that are found in coffee, tea and other foods or flavorings.

The research is a continuation of a 2013 study showing that plant-based flavorings could be damaging to DNA. The earlier findings suggested that, in some cases, the impact of PLPs was comparable to the effect of chemotherapy drugs. So Johns Hopkins researcher Scott Kern, MD, and colleagues set out to understand why the toxins weren’t harming cells and causing illness. Futurity reports on the results of the latest study:

Kern and colleagues found that an enzyme in saliva called alpha-amylase, the blood protein albumin, and the muscle protein myoglobin all protect cells from DNA breakage by tea, coffee, and isolated PLPs.

Kern emphasizes that the saliva enzyme and the proteins don’t protect against chemotherapy drugs, which also damage DNA. That suggests that defenses against PLPs may have evolved, in response to natural plant compounds that have been part of human diets for a long time.

Surprisingly, cells do not seem to need the protein protectors after a period of exposure to the toxins.

Previously: What is coffee?, For new moms, coffee scores a point: Caffeine doesn’t seem to interfere with baby’s sleep in study and Does coffee lower the risk of prostate cancer?

Chronic Disease, Health Costs, Health Policy, Nutrition, Obesity, Stanford News

Study shows banning soda purchases using food stamps would reduce obesity and type-2 diabetes

Study shows banning soda purchases using food stamps would reduce obesity and type-2 diabetes

soda

In the late 1800s and early 1900s, carbonated beverages such as Coca-Cola, Dr Pepper and 7UP were sold as nerve tonics and health drinks. But, we now know that sugary sodas contribute to obesity, type-2 diabetes and cavities. Still, most Americans drink more soda than they like to admit.

Even though sugar-laden soft drinks have no nutritional value, they are still eligible for food stamps. Nutrition researchers and some politicians have advocated for a ban on buying sugar-sweetened drinks with food stamps but the U.S. Department of Agriculture, which runs the program, is under tremendous pressure from beverage company lobbyists to keep the existing regulations.

Sugary drinks are especially concerning because too many liquid calories put consumers at a higher risk of developing type-2 diabetes. Some nutrition experts are concerned that taxpayers are subsidizing an unhealthy diet, which will result in higher medical costs for Medicare and Medicaid down the road, when food stamp recipients experience the health problems associated with obesity and diabetes.

In a new study (subscription required) published in this month’s Health Affairs, Sanjay Basu, MD, PhD, an assistant professor of medicine at the Stanford Prevention Research Center, and his colleagues created a computer model to simulate the effects of a soda ban on the health of food stamp recipients. They found that obesity would drop by 1.12 percent for adults, and by 0.41 percent for children, affecting about 281,000 adults and 141,000 children. Type-2 diabetes would also drop by 2.3 percent.

The researchers also calculated the effects of reimbursing participants 30-cents for each dollar spent on fruits and vegetables. The subsidy did not affect obesity or diabetes rates, but doubled the number of people who ate the recommended number of fruits and vegetables each day. A county in Massachusetts tried the same reimbursement system as part of the USDA’s Healthy Incentives pilot study, and saw a similar increase in the fruit and vegetable purchases of food stamp recipients.

“It’s really hard to get people to eat their broccoli,” said Basu in a press release. “You have to make it really cheap, and even then, sometimes people don’t know what to do with it.” But, with one in seven Americans receiving food stamps, he points out that these small changes can have wide-ranging effects.

“It’s very rare that we can reach that many people with one policy change and just one program.”

Patricia Waldron is a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Food stamps and sodas: Stanford pediatrician weighs inCan food stamps help lighten America’s obesity epidemic? and Stanford’s Sanjay Basu named a Top Global Thinker of 2013
Photo by Andy Schultz

Nutrition, Pediatrics, Public Health

Who’s hungry? You can’t tell by looking

child for hunger post2How can you tell if a child is hungry? Well, looks alone don’t tell the story.

That’s the message of a new photo exhibit on child hunger, which opened May 22 at San Francisco City Hall. The exhibit includes 20 photos of Bay Area children, who all appear to be healthy and well-fed. But half of them qualify as “food insecure,” meaning they and their families often go without enough to eat. In fact, one of four children in California lacks adequate food and may suffer the ache of hunger, what pediatrician Lucy Crain, MD, MPH, and her colleagues are calling a “silent epidemic.”

“I think people don’t want to focus on the prevalence of hunger and poverty. But we have to get it out in the open and acknowledge that it’s there. There shouldn’t be one child that goes to bed hungry for lack of food,” said Crain, who is an adjunct clinical professor of pediatrics at Stanford. Crain helped organize the exhibit, part of a larger campaign of the Child Health Advocacy Committee of the Northern California Chapter of the American Academy of Pediatrics to end childhood hunger.

The campaign was begun in response to the recent recession, when committee members all were reporting increased rates of hunger among their patients, said Lisa Chamberlain, MD, MPH, an assistant professor of pediatrics at Lucile Packard Children’s Hospital Stanford and founder of the advocacy group. Then in 2013, Congress threatened to eliminate the Supplemental Nutrition Assistance Program, which includes food stamps, on which millions of families depend. Congress did decrease the program benefits, with the result that more families and children are hungry and food banks are scrambling to keep up with demand, said Crain, who recently retired from her practice at Lucile Packard Children’s Hospital Stanford, where she treated children with disabilities.

child for hunger postAt one meeting, the pediatrician activists were struck by the fact that it is hard to tell which patients were hungry, noting, “You just can’t tell by looking – it’s all around us.” They decided to draw attention to the problem among legislators and the public at large and increase awareness among pediatricians and other health care professionals, who often fail to screen children for hunger issues. Children who lack adequate food, particularly those younger than age 3, may have developmental problems and are more likely to be in poor health as they grow up, studies show.

To illustrate the problem, the group enlisted the help of San Francisco documentary photographer Karen Ande, who has won awards for her work in photographing children in Africa (Karen happens to be a friend of mine who collaborated with me on a book on AIDS in Africa). She volunteered her time for the project, in which she shot photos of 20 children at a health fair and in neighborhoods in San Francisco. The project team screened the same children for hunger issues using the two most reliable questions from a survey developed by the U.S. Department of Agriculture. Half of the children were found to be food insecure.

“The real power of these photos is that you can’t tell by looking who screened positive for food insecurity and who did not,” said Crain, who is also a clinical professor emerita at UCSF.

The advocacy group is recommending to the American Academy of Pediatrics that its guidelines include screening for food insecurity as part of routine child health visits. If pediatricians know a family has inadequate food, they can refer parents to local resources, such as food banks and food pantries, or encourage them to apply for CalFresh, the state’s food stamp, supplemental nutrition program, Crain said.

As part of its campaign, the group also is preparing posters to be delivered to 2,000 Northern California pediatricians, as well as a BART display of the children’s photos. Collaborators in the project include the Food Security Task Force of the San Francisco Department of Public Health, the San Francisco Food Bank, WIC, CalFresh and the San Francisco Unified School District, all working to help achieve San Francisco Mayor Ed Lee’s goal of eliminating widespread hunger in the city by 2020.

Previously: Could a palm oil tax lower the death rate from cardiovascular disease in India?Lucile Packard joins forces with Ravenswood School District to feed families during the summer breakDoctors tackling child hunger during the summer and Annual federal statistics on children’s well-being released

Photos by Karen Ande

Chronic Disease, Health Policy, Nutrition, Obesity, Pediatrics, Videos

Fed Up: A documentary looks for answers about childhood obesity

Fed Up: A documentary looks for answers about childhood obesity

I can’t wait to see Fed Up, a new documentary about childhood obesity.

In the early 2000s, when I was earning a PhD in nutrition at UC Davis, I heard a lot of scientific debate about possible causes of the U.S. obesity epidemic. Was it too much fat in our diets? Too much sugar? Processed food? Junk food ads on TV? An “obesogenic environment” – one in which snacks are ubiquitous, adults drive everywhere and neighborhoods aren’t safe enough for kids to play outside?

Or was it something else?

“The message has been pushed on us: It’s your fault you’re fat,” says Mark Hyman, MD, chair of the Institute for Functional Medicine, in the Fed Up trailer above.

The movie assembles an impressive roster of experts in nutrition research, pediatric health and public advocacy to oppose that message. Michael Pollan, Mark Bittman, Robert Lustig, Marion Nestle, Harvey Karp, former President Bill Clinton and others say we should not be blaming individuals – especially kids – for struggles with their weight. Instead, they are taking a hard look for answers at the food environment.

“This is the first generation of American children expected to lead shorter lives than their parents,” says a voice-over in the Fed Up trailer. That definitely makes untangling the causes of the obesity epidemic worthy of the efforts of our best scientists. Like I said, I can’t wait to see it.

Previously: Childhood obesity a risk for imminent heart problems, research shows, Using hip hop to teach children about healthy habits and Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert
Via Food Politics

Neuroscience, Nutrition, Obesity, Research

Changing views on dietary fiber’s role in weight loss

Changing views on dietary fiber's role in weight loss

food girlAs the brain-gut connection comes into sharper focus, new insights into obesity are emerging. A recent study has found that dietary fiber’s role in weight loss, commonly attributed to releasing appetite-suppressing hormones in the gut, may be a matter of the mind. As Nature News reports, researchers from the UK and Spain showed in a study in mice how a product of fiber fermentation reduced food intake by influencing a region of the brain.

From the piece:

[The researchers] fed mice fibre labelled with carbon-13, which has an additional neutron from the more common carbon-12 that gives its nuclei a magnetic spin and therefore makes it easy to track as it progresses through the body’s chemical reactions. The fibre was fermented as usual into acetate, which turned up not only in the gut, but also in the hypothalamus, a part of the brain known to be involved in regulating appetite. There, the researchers found, it was metabolized through the glutamine-glutamate cycle, which is involved in controlling the release of neurotransmitters associated with appetite control. The same model has been proposed for acetate metabolism after drinking alcohol.

The mice fed with large doses of fermentable fibre ate less food, and ended up weighing less than control mice that were fed unfermentable fibre.

The article notes the researchers plan to investigate enriching fiber with acetate to aid digestion and appetite control. “It’s sort of a way of having your cake, and not eating it,” said Jimmy Bell, PhD, one of the study’s researchers and a biochemist at Imperial College London.

Previously: Examining how microbes may affect mental healthCould gut bacteria play a role in mental health? and Animal study shows a protein in the brain may regulate appetite
Photo by Harmon

In the News, Nutrition, Public Health

Health initiatives at the White House gain popularity

Health initiatives at the White House gain popularity

Barack Obama, Michelle ObamaIn case you missed it, The Washington Post recently took a look at how the Obamas are bringing flavors of healthy eating and activity into their home. An article describes how a culture of health drives not only President and First Lady Obama, but also influences their family, members of the current administration and nation-wide initiatives.

From the piece:

Earlier this year, there was an intense battle for bragging rights inside the complex as teams of six with names such as “Runnin’ Like Amtrak,” from Vice President Biden’s staff, and “Team Engage (Our Core),” from the Office of Public Engagement, earned a point for every 30 minutes of “moderate-to-vigorous physical activity” performed each day. Each team totaled its points each week.

“The culture here has shifted pretty dramatically, in direct ways and indirect ways, based on their leadership,” said Sam Kass, executive director of first lady Michelle Obama’s Let’s Move initiative and the White House senior policy adviser for nutrition policy. “I think we really live that. I think that’s been a transformation for the kitchen

In Obamaworld, the methods staff members use to reach their diet and fitness goals reflect their faith in the power of technology and data. Council of Economic Advisers Chairman Jason Furman, [PhD,] who got kudos from the president after he lost 50 pounds, surveyed the scientific literature on weight loss, tracked his food consumption and rate of physical behavior electronically and converted it into a spreadsheet to analyze it properly.

Past presidents and presidential candidates have taken different stances on eating and exercise behavior; as the article notes, “the cultural shift has political consequences.”

Previously: Classroom cupcakes: Should “party foods” at schools be limited?, White House announces “Apps for Healthy Kids” winners and An edible forest grows in Richmond: Urban gardening program teaches kids about food, nutrition
Photo by ASSOCIATED PRESS

In the News, Nutrition, Research

Examining how food texture impacts perceived calorie content

Examining how food texture impacts perceived calorie content

brownies_041614The texture of a food – whether it’s creamy or crunchy – may influence a person’s overall consumption and his perception on whether the food is calorie-rich or diet-friendly. That’s according to findings recently published in the Journal of Consumer Research.

For the study, researchers conducted five laboratory studies during which individuals were asked to sample hard, soft, rough or smooth foods and then give calorie estimations for each food. During one of the experiments, participants were asked to watch TV ads while eating bit-sized brownies. As the Huffington Post reports:

… half of the participants were asked to estimate how many calories they thought the brownies had, while the other half were not. Within these groups, half of the participants were given brownie bits that were soft, while the others were given ones that were hard.

Among the participants who were not asked to focus on the calorie content of the brownies, they consumed more soft brownie bits than hard brownie bits. However, among the participants who were asked to focus on the calorie content, they consumed more of the hard brownie bits than the soft ones.

The study is part of a growing body of scientific evidence showing that several factors can impact whether we consider foods to be healthy or fattening and how much we eat. Past research has shown that people frequently underestimate the calories they’re eating and that many of us tend to overeat in sit-down restaurants rather than fast-food spots. Additionally, the sequence of foods may affect how we calculate calorie content, and the color of tableware can influence how much we eat.

Previously: Obesity and smoking together may decrease taste of fat and sweet but increase consumption, Cereal-eaters: How much are you really consuming?, Fruit-filled Manga comics may increase kids’ consumption of healthy food, and Can dish color influence how much you eat?
Photo by Sarah

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