McKnight Pediatrics

Stay In Touch

Meat Study Researcher Didn't Report Ties to Food Industry

October 8, 2019

From The New York Times:

A surprising new study challenged decades of nutrition advice and gave consumers the green light to eat more red and processed meat. But what the study didn't say is that its lead author has past research ties to the meat and food industry.

The new report, published this week in the Annals of Internal Medicine, stunned scientists and public health officials because it contradicted longstanding nutrition guidelines about limiting consumption of red and processed meats. The analysis, led by Bradley C. Johnston, an epidemiologist at Dalhousie University in Canada, and more than a dozen researchers concluded that warnings linking meat consumption to heart disease and cancer are not backed by strong scientific evidence.

Several prominent nutrition scientists and health organizations criticized the study's methods and findings. But Dr. Johnston and his colleagues defended the work, saying it relied on the highest standards of scientific evidence, and noted that the large team of investigators reported no conflicts of interest and conducted the review without outside funding.

Dr. Johnston also indicated on a disclosure form that he did not have any conflicts of interest to report during the past three years. But as recently as December 2016 he was the senior author on a similar study that tried to discredit international health guidelines advising people to eat less sugar. That study, which also appeared in the Annals of Internal Medicine, was paid for by the International Life Sciences Institute, or ILSI, an industry trade group largely supported by agribusiness, food and pharmaceutical companies and whose members have included McDonald's, Coca-Cola, PepsiCo and Cargill, one of the largest beef processors in North America. The industry group, founded by a top Coca-Cola executive four decades ago, has long been accused by the World Health Organization and others of trying to undermine public health recommendations to advance the interests of its corporate members.

To read more, click here.

Pouch Problems

October 3, 2019

From WebMD:


Walk the baby food aisle and you'll quickly notice that those miniature glass jars of baby food from your childhood are being overtaken by squeezable, suck-able, disposable pouches.

A decade after they hit the shelves, billed as a mess-free portable option for on-the-go families, the puree-filled packages now make up more than a quarter of baby food sales in the United States. Nearly a third of 2-year-olds' packed lunches at day care contain at least one pouch, one recent University of Texas Austin study found, and some toddlers are getting more than half of their midday calories in pouch form.

That concerns child health experts who say that while the pouches are fine as an occasional snack, their overuse could potentially breed poor eating habits and stunt development of feeding skills and motor coordination at a critical stage of life.

"Many of us in the medical field have a love-hate relationship with pouches," says Kara Larson, a speech language pathologist and feeding specialist at Boston Children's Hospital. "They're convenient and travel well and are often a better choice than cookies or chips. But parents need to use them in moderation."

For infants and toddlers, Larson says, eating is an important learning experience. Scraping a spoon across a bowl and lifting it to the mouth develops motor coordination. Plucking cut-up bits of banana from a high-chair tray develops grasping skills. And unlike sucking from a pouch -- which requires a front-to-back tongue motion -- chewing soft foods requires a child to develop side-to-side tongue motions needed for eating and speech later in life.

"If children are just sucking from a pouch all the time, we worry that some of that tactile experience with food might be lost," she says.

Parents often like pouches for their wide variety of seemingly healthy flavors, ranging from quinoa and kale mixtures to organic vegetable blends. But experts warn that the actual taste of those vegetables and grains is often masked with sugar, which could pose dental problems and breed picky eaters.

"Children at this age are developing taste preferences that will follow them throughout life," says Courtney Byrd-Williams, PhD, a behavioral scientist at UTHealth School of Public Health in Austin, TX. "If they are used to eating overly sweet fruit or aren't exposed to plain vegetables, they are less likely to like them as adults."

She also worries that because pouches are far easier to suck down quickly, they might encourage children to keep eating, even when they're already full -- a bad habit that could cause problems in adulthood.

All that said, Larson and Byrd-Williams see no harm in offering babies 6 months or older and toddlers an occasional pouch -- in the grocery store, in the car, at big brother's soccer game -- when sitting down for a snack isn't practical. Just don't exceed one or two pouches per day, look for low-sugar/high-fiber options, and don't let convenience trump health.

"When we consider what convenience food has done to adult health, there are plenty of reasons to pause before passing your child another pouch," Byrd-Williams says.

Zantac Pulled From Shelves Over Carcinogen Fears

October 1, 2019

From The New York Times:

The pharmacy chains Walgreens, Rite Aid and CVS have moved to stop selling the heartburn medicine Zantac and its generic versions after the Food and Drug Administration warned this month that it had detected low levels of a cancer-causing chemical in samples of the drug.

A Walgreens spokesman said in a statement on Monday that the company had pulled the drug from its shelves "while the FDA continues its review of the products." A Rite Aid spokesman said the company was "in the process of removing Zantac and generic versions sold under the Rite Aid name from its shelves."

Walgreens and CVS, which announced its move on Saturday, both noted that the drug, which is known as ranitidine, has not been recalled. The companies said customers who had bought the products could return them for a refund.

The F.D.A. has said it is investigating the source of the contamination as well as the risk to patients, recommending that they talk to their doctors and that those who take over-the-counter versions consider switching to a different medication.

Zantac, the brand-name version of the drug, is sold by Sanofi, but generic versions are widely sold.

This month, the drug maker Novartis said that its generic-drug division, Sandoz, had stopped distributing a prescription form of ranitidine worldwide while it investigates the F.D.A.'s findings. GlaxoSmithKline has also stopped shipping its generic version of the drug, as well as Dr. Reddy's Laboratories, a major generic manufacturer.

The companies, including Sanofi, have stopped short of recalling their products in the United States. In a statement on Monday, Sanofi said that the levels of the contaminant that the F.D.A. had found in "preliminary tests barely exceed amounts found in common foods."

The company added: "We are working closely with the F.D.A. and are conducting our own robust investigations to ensure we continue to meet the highest quality safety and quality standards."

Last week, Apotex, which makes store-branded versions of Zantac for Walgreens, Walmart and Rite-Aid, recalled its ranitidine products.

The European Medicines Agency is also reviewing the drug. Canada has ordered a halt to all distribution of ranitidine while it investigates.

In its warning on Sept. 13, the F.D.A. said that it had found low levels of a cancer-causing contaminant, a type of nitrosamine called nitrosodimethylamine, or NDMA, in the heartburn medications.

Nitrosamines can cause tumors in the liver and other organs in lab animals, and they are believed to be carcinogenic in humans. NDMA can form during manufacturing if the chemical reactions used to make the drug are not carefully controlled, the F.D.A. has said.

Ranitidine is a histamine blocker that works to lower the acid created in the stomach, according to the F.D.A. The medication is sometimes prescribed to prevent ulcers of the stomach and intestines as well as gastroesophageal reflux disease, the agency says.

CVS said it would continue to sell other histamine blockers, including Pepcid, Tagamet and the generic equivalents famotidine and cimetidine.

The Vaping Illness Outbreak: What We Know So Far

September 26, 2019

From NPR.org:

An outbreak of severe lung disease among users of electronic cigarettes continues to spread to new patients and states, and public health officials say it's too soon to point to a cause.

According to the latest report from the Centers for Disease Control and Prevention, a total of 805 cases have been reported in 46 states and the U.S. Virgin Islands. The CDC has confirmed 12 deaths, in 10 states. Nearly three-quarters of cases are male and 83% are under the age of 35, out of the 373 cases for which the CDC has complete data.

Public health officials are taking urgent steps to identify what is causing previously healthy vape users to develop pneumonia-like symptoms. But the results are still inconclusive.

In a press briefing on Sept. 19, the CDC reported that states continue to see new cases. "It is an ongoing outbreak," said Dr. Anne Schuchat, the CDC's principal deputy director.

Here's what we know so far about the outbreak.

What seems to be causing the illness?

The CDC suspects "chemical exposure," but experts have not yet identified a specific agent as the culprit. There is no definitive link to any brand of device, ingredient, flavor or substance. The outbreak has affected users of both THC- and nicotine-containing products, but it is more prevalent among THC vapers than users who self-report using only nicotine products. Because a large number of the patients reported combining nicotine products with THC or CBD products, some researchers are looking into whether the illness may be a result of mixing substances.

In all confirmed cases, patients reported vaping within 90 days of developing symptoms, and most had vaped within a week of symptom onset. Patients with confirmed cases have been tested to rule out infections that could explain their symptoms. There is no indication that the outbreak is contagious.

What are the symptoms?

Patients report experiencing rapid onset of coughing, weight loss and significant breathing difficulties. Other symptoms may include nausea, vomiting and diarrhea. Symptoms generally appear over the course of a few days but can take as long as a few weeks to arise. The majority of patients are hospitalized, and while many of their symptoms overlap, their various diagnoses have included lipoid pneumonia (which can occur when oil enters the lungs), acute eosinophilic pneumonia (caused by the buildup of a type of white blood cell in the lungs) and acute respiratory distress syndrome.

To read more, click here.