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October 2019 Archives

Many U.S. Kids Not Getting Enough Sleep on Weeknights

October 30, 2019


Roughly a third of U.S. schoolchildren do not get the recommended amount of sleep on weeknights, researchers reported here. The good news is that those who do get adequate sleep are more likely to have a positive outlook on school and exhibit other signs of flourishing.

"Overall, the results showed that if school-age children don't sleep enough, they are less likely to flourish or show a positive approach towards learning" study researcher Hoi See Tsao, MD, FAAP, a pediatrician affiliated with Hasbro Children's Hospital at the Warren Alpert Medical School of Brown University, told Infectious Diseases in Children.

Tsao and colleagues analyzed responses from parents and caregivers of 49,050 children aged 6 to 17 years in the combined 2016-2017 National Survey of Children's Health. Respondents answered questions on how many hours of sleep on average a randomly selected child in their household received. Based on AAP guidelines, sufficient sleep was defined as getting at least 9 hours on an average weeknight for children aged 6 to 12 years and at least 8 hours on an average weeknight for children aged 13 to 17 years.

Researchers also analyzed parent and caregiver responses for "flourishing markers" in children -- such as whether they showed interest and curiosity in learning new things, cared about doing well in school, worked to finish the tasks they started, did all required homework and stayed calm and in control when faced with a challenge.

Researchers found that insufficient sleep was reported in 36.4% of children aged 6 to 12 years and 31.9% of children aged 13 to 17 years. Broken down by age group, children aged 6 to 12 years who did not get the recommended amount of sleep had:

  • 61% increased odds of not showing interest and curiosity in learning new things;

  • 45% increased odds of not caring about doing well in school;

  • 44% increased odds of not completing their homework; and

  • 18% increased odds of not finishing tasks they started.

With 7 or fewer hours of sleep on an average weeknight, children aged 12 to 17 years had:

  • 34% increased odds of not showing interest and curiosity in learning new things;

  • 36% increased odds of not completing their homework;

  • 20% increased odds of not finishing tasks they started; and

  • 34% increased odds of not staying calm and in control when faced with a challenge.

Tsao and colleagues, who adjusted their analyses for numerous factors -- age, sex, race, ethnicity, federal poverty level, screen time, adverse childhood experiences including abuse and neglect, and even mental health conditions that could potentially interfere with sleep -- found that teens who did not get 8 or more hours of sleep on weeknights had 35% increased odds of not demonstrating a combined measure of the flourishing markers, whereas children aged 6 to 12 years who did not reach the 9-hour mark in sleep each night had 15% increased odds of not demonstrating the combined measure -- although this finding was not statistically significant.

Tsao said efforts to help children get the recommended amount of sleep each night should especially focus on limiting digital media use before bedtime, creating bedtime routines and delaying school start times -- a strategy supported by the AAP that has been associated with better academic performance in students.

"I think the implications of the study are vast," Tsao said. "For pediatricians, the study reinforces the message that we're trained to be counselors and resources for families if they're having trouble getting their children to sleep at a regular time." - by John Schoen

Reference: Tsao HS, et al. Sounding the alarm on the importance of sleep: The positive impact of sufficient sleep on childhood flourishing. Presented at: AAP National Conference & Exhibition; Oct. 25-29, 2019; New Orleans.

Disclosure: Tsao reports no relevant financial disclosures.

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.

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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.