Reckitt Benckiser (Netherlands)

Growth patterns of breastfed infants show substantial inter-individual differences, partly influenced by breast milk (BM) nutritional composition. However, BM nutritional composition does not accurately indicate BM nutrient intakes. This study aimed to examine the associations between both BM intake volumes and macronutrient intakes with infant growth. Mother–infant dyads (n 94) were recruited into the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF) from a single maternity hospital at birth; all infants received exclusive breast-feeding (EBF) for at least 6 weeks. Infant weight, length and skinfolds thicknesses (adiposity) were repeatedly measured from birth to 12 months. Post-feed BM samples were collected at 6 weeks to measure TAG (fat), lactose (carbohydrate) (both by 1H-NMR) and protein concentrations (Dumas method). BM intake volume was estimated from seventy infants between 4 and 6 weeks using dose-to-the-mother deuterium oxide (2H2O) turnover. In the full cohort and among sixty infants who received EBF for 3+ months, higher BM intake at 6 weeks was associated with initial faster growth between 0 and 6 weeks (β + se 3·58 + 0·47 for weight and 4·53 + 0·6 for adiposity gains, both P < 0·0001) but subsequent slower growth between 3 and 12 months (β + se − 2·27 + 0·7 for weight and −2·65 + 0·69 for adiposity gains, both P < 0·005). BM carbohydrate and protein intakes at 4–6 weeks were positively associated with early (0–6 weeks) but tended to be negatively related with later (3–12 months) adiposity gains, while BM fat intake showed no association, suggesting that carbohydrate and protein intakes may have more functional relevance to later infant growth and adiposity.

The Codex Alimentarius Commission, a central part of the joint Food and Agricultural Organization/World Health Organizations Food Standards Program, adopts internationally recognized standards, guidelines, and code of practices that help ensure safety, quality, and fairness of food trade globally. Although Codex standards are not regulations per se, regulatory authorities around the world may benchmark against these standards or introduce them into regulations within their countries. Recently, the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU) initiated a draft revision to the Codex standard for follow-up formula (FUF), a drink/product (with added nutrients) for young children, to include requirements for limiting or measuring the amount of sweet taste contributed by carbohydrates in a product. Stakeholders from multiple food and beverage manufacturers expressed concern about the subjectivity of sweetness and challenges with objective measurement for verifying regulatory compliance. It is a requirement that Codex standards include a reference to a suitable method of analysis for verifying compliance with the standard. In response, AOAC INTERNATIONAL formed the Ad Hoc Expert Panel on Sweetness in November 2020 to review human perception of sweet taste, assess the landscape of internationally recognized analytical and sensory methods for measuring sweet taste in food ingredients and products, deliver recommendations to Codex regarding verification of sweet taste requirements for FUF, and develop a scientific opinion on measuring sweet taste in food and beverage products beyond FUF. Findings showed an abundance of official analytical methods for determining quantities of carbohydrates and other sweet-tasting molecules in food products and beverages, but no analytical methods capable of determining sweet taste. Furthermore, sweet taste can be determined by standard sensory analysis methods. However, it is impossible to define a sensory intensity reference value for sweetness, making them unfit to verify regulatory compliance for the purpose of international food trade. Based on these findings and recommendations, the Codex Committee on Methods of Analysis and Sampling agreed during its 41st session in May 2021 to inform CCNFSDU that there are no known validated methods to measure sweetness of carbohydrate sources; therefore, no way to determine compliance for such a requirement for FUF.

Gastroesophageal reflux disease encompasses a wide spectrum of disorders related to the reflux of gastric contents into the esophagus. Extraesophageal reflux (EER) may be suspected in patients with unexplained chronic cough, pharyngolaryngeal symptoms, and asthma. For physicians, suspected EER is challenging as there is currently no tool that can reliably make a definitive diagnosis. Endoscopic signs are not specific, pharyngeal and proximal reflux monitoring are not reliable, and if distal pH or pH-impedance monitoring can identify patients with abnormal reflux, they cannot predict the response to therapy. Controlled randomized trials have failed to reliably demonstrate any benefit of high-dose proton-pump inhibitors over placebo in patients with laryngeal symptoms, chronic cough, and asthma. Overall, the role of gastroesophageal reflux has been largely overestimated in patients with suspected EER. Especially when proton-pump inhibitors failed to improve symptoms, other diagnosis should be considered, such as functional laryngeal disorders which are probably much more prevalent in these patients than pathologic gastroesophageal reflux.

Figure: DVT within the common femoral vein.FigureI was really spooked by a recent article in the Journal of Emergency Medicine reporting a missed diagnosis of deep venous thrombosis (DVT). A young, healthy patient presented to the ED complaining of unilateral leg swelling. She was evaluated on her initial visit with a radiology-performed lower extremity ultrasound, which was negative. The patient was discharged home with instructions to have a repeat scan in seven days because she was considered high risk. The patient returned 14 days after the initial presentation with increased swelling to her calf and again had a radiology-performed lower extremity ultrasound. It was negative, and again the patient was discharged. Tragically, the patient presented to the ED a few hours later in respiratory distress and ultimately died despite attempts at resuscitation. An autopsy revealed bilateral pulmonary emboli and thrombi to the lower extremity veins. These types of reports can cause anxiety among emergency physicians. Lower extremity ultrasound has become the standard for evaluating patients for DVT and its limitations may not be widely known. Many EPs may not evaluate the images that are taken and may not be aware of the scanning protocol of their radiology department. Does this matter? A meticulous method of following the common femoral vein through its branches was initially used when ultrasound was first introduced as a method of evaluating for DVT. This involved serial compression to the ankle, but it was time-consuming and frequently technically difficult to perform because of difficulties in consistently being able to visualize the calf veins. When done well, whole leg compression ultrasound has excellent sensitivity in diagnosing DVT. Over time, however, lower extremity ultrasound has been scaled back for time and technical concerns, and most imaging departments do not image distal to the knee. Again, what is the significance of this to our evaluation of these patients? A considerable amount of research exists comparing these scaled-back methods (frequently referred to as two-point or three-point compression ultrasound) with the standard whole-leg ultrasound, and most have found favorably for the limited studies. One caveat, however: The best-powered studies added D-dimer to the limited ultrasounds. How many of us are including D-dimer in our routine evaluation of these patients? The significance of distal DVT remains somewhat questionable. Multiple sources posit that these thrombi do not pose significant risk for future significant embolization. But it doesn't seem that we're willing to completely ignore these findings just yet because most DVT diagnosis high-risk algorithms advocate repeating the limited studies after one week to catch propagating thrombi from the calf. (See algorithm from CMAJ 2006;175[9]:1087 at http://bit.ly/1ME8aHB.) No mention was made of a D-dimer in this tragic case, and I suspect that many of us don't add a D-dimer to the workup even when we are aware that the radiology-performed ultrasound is limited in scope. Would it have made a difference in this patient? Is presumptive anticoagulation the answer? What about adding CT venography to the workup of high-probability patients with negative ultrasounds? No clear answers to the dilemmas encountered in the evaluation of these patients are evident, but cases such as these certainly open up many questions. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at [email protected].

Fatal and nonfatal suicide attempts are far more common in opioid-dependent individuals than in the general population. More research is needed to understand the specific risk factors for suicidal behaviors in this patient population, particularly outside of the United States and Western Europe. This study investigated the correlates of suicide attempts among Polish patients in methadone maintenance treatment and interpreted results in the context of findings from other countries. The study was based on a sample of 240 individuals recruited from a methadone maintenance clinic in Poland. Participants were interviewed using standardized measures. Consistent with studies in other countries, sexual abuse, depression, alcohol dependence, and impulsivity were associated with suicide attempt. Additionally, those patients with somatic comorbidity had an increase in odds (odds ratio = 2.6) of suicide attempt. The results of our study suggest a potential benefit to treatment approaches that address somatic concerns of methadone-maintenance patients. More research is needed to identify, assess, and understand possible cultural and regional differences between opioid-dependent populations to better tailor prevention strategies.

Preventable chronic disease has proven to be a stubborn problem, responsible for 60% of deaths worldwide, and its associated morbidity and mortality has not changed in 40 years. The real issue in disease prevention is the lack of progress and the seeming absence of innovation.1 Beedie et al 's2 recent editorial reminds us of the importance of phase IV trials to study effectiveness, not just efficacy, of exercise, arguing that what matters to those who make funding decisions are health outcomes, not proxy measures. We argue that these are also the outcomes that matter to the people whom these interventions are supposed to help: patients and members of the public. It is well past time to include them in solving this long-standing problem. Disease prevention is not a problem for which the core issue is a lack of scientific evidence for and against exercise, regardless of the phase of research. Restricting our perspective to what can be accomplished by continuing to accumulate scientific evidence in the fight against chronic disease relegates us to the fringes of a complex problem when …

Growing evidence indicates that dopamine (DA) D(3) receptors are involved in the control of drug-seeking behavior and may play an important role in the pathophysiology of substance use disorders. First, DA D(3) receptors are distributed in strategic areas belonging to the mesolimbic DA system such as the ventral striatum, midbrain, and pallidum, which have been associated with behaviors controlled by the presentation of drug-associated cues. Second, repeated exposure to drugs of abuse has been shown to produce neuroadaptations in the DA D(3) system. Third, the synthesis and characterization of highly potent and selective DA D(3) receptor antagonists has permitted to further define the role of the DA D(3) receptor in drug addiction. Provided that the available preclinical and preliminary clinical evidence can be translated into clinical proof of concept in human, selective DA D(3) receptor antagonists show promise for the treatment of substance use disorders as reflected by their potential to (1) regulate the motivation to self-administered drugs under schedules of reinforcement that require an increase in work demand and (2) disrupt the responsiveness to drug-associated stimuli that play a key role in the reinstatement of drug-seeking behavior triggered by re-exposure to the drug itself, re-exposure to environmental cues that had been previously associated with drug-taking behavior, or stress.