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Anticona, C., Hansson, L., Johansson, I. & Lif Holgerson, P. (2024). Exploring the possible impact of oral nutritional supplements on children's oral health: an in vitro investigation. Dentistry Journal, 12(3), Article ID 78.
Open this publication in new window or tab >>Exploring the possible impact of oral nutritional supplements on children's oral health: an in vitro investigation
2024 (English)In: Dentistry Journal, E-ISSN 2304-6767, Vol. 12, no 3, article id 78Article in journal (Refereed) Published
Abstract [en]

Eight pediatric oral nutritional supplements (ONSs) and 0.5% fat bovine milk were examined in vitro regarding their effect on the adhesion of three caries-related bacteria, Streptococcus mutans (strain CCUG 11877T), Lactobacillus gasseri (strain CCUG 31451), and Scardovia wiggsiae (strain CCUG 58090), to saliva-coated hydroxyapatite, as well as their pH and capacity to withstand pH changes. Bacteria were cultivated and radiolabeled. The adhesion assays used synthetic hydroxyapatite coated with whole or parotid saliva. Measurements of pH and titration of the products with HCl and NaOH were conducted in triplicate. Three ONSs promoted the S. mutans adhesion to saliva-coated hydroxyapatite (increase from 35% to >200%), supporting caries risk enhancement. S. wigssiae and L. gasseri adhered only to one and no ONS, respectively. Most supplements had limited buffering capacity to counteract acidification changes, suggesting their low capacity to neutralize acids, and one ONS showed a significant capacity to counteract basic changes, suggesting a high erosive potential. S. mutans adhesion was influenced by the ONS pH and volume NaOH added to reach pH 10. L. gasseri and S. wiggsiae adhesion was influenced by the ONSs' carbohydrate and fat content. Interdisciplinary efforts are needed to increase awareness and prevent the possible negative impact of ONSs on children's oral health.

Place, publisher, year, edition, pages
MDPI, 2024
Keywords
cariogenic potential, dental erosive potential, oral health, pediatric oral nutritional supplements
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-222977 (URN)10.3390/dj12030078 (DOI)001191914300001 ()38534302 (PubMedID)2-s2.0-85188792768 (Scopus ID)
Available from: 2024-04-11 Created: 2024-04-11 Last updated: 2024-04-11Bibliographically approved
Anticona, C., Hansson, L., Johansson, I. & Lif Holgerson, P. (2024). Exploring the possible impact of oral nutritional supplements on children’s oral health: an in vitro investigation. Dentistry Journal, 12(3), Article ID 78.
Open this publication in new window or tab >>Exploring the possible impact of oral nutritional supplements on children’s oral health: an in vitro investigation
2024 (English)In: Dentistry Journal, E-ISSN 2304-6767, Vol. 12, no 3, article id 78Article in journal (Refereed) Published
Abstract [en]

Eight pediatric oral nutritional supplements (ONSs) and 0.5% fat bovine milk were examined in vitro regarding their effect on the adhesion of three caries-related bacteria, Streptococcus mutans (strain CCUG 11877T), Lactobacillus gasseri (strain CCUG 31451), and Scardovia wiggsiae (strain CCUG 58090), to saliva-coated hydroxyapatite, as well as their pH and capacity to withstand pH changes. Bacteria were cultivated and radiolabeled. The adhesion assays used synthetic hydroxyapatite coated with whole or parotid saliva. Measurements of pH and titration of the products with HCl and NaOH were conducted in triplicate. Three ONSs promoted the S. mutans adhesion to saliva-coated hydroxyapatite (increase from 35% to >200%), supporting caries risk enhancement. S. wigssiae and L. gasseri adhered only to one and no ONS, respectively. Most supplements had limited buffering capacity to counteract acidification changes, suggesting their low capacity to neutralize acids, and one ONS showed a significant capacity to counteract basic changes, suggesting a high erosive potential. S. mutans adhesion was influenced by the ONS pH and volume NaOH added to reach pH 10. L. gasseri and S. wiggsiae adhesion was influenced by the ONSs’ carbohydrate and fat content. Interdisciplinary efforts are needed to increase awareness and prevent the possible negative impact of ONSs on children’s oral health.

Place, publisher, year, edition, pages
MDPI, 2024
Keywords
cariogenic potential, dental erosive potential, oral health, pediatric oral nutritional supplements
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-222870 (URN)10.3390/dj12030078 (DOI)001191914300001 ()2-s2.0-85188792768 (Scopus ID)
Available from: 2024-04-15 Created: 2024-04-15 Last updated: 2024-04-15Bibliographically approved
Wikner, A., Johansson, K., Enocson, E., Sthen Bergdahl, M., Hansson, L., Rydberg, A. & Sandberg, C. (2024). Lower bone strength in young patients with Fontan circulation compared to controls. Cardiology in the Young
Open this publication in new window or tab >>Lower bone strength in young patients with Fontan circulation compared to controls
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2024 (English)In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives: Previous reports indicate bone deficits in patients with Fontan circulation. However, the consequences of these deficits on bone strength and when these changes occur are unclear.

Aim: To compare the tibial bone strength-strain index between young patients (6-19 years) with Fontan circulation and age- and sex-matched controls, and to determine strength-strain-index in subgroups of children (6-12 years) and adolescents (13-19 years) versus controls.

Method: The tibia was examined with peripheral quantitative CT. Based on the assessed data, bone strength-strain index was calculated in the lateral and anterior-posterior directions.

Results: Twenty patients with Fontan and twenty controls (mean age 13.0 ± 4.4 years; 50% females) were examined. Patients had a lower strength-strain index in the lateral direction compared to controls (808.4 ± 416.8mm3 versus 1162.5 ± 552.1mm3, p = 0.043). Subgroup analyses showed no differences regarding strength-strain index in children (6-12 years) with Fontan circulation compared to controls. However, the adolescents (13-19 years) with Fontan circulation had lower strength-strain indexes in both the lateral and anterior-posterior directions compared to controls (1041.4 ± 299.8mm3 versus 1596.4 ± 239.6mm3, p < 0.001, and 771.7 ± 192.4mm3 versus 1084.9 ± 215.0mm3, p = 0.004). When adjusted for height, there were differences between patients (6-19 years) and controls in strength-strain indexes in both the lateral and anterior-posterior directions. In subgroup analyses, the results remained robust.

Conclusion: Young patients (6-19 years) with Fontan circulation have a lower strength-strain index in the tibia compared to controls. Subgroup analyses show that this deficit is mainly driven by the differences in adolescents (13-19 years), which might suggest that bone strength decreases with age.

Place, publisher, year, edition, pages
Cambridge University Press, 2024
Keywords
adolescents, bone mineral content, bone mineral density, CHD, children, Strength-strain index, total cavo-pulmonary connection
National Category
Pediatrics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-222429 (URN)10.1017/S1047951124000404 (DOI)38450512 (PubMedID)2-s2.0-85187115758 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20160496
Available from: 2024-03-19 Created: 2024-03-19 Last updated: 2024-03-19
Hansson, L., Sandberg, C., Öhlund, I., Lind, T., Sthen Bergdahl, M., Wiklund, U., . . . Rydberg, A. (2022). Vitamin D, liver-related biomarkers, and distribution of fat and lean mass in young patients with Fontan circulation. Cardiology in the Young, 32(6), 861-868
Open this publication in new window or tab >>Vitamin D, liver-related biomarkers, and distribution of fat and lean mass in young patients with Fontan circulation
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2022 (English)In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 32, no 6, p. 861-868Article in journal (Refereed) Published
Abstract [en]

Introduction/aim: Young patients with Fontan circulation may have low serum 25-hydroxyvitamin D levels, an affected liver, and unhealthy body compositions. This study aimed to explore the association between vitamin D intake/levels, liver biomarkers, and body composition in young Fontan patients.

Method: We collected prospective data in 2017 to 2018, obtained with food-frequency questionnaires, biochemical analyses of liver biomarkers, and dual-energy X-ray absorptiometry scans in 44 children with Fontan circulation. Body compositions were compared to matched controls (n = 38). Linear regression analyses were used to investigate associations of biomarkers, leg pain, and lean mass on serum levels of 25-hydroxyvitamin D. Biomarkers were converted to z scores and differences were evaluated within the Fontan patients.

Results: Our Fontan patients had a daily mean vitamin D intake of 9.9 µg and a mean serum 25-hydroxyvitamin D of 56 nmol/L. These factors were not associated with fat or lean mass, leg pain, or biomarkers of liver status. The Fontan patients had significantly less lean mass, but higher fat mass than controls. Male adolescents with Fontan circulation had a greater mean abdominal fat mass than male controls and higher cholesterol levels than females with Fontan circulation.

Conclusion: Vitamin D intake and serum levels were not associated with body composition or liver biomarkers in the Fontan group, but the Fontan group had lower lean mass and higher fat mass than controls. The more pronounced abdominal fat mass in male adolescents with Fontan circulation might increase metabolic risks later in life.

Place, publisher, year, edition, pages
Cambridge University Press, 2022
Keywords
CHD, Fontan circulation, vitamin D, micronutrient intake, body composition
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-176573 (URN)10.1017/S1047951121003115 (DOI)000752691600001 ()34338624 (PubMedID)2-s2.0-85112065396 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20160496
Note

Originally included in thesis in manuscript form.

Available from: 2020-11-09 Created: 2020-11-09 Last updated: 2022-11-29Bibliographically approved
Sandberg, C., Frisk, E., Hansson, L., Isberg, A., Rylander Hedlund, E., Sjöberg, G. & Rydberg, A. (2020). Impaired knee extension muscle strength in adolescents but not in children with Fontan circulation. Cardiology in the Young, 30(8), 1138-1143
Open this publication in new window or tab >>Impaired knee extension muscle strength in adolescents but not in children with Fontan circulation
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2020 (English)In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 30, no 8, p. 1138-1143Article in journal (Refereed) Published
Abstract [en]

Introduction: Impaired isometric muscle strength was previously reported in adults with Fontan circulation. However, it is unclear if this impairment is present in children and adolescents with Fontan circulation. We investigated isometric muscle strength of the lower limb in patients (6–18 years) with Fontan circulation in comparison with healthy controls.

Method: In this cross-sectional study, 43 patients (6–18 years) with Fontan circulation and 43 age- and sex-matched controls were included. Isometric knee extension and plantar flexion muscle strength were assessed using dynamometry (Newton, N). Lean mass of the legs was assessed with dual-energy X-ray absorptiometry. Analyses were performed on group level (n = 43), and for subgroups that included children aged 6–12 years (n = 18) and adolescents aged 13–18 years (n = 25).

Results: On group level, the patients with Fontan circulation had impaired isometric knee extension strength in comparison with the controls (p = 0.03). In subgroup analyses, impaired isometric knee extension strength was present in the adolescents (p = 0.009) but not in the children groups. For plantar flexion, there was no difference between patients and controls. There was no difference in lean mass between patients and controls (9.6 ± 4.3 kg vs. 10.8 ± 5.6 kg, p = 0.31). However, the lean mass was highly correlated to isometric knee extension strength (patients r = 0.89, controls r = 0.96, p < 0.001) and isometric plantar flexion strength (patients r = 0.7, controls r = 0.81, p < 0.001).

Conclusion: The finding of impaired isometric knee extension muscle strength in adolescents (13–18 years) with Fontan circulation and no corresponding impairment in the children group (6–12 years) could imply that isometric muscle strength gets more impaired with age.

Place, publisher, year, edition, pages
Cambridge University Press, 2020
Keywords
CHD, Fontan circulation, isometric muscle strength, knee extension, plantar flexion, dynamometry
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-174852 (URN)10.1017/S1047951120001675 (DOI)000562473300011 ()32571442 (PubMedID)2-s2.0-85089607723 (Scopus ID)
Available from: 2020-09-18 Created: 2020-09-18 Last updated: 2023-03-24Bibliographically approved
Hansson, L., Lind, T., Öhlund, I., Wiklund, U. & Rydberg, A. (2020). Increased abdominal fat mass and high fat consumption in young school children with congenital heart disease: results from a case-control study. Journal of human nutrition and dietetics, 33(4), 566-573
Open this publication in new window or tab >>Increased abdominal fat mass and high fat consumption in young school children with congenital heart disease: results from a case-control study
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2020 (English)In: Journal of human nutrition and dietetics, ISSN 0952-3871, E-ISSN 1365-277X, Vol. 33, no 4, p. 566-573Article in journal (Refereed) Published
Abstract [en]

Background We have previously found that infants with complex congenital heart disease (CHD) experience growth failure despite high-energy dietary supplementation. This is a follow-up and comparison with healthy controls at 9 years of age regarding body composition and macronutrient intake, especially in relationship to the diet provided during infancy. Methods Anthropometric changes in 10 children with CHD at 12 months and at 4 and 9 years of age were analysed as Z-scores. To assess body composition and food intake at 9 years of age, a dual-energy X-ray absorptiometry scan and a 3-day food diary were completed and compared with age- and gender-matched controls using Wilcoxon's signed-rank test for matched pairs. Results Growth changes from 12 months to 9 years, converted to Z-scores for weight for height and height for age, were significantly different within the group of children with complex CHD, although no growth differences were seen in comparison with healthy controls at 9 years of age. However, the children with CHD had statistically higher abdominal fat mass index and higher daily intake of fat, particularly from saturated fatty acid in g kg-1 compared to controls. Conclusions At 9 years of age, children with complex CHD with growth failure and high fat intake in infancy have normalised growth but increased abdominal fat mass and higher intake of saturated fatty acid compared to their peers. Nutritional monitoring in early childhood may detect unhealthy diet quality and prevent later health risks in this group.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
children, congenital heart disease, dietary fatty acid, dual-energy X-ray absorptiometry, growth, macronutrient intake
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-168120 (URN)10.1111/jhn.12739 (DOI)000511230800001 ()32026539 (PubMedID)2-s2.0-85079068866 (Scopus ID)
Available from: 2020-02-21 Created: 2020-02-21 Last updated: 2023-05-05Bibliographically approved
Hansson, L. (2020). When the paediatric heart is affected: impact on nutrition, growth and body composition from infancy to adolescence. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>When the paediatric heart is affected: impact on nutrition, growth and body composition from infancy to adolescence
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Children with complex congenital heart disease (CHD) and very low birth weight (VLBW) infants with a patent ductus arteriosus (PDA) are two distinct groups of patients with different clinical care needs. Irrespective of the type of heart condition, nutritional intake and growth is largely affected in these individuals during infancy. Although medical care for these conditions has significantly improved in the last several decades, there is still a considerable need for improvement in nutritional support to reach satisfactory growth and development in both these patient groups. In children with complex CHD, there often is underlying malnutrition related to the type and severity of cardiac defect, which constitutes the reason for increased energy metabolism and feeding difficulties. In VLBW infants with a haemodynamically significant PDA (hsPDA), additional fluid regulation may result in a subsequent decrease in macronutrient intake. Current knowledge regarding the consequences of growth restrictions and nutritional intake during infancy, as well as body composition and nutritional intake later in childhood, is scarce. The overall aim of this thesis was to explore energy and nutritional intakes in infants, children and adolescents with complex CHD or hsPDA, as well as investigate growth and body composition in these patient groups.

Methods

In this thesis, four observational studies were conducted. In paper I, the study population consisted of 11 CHD infants and 22 matched controls. A follow up study (paper III) was conducted on these CHD infants at 9 years of age and compared to a new set of age-matched controls (n=10). In paper II, 42 VLBW infants with hsPDA, and 48 referents with VLBW were studied. In paper IV, 44 children and adolescence with Fontan circulation were compared to 38 matched controls. From infancy to adolescence, data on energy, macro- and micronutrient intakes was retrieved from hospital records, from 3-day food diaries or from food frequency questionnaires. Further, anthropometric measures and dual-energy X-ray absorptiometry (DXA) scans were performed and venous blood samples were analysed. 

Results

In paper I, infants with complex CHD had a higher dietary fat intake and lower carbohydrate and iron intakes compared to controls. Additionally, energy intake did not meet the requirements for growth in the CHD infant cohort, resulting in significantly lower Body Mass index (BMI) for age z-score. In paper II, fluid intakes was restricted after hsPDA diagnosis in VLBW infants resulting in a decrease in energy and protein intakes. The z-score of weight change during the first 28 days of life depended on both PDA status and energy intake. In the follow-up study of the complex CHD infants (paper III), growth was comparable to controls at 9 years of age suggesting a catch-up effect. Despite comparable BMI z-scores, the children with CHD had a higher abdominal fat mass index (FMI) and higher daily intake of fat, particularly from saturated fats, compared to controls. In paper IV, the Fontan population had a daily mean vitamin D intake of 9.9 µg and a mean serum 25‑hydroxyvitamin D of 56 nmol/L however, 42% had below sufficient levels. These factors were not associated with lean mass index (LMI), Fat mass index (FMI), or biomarkers of liver status. The Fontan population had significantly less LMI, but higher FMI than controls. Male adolescents with Fontan circulation had a greater mean abdominal FMI than male controls and higher cholesterol levels than females with Fontan circulation.

Conclusion

Infants with complex CHD, and VLBW infants with hsPDA did not grow as expected with the energy and nutrition provided to them. Follow-up at 9 years of age showed children with complex CHD had caught-up in growth but had increased abdominal FMI and higher intake of saturated fatty acids. In children and adolescents with Fontan circulation, vitamin D levels and intake was not associated with body composition or liver biomarkers. However, it was noted that the Fontan population had a lower LMI and higher FMI compared to controls. Nutritional progress in children with heart conditions can promote growth and improve dietary quality between infancy and adolescence, potentially working to counteract later health risks.

Abstract [sv]

Enkel sammanfattning på svenska

Bakgrund Barn med komplexa medfödda hjärtfel och prematura barn medmycket låg födelsevikt (<1500 g) och med ett öppetstående fosterkärl (PDA) ärtvå skilda grupper av patienter med olika behov av klinisk vård. Gemensamt förbåda grupperna är dock att spädbarnens behov av näring och deras tillväxtpåverkas negativt av sjukdomstillståndet. Även om den medicinska vården fördessa spädbarn har förbättrats avsevärt under de senaste decennierna, finns detfortfarande ett stort behov av förbättring av näringsstödet för att de ska nåtillfredsställande tillväxt och utveckling. Hos barn med komplexa medföddahjärtfel finns det ofta en underliggande undernäring som är relaterad till typenoch svårighetsgraden av hjärtfelet och som ofta orsakar en förhöjdenergimetabolism och ökade matningssvårigheter. Hos prematura barn medmycket låg födelsevikt och med en betydelsefull PDA kan en ytterligarevätskereglering de första dagarna i livet resultera till en minskning avnäringsintaget. Nuvarande kunskaper om konsekvenserna av otillräckligtnäringsintag och försämrad tillväxt under spädbarnstiden, samtkroppssammansättningen och näringsintaget senare i barndomen, är mycketbegränsad. Det övergripande syftet med denna avhandling var att utforska energioch näringsintag hos spädbarn, barn och ungdomar med komplexa medföddahjärtfel eller prematura barn med PDA, samt att undersöka tillväxt ochkroppssammansättning i dessa patientgrupper.

Metod I denna avhandling genomfördes fyra observationsstudier. I artikel 1 bestod studiepopulationen av 11 spädbarn med komplexa medfödda hjärtfel och 22 matchade kontroller. En uppföljningsstudie (artikel 3) genomfördes på dessa spädbarn vid 9 års ålder och jämfördes med en ny uppsättning åldersmatchade kontroller (n = 10). I artikel 2 studerades 42 prematura barn med mycket låg födelsevikt och PDA och 48 prematura barn med mycket låg födelsevikt utan PDA. I artikel 4 jämfördes 44 barn och ungdomar med enkammarhjärta med 38 matchade kontroller. Data om intag av energi, makro- och mikronäringsämnen hämtades från sjukhusjournaler, från 3-dagars matdagböcker eller från frekvensformulär av matintag. Vidare utfördes antropometriska mätningar och röntgenundersökningar (DXA) och venösa blodprover analyserades.

Resultat I artikel 1 hade spädbarn med komplexa medfödda hjärtfel högre fettintag samt lägre intag av kolhydrater och järn jämfört med kontroller. Hos spädbarnen med komplexa medfödda hjärtfel uppfyllde energiintaget inte behoven för en optimal tillväxt, vilket resulterade till signifikant lägre BMI zscore. I artikel 2 sågs ytterligare begränsningar av vätskeintaget efter PDA diagnosen hos prematurer med mycket låg födelsevikt vilket resulterade i en minskning av energi- och proteinintaget. Viktförändringarna i z-score under de första 28 dagarna av livet var beroende av både PDA status och energiintaget. I uppföljningsstudien av spädbarn med komplexa medfödda hjärtfel (artikel 3), var tillväxten jämförbar med kontroller vid 9 års ålder, vilket tyder på en upphämtning av tillväxten. Trots jämförbara BMI z-score hade barnen med komplexa medfödda hjärtfel en högre andel bukfett och ett högre dagligt intag av fett, särskilt mättade fetter, jämfört med kontroller. I artikel 4 hade barn och ungdomar med enkammarhjärta ett dagligt genomsnittligt D-vitaminintag på 9,9 µg och ett genomsnittligt 25-hydroxy-vitamin D i serum på 56 nmol/L, dock hade 42 % lägre nivåer än normalt. Dessa faktorer var inte associerade med fettfri massa (inklusive muskelmassa), fettmassa eller biomarkörer för leverstatus. Barn och ungdomar med enkammarhjärta hade betydligt mindre fettfri massa, men högre fettmassa än kontroller. Manliga ungdomar med enkammarhjärta hade en högre mängd bukfett än manliga kontroller och högre kolesterolnivåer än kvinnliga deltagare med enkammarhjärta.

Slutsats Spädbarn med komplexa medfödda hjärtfel och prematurer med mycket låg födelsevikt med en betydelsefull PDA, växte inte som förväntat med den energi och näring som de fick. Uppföljning vid 9 års ålder visade att barn med komplexa medfödda hjärtfel hade återhämtat sin tillväxt men de hade en ökad mängd bukfett och högre kostintag av mättat fett. Hos barn och ungdomar med enkammarhjärta fanns indikationer på låga nivåer av D vitamin i serum trots ett adekvat intag via kosten. D vitaminnivåerna var inte associerade med kroppssammansättning eller leverbiomarkörer. Det noterades dock att barnen och ungdomarna med enkammarhjärta hade högre fettmassa och lägre fettfri massa jämfört med kontroller. Förbättringar i energi och näringsintag hos barn med hjärtsjukdom bör prioriteras för att främja tillväxt och påverka kostkvaliteten från spädbarnsålder till tonårstid. Dessa åtgärder kan ytterligare motverka senare hälsorisker. Fortsatt näringsforskning i en större kontext behövs för att bekräfta våra forskningsresultat.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2020. p. 60
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2105
Keywords
Congenital heart disease, Patent ductus arteriosus, Preterm infant, Infant growth, Energy intake, Dietary fatty acid, Micronutrient intake, Vitamin D, Dual-energy X-ray absorptiometry (DXA), Fontan circulation.
National Category
Medical and Health Sciences
Research subject
Pediatrics; Food and Nutrition; Cardiology
Identifiers
urn:nbn:se:umu:diva-176581 (URN)978-91-7855-396-9 (ISBN)978-91-7855-397-6 (ISBN)
Public defence
2020-12-04, Bergasalen, byggnad Q0, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2020-11-13 Created: 2020-11-09 Last updated: 2022-10-03Bibliographically approved
Hansson, L., Lind, T., Wiklund, U., Öhlund, I. & Rydberg, A. (2019). Fluid restriction negatively affects energy intake and growth in very low birthweight infants with haemodynamically significant patent ductus arteriosus. Acta Paediatrica, 108(11), 1985-1992
Open this publication in new window or tab >>Fluid restriction negatively affects energy intake and growth in very low birthweight infants with haemodynamically significant patent ductus arteriosus
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 11, p. 1985-1992Article in journal (Refereed) Published
Abstract [en]

Aim: We explored if fluid restriction in very low birthweight (VLBW) infants with a haemodynamically significant patent ductus arteriosus (PDA) affected energy and protein intakes and growth.

Methods: Retrospectively, we identified 90 VLBW infants that were admitted to Umea University Hospital, Sweden, between 2009 and 2012: 42 with and 48 without haemodynamically significant PDA (hsPDA). Anthropometric, fluid, energy and protein intake data during the first 28 days of life were expressed as z‐scores.

Results: In the 42 infants diagnosed with hsPDA, fluid intake was restricted after diagnosis, resulting in a decrease in energy and protein intake. No decrease was observed in the other 48 infants in the cohort. Multivariate analysis showed that the z‐score of weight change depended on both ductus arteriosus status and energy intake; thus, infants with hsPDA did not grow as expected with the energy provided to them.

Conclusion: Energy and protein intake was diminished in prematurely born infants with hsPDA when fluid was restricted after diagnosis. The initial reduction in intakes may have contributed to the lower postnatal growth observed in these infants.

Keywords
Fluid restriction, Infant growth, Nutrition, Patent ductus arteriosus, Premature infants
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-165667 (URN)10.1111/apa.14815 (DOI)000489595000009 ()30980416 (PubMedID)2-s2.0-85066861622 (Scopus ID)
Available from: 2019-12-06 Created: 2019-12-06 Last updated: 2023-03-24Bibliographically approved
Hansson, L., Öhlund, I., Lind, T., Stecksén-Blicks, C. & Rydberg, A. (2016). Dietary intake in infants with complex congenital heart disease: a case-control study on macro- and micronutrient intake, meal frequency and growth. Journal of human nutrition and dietetics (Print), 29(1), 67-74
Open this publication in new window or tab >>Dietary intake in infants with complex congenital heart disease: a case-control study on macro- and micronutrient intake, meal frequency and growth
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2016 (English)In: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 29, no 1, p. 67-74Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Children with severe congenital heart disease (CHD) need considerable nutritional support to reach normal growth. The actual intake of macro- and micronutrients in outpatient CHD infants over a 6-month period in infancy is not described in the literature. The present study aimed to prospectively investigate the distribution between macro- and micronutrient intake, meal frequency and growth in children with CHD.

METHODS: At 6, 9 and 12 months of age, a 3-day food diary and anthropometric data were collected in 11 infants with severe CHD and 22 healthy age- and feeding-matched controls. Macro- and micronutrient intake, meal frequency and growth were calculated.

RESULTS: Compared to the healthy controls, CHD infants had a statistically significantly higher intake of fat at 9 months of age (4.8 versus 3.6 g kg(-1) day(-1) ), a higher percentage energy (E%) from fat, (40.6% versus 34.5%) and a lower E% from carbohydrates (46.1% versus 39.6%) at 12 months of age, and a lower intake of iron (7.22 versus 9.28 mg day(-1) ) at 6 months of age. Meal frequency was significantly higher at 6 and 9 months of age (P < 0.01). Mean Z-score weight for height, weight for age and body mass index for age were significant lower (P < 0.01) at all time points.

CONCLUSIONS: Despite a higher intake of energy from fat and a higher meal frequency, the intake does not meet the needs for growth, and the results may indicate a low intake of micronutrients in CHD infants.

Keywords
congenital heart disease, energy intake, growth, meal frequency, micronutrient intake
National Category
Pediatrics Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-101471 (URN)10.1111/jhn.12285 (DOI)000369167500008 ()25514839 (PubMedID)2-s2.0-84955609449 (Scopus ID)
Available from: 2015-03-31 Created: 2015-03-31 Last updated: 2023-03-24Bibliographically approved
Hansson, L., Rydberg, A. & Stecksen-Blicks, C. (2012). Oral microflora and dietary intake in infants with congenital heart disease: a case control study. European Archives of Paediatric Dentistry, 13(5), 238-243
Open this publication in new window or tab >>Oral microflora and dietary intake in infants with congenital heart disease: a case control study
2012 (English)In: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 13, no 5, p. 238-243Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Infants with moderate to severe congenital heart disease (CHD) are at a higher risk for growth failure and malnutrition due to increased metabolic demands and inadequate energy intake. This state requires meals that are more frequent and a special enriched diet, which may have negative implications on oral health.

AIM: To examine the oral colonisation of some bacteria associated with caries development during infancy; mutans streptococci (MS) and lactobacilli (LCB) in infants with CHD and whether their dietary intake had an impact on the bacterial levels.

DESIGN: This was a prospective case-control study. 11 infants with CHD and 22 healthy, age-matched infants were enrolled. Saliva samples and food diaries were collected at 6, 9, and 12 months of age. The total viable counts of MS and LCB in saliva were determined, and energy intake, meal frequency, intake of proteins, fat, carbohydrates and sucrose were calculated.

RESULTS: At 12 months of age, the MS count was higher in the CHD group than in the controls (p<0.01), and MS constituted a higher ratio of the total viable count of oral bacteria (p<0.01). Meal frequency was higher in the CHD group at 6 and 9 months of age than in the controls (p<0.05). The intake of sucrose did not differ between the groups, while the total carbohydrate intake was higher in the control group at 6 and 12 months of age (p<0.05). Compared with the control group, which had six courses of antibiotic administration, the CHD infants had 21 courses (p<0.05).

CONCLUSIONS: Infants with severe CHD have higher levels of MS at 12 months of age than the healthy controls. A higher meal frequency and use of diuretic medication and antibiotics may have influenced MS colonisation.

National Category
Pediatrics Dentistry
Identifiers
urn:nbn:se:umu:diva-60571 (URN)10.1007/BF03262877 (DOI)23043879 (PubMedID)2-s2.0-84867684432 (Scopus ID)
Available from: 2012-10-17 Created: 2012-10-17 Last updated: 2023-03-23Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3060-031x

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