Brunhild M. Halm

Isoflavones in breastfed infants after mothers consume soy.

BACKGROUND The bioavailability of isoflavones in children after soy exposure is uncertain. OBJECTIVE We aimed to compare isoflavone patterns in infants exposed to isoflavone-containing breast milk (BF), in tofu-fed (TF) infants, and in mothers consuming a soy beverage. DESIGN Eighteen nursing mothers who were not feeding soy foods to their infants consumed one daily serving of a soy protein beverage for 2-4 d and collected their own milk and urine and infant urine. Plasma was collected from infants if venous blood draws were ordered by pediatricians. Blood and urine were collected from additional children after they consumed tofu. Isoflavones were measured by liquid chromatography-mass spectrometry. RESULTS In 7 subjects, isoflavone values increased significantly from baseline after mothers ate soy: in maternal urine (x +/- SEM) from 18.4 +/- 13.0 to 135.1 +/- 26.0 nmol/mg creatinine, in breast milk from 5.1 +/- 2.2 to 70.7 +/- 19.2 nmol/L, and in infant urine from 29.8 +/- 11.6 to 111.6 +/- 18.9 nmol/mg creatinine. The mean isoflavone concentration in plasma obtained from 11 BF infants was 19.7 +/- 13.2 nmol/L. TF infants had much higher mean isoflavone values (urine, 229 +/- 129 nmol/mg creatinine; plasma, 1049 +/- 403 nmol/L). Statistically significant correlations were observed between the types of fluids investigated within mothers, between mothers and infants, and within infants. Urinary isoflavone excretion per hour adjusted for dose per body weight was 81% lower for BF infants and 24% higher for TF infants than for their mothers after eating soy. CONCLUSIONS More isoflavones appear in children than in adults after adjustment for isoflavone intake. Systemic isoflavone exposure in infants can be determined by urinary analysis.

Phytoestrogenic isoflavonoids in epidemiologic and clinical research.

Isoflavones (IFLs) are natural products to which humans have been traditionally exposed predominantly through soy foods; more recently humans are also exposed to them through soy protein addition to processed foods or through supplements. They are structurally similar to steroidal estrogens and can exert estrogenic or antiestrogenic effects depending on their concentrations and on the tissue considered. These properties qualify IFLs to be classified as phytoestrogens and are believed to account for many of the biological effects observed for soy and/or IFL exposure including benefits for bone and heart health or prevention of menopausal symptoms and certain types of cancer. In order to evaluate the function of IFLs, alone or when exposure happens through soy intake, pharmacokinetics and bioavailability are critical issues to be considered in epidemiologic and clinical research. For this purpose precise, accurate, robust, fast, and affordable techniques for IFL analyses are required.

Comparing ease of intraosseous needle placement: Jamshidi versus cook

In a sample of 34 study subjects, Cook and Jamshidi intraosseous (IO) needles were compared for ease of insertion into turkey bones. The averaged lapsed time of insertion was significantly shorter using the Jamshidi needle (25.5 v 56.2 seconds, P < .0001). The mean difficulty of insertion score was lower using the Jamshidi needle (3.0 v 7.1 on a 10-cm visual analog scale, P < .0001). The less costly Jamshidi needle is easier to use in IO insertion in this turkey bone model.

Isoflavones from soya foods are more bioavailable in children than adults.

The purpose of the present study was to determine whether children experience a higher systemic exposure to isoflavonoids when consuming a body weight-adjusted dose of soya compared with adults. Forty study participants were recruited from a local Waldorf school, including twenty-one children and nineteen adults. Participants collected a baseline urine sample and ate immediately thereafter a body weight-adjusted dose of soya nuts (15 g/54.4 kg equivalent to 0.615 (SD 0.036) mg total isoflavones/kg) followed by a 12 h urine collection. Nineteen children and eighteen adults completed the protocol correctly (fourteen child-parent pairs). Children, compared with adults, showed a statistically significant (P < 0.05 by unpaired t test) higher urinary isoflavone excretion rate for daidzein (+39%), genistein (+44%), all non-metabolites (daidzein + genistein + glycitein; +41%) and total isoflavonoids (+32%). Isoflavones are more bioavailable in children v. adults. Urine is an excellent medium to determine systemic isoflavone exposure in children due to its non-invasiveness and high compliance, in particular when collected overnight; it also allows evaluation of completeness of specimen collection.

Isoflavones in children and adults consuming soy

Soy and their isoflavones (IFLs) are believed to protect against breast cancer, particularly when exposure occurs during childhood. Little is known about the bioavailability of IFLs in children and how this is affected by oral antibiotics (OABX). We measured IFLs by LC/MS and found that the urinary IFL excretion rate (UIER) reflects circulating IFLs accurately when area-under-curve (AUC) and identical time intervals are used (r=0.93; p<0.001). UIER in children and adults was determined when healthy and when on OABX by collecting urine in pairs of baseline and overnight specimen before and after consuming soy nuts, respectively. Compared to when healthy, children on OABX showed significantly decreased UIER but adults on OABX showed increased UIER (p<0.05). All 37 healthy children showed significantly higher UIERs compared to all 34 healthy adults. UIER is an adequate surrogate for determining IFL bioavailability and for measuring soy or IFL exposure in epidemiologic and other studies.

Oral antibiotics decrease urinary isoflavonoid excretion in children after soy consumption.

How oral antibiotics (OABX) alter isoflavones (IFLs) in soy-consuming children is unknown. We evaluated OABX effects on urinary IFL excretion rates (UIERs) in 17 children, ages 4 to 17 yr, who provided 2 urine collections in pairs of a baseline urine and an overnight urine collection after consuming a body-weight-adjusted dose of soy nuts. The first collection was during OABX treatment for a bacterial infection and the second when healthy and off antibiotics. IFL food levels and UIERs were measured for nonmetabolites (NM), namely, daidzein, genistein (GE), and glycitein, and the metabolites (M) dihydrodaidzein, dihydrogenistein, equol, and O-desmethylangolensin (DMA), by liquid chromatography mass spectrometry. Urinary IFLs were hypothesized to change after OABX due to intestinal microflora alterations. A total of 11 children completed the study correctly. During OABX use, UIER (nmol/h/kg) for GE (6.4 ± 1.0 vs. 10.1 ± 1.6), all NM (27.5 ± 4.8 vs. 36.2 ± 4.7), and total IFLs (all NM + all M; 29.4 ± 5.0 vs. 38.8 ± 4.8) was reduced (P < 0.05) vs. when healthy. In contrast, a trend toward more DMA production during OABX was observed (1.2 ± 0.6 vs. 0.4 ± 0.3, P = 0.13). The reduction in urinary IFL appearance could be due to the changes of intestinal bacteria by OABX and/or due to processes related to the infection.

Urinary Isoflavones Are Increased in Adults, But Decreased in Children, Consuming Soy When on Oral Antibiotic Therapy

The goal of this study was to evaluate how oral antibiotics (OABX) change the appearance of isoflavones (IFLs) in adults and children after soy consumption. The urinary IFL excretion rate (UIER) known to reflect circulating IFLs was hypothesized to change due to intestinal microflora changes by OABX. Subjects provided urine collections in pairs of a baseline urine and an overnight urine before and after consuming soy nuts first during OABX treatment and then again when healthy. During OABX versus when healthy, UIER (nmol/h/kg) in adults (n = 12) was increased (P < 0.05) for daidzein (35.2 ± 7.2 vs. 18.9 ± 2.4), daidzein + genistein + glycitein [nonmetabolites (NM); 42.6 ± 8.0 vs. 23.6 ± 2.9), and total isoflavonoids (Total IFLs; daidzein + genistein + glycitein + dihydrodaidzein + dihydrogenistein + equol + O-desmethylangolensin) (51.5 ± 10.3 versus 29.6 ± 4.7). In contrast, children (n = 7) showed reduced UIER (P < 0.05) when on OABX versus when healthy for daidzein (36.3 ± 6.4 vs. 46.8 ± 4.7), dihydrodaidzein (1.2 ± 0.6 vs. 3.0 ±1.1), NM (46.3 ± 8.2 vs. 59.5 ± 6.0), dihydrodaidzein + dihydrogenistein + equol + O-desmethylangolensin (1.0 ± 0.8 vs. 4.3 ± 1.3), and Total IFLs (48.2 ± 8.5 vs. 63.8 ± 6.4).

Coenzyme Q10, carotenoid, tocopherol, and retinol levels in cord plasma from multiethnic subjects in Hawaii.

Abstract Coenzyme Q10 (Q10), carotenoids, tocopherols, and retinol are the major circulating lipid-phase micronutrients (LPM) known to help mitigate oxidative damage and prevent chronic diseases. However, the functions of these compounds in newborns are little understood. This is due, in part, to the paucity of studies reporting their concentrations in this population. We measured Q10, carotenoids, tocopherols, and retinol in cord plasma from 100 multiethnic subjects living in Hawaii using HPLC with diode array and electrochemical detection. Appropriate internal standards were used including, for the first time, custom designed oxidized (UN10) and reduced (UL10) Q10 analogues. These compounds reflected the oxidation of UL10 to UN10 that occurred during sample processing and analysis and thus permitted accurate adjustments of natively circulating Q10 levels. All LPM measured were much lower in cord than in peripheral plasma. Cord plasma levels of total carotenoids, tocopherols, and retinol were approximately 10-fold, 3- to 5-fold and 1.5- to 3-fold lower than those in children or women. Cord plasma levels of total Q10 (TQ10; median, 113 ng/mL) were approximately 2-fold or 7- to 9-fold lower than peripheral plasma levels of neonates or children and adults, respectively. In contrast, the UN10/TQ10 ratio was substantially higher in cord (24%) than in peripheral plasma of children (3–4%) or adults (9%). Among the 5 ethnic groups in our cohort, no differences were observed in the levels of UN10, UL10, or TQ10. However, significant differences in many of the LPM were observed between ethnicities. More research is needed to explain these phenomena.

Diagnosis of an intraventricular hemorrhage by a pediatric emergency medicine attending using point-of-care ultrasound: a case report.

For the past 2 decades, point-of-care ultrasound (POCU) has been increasingly performed in adult emergency medicine for a variety of indications. However, the incorporation of POCU into pediatric emergency medicine has been much slower. Cranial ultrasound is an integral part in neonatology and is routinely used to diagnose intraventricular hemorrhage (IVH). Although cranial ultrasound is not considered a core emergency ultrasound application in the 2008 American College of Emergency Physicians ultrasound guidelines, this novel approach may prove beneficial in the emergency department (ED) setting. We report a case of a 16-day-old male that presented to the pediatric ED with fussiness and found to be anemic. An IVH was diagnosed for the first time using POCU by a pediatric ED attending. Sonographic characteristics of an IVH may be helpful in the prompt diagnosis of this condition, thereby reducing morbidity and mortality and improving the final outcome.

Diagnosis of intussusception using point-of-care ultrasound in the pediatric ED: a case report.

Over the past decades, ultrasonography (US) expanded from radiology to many different specialties including emergency medicine. In 1999, the American Academy of Emergency Medicine published its position statement defining point-of-care (POC) US as a sonographic imaging procedure by an emergency physician on a patient in the emergency department (ED) in an effort to detect acute medical problems. In 2001, the American College of Emergency Physicians issued a policy statement on the use of emergency US, endorsing its use in EDs nationwide. Since then, POC US use has dramatically increased, particularly in adult patients. Pediatric emergency medicine attendings have been slower to understand the importance of this application in the diagnosis of some specific pediatric conditions. This report illustrates the use of POC US in a case of a 10-month-old male infant that presented to the ED with fussiness as the only symptom. A diagnosis of intussusception was made using real-time POC US by a pediatric emergency medicine attending that was subsequently confirmed with radiology department US. The use of POC US and knowledge of the sonographic characteristics of intussusception can help the physician in the early diagnosis of intussusception and thereby reduce the likelihood for surgical reduction or even intestinal resection. The diagnosis of intussusception is best performed by an experienced sonographer, such as the radiologist. However, if a delay for this study is anticipated, POC US by a physician trained in POC US can be crucial in reducing time to diagnosis and definitive treatment.