Marco Sala

Feeding practices of infants through the first year of life in Italy

Aim: To investigate infant feeding practices through the first year of life in Italy, and to identify factors associated with the duration of breastfeeding and early introduction of solid foods. Methods: Structured phone interviews on feeding practices were conducted with 2450 Italian‐speaking mothers randomly selected among women who delivered a healthy‐term singleton infant in November 1999 in Italy. Interviews were performed 30 d after delivery and when the infants were aged 3, 6, 9 and 12 mo. Type of breastfeeding was classified according to the WHO criteria. Results: Breastfeeding started in 91.1% of infants. At the age of 6 and 12mo, respectively, 46.8% and 11.8% of the infants was still breastfed, 68.4% and 27.7% received formula, and 18.3% and 65.2% were given cows milk. Solids were introduced at the mean age of 4.3 mo (range 1.6–6.5 mo). Introduction of solids occurred before age 3 and 4 mo in 5.6% and 34.2% of infants, respectively. The first solids introduced were fruit (73.1%) and cereals (63.9%). The main factors (negatively) associated with the duration of breastfeeding were pacifier use (p > 0.0001), early introduction of formula (p > 0.0001), lower mothers age (p > 0.01) and early introduction of solids (p= 0.05). Factors (negatively) associated with the introduction of solids foods before the age of 3 mo were mother not having breastfed (p > 0.01), early introduction of formula (p > 0.01), lower infant bodyweight at the age of 1 mo (p= 0.05) and mother smoking (p= 0.05).

The Efficacy and Safety of γ-Linolenic Acid in the Treatment of Infantile Atopic Dermatitis

The efficacy and safety of γ-linolenic acid in the treatment of atopic dermatitis was evaluated. The children (mean age, 11.4 months) with atopic dermatitis (mean duration, 8.56 months) were openly treated with 3 g/day γ-linolenic acid, for 28 days. Clinical evaluations were carried out every 7 days, and parents were asked to keep a diary, recording details of symptoms of eczema every day. Blood chemistry and immunological tests were done before and after treatment. None of the children showed complete recovery of symptoms. A gradual improvement in erythema, excoriations and lichenification was seen; significant differences were shown for itching (P < 0.01), and the use of antihistamines (P < 0.01). A significant rise in the percentage of circulating CD8 was found. No side-effects were recorded. Dietetic and pharmacological approaches are the basis of the treatment of atopic dermatitis and γ-linolenic acid appears to be a safe and efficient additional therapy for infants and young children.

Hospital admissions for respiratory conditions in children and outdoor air pollution in Southwest Milan, Italy

Aim:  To evaluate whether a relationship exists in hospital admissions for respiratory conditions in children with outdoor pollution in the Southwest Milan, Italy.

Elemental mapping and microimaging by x-ray capillary optics.

Recently, many experiments have highlighted the advantage of using polycapillary optics for x-ray fluorescence studies. We have developed a special confocal scheme for micro x-ray fluorescence measurements that enables us to obtain not only elemental mapping of the sample but also simultaneously its own x-ray imaging. We have designed the prototype of a compact x-ray spectrometer characterized by a spatial resolution of less than 100 microm for fluorescence and less than 10 microm for imaging. A couple of polycapillary lenses in a confocal configuration together with a silicon drift detector allow elemental studies of extended samples (approximately 3 mm) to be performed, while a CCD camera makes it possible to record an image of the same samples with 6 microm spatial resolution, which is limited only by the pixel size of the camera. By inserting a compound refractive lens between the sample and the CCD camera, we hope to develop an x-ray microscope for more enlarged images of the samples under test.

Association of psoriasis-like eruption and Kawasaki disease.

We report a case of a 3‐month‐old female baby showing clinical and hematological signs compatible with Kawasaki disease. A few days after the beginning of the specific therapy, the young patient developed asymptomatic erythematous plaques appearing on the trunk. The histology disclosed a psoriasic pattern. To the best of our knowledge, we describe the youngest baby in the published work developing a psoriasis during the course of Kawasaki disease.

XRF-XANES characterization of deep ice core insoluble dust

An analytical protocol based on X-ray spectroscopic measurements (XRF and Fe and Ti K-edges XAS) has been applied to evaluate the mineralogical phase composition of dust trapped in deep ice cores. Information on the insoluble dust composition and local and species-selective information as oxidation and coordination states has been obtained to recognize the main mineralogical families of aerosol particles contained in deep ice cores. In this framework we point out the possibility to obtain the mineralogical characterization of dust from deep ice core samples from Antarctica by means of XANES spectroscopy.

Dietary glycemic load and macronutrient intake in healthy italian children

The objective is of this study is to examine the relationship of dietary glycemic load (GL) and overall glycemic index (OGI) with macronutrients intake, body mass index (BMI) and insulin sensitivity in healthy children. The subjects comprised of 105 healthy non-obese eight -years old children, 60 boys and 45 girls. A Food Frequency Questionnaire (FFQ) evaluating dietary habits, GL and OGI. Insulin sensitivity was evaluated by the homeostatic model assessment (HOMA). GL was positively associated with dietary total (correlation coefficient, r=0.57) and starch (r=0.67) carbohydrates, daily consumption of pasta and white bread, cooked potatoes, bakery products and cookies, and negatively with dietary fats (r=-0.52). OGI was positively associated with daily consumption of white bread and cookies, and negatively associated with soluble carbohydrates (r=-0.35), and consumption of fibres, proteins, fruit, legumes and carrots. No significant association was found of GL or OGI with BMI or insulin sensitivity. In healthy children, GL and OGI may represent a useful indicator of quality of diet. Asia Pac J Public Health 2005; 17(2): 88-92.

Effect of Nedocromil Sodium on Bronchial Hyperreactivity in Children with Nonatopic Asthma

BACKGROUND AND OBJECTIVES Although cromones inhibit immediate bronchial responses to both allergen and nonspecific challenge, their effectiveness in treating nonatopic childhood asthma is unknown. We therefore investigated a possible effect of nedocromil sodium on bronchial hyperreactivity and asthmatic symptoms in a group of children receiving this drug for nonatopic asthma. STUDY DESIGN AND METHODS A double-blind, placebo-controlled, randomized trial of two parallel groups was carried out in our pediatric respiratory disease clinic. Twenty children with mild, nonatopic asthma hyperreactive to fog-induced challenge were treated with inhaled nedocromil sodium 16 mg each day for 6 weeks (group N) or with a placebo (group P). Five girls and five boys (7 to 13 years of age) were randomly assigned to group N, and three girls and seven boys (aged 6 to 16 years) to group P. Symptoms and bronchodilator use were reported on diary cards. Ultrasonic nebulized distilled water PD10 was measured administering increasing doses of nebulized distilled water (2.5, 5, 10, 20, and 40 L). RESULTS Symptom scores were significantly affected by the active treatment. Baseline lung function was normal and remained unaltered after treatment with nedocromil sodium. Nonspecific reactivity was significantly reduced over time only in the active treatment group. CONCLUSIONS Nedocromil sodium can reduce the severity of asthmatic symptoms and nonspecific bronchial hyperreactivity at fog-induced challenge in children with stable, nonatopic asthma.

PKU-related dysgammaglobulinaemia: The effect of diet therapy on IgE and allergic sensitization

SummaryThe effect of diet on the development of immunoallergic signs and symptoms in children with phenylketonuria (PKU) was evaluated. Immunological indices of 58 children with PKU treated with diets were compared to the immunological indices of 58 healthy (non-PKU) children. In the PKU group, 39 children had been placed on diet therapy within the first month of life; 19 children had been placed on diet therapy after 6 months of age. Total circulating lymphocytes; CD3+, CD4+, CD8+ circulating lymphocytes; and serum IgA, IgM, IgG and total IgE levels were measured for each child. Skin prick tests were performed for common inhalant and food allergens. Every 3 months over the 2-year period of this study, the signs and symptoms of eczema, allergic rhinitis and asthma were recorded.The PKU group had lower IgG levels (p=0.004) and higher total IgE levels (p=0.0001) than the control group. Significantly lower IgE levels were found in children started on diet therapy within the first month of life compared with those started on diet therapy after 6 months of age (p=0.0001). Allergic sensitization was significantly more frequent in the PKU group (24/58 vs 13/58,z=2.00,p<0.05), but no significant difference in the incidence of eczema and allergic rhinitis was found. Asthma was less frequent in the PKU group than in the control group (5/58 vs 14/58,z=2.09,p<0.05). Thus, diet appeared to prevent the development of immunoallergic signs and symptoms.

Traffic-Related Air Pollution and Childhood Asthma

We congratulate Clark et al. (2010) for their interesting article concerning traffic-related air pollution and asthma in children. They examined early-life (in utero and during the first year of life) exposure to traffic-related air pollution in a large population-based study (a nested case–control study including nearly 3,500 children). The authors found an association between elevated early-life exposure to traffic-related air pollution and a higher risk of asthma in preschool-aged children. However, Clark et al. (2010) address aspects, raise questions, and give results that deserve further comment—both concerning specific items and general “structural” criteria used in epidemiological studies on adverse health effects from air pollution. Recent reports have suggested that individual susceptibility could play a previously unsuspected role in the occurrence of diseases (Cetta et al. 2009a), perhaps a role greater than that of the intrinsic toxicity of pollutants (Cetta et al. 2009b). This could explain, at least in part, why it is so difficult to determine a precise threshold concentration that is harmful or safe for each individual (Cetta et al. 2007). But this is just one side of the question. The main question is that, in the absence of adequate and specific markers of exposure, effect and susceptibility, the linear dose and effect model, and the concomitant pollutant concentration and disease occurrence relationship cannot explain the complexity of the phenomenon of host–particle interactions. In particular, initial cell alterations (e.g., oxidative stress, DNA adduct formation) rarely turn into permanent tissue damage and evident disease because of host repair and defence mechanisms. In their article Clark et al. (2010) noted another important aspect that should be considered when comparing pollutant concentrations with the burden of deleterious effects, both at the individual and population levels: acute effects of peak concentrations of pollutants that lead to acute admission to hospital and the chronic damage that causes long-term effects. In fact, we should consider both of these as separate entities. However, we also should consider the effect of air pollution on newborns, which greatly depends on individual susceptibility—either congenital or acquired. This could play a major role in future outcomes and shed new light on the peculiar pathophysiological mechanisms of most pollution-related diseases. Clark et al. (2010) correctly outlined the asynchronism and the delay (0–4 years) between the initial pathogenetic exposure to pollutants (in utero or during the first year of life) and the occurrence and detectability of clinically relevant asthma. This further adds to the complexity of host-particle interactions. There are three issues that should be taken into account in developmental epidemiology studies such as that by Clark et al. (2010). First, epidemiological studies that concomitantly evaluate pollutant concentration and detectable diseases or hospital admissions usually neglect the perinatal damage in fetuses and newborns, which is not immediately detectable but is a delayed manifestation. Second, perinatal damage from air pollution deserves further attention and detailed analysis because it includes fetal malformations, birth defects, and developmental alterations of newborns. Injury from perinatal air pollution exposure could also be responsible for the increased proportion of unsusceptible individuals who, because of their exposure to pollutants during the susceptibility window and because of epigenetic alterations due to environmental factors, will become susceptible. Epigenetic alterations could also transfer this susceptibility to future generations, leading to individuals developing not only asthma at 4 years of age but also respiratory, cardiovascular or systemic diseases ≥ 20 years later. Third, clinical and pathophysiological details are not “details” but basic issues and questions—still unsolved— that should be primary goals for future research. They are critical to improving design of epidemiologic studies and to selecting appropriate models, which should also include biological and pathophysiological parameters and variables because they significantly affect clinical outcomes.