Annotated Abstracts
Article Outline
Ann Marie McCarthy, PhD, RN, PNP
The University of Iowa College of Nursing
Iowa City, Iowa
Margaret Brady, PhD, RN, CPNP
California State University, Long Beach
Long Beach, California
Azusa Pacific University
Azusa, California
Donna Hallas, PhD, APRN, BC, CPNP
Lienhard School of Nursing
Pace University
Pleasantville, New York
The authors conducted a prospective longitudinal study (currently in the eighth year) to evaluate the effect of the reduction of foods known to have a history of high allergen response, as well as a reduction in infant exposure to house dust mites, for the purpose of preventing the development of asthma and allergies in the first 8 years of childhood. Infants who were identified as high risk for development of asthma and allergies by family predisposition were recruited to participate in the study. Infants were divided into two groups, a prophylactic group and a control group. The prophylactic group of infants was either breast-fed, with the mother on a low-allergen diet, or was given a hydrolyzed formula. The intervention included strict elimination of common food allergens such as dairy products, egg, wheat, nuts, fish, and soya in infants until 12 months of age. The prophylactic group also had a reduced exposure to house dust mites by the use of an acaricide for treatment of carpets and upholstery in the infant’s bedroom and lounge areas, as well as the mattress covers in the crib. The control group of infants was either breast-fed with no diet control or given regular formula and were exposed to standard amounts of house dust mites and regular mattresses. This was the first study designed to reduce the exposure to food as well as house dust mites.
A total of 120 infants were recruited into this study, which began as a cohort group in 1990, and the infants/children were assessed at the ages of 1, 2, 4, and 8 years, respectively. Assessments included questionnaires for the parents, physical examination of the infants, and skin prick tests to determine food and aeroallergens. The results revealed that asthma prevalence increased in both groups to the age of 4 years and then stabilized. However, it was found that only one child (1.7%) in the prophylactic group had persistent asthma, while seven children (11.3%) in the control group had persistent asthma. Prevalence of atopic dermatitis was reduced by 50% compared with the control group, which was statistically significant (P = .005). Allergic rhinitis was found to be significantly reduced in the prophylactic group. Likewise, the prevalence of food allergies was consistently lower (50%) in the prophylactic group, but the number did not show a statistical significance. The children in both the prophylactic group and the control group showed an increase with age to sensitization to house dust mites, but the gap widened between the two groups as the children approached 8 years of age.
The authors concluded that the Isle of Wight Prevention Study confirmed a sustained reduction in the effect of allergen avoidance in infancy through the first 8 years of life for infants/children who had a reduced exposure to highly allergic foods and a reduced exposure to house dust mites in the first year of life. The authors plan a further follow-up of this cohort of children through adolescence and into early adult life to evaluate the length of the sustained effect of the treatment intervention.
The National Health, Lung, and Blood Institute Growth and Health Study was designed as a longitudinal study to estimate the prevalence and incidence of being overweight in African American and White girls and to gain insight into the relationship between being overweight and the development of cardiovascular disease risk factors during the adult lifetime. This study was designed based on the results of previous research studies that have shown that children who were overweight during childhood have lipid levels, blood pressure, and elevated insulin levels, and thus these children are at higher risk for coronary heart disease in adulthood compared with adults who were thin during childhood.
A total of 1213 African American girls and 1166 White girls between the ages of 9 or 10 years and 18 years of age were studied. Self-reported measures were obtained from the participants between the ages of 21 and 23 years. Participants were selected from three institutions that included the University of California at Berkeley, University of Cincinnati/Cincinnati Children’s Hospital Medical Center, and Westat, Inc., Rockville, Maryland. These sites were selected so that a large representation of children would be included in the sample and, as such, the participants were from a wide distribution of household incomes as well as from diverse ethnic backgrounds.
The authors used the Centers for Disease Control and Prevention (CDC) definition of overweight, which is the age- and sex-specific 95th percentile for basal metabolic index (BMI). Annual height, weight, and BMI measurements were obtained from girls in the study. These data were then compared with the relationship of adiposity and cardiovascular risk factors using the BMI cut-points on the CDC growth charts. In addition, the following data were obtained: waist circumference; percent body fat; skin fold measurements; blood pressure measurements; and lipid levels from fasting morning blood specimens at visits 1, 3, 5, 7, and 10.
The results of this study revealed the prevalence and incidence of being overweight in African American girls compared with White girls. The rate of being overweight differed significantly by age in the populations studied (P = .001) and tended to increase as the girls grew older, with the increase predominately in the African American population of girls. For all other indicators, such as lipid levels, blood pressure, and fasting insulin levels, the differences between measures for overweight and nonoverweight girls tended to increase with age.
The authors discuss these findings in relation to obesity prevention efforts. These data strongly show the need to consider cultural differences when planning obesity prevention strategies. Another important factor was that the data further revealed that the incidence of obesity was higher in children between the ages of 9 and 12 years. The authors found that most of the interventions on obesity and the assessment of cardiovascular disease risk factors have been within the school systems and thus have not been successful. The authors suggest that community settings have begun to design intervention studies to address obesity issues in childhood. The authors further suggest that clinicians, community leaders, researchers, and public health members design and develop effective innovative obesity prevention interventions that can be utilized for this population of children and young adults with the long-term goal of reducing the incidence of cardiovascular disease in adulthood.
PII: S0891-5245(07)00091-0
doi:10.1016/j.pedhc.2007.03.001
