Living With

GUSTO!

Issue 8

We are pleased to introduce you to Quantitative Magnetic Resonance (QMR), a new method to measure your children’s body composition. QMR (EchoMRI™ Body Composition Analyzer) takes direct measurements of total body fat, lean mass, free water, and total body water in animals and humans. The measurements are based on differences in relaxation times of the hydrogen proton spinning in different environments. The main advantage of this method compared with other techniques lies in its short scanning time, with a typical scan lasting for less than 3 minutes. Furthermore, QMR does not use ionizing radiation (X-rays) and has not been associated with any significant health risk as it uses a low magnetic strength. Moreover, your child will not be subjected to sedation or anesthesia, and slight movement during the scan is acceptable. Several studies have assessed the validity of the QMR method in measuring body composition of humans (Gallagher et al., 2010; Napolitano et al., 2008), including one that was conducted in the paediatric population (Andres et al., 2011). However, these studies were mostly conducted in Western populations and it will be good to assess if this method is also suitable for use in Singapore. Our 5 year old GUSTO children have successfully completed the QMR scan. We are conducting a validation study to assess the accuracy and precision of QMR measurement. The results will inform us of the efficiency, accuracy, and feasibility of the measurement, so that we can make a decision in expanding the measurement to future clinic visits. We would like to take this opportunity to encourage you to consider this quick, fun, and non-invasive method in measuring your children’s body composition. Your participation is greatly appreciated.

Quantitative Magnetic Resonance (QMR)

References Andres, A., Gomez-Acevedo, H., and Badger, T.M. (2011). Quantitative Nuclear Magnetic Resonance to Measure Fat Mass in Infants and Children. Obesity 19, 2089–2095. Gallagher, D., Thornton, J.C., He, Q., Wang, J., Yu, W., Bradstreet, T.E., Burke, J., Heymsfield, S.B., Rivas, V.M., and Kaufman, R. (2010). Quantitative magnetic resonance fat measurements in humans correlate with established methods but are biased. Obes. Silver Spring Md 18, 2047–2054. Napolitano, A., Miller, S.R., Murgatroyd, P.R., Coward, W.A., Wright, A., Finer, N., De Bruin, T.W., Bullmore, E.T., and Nunez, D.J. (2008). Validation of a quantitative magnetic resonance method for measuring human body composition. Obes. Silver Spring Md 16, 191–198.

31.5% 33.7%

68.5% 66.3%

9 months 12 months

Percentage of Mothers Adding Extra Ingredients to Baby's Milk at 9 and 12

months

Yes No

B

Thank you for your effort in reporting your infant feeding practices. With your help, we are able to compile the following article on infant feeding practices when the GUSTO children were 9 and 12 months of age [1].

23.8%

32.7%

45.8%

56.3%

76.2%

67.3%

54.2%

43.7%

9 months 12 months 9 months 12 months

OIL SEASONING

Percentage of Mothers Adding Oil and Seasoning to Baby's Diet at 9 and 12 months

Yes No

A

Figure A Based on the data of 842 GUSTO mums, more than 60% did not add oil to their baby’s diet at 9 and 12 months. Addition of fat (oil) to weaning diet may affect its contribution to total caloric intake and excessive consumption may increase the probability of childhood obesity [2]. Similarly, more than 50% of mothers did not add seasoning when preparing their baby’s food at 9 months, however this dropped to 43.7% at 12 months.

Figure B Slightly more than 30% of mothers reported adding food items into their baby’s milk bottle when feeding at both 9 and 12 months. The most common food items added were pureed food, cereal and baby rusks. Addition of foods into milk increases the overall caloric intake, which could promote weight gain in the long run

13.1% 10.7%

85.6% 87.4%

0.4% 0.6% 0.8% 1.0% 0.1% 0.4%

9 months 12 months

Percentage Distribution of Method of Drinking Milk at 9 and 12 months

Breastfed Milk Bottle Cup Spoon Others

C

Figure C At 9 months, 13.1% of mothers breastfed, while 85.6% fed their babies milk via the bottle and 1.3% via other methods such as a cup, spoon or straw. Bottle-feeding remained the most common method of feeding milk (87.4%) at 12 months, with percentage of those breast-feeding decreasing slightly (10.7%). Bottle-fed infants consume significantly more milk [3] and studies have shown that prolonged bottle-feeding, beyond the weaning age of 12 – 14 months, increases the risk of being overweight [4, 5].

31.6%

26.5%

39.7%

34.2%

9.9%

16.3% 14.8%

12.8%

4.0%

10.2%

9 months 12 months

Percentage Distribution of Method of Drinking Juices and Sweetened Drinks at 9 and 12 months

Do Not Drink Milk Bottle Cup Spoon Others

D

References

1.Toh, J.Y., et al., Infant Feeding Practices – An Asian Perspective. Manuscript in progress. 2015. 2.Milner, J.A. and R.G. Allison, The role of dietary fat in child nutrition and development: summary of an ASNS workshop. American Society for Nutritional Sciences. J Nutr, 1999. 129(11): p. 2094-105. 3.Northstone, K., I. Rogers, and P. Emmett, Drinks consumed by 18-month-old children: are current recommendations being followed? European journal of clinical nutrition, 2002. 56(3): p. 236-244. 4.Gooze, R.A., S.E. Anderson, and R.C. Whitaker, Prolonged bottle use and obesity at 5.5 years of age in US children. The Journal of pediatrics, 2011. 159(3): p. 431-436. 5.Bonuck, K., R. Kahn, and C. Schechter, Is late bottle-weaning associated with overweight in young children? Analysis of NHANES III data. Clinical pediatrics, 2004. 43(6): p. 535-540.

Figure D In addition, 31.6% of the cohort did not drink juices and sweetened drinks at 9 months. Of those who did, 39.7% drank juices and sweetened drinks from a milk bottle, while the rest used cup (9.9%), spoon (14.8%) or other methods such as straw or syringe (4.0%). The trend stayed relatively the same at 12 months, except for a 5.8% increase in babies drinking juices and sweetened drinks using other methods, which was mainly straw.

As children grow and reach their 6th birthday, their bodies begin to prepare for the next important chapter of their lives – Puberty. Normal puberty does not actually begin at 6 years old but some children may develop certain changes that indicate their bodies are preparing for puberty. Some of these changes include oily skin over their noses or even a faint tinge of sweaty body odor. These are normal changes that are caused by hormones produced by the adrenal glands and they inform us that the child is getting ready for puberty. What follows about 1-2 years later in girls are tiny breast buds that may begin to appear as early as 7 years old, whereas in boys the changes are more subtle and involve testicular growth as early as 9 years old. To understand how Singapore children grow and develop across this phase of life, GUSTO will begin to assess pubertal status. As puberty typically begins earlier in girls, we will start by assessing for the above changes in girls from 6 years. In boys, assessment for pubertal changes will begin later from 7-8 years onwards. To learn more about how children prepare for puberty and what changes take place during puberty, please do attend our upcoming annual GUSTO family event in October 2015.

A/Prof

Fabian Yap Note: As the QMR machine is located at KK Women’s and Children’s Hospital, only subjects who have visits at KKH are invited to take part in this procedure. * Measure is pending approval by IRB as of print date

If you have something you would like to tell/ask us or hear about in the next newsletter, please feel free to call our GUSTO hotline at 9367 8944 or email info@gusto.sg.

We look forward to hearing from you!

ANNOUNCEMENT:

GUSTO Halloween Party 2015

Limited Seats! Free Admission!

For more information, please contact us at GUSTO Hotline (9367 8944)

or email us at info@gusto.sg

A/Prof Fabian Yap

A/Prof Lynette Shek