Timing of Solid Food Introduction and Obesity: Hong Kong’s “Children of 1997” Birth Cohort

1. Shi Lin Lin, MPH, 
2. Gabriel M. Leung, MD, 
3. Tai Hing Lam, MD, and
4. C. Mary Schooling, PhD

ABSTRACT

BACKGROUND: Some observational studies in Western settings show that early introduction of solid food is associated with subsequent obesity. However, introduction of solid food and obesity share social patterning. We examined the association of the timing of the introduction of solid food with BMI and overweight (including obesity) into adolescence in a developed non-Western setting, in which childhood obesity is less clearly socially patterned.

METHODS: We used generalized estimating equation models to estimate the adjusted associations of the timing of the introduction of solid food (<3 3="" 5="" 7="" and="">8 months) with BMI z score and overweight (including obesity) at different growth phases (infancy, childhood, and puberty) in 7809 children (88% follow-up) from a Chinese birth cohort, “Children of 1997.” We assessed if the associations varied with gender or breastfeeding. We used multiple imputation for missing exposure and confounders.

RESULTS: The introduction of solid food at <3 age="" associated="" bmi="" but="" clearly="" difference="" em="" family="" in="" including="" infancy="" lower="" mean="" months="" nbsp="" not="" obesity="" of="" or="" overweight="" position="" socioeconomic="" style="border: 0px; font-family: inherit; font-size: inherit; line-height: inherit; margin: 0px; outline-style: none; padding: 0px; text-align: inherit; vertical-align: baseline;" was="" with="">z

score: 0.01; 95% confidence interval (CI): −0.14 to 0.17], childhood (0.14; 95% CI: −0.11 to 0.40), or at puberty (0.22; 95% CI: −0.07 to 0.52), adjusted for SEP and infant and maternal characteristics.

CONCLUSIONS: In a non-Western developed setting, there was no clear association of the early introduction of solid food with childhood obesity. Together with the inconsistent evidence from studies in Western settings, this finding suggests that any observed associations might simply be residual confounding by SEP.

http://pediatrics.aappublications.org/content/early/2013/04/03/peds.2012-2643d.abstract

Validity of Pure-Tone Hearing Screening at Well-Child Visits.

Donna R. Halloran, MD, MSPH; J. Michael Hardin, PhD; Terry C. Wall, MD, MPH
Arch Pediatr Adolesc Med. 2009;163(2):158-163.
Objective: to estimate the sensitivity and specificity of pure-tone audiometry hearing screening in the primary care setting.
Design: prospective cohort study.
Setting: eight academic and private pediatric practices.
Participants: a subset of children from a convenience sample of 1061 children between 3 and 19 years of age were screened for hearing loss using pure-tone audiometry.
Intervention: formal audiologic evaluations (gold standard) for those children referred by their primary care physician (28 children) and for a random sample of children not referred (102 children).
Main Exposure: pure-tone audiometry screening.
Main Outcome: measures Audiologic evaluations.
Results: a total of 28 children were referred to an audiologist for formal hearing testing after pure-tone audiometry screening during a well-child visit, at which 25 children did not pass the initial screening and 3 could not complete the screening. Of the 25 children, only 7 were evaluated by an audiologist, for a follow-up rate of 25%. One child was diagnosed as having hearing loss. Formal audiologic assessment was also performed on a random sample of 102 children who were not referred to the audiologist. For the random sample, hearing loss was identified in 2 of 76 (3%) children who passed and 1 of 16 (6%) children who did not pass pure tone audiometry screening. The sensitivity and specificity of pure-tone audiometry were 50% and 78%, respectively.
Conclusion: in light of the increasing burden on physicians to provide preventive care, this study calls into question the value of hearing screening using pure-tone audiometry during well-child visits given the lack of follow-up after referral and the poor sensitivity.