Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Breastfeeding For The Prevention of Child Chronic Diseases
- James W Prescott (18 February 2001)
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Type 2 Diabetes in Children
- Timothy G Barrett (9 March 2001)
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James W Prescott, Independent Scholar Home
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http://bmj.com/cgi/content/full/322/7283/377 Given the general alarm sounded about the worldwide rise in chronic diseases of children and the primary attention that has been given to the industrialized society with it's corresponding increases in overweight and physical inactivity in children, as etiolgical factors, the omission of the duration of breastfeeding, as a significant contributing factor to the rise in chronic childhood disease, is equally alarming. Despite the many health benefits cited for breastfeeding,e.g. "Breastmilk is the most complete form of nutrition for infants" and"Breastfeeding protects an infant from a wide array of infectious and noninfectious diseases" (HHS Blueprint for Action on Breatfeeding, DHHS Surgeon General David Satcher (http://www.surgeongeneral.gov/sgoffice.htm) and the recommendation of WHO/UNICEF for breastfeeding "two years of age and beyond", the failure to evaluate duration of breastfeeding and its recommendation for prevention of chronic childhood disease is inexplicable. The study of Zhen, et al (2000). "Lactation reduces breast cancer in Shandong Province, China" documented that women who breastfeed for more than 24 months have a significant reduction in breast cancer compared to those women who breastfed for 1-6 months (American J. Epidemiology, 152(12):1129-1135). This writer's study on breastfeeding in tribal cultures found that cultures which breastfeed for 2.5 years or longer are significantly characterized as highly nurturing and non-violent cultures where 77% of these high breastfeeding cultures are rated low or absent in suicide (http://www.violence.de/prescott/ttf/article.html; and work in progress). Tryptophan, an essential amino acid that is richly present in colostrum and breastmilk but not formula milk, is converted to brain serotonin, deficits of which are known to mediate depression, impulse dyscontrol and violence. The above data support the WHO/UNICEF recommendation for breastfeeding "two years of age and beyond" and it appears that 2.5 years of breastfeeding or longer may be necessary to realize the full health benefits of breastfeeding for mother and child. It is incumbent upon all future studies on the health of children to include evaluation of the duration of breastfeeding and the nutritional status of the breastfeeding mother. James W. Prescott, Ph.D.
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Timothy G Barrett, Senior Lecturer Paediatric Endocrinology Birmingham Children's Hospital
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Editor - In their timely editorial on type 2 diabetes in children Fagot-Campagna et al have described the United States experience of this emerging condition.(1) We represent the Paediatric Diabetes Subgroup of the Pan-Birmingham Diabetes Advisory Group, and feel it would be pertinent to describe our own experience of type 2 diabetes in children within Birmingham. We are responsible for 506 children with diabetes mellitus within Birmingham Health Authority; together our hospitals serve a paediatric population of 261 811.(2) The first case of childhood type 2 diabetes in Birmingham was diagnosed in 1993 and since then we have seen 17 children with type 2 diabetes, of whom 10 remain in the paediatric clinics. Of these 17 children, 15 are female and 15 are South Asian. Three have type 2 diabetes post bone-marrow transplantation. In the 12 months to December 2000 67 children presented with diabetes, of whom 4 were new presentations of type 2 diabetes. From this we can estimate that in our population the crude prevalence of type 2 diabetes in children under the age of 18 is 0.038 per 1000 with an annual incidence of 1.52 per 100 000. This compares with a crude prevalence of 1.818 per 1000 and incidence of 23.30 per 100 000 for type 1 diabetes in our population. We have recently reported eight British children aged 9-16 years with type 2 diabetes who are all female and overweight with a positive family history of diabetes.(3) In contrast to the US experience of this condition in Native American, Black and Hispanic children,(4) these children were all of South Asian or Arab origin. They presented insidiously without ketosis and the majority were asymptomatic at time of diagnosis. They all had features of insulin resistance (acanthosis nigricans or high plasma insulin or C-peptide) and the high frequency of associated hypertension, dyslipidaemia and features of polycystic ovarian syndrome in this cohort suggests underlying Metabolic syndrome.(5) It is unclear whether the emergence of type 2 diabetes in ethnic minority children has implications for the wider paediatric population, or what part obesity plays in its development. From our experience, not all of our children with type 2 diabetes are overweight, and this is clearly a heterogeneous condition in children. A national survey is underway under the auspices of the British Society of Paediatric Endocrinology and Diabetes to ascertain how many children are affected in the UK. Sarah Ehtisham Clinical Research Fellow
Nick Shaw Consultant Paediatric Endocrinologist
Stephen Rose Consultant Paediatrician
Tom Lee Consultant Paediatrician
Timothy Barrett Senior Lecturer Endocrinology and Chair, Birmingham
Competing interests: This group is supported by Diabetes UK 1. Fagot-Campagna A, Venkat-Narayan KM, Imperatore G. Type 2 diabetes in children. British Medical Journal 2001;322:377-8 (17 February) 2. Office for National Statistics. Mid-1999 Birmingham Health Authority Population Estimate. 3. Ehtisham S, Barrett TG, Shaw NJ. Type 2 diabetes mellitus in UK children – an emerging problem. Diabetic Medicine 2000;17;867-871 4. American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000;23:381-9 5. World Health Organisation. Definition, Diagnosis and Classification of Diabetes Mellitus and its complications; Part 1: Diagnosis and Classification of Diabetes Mellitus. WHO Department of Noncommunicable Disease Surveillance, Geneva, 1999. |
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