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Compiled by Shanika Sriyananda

Doctors challenge baby feeding myths

Ditch the rice cereal and mashed peas, and make way for enchiladas, curry and even - gasp! - hot peppers.

It's time to discard everything you think you know about feeding babies. It turns out most advice parents get about weaning infants onto solid foods - even from pediatricians - is more myth than science.

That's right, rice cereal may not be the best first food. Peanut butter doesn't have to wait until after the first birthday. Offering fruits before vegetables won't breed a sweet tooth. And strong spices? Bring 'em on.

"There's a bunch of mythology out there about this," says Dr. David Bergman, a Stanford University paediatrics professor. "There's not much evidence to support any particular way of doing things."

Word of that has been slow to reach parents and the stacks of baby books they rely on to navigate this often intimidating period of their children's lives. But that may be changing.

As research increasingly suggests a child's first experiences with food shape later eating habits, doctors say battling obesity and improving the American diet may mean debunking the myths and broadening babies' palates.

It's easier - and harder - than it sounds. Easier because experts say 6-month-olds can eat many of the same things their parents do. Harder because it's tough to find detailed guidance for nervous parents.

"Parents have lost touch with the notion that these charts are guides, not rules," says Rachel Brandeis, a spokeswoman for the American Dietetic Association. "Babies start with a very clean palate and it's your job to mould it."

It's easy to mistake that for a regimented process. Most parents are told to start rice cereal at 6 months, then slowly progress to simple vegetables, mild fruits and finally pasta and meat.

Ethnic foods and spices are mostly ignored by the guidelines - cinnamon and avocados are about as exotic as it gets - and parents are warned of potential allergens such as nuts and seafood for at least a year.

Yet experts say children over 6 months can handle most anything, with a few caveats: Be cautious if you have a family history of allergies; introduce one food at a time and watch for any problems; and make sure the food isn't a choking hazard.

Parents elsewhere in the world certainly take a more freewheeling approach, often starting babies on heartier, more flavourful fare - from meats in African countries to fish and radishes in Japan and artichokes and tomatoes in France.

The difference is cultural, not scientific, says Dr. Jatinder Bhatia, a member of the American Academy of Paediatrics' nutrition committee who says the American approach suffers from a Western bias that fails to reflect the nation's ethnic diversity.

Crazy

Bhatia says he hopes his group soon will address not only that, but also ways to better educate parents about which rules must be followed and which ones are only suggestions.

Rayya Azarbeygui, a 35-year-old Lebanese immigrant living in New York, isn't waiting. After her son was born last year, she decided he should eat the same foods she does - heavily seasoned Middle Eastern dishes like hummus and baba ghanoush.

"My paediatrician thinks I'm completely crazy," says Azarbeygui, whose son is now 13 months old.

"But you know, he sees my child thriving and so says, 'You know what, children in India eat like that. Why not yours?"'

How to introduce healthy children to solid food has rarely been studied. Even the federal government has given it little attention; dietary guidelines apply only to children 2 and older.

In a review of the research, Nancy Butte, a paediatrics professor at Baylor College of Medicine, found that many strongly held assumptions - such as the need to offer foods in a particular order or to delay allergenic foods - have little scientific basis.

Take rice cereal, for example. Under conventional American wisdom, it's the best first food. But Butte says iron-rich meat - often one of the last foods American parents introduce - would be a better choice.

Grain cereals might be worst thing

Dr. David Ludwig of Children's Hospital Boston, a specialist in paediatric nutrition, says some studies suggest rice and other highly processed grain cereals actually could be among the worst foods for infants.

"These foods are in a certain sense no different from adding sugar to formula. They digest very rapidly in the body into sugar, raising blood sugar and insulin levels" and could contribute to later health problems, including obesity, he says.

The lack of variety in the American approach also could be a problem. Exposing infants to more foods may help them adapt to different foods later, which Ludwig says may be key to getting older children to eat healthier.

Allergies

Food allergy fears get some of the blame for the bland approach. For decades doctors have said the best way to prevent allergies is to limit infants to bland foods, avoiding seasonings, citrus, nuts and certain seafood.

But Butte's review found no evidence that children without family histories of food allergies benefit from this.

Others suspect avoiding certain foods or eating bland diets actually could make allergies more likely. Some exposure might be a good thing.

And bring on the spices. Science is catching up with the folklore that babies in the womb and those who are breast-fed taste - and develop a taste for - whatever Mom eats. So experts say if Mom enjoys loads of oregano, baby might, too.

That's been Maru Mondragon's experience. The 40-year-old Mexican indulged on spicy foods while pregnant with her youngest son, 21-month-old Russell, but not while carrying his 3-year-old brother, Christian.

Christian has a mild palate while his younger brother snacks on jalapenos and demands hot salsa on everything.

"If it is really spicy, he cries, but still keeps eating it," says Mondragon, who moved to Denver four years ago.

That's the sort of approach Bhatia says more parents should know about. Parents should view this as a chance to encourage children to embrace healthy eating habits and introduce them to their culture and heritage.

"So you eat a lot of curry," he says, "try junior on a mild curry."

Copyright 2005 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

(AP)

Weight linked to prostate cancer aggression

Local researchers have discovered that obesity increases the risk of a man's prostate cancer progressing rapidly.

Researchers at the University of Texas M.D. Anderson Cancer Center found that men who were obese at the time their prostate cancer was diagnosed, as well as those who gained considerable weight before their diagnosis, were more likely to have an aggressive form of the disease.

"These findings support the view that the development of aggressive forms of prostate cancer may be influenced by environmental effects that occur early in life," said Sara Strom, an epidemiologist who led the study.

Strom said if the findings are validated by follow-up studies, doctors should consider a man's weight and history of weight gain when designing a treatment plan for patients newly diagnosed with prostate cancer, such as incorporating diet and exercise strategies.

Previous studies have suggested a link between obesity and the risk of developing prostate cancer. But Strom's study is the first to associate adult weight gain and a man's body mass at different ages with the risk of progression after the cancer has been surgically treated.

In the study, published this month in Clinical Cancer Research, Strom's team evaluated self-reported measures of obesity at different ages in a group of 526 prostate cancer patients who had their prostate removed. They followed patients for an average of 4 1/2 years.

Specifically, they checked whether the men had rising PSA levels following surgery, which is known as biochemical failure and leads to life-threatening metastasis 30 percent of the time. After removal of the prostate gland, the PSA should be undetectable.

The study found men who were obese (having a body mass index of 30 or more) at the time of diagnosis were more likely to experience rising PSA levels than those who weren't obese; and men who were obese at age 40 had an even greater rate of biochemical failure.

It also found both obesity between ages 25 and 40, and annual weight gain of at least 3 1/2 pounds between age 25 and diagnosis, were associated with more than a doubling of the biochemical failure risk. The average age of prostate cancer diagnosis is the early 60s.

Strom, a cancer survivor herself (she was diagnosed with stomach cancer in 2000), said it's not yet clear how obesity contributes to prostate cancer progression, although leading theories suggest it could be linked to changes in a number of different hormones or lifestyle behaviours.

She said her team is now working with animals in an attempt to understand the mechanism behind obesity's role in prostate cancer progression.

The study was funded by the National Cancer Institute.

(AP)

Detecting abnormal cervical changes

Sometimes, a woman's HPV infection persists, and when the virus is an oncogenic type, her risk of eventually developing cervical cancer increases significantly. Knowing this, physicians have devised screening recommendations that go beyond simple Pap smears, which can miss as many as half of incipient cervical cancers.

In April, the American College of Obstetrics and Gynaecology published new guidelines for detecting and dealing with abnormal cervical changes and HPV infections. The new screening schedule depends heavily on a relatively new test for the DNA from 13 high-risk types of HPV in women with or without abnormal changes in cervical cells.

The target population for this test is women 30 and older who are less likely to have wiped out the viral infection on their own.

Every year in the United States, millions of women are found to have abnormal cellular changes on the cervix.

But only some of these lesions are associated with a cancer-causing virus and likely to progress. The new screening guidelines are meant to be a cost-effective way to distinguish between those who are likely to clear the cellular problem on their own and those who may develop cancer or already have it and, therefore, need more frequent screening or further treatment.

The best way to check for both cell abnormalities and HPV is to have a liquid-based Pap and, using the same fluid, a test for high-risk HPV.

Women 30 and over with negative results on both tests should be re-screened no more often than every three years.

Those with a negative Pap but who are positive for HPV should have both tests repeated 6 to 12 months later.

Those with atypical squamous cells of undetermined significance, or Ascus, on the Pap but are negative for HPV should have a repeat Pap in 12 months.

Those with Ascus and who are positive for HPV should undergo a colposcope, a microscopic look at highlighted cervical cells, and biopsy.

Those with cell changes more ominous than Ascus should undergo colposcope regardless of the HPV results.Two HPV vaccines are in the final stages of testing. One, by GlaxoSmithKline, protects against the two HPV types, 16 and 18, that are most often involved in cancer. The other, by Merck & Co., protects against these two and two others, HPV 6 and 11.

When either vaccine is approved, the ideal group to be immunized will be girls and boys 9 to 15 who aren't yet sexually active. Studies show that education by doctors and an explanation of the high rate of infections among older teenagers can help overcome parents' objections.

( A.P.)

Sleeping pill use by youth soars: Study

The use of sleeping pills among children and very young adults rose 85 per cent from 2000 to 2004, in yet another sign that parents and doctors are increasingly turning to prescription medications to solve childhood health and behavioral problems.

And about 15 per cent of people under age 20 who received sleeping pills were also being given drugs to treat attention deficit and hyperactivity disorder, according to the study by Medco Health Solutions, a managed-care company that makes estimates about medication use in the whole population based on extrapolations from its own data. Drugs used to treat attention disorders can cause insomnia.

Few of the prescriptions given to children and young adults have the approval of the Food and Drug Administration because no sleep medication has been approved for use in children under 18. Still, doctors commonly use medications for patients and disorders for which the drugs have never received formal approval, particularly when those patients are children.

Dr. Robert Epstein, Medco's chief medical officer, said, "It leads you to wonder whether these children are being treated for insomnia caused by hyperactivity or whether the medication itself causes the insomnia." The use of sleeping medicines among adults doubled from 2000 to 2004, Medco found.

To perform its study, Medco took the prescription data from 2.4 million of its customers, a fraction of the more than 55 million Americans for whom it oversees drug plans. In 2000, of the 340,124 patients in this sample age 10 to 19, 554 took sleeping medicines. In 2004, of 342,568 patients age 10 to 19, 1,032 took sleeping pills, according to Medco. After adjusting statistically for the difference between the sample sizes, the jump in sleeping pill use was 85 percent, the company said.

The company found that the older the person, the more likely they were to use sleeping pills. Of those age 20 to 44, nearly 3 percent - or 2.8 million people - received prescriptions for sleep medicines in 2004, Medco found. More than 5 per cent of those age 45 to 64, or 3.3 million people, used the pills that year, while more than 6 percent of those age 65 and older, or more than 2.2 million people, took sleeping pills, according to Medco.

At every age, girls and women were more likely than boys and men to take sleeping pills. Among those 65 and older, for instance, roughly twice as many women as men got the drugs in 2004, Medco found.

"Although the elderly are still the most frequent users of sleeping aids, the evidence found in this study shows that younger adults and children are starting to use these medications with even greater frequency," Dr. Epstein said.

The increase is part of a broader rise in prescriptions for children, particularly for behavioral medicines, said Ann Smith, a Medco spokeswoman.

Expensive marketing campaigns by makers of sleeping pills were an important factor behind the rising drug use, several experts said. And because those campaigns expanded in 2005 after the introduction of a new pill, Lunesta, experts said the drugs' use quite likely increased even faster this year. Medco did not have data for 2005.

"When new products come out, they generally expand the marketplace," Dr. Epstein said. Executives for Sepracor, Lunesta's maker, have said that their advertising spending would initially rival that of McDonald's.

Experts were divided about whether all these pills helped or hurt those taking them. Dr. Andrew D. Krystal, director of the insomnia and sleep research program at Duke Medical Center, said that insomnia had long been undertreated, and that few doctors recognized how much insomnia could worsen other medical problems. Long-term medication can help relieve these problems, he said.

Dr. Krystal said he consulted for and did research paid for by several drug companies.

Gregg Jacobs, an assistant professor of psychiatry at Harvard Medical School, said the trends reported by Medco were unfortunate because "too many prescriptions are being written for people who don't need a prescription or who would do just as well or better with cognitive behavioral therapy, which doesn't have the side effects of medication." Dr. Jacobs said drug companies exaggerated their pills' beneficial effects and underplayed their deleterious ones.

For instance, Sepracor's own studies of Lunesta show that the drug reduces the time that insomniacs take to fall asleep by just 15 minutes - from a little more than an hour to around 50 minutes, Dr. Jacobs said.

And insomniacs who take Lunesta still sleep only about six hours a night, he said. "Lunesta doesn't work that much better than a sugar pill; it impairs your cognitive performance the next day, and as soon as you stop taking the drug your insomnia comes right back," said Dr. Jacobs, who said he did not consult for drug makers.

David Southwell, Sepracor's chief financial officer, responded, "The drug clearly puts you to sleep, and clearly our drug keeps you asleep longer not only than placebo but longer than other shorter-acting drugs."

(AP)

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