Suchergebnisse

SummaryThe possibility that early nutrition has long term consequences in man has been much debated. There have been limited opportunities to perform formal randomised studies on the effect of early nutrition in man and many studies have been flawed by problems with study design. Infants born preterm are a special group. At the start of this study in 1982 evidence on which to base choice of diet was inconsistent and related only to short term outcome, and diets available for such babies differed greatly in nutrient content. In this group it was both ethical and practical to conduct a formal, randomised trial of early diet and outcome and the results were clearly needed for management decisions.A long term prospective outcome study was undertaken on 926 preterm infants randomly assigned to the diet received in the neonatal period. Surviving children have been followed at 9 months, 18 months and now 7½–8 years of age. The findings suggest that children fed a nutrient supplemented preterm formula perform better than those fed a standard formula milk, and also that human milk may contain factors which promote brain growth or development. Outcome data from the randomised trials show that a very brief period of dietary manipulation (on average for the first 4 weeks of life) influences later development.

This paper reviews the Australian historical record in health and gender inequalities since the mid nineteenth century through to the end of the twentieth century, using survival data from an historical cohort of impoverished people born in the Melbourne Lying‐In Hospital between 1857 and 1900. This data reveals the long shadow cast by disadvantage in early life and the critical importance of secure households in supporting infancy and childhood. Above all, the income security and support of mothers, was critical to survival of infants and children, and those households trapped in the casual economy, remained the most vulnerable to premature death. Only the improvements in labour force regulation, government employment and trade education after World War II, broke the cycle of poverty that had persisted in Australia since the earliest days of European settlement.

AbstractThere are no data on whether parents of twins will disclose mode of conception to researchers or to their children, who will be informants in adulthood. We sent 1600 questionnaires about this via the Victorian branch of the Australian Multiple Birth Association, to be returned anonymously. Parents were asked how their twins were conceived and whether those who used assisted conception would disclose this to researchers studying assisted conception, twin pregnancy or twin children, or to their children. Comments were invited. Altogether 975 (61%) questionnaires were returned and 389 (40%) indicated use of some form of assisted conception: 75 (19%) ovarian stimulation alone, 165 (42%) In Vitro Fertilisation, 132 (34%) Intracytoplasmic Sperm Injection, and 17 (4%) Gamete Intrafallopian Transfer, with 20 reporting use of donor eggs and thirteen donor sperm. Of those using assisted conception, the proportion reporting that they would not, or may not, tell researchers was 5% for assisted conception studies, 6% for twin pregnancy studies, and 7% for studies of twin children, while 7% reported that they would not, or may not, tell their children. From the comments (from 374/975; 38%) it was clear that questions about mode of conception can be offensive to some parents of twins, unless there is a need to know. Further, the question 'are your twins natural?' should be avoided. We believe the question 'Did you need medical help to conceive your twins', followed up with specific questions, is more acceptable.

AbstractThe Australian Twin Registry (ATR) has, since the late 1970s, enrolled more than 30,000 pairs of all zygosity types and ages willing to consider participation in approved research studies. Its core functions are the recruitment to, and maintenance of, an up-to-date database containing contact details and baseline information, and the management of fair and equitable access so as to enhance medical and scientific research. The ATR has facilitated more than 430 studies producing 525 peer-reviewed publications using a variety of designs including classic biometrical twin and twin family studies, co-twin control studies, intervention studies, longitudinal studies, and studies of issues relevant specifically to twins. The ATR is supported for 2004 to 2009 by an Australian National Health and Medical Research Council (NHMRC) Enabling Grant, a new form of funding which recognizes the importance of long-term support for shared national resources. New initiatives include: integration with the Western Australian Twin Child Health (WATCH) cohort and the new Western Australian Twin Registry (WATR); foundation of a cohort of mothers and their twin children recruited from the time of diagnosis of the multiple gestation (match); a national Twins Festival run in collaboration with the Australian Multiple Birth Association (AMBA); promotion of the ATR at medical conferences; and fostering an active network of researchers from a range of disciplines and providing financial support for new researchers to attend international twin research workshops. Consistent with its mission statement, the long-term goal of the ATR is to make twin studies a standard component of medical and scientific research.

The Peri/postnatal Epigenetic Twins Study (PETS) is a longitudinal cohort of 250 pairs of Australian twins and their mothers, who were recruited mid-way through pregnancy from January 2007 to September 2009. The study is centered on the developmental origins of health and disease paradigm (DOHaD) in which an adverse intrauterine environment predisposes the individual to complex disease in later life by reducing growth in utero and adversely altering developmental plasticity. Data concerning diet and lifestyle were collected from mothers during pregnancy, and samples of plasma and serum taken at 28 weeks' gestation. We attended 75% of all births, at which time we collected multiple biological samples including placenta, cord blood, and neonatal cheek cells, the latter from 91% of pairs. Chorionicity was recorded and zygosity was determined by DNA testing where necessary. Approximately 40% of the twins are monozygotic, two-thirds of which are dichorionic. Twins were seen again at 18 months of age and repeat blood and cheek swabs taken where possible. Studies of gene expression and the epigenetic marks of DNA methylation have so far revealed that twins exhibit a wide range of epigenetic discordance at birth, that one-third of the epigenome changes significantly between birth and 18 months; shared (maternal) environment, genetic factors, and non-shared intrauterine environment contribute to an increasing proportion of epigenetic variation at birth, respectively, and affect tissues differently, and that within-pair birth weight discordance correlates with epigenetic discordance in genes associated with lipid metabolism, supporting an epigenetic mechanism for DOHaD.