Vitamin D replacement had a positive impact on musculoskeletal parameters in girls, especially during the premenarcheal period.

Vitamin D(3) at doses equivalent to 2000 IU/d for 1 yr is safe in adolescents and results in desirable vitamin D levels.

BackgroundBreastfeeding is a cost-effective public health intervention that reduces infant morbidity and mortality in developing countries. In Lebanon, breastfeeding exclusivity and continuation rates are disappointingly low. This qualitative study aims at identifying barriers and promoters of breastfeeding in the Lebanese context by exploring mothers' perceptions and experiences in breastfeeding over a one year period.MethodsWe conducted focus group discussions in three hospitals in Beirut, Lebanon, and followed up 36 breastfeeding mothers with serial in-depth interviews for one year post-partum or until breastfeeding discontinuation.ResultsThemes generated from baseline interviews revealed several positive and negative perceptions of breastfeeding. Longitudinal follow up identified insufficient milk, fear of weight gain or breast sagging, pain, sleep deprivation, exhaustion, or maternal employment, as reasons for early breastfeeding discontinuation. Women who continued breastfeeding for one year were more determined to succeed and overcome any barrier, relying mostly on family support and proper time management.ConclusionsIncreasing awareness of future mothers about breast feeding difficulties, its benefits to children, mothers, and society at large may further promote breastfeeding, and improve exclusivity and continuation rates in Lebanon. A national strategy for early intervention during school years to increase young women's awareness may improve their self-confidence and determination to succeed in breastfeeding later. Moreover, prolonging maternity leave, having day-care facilities at work, creation of lactation peer support groups and hotlines, and training of doctors and nurses in proper lactation support may positively impact breastfeeding exclusivity and continuation rates. Further research is needed to assess the effectiveness of proposed interventions in the Lebanese context.

The association between isolated congenital heart defects and consanguinity was examined in 759 Lebanese patients with different types of congenital heart malformations. The subjects were patients of the Children's Cardiac Registry Center (CCRC) at the American University of Beirut Medical Center. The proportion of first-cousin marriages among cardiac subjects was compared to that of the National Collaborative Perinatal Neonatal Network (NCPNN), after adjusting for the subjects' geographic distribution, and to the highest proportion reported by NCPNN. In general, the proportion of overall parental consanguinity and first-cousin matings among CCRC subjects (34.7 and 20.2%, respectively) were significantly higher than the highest proportion of first-cousin marriages reported by NCPNN (Bekaa subjects; 13.2%) (P < 0.0001). Comparison with the NCPNN-adjusted first-cousin mating proportion revealed a significantly increased rate of consanguinity in all categories of cardiac malformations except great vessel and coronary artery lesions (P < 0.05). The following lesions were significantly associated with increased parental consanguinity: aortic anomalies (aortic insufficiency, aortic stenosis, bicuspid aortic valve), atrial septal defect, double-outlet right ventricle, pulmonary atresia, patent ductus arteriosus, pulmonic stenosis, tetralogy of Fallot, and ventricular septal defect (P < 0.05). Higher maternal education was the only variable that was negatively correlated with parental consanguinity (P = 0.037). Our study emphasizes the role of homozygous recessive genes in the causation of different types of isolated congenital heart malformations, known to follow a multifactorial pattern of inheritance. There is an urgent need for educating the public on the deleterious effects of inbreeding, especially in developing countries with high overall consanguinity rates and limited financial resources.

ABSTRACT. Background. Vitamin D is essential for skeletal growth, but there are currently no guidelines for vitamin D supplementation after infancy. This study investigates vitamin D insufficiency in healthy children.Methods. Children ages 10 to 16 years from 3 private schools in Beirut, Lebanon, with differing socioeconomic status (SES) were studied: 169 in the spring of 1999 and 177 in the following fall; 83 students participated in both study phases. They had a physical examination, answered a dietary questionnaire, and blood was drawn for calciotropic hormones and indices of bone turnover.Results. Overall, 52% of the students were vitamin D-insufficient; the proportion of insufficiency was 65% in the winter and 40% at the end of the summer. During both seasons, girls had lower vitamin D levels than did boys; those who followed the dress code of covered head, arms, and legs had the lowest levels. Students in the mid-SES school had lower 25-hydroxyvitamin D (25-OHD) levels than did the ones from the high-SES school. After adjusting for confounders, gender, SES, and body mass index remained the significant predictors of vitamin D levels in both seasons (R 2 ‫؍‬ 0.53, for spring and 0.28 for fall). There was a significant inverse correlation between 25-OHD levels and parathyroid hormone levels that was best fitted by a curvilinear model (R 2 ‫؍‬ 0.19). V itamin D, the precursor of the active metabolite calcitriol, 1,25(OH) 2 vitamin D, is a steroid hormone that is essential for bone growth and development in children and skeletal health in adults. 1 Although nutritional rickets caused by severe vitamin D deficiency is almost eradicated from developed countries, it is still ranked among the 5 most prevalent diseases in developing countries. 2 It is recognized that less severe vitamin D deficiency (otherwise called insufficiency) has a deleterious effect on skeletal health in adults and elderly 3-6 ; however, its impact on bone metabolism in children and adolescents is less clear. The consensus has been that most adolescents should be able to synthesize sufficient vitamin D by brief exposure to sunlight and that only children living in extreme northern or southern latitudes may require supplementation with D 7,8 ; examination of the recent evidence leads to different conclusions. Indeed, 80% of children and adolescents had insufficient vitamin D levels (25-hydroxyvitamin D [25-OHD] levels Ͻ20 ng/mL) in the winter in 4 studies conducted in Spain, France, and Finland. 9 -12 Although it is expected that children of different genders and socioeconomic background would have different lifestyles (exercise, sunlight exposure, and nutrition), the few studies evaluating vitamin D levels in children and adolescents have mostly done so in boys and have not systematically examined the impact of socioeconomic status (SES) on vitamin D levels. An increasing body of evidence confirms a key role of calcium in bone mass accretion in children and adolescents [13][14][15] ; however, the impact of vitamin D insufficiency and, theref...

Background: Optimal dietary calcium and possibly vitamin D intake throughout childhood and adolescence may enhance bone mineral accrual. Little data on the intake of these nutrients in Mediterranean countries exist, and predictors of their suboptimal intake are not well defined. Objective: To evaluate systematically the effect of gender, lifestyle factors, and socioeconomic status on mean calcium and vitamin D intake in healthy school children and adolescents from Lebanon. Design: A total of 385 students aged 10-16 y were selected from four public and four private schools between Fall 1999 and Spring 2000. Information on calcium and vitamin D intake, through a semiquantitative food frequency questionnaire that was validated against a 7-day daily record, and on socioeconomic and lifestyle factors were obtained. Results: Only 12% of the students met the adequate intake (AI) recommendation of 1300 mg of calcium/day, and only 16% met the AI recommendation of 200 IU of vitamin D/day. Boys had a significantly higher mean daily calcium intake than girls. Socioeconomic status as assessed by children's pocket money was a predictor of higher calcium and vitamin D intake. Eating breakfast and physical activity were other correlates of daily calcium and vitamin D intake. Conclusions: Only a minority of students in our study met the AI for calcium and vitamin D. Gender, lifestyle factors, and socioeconomic status were significant predictors of calcium and vitamin D intake. Our findings have important implications regarding the institution of dietary public health strategies to promote skeletal health in Mediterranean countries during a critical time for bone mass accrual.

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Background Effective evidence-based breastfeeding support interventions can bolster breastfeeding practices. This study investigated the effect of a multi-component breastfeeding support intervention delivered in hospital and home settings on six-month exclusive breastfeeding (EBF) relative to standard care. Methods This is a parallel group, randomized clinical trial, in which 362 healthy pregnant women with singleton pregnancy were randomly allocated to a multi-component intervention that included antenatal breastfeeding education, professional, and peer support, delivered in hospital and home settings for six months (experimental, n = 174), or to standard care (control, n = 188). The primary outcome was six-month EBF rate. Secondary outcomes were exclusive and any breastfeeding rates at one and three months, maternal breastfeeding knowledge, attitude, and behavior at six months, and satisfaction with the intervention. Results The crude six-month EBF rate was similar in both groups (35.2% vs. 28.1% in the experimental and control groups, respectively, p = 0·16). In adjusted analysis, six-month exclusivity was twice as likely in the experimental group relative to standard care (OR = 2.02; 95%CI : 1.20 to 3.39); whereas the odds for any breastfeeding were similar. Participants compliant with all three components were six times more likely to practice EBF for six months relative to standard care (OR = 6.63; 95% CI : 3.03 to 14.51). Breastfeeding knowledge of the experimental group, at six months, was significantly improved compared to the control. No changes were observed in breastfeeding attitude or behavior. Conclusions Combining education with peer and professional breastfeeding support improved six-month breastfeeding exclusivity and knowledge.