Journals watch: Infantile colic and desensitisation to sex and violence in films

Too busy to read the journals? Dr Simon Hunter selects the latest papers of interest to GPs including probiotics and infantile colic, stopping statins after acute MI and desensitisation to sex and violence in films.

A probiotic can improve symptoms of infantile colic, the study found (SPL)
A probiotic can improve symptoms of infantile colic, the study found (SPL)

Probiotics and infantile colic

J Pediatr 2015; 166: 74-8

A sizable proportion of infants cry excessively and inconsolably with associated gas passing. If this lasts for more than three hours a day for three or more days a week in an otherwise well child, it is termed infantile colic.

Various aetiologies have been proposed and previous studies have found that infants with colic have different intestinal microbiota from those without colic.

This randomised placebo controlled study in Canada looked at the effectiveness of a probiotic in the treatment of infantile colic in breastfed infants.

Infants aged three weeks to six months with no existing illnesses, especially oesophageal reflux, were enrolled. They were either given the probiotic Lactobacillus reuteri in sunflower oil daily for 21 days, or a placebo oil.

Over the 21 days, the researchers found the probiotic group experienced significantly fewer hours of crying and fussing, at 64 minutes versus 102 minutes per day.

They concluded that in this group of infants, L reuteri made a significant difference to symptoms with no reported adverse events.

Resting heart rate and the risk of developing metabolic syndrome

Heart 2015; 101: 44-9

It has been demonstrated that there is a correlation between resting heart rate (RHR) and cardiovascular and all-cause mortality.

Metabolic syndrome (MetS) is a cluster of risk factors - abdominal adiposity, low HDL, high triglycerides, hypertension and impaired glucose tolerance - leading to a higher risk of diabetes and cardiovascular disease.

This study in China aimed to discover if there is a positive relationship between RHR and MetS and if RHR is a predictor of MetS.

In the study, almost 90,000 people were surveyed and 25% were found to have MetS. The researchers found a positive relationship between RHR and MetS.

After adjusting for variables, the OR of having MetS was 1.49 with an RHR of 95-104 compared with an RHR of 44-64.

More importantly, in those individuals without MetS at the beginning of the study, a higher RHR predicted a higher chance of developing MetS. The OR of developing MetS four years later was 1.41 in those with an RHR of 95-104 compared with those with a low RHR.

Measuring RHR might be a simple way to spot those at risk of current or future metabolic syndrome.

Stopping statins after acute MI

Am J Cardiol 2015; 115: 1-7

High-dose statins are now routine treatment in patients who have had an acute MI and are commenced while the patient is in hospital.

It is well known that adherence to long-term therapy is suboptimal in many patients. Statins in particular have a negative image in some patients' minds.

This study in Korea used a registry of patients who had sustained an acute MI who were not previously on a statin and had survived for a year.

They compared patients who had continued their statin with those who had stopped it. They had a high discontinuation rate; 3,204 continued and 603 discontinued. Patients were followed up for four years.

The study found high mortality in those who discontinued their statins, with a hazard ratio of 3.45. This was primarily due to cardiac death.

There was no increase in non-fatal MI, revascularisation or stroke.

This study demonstrates the need for patient education regarding the benefits of long-term statin use and the dangers of discontinuation.

FODMAP diet in IBS patients

Gut 2015; 64: 93-100

FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) are poorly absorbed short-chain carbohydrates which are increasingly implicated in the causation of irritable bowel syndrome (IBS). A recent study showed 75% of patients with IBS improved on a FODMAP exclusion diet.

In this study in Australia, 27 IBS patients and six healthy subjects were randomised to either a FODMAP diet or a normal diet for 21 days, then after a washout period, were crossed over to the other diet.

During the run-in period and days 17 to 21, faeces were compared for pH, short-chain fatty acid concentrations and bacterial abundance and diversity.

The faeces were similar in both the IBS group and the normal subjects in the run-up period, but on the FODMAP diet, the pH was higher, and there was greater microbial diversity and lower microbial abundance in the FODMAP group. Short-chain fatty acids were not affected.

This study shows that a FODMAP diet has a distinct effect on colonic flora. Whether this is necessarily a good thing is unclear.

Oligosaccharides, which are restricted in the FODMAP diet, have previously been shown to have a beneficial effect on gut flora. Short-chain fatty acids are a product of bacterial fermentation and are beneficial to gut health. The authors suggested caution in recommending a long-term FODMAP diet.

Desensitisation to sex and violence in films

Pediatrics 2014; 134: 877-84

Film rating systems exist to help parents control what is watched by their children. Over the years, the amount of violence allowable for younger viewers has steadily increased, and there has been some slippage in the amount of sex permitted in these films. The Dutch rating board says this is in response to changing parental attitudes.

This study looked at whether serial exposure to films with sexual and violent content would desensitise the parents to the content and allow younger children to watch it.

The parents watched a series of random clips showing either sex or violence and were asked what age of children the content would be suitable for.

As the clips progressed, the average age for watching violent content decreased from 16.9 to 13.9 years, and for sexual content, from 17.3 to 14 years.

The researchers considered that repeated parental exposure to sexual or violent films would desensitise them to the content and allow younger children to watch it.

  • Dr Hunter is a GP in Bishop's Waltham, Hampshire, and a member of our team who regularly review the journals

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Routinely assess the patient's pulse rate when doing five-yearly BP, to suggest those who are at risk of developing metabolic syndrome
  • Review all patients who are discharged post-MI to educate them about the rationale for statin treatment
  • Arrange for a dietitian to visit the surgery for an educational meeting to discuss the practicalities of a FODMAP diet

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