Small for gestational age children have specific food preferences To the Editor: Oliveira et al1 reported increased feeding difficulties in children born small for gestational age detected at 4-6 months of life, compared with children who were born appropriate for gestational age. Although their study did not evaluate food preferences, the authors state: “. it may be that low birth weight condition (as a proxy of in utero growth restriction) programs the appetite and satiety mechanisms, and ultimately influences the desire for specific foods”. Our group has shown that this is indeed the case.2,3 From the first day of life, it is possible to detect differences in the hedonic response to the sweet taste according to the degree of intrauterine growth restriction of the newborn.4 At 3 years of age, girls with intrauterine growth restriction are more impulsive in a task that uses a sweet treat as a reward.5 Over the life-course, we and others have shown that the exposure to intrauterine adverse events (often culminating with low birth weight) programs the individuals’ feeding preferences, increasing their intake of foods rich in carbohydrates or fat, rather than fruits and vegetables.2,6,7 Besides appetite and satiety mechanisms, impaired fetal growth may program the neurobiological processes involved in reward sensitivity, impulsivity, and cue interpretation, persistently shaping food responsivity in small for gestational age children.7 In addition, feeding difficulties that happen in a crucial period for flavor learning8 may contribute to food monotony and consolidate the preference for palatable foods in these individuals. This population seems vulnerable to have altered feeding behavior and preferences over their life course. Further studies investigating factors that can modify the association between low birth weight and altered feeding styles and choices are needed. R.D.M. has a postdoctoral fellowship supporting grant from the Coordination for the Improvement of Higher Education Personnel–Brazil.

Roberta Dalle Molle, PhD Patrıcia Pelufo Silveira, MD, PhD Department of Pediatrics Faculty of Medicine Federal University of Rio Grande do Sul Clinical Hospital of Porto Alegre Porto Alegre, Rio Grande do Sul, Brazil http://dx.doi.org/10.1016/j.jpeds.2015.01.053

3. 4. 5. 6. 7. 8.

spontaneous carbohydrate intake in young women. Pediatr Res 2009; 65:215-20. Portella AK, Kajantie E, Hovi P, Desai M, Ross MG, Goldani MZ, et al. Effects of in utero conditions on adult feeding preferences. J Dev Orig Health Dis 2012;3:140-52. Ayres C, Agranonik M, Portella AK, Filion F, Johnston CC, Silveira PP. Intrauterine growth restriction and the fetal programming of the hedonic response to sweet taste in newborn infants. Int J Pediatr 2012;2012:657379. Silveira PP, Agranonik M, Faras H, Portella AK, Meaney MJ, Levitan RD, et al. Preliminary evidence for an impulsivity-based thrifty eating phenotype. Pediatr Res 2012;71:293-8. Kaseva N, Wehkalampi K, Hemio K, Hovi P, Jarvenpaa AL, Andersson S, et al. Diet and nutrient intake in young adults born preterm at very low birth weight. J Pediatr 2013;163:43-8. Portella AK, Silveira PP. Neurobehavioral determinants of nutritional security in fetal growth-restricted individuals. Ann NY Acad Sci 2014;1331:15-33. Beauchamp GK, Mennella JA. Early flavor learning and its impact on later feeding behavior. J Pediatr Gastroenterol Nutr 2009;48:S25-30.

More about adolescent competitive swimming To the Editor: I am interested in knowing more about the subjects studied by Zaina et al.1 Although the authors report several physical exam findings in both the competitive swimmers and the age-matched controls, they did not comment on either the sex maturity ratings (SMR) or the presence of generalized joint hypermobility. As competitive swimming may select from a population of more physiologically mature same chronologically-aged youth, the assumption that the “pubertal growth spurt” would be similar in swimmers and non-swimmers cannot be made, and the contribution of increased muscle mass in adolescents of higher SMR is not considered. Additionally, it is known that there is an association of joint hypermobility with increased low back pain2,3 and a finding of increased joint laxity in “elite” compared with recreational swimmers.4 Without including the variables of the SMR and the assessment of generalized joint hypermobility by either the Beighton Scale or the modified Criteria of Carter and Wilkinson, the findings reported may be attributable to a self-selected population of adolescent competitive swimmers based on more advanced SMR and increased laxity of their joints. Kenneth Noel Schikler, MD Divisions of Adolescent Medicine and Pediatric Rheumatology Department of Pediatrics University of Louisville School of Medicine Louisville, Kentucky http://dx.doi.org/10.1016/j.jpeds.2015.02.004

References 1. Oliveira A, de Lauzon-Guillain B, Jones L, Emmett P, Moreira P, Ramos E, et al. Birth weight and eating behaviors of young children. J Pediatr 2015; 166:59-65. 2. Barbieri MA, Portella AK, Silveira PP, Bettiol H, Agranonik M, Silva AA, et al. Severe intrauterine growth restriction is associated with higher

References 1. Zaina F, Donzelli S, Lusini M, Minnella S, Negrini S. Swimming and spinal deformities: a cross-sectional study. J Pediatr 2015;166:163-7. 1547