Lai Ling Hui

Face recognition involves a prolonged developmental process where individuals gradually develop a more consistent yet idiosyncratic visual routine with increasing age. In contrast to this early developmental trend, among 301 middle and older participants, we observed that age was associated with lower eye movement consistency, suggesting an inverted-U shape across the lifespan, and consistency could partially account for the association between age and declined face recognition performance. Also, a less eyes-focused eye movement pattern predicted poorer recognition performance together with lower consistency, suggesting that the idiosyncratic eye movement patterns acquired during early adulthood continue to contribute significantly. Additionally, lower eye movement consistency was associated with poorer selective attention and inhibitory control, indicating that the decline in consistency may reflect difficulties in executing learned visual routines. These findings have important implications for understanding cognitive aging and potential interventions to delay its process through training in face recognition and related visual strategies.

Background Exclusive breastfeeding (EBF) rates at 6 months postpartum remain low globally and in Hong Kong. This prospective mixed-method study examined the barriers to and facilitators of sustaining EBF until 6 months postpartum. Methods Nine hundred forty-two pregnant women completed baseline and at least one of the five follow-up surveys: immediate (<7 days) (T1), 1 month (T2), 2 months (T3), 4 months (T4), and 6 months postpartum (T5). The response rates were 81.0% (T1), 69.9% (T2), 67.3% (T3), 65.8% (T4) and 81.4% (T5). Eighteen participants and 6 partners participated in either individual or focus group interviews at 6 months postpartum. Results The quantitative study found that mothers who worked full-time, had attained lower levels of education, lacked breastfeeding experience, and had caesarean sections were less likely to practise EBF at 6 months postpartum. In contrast, mother-in-law’s breastfeeding experience, higher breastfeeding intention and better breastfeeding knowledge were positively associated with EBF at 6 months postpartum. Qualitative data identified perceived insufficient breast milk and returning to work as the main barriers, while support from family was the key facilitator. Conclusions In addition to education and support for mothers, in order to sustain EBF, it is crucial to engage with family members and for workplaces to create more conducive environments. Impact This large-scale mixed methods cohort study describes mothers’ feeding practices and perspectives from the immediate postpartum period until 6 months. Factors associated with EBF at 6 months included (1) mother and infant attributes, (2) workplace and employment, (3) family and community, and (4) health systems and services. Policies and strategies extending to family members, workplace and health system will create a more conducive environment for sustaining EBF.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is estimated to affect over 30% of the global population with a rising trend, posing significant healthcare burden due to its progression and increased risk of related metabolic diseases. Dietary intervention plays an important role in the prevention and management of MASLD. Ketogenic diets represent a range of high-fat, moderate-protein, very low-carbohydrate (< 20–50 g/day) diets that induce nutritional ketosis. These diets have been proposed to benefit patients with MASLD by promoting weight loss, reducing inflammation and insulin resistance through different pathways. This review summarized the current findings on the outcomes of ketogenic diets on patients with MASLD regarding the liver, plasma lipid profile, systemic inflammation and gut microbiota. Studies showed that short- to medium- term ketogenic diets, with or without calorie restriction, are able to lower plasma triglycerides and ameliorate hepatic steatosis, steatohepatitis and fibrosis in MASLD. In particular, studies found ketogenic diets may be more effective in alleviating hepatic steatosis in short time periods than calorie-matched, high-carbohydrate, low-fat diets. Evidence on the impact on plasma high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) was mixed. Clinical trials investigating the effects on different markers of systemic inflammation and the composition of gut microbiota among patients with MASLD were scarce. To better understand the role of ketogenic diets in MASLD management, longer-term, well-controlled trials are warranted to clarify their potential benefits and risks, and whether they are varied by types of fats. Appropriate and sustainable formulations of ketogenic diets that maximize benefits and minimize side effects remain to be determined.

Aims/hypothesis: We aimed to examine offspring adiposity trajectories from birth to age 9–14 years and to assess the joint associations of maternal overweight and gestational diabetes mellitus (GDM) with these trajectories. Methods: This is a prospective cohort study with 564 mother–child dyads from the Hyperglycemia and Adverse Pregnancy Outcome study Hong Kong field centre. Assessments and anthropometric measurements were taken during pregnancy, at delivery and at median ages of 7 and 10 years postpartum. Offspring adiposity was primarily assessed using sum of skinfold thickness. We used linear mixed-effect models to evaluate the independent and joint associations of maternal overweight and GDM with the offspring adiposity trajectories, and applied group-based trajectory modelling to identify distinct patterns of adiposity development based on both statistical indices and clinical interpretability. Results: Offspring skinfold thickness trajectories varied significantly based on maternal overweight and GDM (pp=0.006) of the rapidly increasing trajectory. Linear mixed-effect model analysis showed greater increases in skinfold thickness among offspring of mothers with either condition, with the highest trajectory observed in offspring of mothers with both conditions (β 1.62; 95% CI 0.69, 2.54; p=0.001). Conclusions/interpretation: Maternal overweight and GDM are independently and jointly associated with rapidly increasing adiposity trajectories from birth to early adolescence. The findings underscore the importance of considering both maternal metabolic conditions when evaluating offspring adiposity risk. Graphical

This study examines the compliance of the digital marketing strategies used by formula companies and social media influencers in promoting commercial milk formula (CMF) for infants and young children with the International Code of Marketing of Breast‐milk Substitutes (International Code) and the Hong Kong Code of Marketing of Formula Milk and Related Products, and Food Products for Infants & Young Children (HK Code). Content analyses on influencers' posts, websites and social media sites of five major formula companies were conducted to identify the digital marketing strategies used, evidence of product cross‐promotion, and compliance with the International and HK Codes. Statistical analyses were performed to assess the associations between marketing strategies and social media interactions (likes/comments/shares). The findings revealed widespread noncompliance to the two codes by both influencers and formula companies. Of 1036 influencer (n = 493) and formula company (n = 543) materials mentioned products covered by the Codes, all influencer materials and 95% of company materials violated at least two provisions of the Codes. Persistent brand promotion and cross‐promotion strategies were observed in CMF marketing in Hong Kong, with tactics such as parents' sharing, showing images of happy children and families, and celebrity endorsements leading to higher social media interactions. The extensive CMF promotion by influencers and the covert cross‐promotion and brand promotion are of particular concern given the lack of regulation in this area. The study calls for a comprehensive review and introduction of legalisation in Hong Kong to govern CMF marketing, ensuring enforcement as outlined in the Convention on the Rights of the Child.

Breastfeeding protects mothers against breast cancer. Our study aimed to estimate the healthcare cost-savings resulting from a reduction in breast cancer attributed to an increase in the breastfeeding rate in Hong Kong. This is an economic evaluation. We constructed an individual-based Monte Carlo method to simulate with probabilistic sensitivity analysis the development of breast cancer over a woman’s lifetime in a hypothetical birth cohort aged 20 years in 2018 (n = 33500) using best available data mainly from government statistics. We predicted the cases of, and deaths due to breast cancer in the base case (with the actual breastfeeding rate in 2018) and two hypothetical optimal scenarios (90% exclusive breastfeeding for six months or cumulative exclusive/partial breastfeeding for at least 12 months). The healthcare cost-savings, the number of deaths averted and the increase in disability-adjusted life years (DALYs) due to the prevention of breast cancer attributed to a higher breastfeeding rate were then deduced, assuming an annual discount rate of 3%. Increasing the proportion of parous women breastfeeding exclusively for six months from 26 to 90% averted 266 (95% CI 259, 273) or ~ 10% of all-stage breast cancer cases, 18 deaths (95% CI 17, 19) and 399 DALYs (95% CI 381, 416), over the lifetime of each annual cohort of women in Hong Kong. The lifetime medical costs that could be saved would be ~ USD3 million using 2018 prices. However cost-savings were 5-times less in another scenario where the cumulative partial/exclusive breastfeeding for 12 months in parous women is increased to 90% due to its weaker protection against breast cancer compared to exclusive breastfeeding. Promoting and protecting breastfeeding could lead to cost-savings for treating breast cancer in Hong Kong. Our analysis can inform the annual healthcare budget that could be allocated to promote exclusive breastfeeding for six months.

Purpose of Review: Supplementation of nicotinamide mononucleotides (NMN) has been claimed to improve metabolic function. We reviewed human randomised controlled trials (RCTs) of NMN to evaluate its effect on markers of glucose and lipid metabolism. Recent Findings: Eight RCTs on NMN (dosage ranged 250–2000 mg/d for a duration of 14 days to 12 weeks) involving a total of 342 middle-age/older adults (49% females, mainly non-diabetic) reporting at least one outcome on glucose control or lipid profile published in 2021–2023 were reviewed. The random-effects meta-analyses indicated no significant benefit of NMN on fasting glucose, fasting insulin, glycated hemoglobin, homeostatic model assessment for insulin resistance and lipid profile. Summary: Based on the small number of RCTs involving mainly relatively healthy adults, short-term supplementation of NMN of 250-2000 mg/d did not show significantly positive impacts on glucose control and lipid profile.

Context: Ketogenic diets and ketone supplements have gained popularity among endurance runners given their purported effects: potentially delaying the onset of fatigue by enabling the increased utilization of the body’s fat reserve or external ketone bodies during prolonged running. Objective: This systematic review was conducted to evaluate the effects of ketogenic diets (>60% fat and 2 max], race time, time to exhaustion and rate of perceived exertion). Results: VO ₂ max was assessed by incremental test to exhaustion. Endurance performance was assessed by time trials, 180-minute running trials, or run-to-exhaustion trials; 5 studies on ketogenic diets and 7 studies on ketone supplements involving a total of 132 endurance runners were included. Despite the heterogeneity in study design and protocol, none reported benefits of ketogenic diets or ketone supplements on selected markers of aerobic performance compared with controls. Reduction in bodyweight and fat while preserving lean mass and improved glycemic control were reported in some included studies on ketogenic diets. Conclusion: This review did not identify any significant advantages or disadvantages of ketogenic diets or ketone supplements for the aerobic performance of endurance runners. Further trials with larger sample sizes, more gender-balanced participants, longer ketogenic diet interventions, and follow-up on metabolic health are warranted.

Aim: This study estimated the healthcare cost savings for the government due to the prevention of gastroenteritis (GE) infections and lower respiratory tract infections (LRTI) in the first year of life, attributed to an increase in the exclusive breastfeeding rate at 4 months in Hong Kong.Methods: The model used the best available data inputs, with uncertainty considered using probabilistic sensitivity analysis. We additionally assessed the impact of neonatal jaundice (NNJ) on the economic benefits of increasing exclusive breastfeeding rates.Results: During 2010–2019, five admissions for GE and three admissions for LRTI per 1000 births would have been prevented in the first year of life if the exclusive breastfeeding rate at 4 months increased from the actual levels (~15–30%) to 50%, resulting in annual healthcare cost savings of USD1.05 (95% CI 1.03–1.07) million/year. The cost saving would reach USD1.89 (95% CI 1.86–1.92) million/year if the exclusive breastfeeding rate at 4 months increase to 70%. However, if higher NNJ admissions during 7–90 days related to more exclusive breastfeeding are considered, the cost saving would reduce by 60%.Conclusion: Our findings can guide policymakers in allocating budget and resources for breastfeeding promotion in Hong Kong. The prevention of unnecessary NNJ admissions would maximise the economic benefits of exclusive breastfeeding at 4 months.

With the growth of social networking, parents are increasingly sharing their experiences and opinions or seeking help with childcare through online platforms. This study explored breastfeeding-related topics that Hong Kong mothers raise on social networking sites and how other mothers respond; and how these sites could be a facilitator or barrier to breastfeeding. An online ethnographic approach was used to collect breastfeeding-related discussions (posts and responses) among mothers from three sources: two closed moderated Facebook groups with more than 1000 members, and one open unmoderated forum (Baby Kingdom) (26 December 2021-26 May 2022). Posts not related to breastfeeding (e.g., about formula feeding only) were excluded. Data were collected by a nonparticipatory approach to avoid disrupting the dynamics of the groups. In total, 131 original posts and their 802 responses were collected, of which the common topics discussed were breastfeeding technique, breastfeeding-related health issues, breastfeeding mothers returning to work, and COVID-19 vaccination/infection during breastfeeding. The responses to the queries on breastfeeding technique and health issues in the closed groups were mostly about sharing breastfeeding knowledge and health information to provide timely emotional support and practical solutions. Although similar responses were observed in the open forum, sharing experiences in using formula milk were frequently observed in the responses to posts related to breastfeeding. Social networking sites could be facilitators and barriers to breastfeeding. The potential for infant formula promotion in open forums requires further monitoring and evaluation. Moderation and support from trained professionals or peers could be important.