Two types of nutritional rickets in infants

In 100 infants with nutritional rickets, i.e., responsive to vitamin D therapy, we found a close inverse relationship between serum phosphorus, on the one hand, and serum alkaline phosphatase and the presence of radiological signs of rickets, on the other. There was no correlation between serum calcium and the severity of bone lesions. It is concluded that hypophosphatemia but not hypocalcemia is typical of rickets. Since hypophosphatemia and rickets can be produced experimentally by phosphate deficiency alone, we suggest our infants can be divided into two groups, one with true vitamin D deficiency that leads to hypocalcemia and no or mild bone lesions, and one with primary phosphate deficiency, resulting perhaps from a defect in phosphate transport, which leads to rickets and hypophosphatemia.     

Multiple food allergy: a possible diagnosis in breastfed infants

Six infants suspected of food allergy during breastfeeding were evaluated using prick tests, total IgE, RASTs and intestinal permeability measurements during fast and provocation with mother's milk. An elimination diet was undertaken in mothers, removing first cow's milk protein (CMP), then, when inefficient, all foods suspected on the clinical history or a positive prick test in the child, followed by oral challenges in mother's diet with the corresponding food. The sole CMP-free diet in mothers always proved insufficient. In four, an additional diet excluding two to three other foods cleared the symptoms. Oral provocations in mother's diet with those foods were positive in all. In two, mothers turned down a diet excluding more than four foods, symptoms cleared while feeding the child with an extensively hydrolysed formula, whereas challenges with mother's milk induced immediate reactions. Intestinal permeability was altered during provocation tests with mother's milk sampled before maternal diet. Food allergy during breastfeeding may be due to multiple foods and the inefficacy of the sole CMP elimination in mothers does not rule out food sensitization.     

Setting standards for product selection: allergy prevention

It is axiomatic to state that if products made of natural rubber latex were not used in health care settings then there would be no problems of acquired hypersensitivity from such products. Although synthetic materials are available they do not currently possess the same technical qualities of elasticity and comfort, nor do they deliver the desired degree of protection against biological agents as gloves made out of natural rubber latex. Selection of gloves either for non-sterile procedures or sterile surgical use should be based on this understanding, and gloves with minimal levels of extractable latex proteins should be used.     

Family education, a model for allergy prevention

It is frequent the lack of family adherence toward the therapeutic measures of the allergic diseases. The incidence in the therapeutic non compliance of the asthmatic patients vary from 20 to 80%. In the last decades, the symptomatic expression of the atopic diseases (AD) in the infancy, and in the adolescence of Venezuelans has been transformed into a health care problem, with an inaccessible therapeutic cost for the state and the family. The setup of the first allergic prevention program improved attitudes and perceptions toward bronchial asthma, allergic rhinitis, and atopic dermatitis, by the education of the risk family group, based on the results from previous investigations and adapted to the procedures and customs that govern our current society. A research project, through a multi-disciplinary group included an educational program model for the prevention of allergic diseases in a population from Caracas, Venezuelan allergic pregnant mothers, and their respective couples of a high and middle socioeconomic levels with no helminthic infections (n = 482), group A. Two subgroups were randomly selected for prospective evaluation: A1 (n = 20) without participation in the preventive program or control group, and A2 (n = 15) with participation in the program or intervened group, including strategies to be applied by the family, application of measures and reached goals; immunologic, pediatric, and nutritional sequential control; group B (n = 66), to validate the laboratory tests, and group C (n = 364) to validate immunoclinical diagnoses, in vivo immunodiagnostic tests to the parents and children (clinical history, skin prick tests for cow's milk, egg white, wheat, soybean, cladosporium and Dermatophagoides pteronnysinus), and in vitro tests (total serum IgE, Phadiatop, and Rast to the allergens previously selected). In conclusion, the program permits the identification of atopic risk children, sponsors the systematical application of intervention measures, economic, viable and projected toward the family affected, indicating a positive change through a self-family-management training and new conduct plans, facilitating the participation among the family, the community and the health team, that certifies, an optimistic therapy in the reduction of the clinical manifestations of the atopic diseases in young infants from this tropical population studied.     

Selenate fortification of infant formulas improves the selenium status of preterm infants

The purpose of this study was to determine whether selenate fortification of infant formula would improve the selenium status of relatively well, growing, preterm infants during the first 12 wk of enteral feeding. A high-selenium group (n = 7, mean body weight = 1312 g) received selenate-fortified preterm and full-term infant formulas containing 0.36 and 0.22 mumol Se/L, respectively, and a low-selenium group (n = 10, mean body weight = 1262 g) received non-selenium-fortified preterm and full-term infant formulas containing 0.12 and 0.11 mumol Se/L, respectively. There were no significant differences in growth between the two groups throughout the study. The high-selenium group had significantly greater mean selenium intakes than did the low-selenium group from weeks 2 to 12. Plasma selenium concentrations decreased over the study period in the low-selenium group. Plasma selenium-dependent glutathione peroxidase activity was greater in the high-selenium group at week 12 only. Red blood cell selenium concentrations decreased over time in both groups and were significantly greater in the high-selenium group at weeks 4, 8, and 12. Plasma selenium concentrations were significantly correlated with plasma glutathione peroxidase activity for all infants on study day 1 and at weeks 4 and 12. Selenium intake of all infants was significantly correlated with plasma glutathione peroxidase activity at 12 wk. Selenate fortification of infant formulas can improve the selenium status of preterm infants. Current selenium contents of infant formulas and recommendations for dietary intakes of selenium for some preterm infants may be inadequate.     

Chemical and nutritional evaluation of two amaranth (Amaranthus cruentus)-based infant formulas

The objective of this study was to calculate, prepare and evaluate the Protein Efficiency Ratio (P.E.R.) and Net Protein Utilization (N.P.U.) of two infant formulas made with amaranth (Amaranthus cruentus). Both formulas were formulated to match a previously developed and tested soy-oats infant formula. No significant differences were found between the three formulas with respect to corrected Protein Efficiency Ratio (P.E.R.) and Net Protein Utilization (N.P.U.) values. Only the product made with the 1-R fraction of amaranth was found to have a significantly lower P.E.R. than casein.     

Energy balance and metabolic rate in preterm infants fed with standard and high-energy formulas

1. Energy balances were performed on sixteen low birth weight preterm infants over 7-10 d periods on a standard low-solute infant formula (2600 kJ/l), and on four high-energy formulas, providing different energy densities up to 3760 kJ/l. In two of the high-energy formulas the additional fat energy was provided by peanut oil, and the other two by medium chain triglycerides (MCT). Anthropometric measurements and metabolic rate (MR) determinations were made during the balance periods. 2. Mean energy retention on the standard formula was 66% of the intake and declined to below 50% on the two feeds providing the highest energy. Extensive energy balance data on the standard formula are available for reference. 3. Net absorption of dietary energy increased on all the high-energy formulas, rising from 362 kJ/kg per d on the standard formula to 453 kJ/kg per d on the highest energy-formula (P < 0.001). There was no advantage in using MCT. 4. Net absorption of dietary energy improved with advancing maturity, irrespective of the formula. 5. In spite of the increased dietary energy retention, there was no increase in growth rate during periods of feeding with the high-energy formulas. 6. Fasting and postprandial MR increased by 10.4 and 12.8% respectively on the highest energy feeds. 7. It is concluded that, at least in the short term, this type of high-energy feeding increases MR at the expense of growth and thus is probably of no advantage to the infant.     

Randomised controlled trial of L-carnitine as a nutritional supplement in preterm infants

AIMS: To evaluate the effect of L-carnitine supplementation (25 mg/kg/d) on the growth and incidence of hypoglycaemia in preterm infants. METHODS: A double blind, placebo controlled randomised trial, stratified for gestational age, was conducted of 86 preterm infants between 28 and 34 gestational weeks. The median gestational ages in the carnitine group and placebo groups were 30.7 weeks (range 28.0 to 33.6) and 31.4 weeks (range 28.0 to 33.9), respectively. The median birthweights were 1.557 kg (range 0.944 to 2.275) and 1.645 kg (range 0.885 to 2.545), respectively. RESULTS: Mean plasma free carnitine concentrations were below values for normal term infants in both groups on day 1 (carnitine group 44.8 mumol/l, placebo group 25.5 mumol/l) in the placebo group on day 7 (50.7 mumol/l), but in neither group on days 14 and 28. Total, free, and acylcarnitine concentrations were significantly increased in both urine and blood in the L-carnitine group. There was no significant difference between the placebo and carnitine supplemented groups in growth rate, as assessed by weight, length, skinfold thickness and head circumference measurements, or in the incidence of episodes of hypoglycaemia. CONCLUSION: The addition of carnitine as a nutritional supplement at a dose of 25 mg/kg/day did not improve growth in our group of preterm infants nor protect them from episodes of hypoglycaemia.     

Intolerance to protein hydrolysate infant formulas: an underrecognized cause of gastrointestinal symptoms in infants

The purpose of this study was to determine the effectiveness of an amino acid-based infant formula in infants with continued symptoms suggestive of formula protein intolerance while they were receiving casein hydrolysate formula (CHF). Twenty-eight infants, 22 to 173 days of age, were enrolled; each had received CHF for an average of 40 days (10 to 173 days) and continued to have bloody stools, vomiting, diarrhea, irritability, or failure to gain weight, or a combination of these symptoms. Sigmoidoscopy with rectal biopsy was performed in all infants. The infants then received an amino acid-based infant formula, Neocate, for 2 weeks. After 2 weeks of treatment, 25 of the infants demonstrated resolution of their symptoms and underwent challenge with CHF. Of the 25 who were challenged, eight tolerated the CHF and the remainder had recurrence of their symptoms. The histologic features in these infants varied from eosinophilic infiltration to normal. We conclude that not all infants with apparent formula protein-induced colitis respond to CHF and that these infants may have resolution of their symptoms when fed an amino acid-based infant formula.     

Allergy to extensively hydrolyzed cow milk proteins in infants: identification and treatment with an amino acid-based formula

OBJECTIVE: To evaluate acetowhite changes of the cervix and vulva as a predictor of human papillomavirus (HPV) infection. METHODS: In this population-based study all women aged 19, 21, 23, and 25 years and registered as living in a primary health care area within the city of Ume?, Sweden were eligible for inclusion. Each participant underwent a gynecologic examination with sampling of epithelial cells for HPV-DNA detection and Papanicolaou smear. Colposcopy was performed 5 minutes after application of 5% acetic acid. A two-step polymerase chain reaction (PCR) technique was employed for HPV-DNA detection. RESULTS: Colposcopy and sampling of epithelial cells could be performed in 535 women. The sensitivity of detection of HPV infection by the acetowhitening of the cervix was 22% (95% confidence interval [CI] 18%, 26%). The specificity of detection of HPV infection by the acetowhitening of the cervix was 90% (95% CI 87%, 93%). The sensitivity of detection of HPV infection by cytology was 13% (95% CI 10%, 16%), and the specificity was 99% (95% CI 98%, 100%). The combination of acetowhitening and cytology did not improve the diagnostic value. CONCLUSION: Acetowhitening of the cervix and vulva has low sensitivity as a predictor of HPV infections as determined by PCR.     

The use of molybdenum for the prevention of nutritional copper poisoning in housed sheep

An experiment was designed to investigate the practical possibility of incorporating small quantities of molybdenum salts into the high copper diets of intensively fattening lambs to prevent or reduce the gradual accumulation of copper from feed. At slaughter (14 weeks of age) lambs which had received Mo supplement (7.7 ppm Mo) showed liver copper levels which were 40.1 per cent lower than those in the control group which, in turn, presented a mean liver copper concentration near the upper limit of the normal range for adult sheep. Changes in blood ceruloplasmin and SGOT levels and in the comparative rate of accumulation of liver copper indicated that the addition of ammonium molybdate to the concentrate diet might be a useful method of reducing the risk of nutritional copper poisoning in housed sheep.     

Role of protein degradation in the growth of livers after a nutritional shift

Four patients with idiopathic pituitary dwarfism were shown to have growth hormone (GH), adrenocorticotropin (ACTH), and luteinizing hormone (LH) deficiencies. Basal levels of thyrotropin (TSH) were within normal range in three patients and slightly elevated in one. Exaggerated and delayed responses were obtained after TSH-releasing hormone (TRH) stimulation. Serum thyroxine (T4) values were low (2.3 +/- 0.4 mug/100 ml), while triiodothyronine (T3) levels were in the normal range (1.22 +/- 0.25 ng/ml), both rising substantially after exogenous TSH and consecutive TRH administration. Their hypothyroid state was, therefore, probably due to TRH deficiency. To examine the dose of L-T4 necessary to produce inhibition of the TSH response to TRH, 50 mug/m2/day of L-T4 was administered to these patients. At the end of 4 weeks of replacement, serum T4 rose to 5.2 +/- 0.5 mug/100 ml, whereas T3 was unchanged from the previous levels, after which TSH responses to TRH were completely suppressed in all patients. As a control group, six patients with primary hypothyroidism received gradually increasing doses of L-T4 for 4-week periods, and TSH response to TRH was tested at the end of each dosage of L-T4, until complete inhibition of TSH release was obtained. The primary hypothyroid patients required approximately 150 mug/m2/day of L-T4 for suppression of TSH response to TRH. At this dosage, serum T4 and T3 levels were 8.5 +/- 0.9 mug/100 ml and 2.34 +/- 0.5 ng/ml respectively, which were significantly higher than those levels in the pituitary dwarfs (P less than 0.001 for T4 and P less than 0.01 for T3). These observations indicate that the set point of TSH release in feedback inhibition by throxine is low in idiopathic hypopituitarism with TRH deficiency, and TRH seems to control the pituitary sensitivity to feedback regulation of thyroid hormones.     

Three-month nutritional supplementation in Indonesian infants and toddlers benefits memory function 8 y later

Does short-term supplementary feeding during infancy and childhood have long-lasting effects? In 1986, 334 children aged 6-60 mo living on rural tea plantations in West Java, Indonesia, participated in a 3-mo randomized trial to test the effects of a dietary supplement providing approximately 1672 kJ (400 kcal) energy/d, with about the same nutrient density as local foods. We returned to the same communities in 1994 and enrolled 231 (125 supplemented, 106 control) of the original subjects in a follow-up study of the long-term effects of supplementation. We assessed these subjects by using several measures: anthropometry, iron status, information processing, Peabody Picture Vocabulary Test, word fluency, and an arithmetic test. The supplemented group showed no differences from those in the control group. However, when the analysis was limited to subjects who had received the supplement before the age of 18 mo (n = 73), the supplemented children performed better than control children on the Sternberg test of working memory (decision time intercept: probe absent, P = 0.002; probe present, P = 0.053). After considering possible confounders, we concluded that the supplementation during infancy was responsible for the difference. This finding shows that supplementation can have long-lasting effects on a specific domain if the child receives it at the appropriate stage of development.