Effect of peritoneal dialysate on bioelectrical impedance analysis variability in pediatric patients receiving peritoneal dialysis

BACKGROUND

Previous adult studies have yielded conflicting results regarding whether the presence (D +) or absence (D-) of peritoneal dialysate affects the accuracy of bioelectrical impedance analysis (BIA) measurements. The aim of this study was to investigate whether the accuracy of BIA data varies between D + and D- measurements in children.

METHODS

This cross-sectional study recruited chronic kidney disease stage 5 patients aged 3 to 18 years who received peritoneal dialysis. Body composition was assessed by multifrequency BIA, and values were compared between D + and D- measurements using the intraclass correlation coefficient (ICC).

RESULTS

Fifty paired BIA measurements were collected from 18 patients with a mean age of 13.6 ± 4.1 years and a mean dialysate fill volume of 1,006 ± 239.7 ml/m2. Sixteen out of 17 BIA parameters (94.1%) exhibited excellent correlations between D + and D- measurements (ICC values = 0.954, 0.998). There was a trend of increased fluid status, including extracellular water, edema index, and overhydration, in D + measurements, with mean differences (95% CIs) of 0.5 (0.4, 0.6) L, 0.002 (0.001, 0.002), and 0.1 (0.1, 0.2) L, respectively. Soft lean mass and fat-free mass were higher in D + measurements, with mean differences (95% CIs) of 1.4 (1.2, 1.6), and 1.6 (1.4, 1.8) kg, respectively. In addition, patients older than 10 years had a stronger correlation between D + and D- measurements than younger patients.

CONCLUSIONS

A total of 94.1% of BIA parameters exhibited excellent correlations between D + and D- measurements, especially patients older than 10 years. We recommend that BIA measurements be collected from children regardless of the presence of peritoneal dialysate.

Effects of a new amino acid, rice glucose polymer-based, and commercial amino acid-based formulas on growth and protein status of infants with cow's milk protein allergy

BACKGROUND

Infants with cow's milk protein allergy (CMPA) are at risk for nutrient inadequacy and impaired growth.

OBJECTIVE

To evaluate the effect of a new amino acid-based formula (nAAF) compared with commercial amino acid-based formula (cAAF) on growth and protein status of cow's milk protein (CMP)-allergic infants and to compare their growth with those of healthy infants.

METHODS

Infants less than 6 months of age with CMPA were enrolled in the nAAF or cAAF groups. Healthy infants fed breast milk (BM) or infant formula (IF) were controls. They remained on their formula/milk until day 28 of the study. Anthropometric evaluation was performed at birth, day 0 and day 28 of the study and calculated to z-scores of weight-for-age (WAZ), length-for-age (LAZ) and head circumference-for-age (HAZ). Plasma amino acids, albumin, urea nitrogen, and creatinine were assessed for infants with CMPA on day 0 and day 28.

RESULTS

The nAAF and cAAF groups did not differ in increases in WAZ [regression coefficient (95%CI): 0.088 (-0.619, 0.796), p = 0.791], LAZ [0.045 (-0.789, 0.880, p = 0.909], and HAZ [-0.645 (-2.082, 0.793), p = 0.337] between day 0 and day 28. The increases in WAZ and LAZ during 28 days in the nAAF group did not differ from the controls. The changes in the blood chemistry values, except albumin, were not different between CMPA groups.

CONCLUSIONS

The nAAF, similar to the cAAF, supports growth and protein status for infants with CMPA, and it might be used as a substitute for the cAAF.

Prevalence and risk factors for pediatric acute and chronic malnutrition: A multi-site tertiary medical center study in Thailand

BACKGROUND AND OBJECTIVES

Malnutrition is a major public health concern that increases morbidity and mortality in hospitalized patients, particularly those in developing countries. This study aimed to investigate its prevalence, risk factors, and impact on clinical outcomes in hospitalized children and adolescents.

METHODS AND STUDY DESIGN

We conducted a prospective cohort study in patients aged 1 month to 18 years who were admitted to four tertiary care hospitals between December 2018 and May 2019. We collected demographic data, clinical information, and nutritional assessment within 48 hours of admission.

RESULTS

A total of 816 patients with 883 admissions were included. Their median age was 5.3 years (interquartile range 9.3). Most patients (88.9%) were admitted with mild medical conditions (e.g., minor infection) or noninvasive procedures. The prevalence of overall malnutrition was 44.5%, while that of acute and chronic malnutrition was 14.3% and 23.6%, respectively. Malnutrition was significantly associated with age ≤2 years, preexisting diseases (cerebral palsy, chronic cardiac diseases, and bronchopulmonary dysplasia), and muscle wasting. Addi-tional risk factors for chronic malnutrition included biliary atresia, intestinal malabsorption, chronic kidney disease, as well as inability to eat and decreased food intake for >7 days. Malnourished patients had a significantly longer hospitalization duration, higher hospital cost, and nosocomial infection rates than did well-nourished patients.

CONCLUSIONS

Patients with chronic medical conditions on admission are at risk for malnutrition. Therefore, determination of admission nutritional status must be assessed, and its management are requisites for improved inpatient outcomes.

Bone Mineral Density and Serum 25OHD in Children and Adolescents With Juvenile Idiopathic Arthritis

Low bone mass is one of the complications of juvenile idiopathic arthritis (JIA). However, a study focusing on the low bone mass in children and adolescents with JIA in Southeast Asian countries is limited. This study aimed to evaluate the bone mineral density (BMD) of Thai patients with JIA and identify factors correlated with BMD. A cross-sectional study was conducted at a tertiary-care center. The BMD of the lumbar spines (BMDLS) and the total body (BMDTB) were measured by dual-energy X-ray absorptiometry. Thirty-eight patients were enrolled between July 2015 and January 2016. No patient had low BMDLS, and only 2 (5.3%) had low BMDTB. Serum 25-hydroxyvitamin D (25OHD) levels were significantly positively correlated with the BMDTB Z-score (coefficient: 0.047; 95% confidence interval = 0.011-0.082; P = .012). Our study demonstrated a very low prevalence of low bone mass. Optimization of the serum 25OHD level should be encouraged.

Maternal iron kinetics and maternal-fetal iron transfer in normal-weight and overweight pregnancy

BACKGROUND

Inflammation during pregnancy may aggravate iron deficiency (ID) by increasing serum hepcidin and reducing iron absorption. This could restrict iron transfer to the fetus, increasing risk of infant ID and its adverse effects.

OBJECTIVES

We aimed to assess whether iron bioavailability and/or iron transfer to the fetus is impaired in overweight/obese (OW) pregnant women with adiposity-related inflammation, compared with normal-weight (NW) pregnant women.

METHODS

In this prospective study, we followed NW (n = 43) and OW (n = 40) pregnant women who were receiving iron supplements from the 14th week of gestation to term and followed their infants to age 6 mo. We administered 57Fe and 58Fe in test meals mid-second and mid-third trimester, and measured tracer kinetics throughout pregnancy and infancy.

RESULTS

In total, 38 NW and 36 OW women completed the study to pregnancy week 36, whereas 30 NW and 27 OW mother-infant pairs completed the study to 6 mo postpartum. Both groups had comparable iron status, hemoglobin, and serum hepcidin throughout pregnancy. Compared with the NW, the OW pregnant women had 1) 43% lower fractional iron absorption (FIA) in the third trimester (P = 0.033) with median [IQR] FIA of 23.9% [11.4%-35.7%] and 13.5% [10.8%-19.5%], respectively; and 2) 17% lower maternal-fetal iron transfer from the first tracer (P = 0.051) with median [IQR] maternal-fetal iron transfer of 4.8% [4.2%-5.4%] and 4.0% [3.6%-4.6%], respectively. Compared with the infants born to NW women, infants born to OW women had lower body iron stores (BIS) with median [IQR] 7.7 [6.3-8.8] and 6.6 [4.6-9.2] mg/kg body weight at age 6 mo, respectively (P = 0.024). Prepregnancy BMI was a negative predictor of maternal-fetal iron transfer (β = -0.339, SE = 0.144, P = 0.025) and infant BIS (β = -0.237, SE = 0.026, P = 0.001).

CONCLUSIONS

Compared with NW, OW pregnant women failed to upregulate iron absorption in late pregnancy, transferred less iron to their fetus, and their infants had lower BIS. These impairments were associated with inflammation independently of serum hepcidin.This trial was registered at clinicaltrials.gov as NCT02747316.

Hospital-acquired malnutrition in paediatric patients: a multicentre trial focusing on prevalence, risk factors, and impact on clinical outcomes

Alteration of nutrient metabolism during hospital stay may cause a deterioration in patients' nutritional status. The aim of this study was to determine the prevalence and possible risk factors for nutritional deterioration in hospitalized children. A multicentre prospective study was conducted among the patients aged 1 month to 18 years in tertiary-care hospitals, between December 2018 and May 2019. Demographic data, illness, and nutritional assessment on the first and the last day of admission were collected. There were 623 patients enrolled in this study with the median age of 4.3 years. Two thirds of the patients had at least one underlying disease. Eighty-eight percent of the patients were admitted with mild medical conditions including a scheduled cycle of chemotherapy or immunosuppressive drugs, minor infection, and non-invasive procedures. The prevalence of nutritional deterioration (reduction in body mass index ≥ 0.25 Z-score) was 24% and was associated with a significantly higher rate of nosocomial infection (24% vs. 11%, p < 0.001) compared to patients without hospital-acquired malnutrition. Risk factors included moderate to severe medical conditions (AOR 1.90, 95% CI 1.09-3.31, p = 0.024), pneumonia (AOR 1.85, 95% CI 1.05-3.28, p = 0.034), seizure (AOR 2.82, 95% CI 1.28-6.19, p = 0.01), and surgery (AOR 2.98, 95% CI 1.60-5.56, p = 0.001). Nutritional management showed a significant reduction in the incidence of hospital-acquired malnutrition and a trend towards a 60% decrease in infectious complications in patients with moderate to severe medical conditions.Conclusions: Approximately one fourth of paediatric patients developed malnutrition during hospitalization. Nutritional screening, assessment, and treatment should be implemented to improve the outcomes of hospitalized paediatric patients. What is Known: • Malnutrition at admission has a negative impact on outcomes of patients, including prolonged hospitalization, increased costs of care, and a higher rate of nosocomial infection. What is New: • Hospital-acquired malnutrition can occur regardless of prior nutritional status and is predominantly related to illness severity. • Malnourished patients with nutritional intervention experience an improvement in their nutritional status as well as a lower risk of developing hospital morbidity during hospitalization.

Twelve-month growth and accession of tolerance in infants with cow's milk protein allergy compared among those fed with breast milk or alternative formulae

BACKGROUND

Cow's milk protein allergy (CMPA) is a common food allergy in children. The impact of various feeding regimens on growth in infants with CMPA is not sufficiently well understood.

OBJECTIVE

To investigate 12-month growth and accession of tolerance in infants with CMPA compared among those fed with breast milk or alternative formulae.

METHODS

This retrospective study included CMPA infants with treatment adherence for at least six months. Infants were categorized into the following feeding regimen groups: soy-based formula (SF), extensively hydrolyzed protein formula (EHF), commercial amino acid-based formula (cAAF), new amino acid-based formula (nAAF), chicken-based formula, and breast milk. Weight-for-age z-score (WAZ), length-for-age z-score (LAZ), and weight-for-length z-score (WLZ) were evaluated at diagnosis and at follow-ups. Clinical manifestations, other allergenic foods, and time to tolerance of CMP were assessed.

RESULTS

One hundred and sixteen infants were enrolled. Infants consuming EHF had markedly improved WAZ. Infants with one symptom at diagnosis, those who had gastrointestinal symptom, and those with allergy to only CMP had more pronounced growth improvement. Compared to breast milk, SF and EHF were significantly associated with lower probability of tolerance to CMP (HR: 0.14, 95%CI: 0.03-0.62; and, HR: 0.21, 95%CI: 0.07-0.64, respectively). Those allergic to only CMP were more likely to develop tolerance to CMP than those allergic to CMP and other foods.

CONCLUSIONS

Improvement in growth was significantly more pronounced in CMP-allergic infants fed with EHF. Accession of tolerance to CMP was associated with breast milk as the therapeutic diet.

The benefits of a novel chicken-based oral nutritional supplement for older adults: A double-blind randomized controlled trial

BACKGROUND AND OBJECTIVES

A considerable proportion of older adults are lactose intolerant. The aim of this study was to investigate the clinical safety, efficacy, and tolerability of a chicken-based oral nutritional supplement (ONS).

METHODS AND STUDY DESIGN

Double-blind randomized controlled trial. Subjects in the intervention group received chicken-based ONS, and those in the control group received a similarly flavored oral fluid placebo. All subjects were followed-up every two months for a total of 6 months.

RESULTS

Thirty-eight older adults aged ≥70 years were recruited. The mean age and BMI were 81.5±5.6 years and 19.6±2.5 kg/m2. At the end of this trial, there was no statistically significant change in sarcopenia-related variables in the intervention group. However, the higher-level physical activity (PA) group within the intervention group had a significantly improved usual gait speed (UGS) compared to the lower-level PA group (p=0.04). The adjusted mean differences in UGS between the high and low level PA groups in the intervention and placebo groups were 0.149 m/sec and 0.083 m/sec, respectively. Significant difference was observed for changes in two bone markers between the intervention and placebo groups.

CONCLUSIONS

The chicken-based ONS evaluated in this study was well-tolerated. No improvement of sarcopenia-related components was shown by the study ONS. Up to nearly an 80% increase in adjusted mean difference in UGS between the high and low level PA groups was observed in the nutritional intervention group compared to the zero-protein calorie placebo group. Significant improvement in age-related bone resorption was the earliest advantage of taking our ONS.

Prevalence of and factors associated with thiamin deficiency in obese Thai children

BACKGROUND AND OBJECTIVES

Obesity is a state that results from excessive energy consumption, and obese people often have micronutrient deficiencies. The objective of this study was to investigate the prevalence of and factors associated with thiamin deficiency in obese Thai children.

METHODS AND STUDY DESIGN

This cross-sectional study was conducted at Faculty of Medicine Siriraj Hospital, Mahidol University during 2014 to 2017. Children aged 7-15 years old with exogenous obesity were recruited. Symptoms and signs of thiamin deficiency were evaluated. Erythrocyte transketolase activity was measured by thiamin pyrophosphate effect (TPPE), with ≥15% indicating thiamin deficiency. Dietary consumption from a 5-day food diary and food frequency questionnaire was calculated by INMUCAL software. Other medical complications of obesity were also evaluated.

RESULTS

One hundred and twenty-four subjects (81 males and 43 females) were enrolled, with a mean age of 10.9 years. Fifty-two subjects had abnormal TPPE for an overall prevalence of thiamin deficiency of 42%. Manifestations of thiamin deficiency included numbness, weakness, and calf muscle cramping. TPPE test results were correlated with at least one symptom or a sign of thiamin deficiency (p<0.01). The thiamin-deficient group tended to have higher proportion of morbid obesity and larger waist circumferences than thiamin-sufficient group. The thiamindeficient group tended to consume less thiamin in relation to energy intake than the thiamin-sufficient group (p=0.057). Items of foods consumed were statistically indistinguishable between groups.

CONCLUSIONS

The results of this study revealed a 42% prevalence of thiamin deficiency among obese Thai children, and most of those cases were subclinical.

Reconfirmation of improved tolerance to a new amino acid-based formula by infants with cow's milk protein allergy

BACKGROUND AND OBJECTIVES

Reasons for intolerance to commercial amino acid-based formulas (cAAF) in infants diagnosed with cow's milk protein allergy (CMA) remain unknown. We assume that minute amounts of proteins, presenting in the glucose polymers derived from corn starch (cGPs), can elicit the intolerance to the cAAFs observed in some infants with CMA. By replacing cGPs with glucose polymers derived from rice starch (rGPs), a new amino acid-based (nAAF) formula has been shown to be better tolerated than an existing cAAF. This study was carried out to corroborate the superiority of nAAF over a different commercially available cAAF.

METHODS AND STUDY DESIGN

Infants with CMA aged less than 4 months underwent a double-blind, placebo-controlled food challenge. They consumed each of the 2 test formulas for 14 days before switching to the other one. Following the 28-day challenge period, infants consumed the tolerated formula for 4 weeks as an at-home open challenge.

RESULTS

Out of 36 infants who completed the study, 18 were intolerant to the cAAF, seven of whom (38.8%) were also intolerant to the nAAF. Eleven of the 18 infants who were intolerant to the cAAF tolerated the nAAF (p<0.01).

CONCLUSIONS

This study reconfirms that substitution of rGPS for cGPs in the amino acid-based formula improves tolerance of young infants with CMA.

REPEATED SCLEROTHERAPY SUCCESSFULLY TREATS A CHILD WITH IDIOPATHIC CHYLURIA: A CASE REPORT

We describe a clinical course of idiopathic chyluria in a previously healthy 8-year-old Thai boy, with a 1-year history of cloudy white urine undergoing antibiotic treatment. The patient was investigated for the causes but they all proved negative. Cystoscopy and retrograde pyelography demonstrated a renolymphatic fistula of the right kidney. The patient was refractory to a mediumchain triglyceride-rich diet. Ultimately, sclerotherapy with 1% povidone iodine was employed twice, which resulted in a resolution of the disorder. We emphasize that chyluria, even though a very rare condition of chylous disorders, but ultimately can be initially managed by providing a medium-chain triglyceride-rich diet and is curable by sclerotharapy. Importantly, medium-chain triglyceride-rich diet can be applied to treat other types of chylous disorders.

Improved Tolerance to a New Amino Acid-Based Formula by Infants With Cow's Milk Protein Allergy

BACKGROUND

Prevalence and severity of cow's milk protein allergy (CMA) in infants are increasing. A proportion of infants with CMA still elicit signs and symptoms of CMA while ingesting commercial amino acid-based formulas (AAFs). We propose that protein in glucose polymers (GPs) derived from corn starch in the AAFs might be the cause of intolerance to AAF in some infants. We thus have produced small molecules of GPs from rice starch, eliminating the protein fraction from them, and subsequently used them as the sole source of carbohydrate in a new amino acid-based formula (NAAF).

METHODS

The efficacy of the NAAF was compared with that of an AAF in a double-blind, placebo-controlled food challenge (DBPCFC) in young infants with CMA aged <4 months. Infants consumed each formula for 14 days before switching to the other one. If no respiratory, dermatologic, and gastrointestinal symptom occurred, it was considered tolerance. After the challenge, infants consumed the tolerated formula for 4 weeks to prove real tolerance to that formula.

RESULTS

Of 46 infants, 23 were intolerant to the AAF, of whom 7 (30.4%) were also intolerant to the NAAF. Sixteen of the 23 infants who were intolerant to the AAF could tolerate the NAAF ( P < .05). The minimal important difference of decreasing percentage of intolerance to the NAAF was 34.8% compared with the infants who were intolerant to the AAF.

CONCLUSION

The NAAF is better tolerated than a commercially available AAF for the management of infants with CMA.

Carnitine-acylcarnitine translocase deficiency: Two neonatal cases with common splicing mutation and in vitro bezafibrate response

BACKGROUND

Mitochondrial fatty acid oxidation (FAO) disorders are among the causes of acute encephalopathy- or myopathy-like illness. Carnitine-acylcarnitine translocase (CACT) deficiency is a rare FAO disorder, which represent an energy production insufficiency during prolonged fasting, febrile illness, or increased muscular activity. CACT deficiency is caused by mutations of the SLC25A20 gene. Most patients developed severe metabolic decompensation in the neonatal period and died in infancy despite aggressive treatment.

PATIENTS AND METHODS

We herein report the clinical findings of two unrelated cases of CACT deficiency with mutation confirmation, and in vitro bezafibrate responses using in vitro probe acylcarnitine (IVP) assay. Patients 1 and 2 are products of nonconsanguineous parents. Both patients developed cardiac arrest at day 3 of life but survived the initial events. Their blood chemistry revealed hypoglycemia and metabolic acidosis. The acylcarnitine profiles in both patients demonstrated increased long-chain acylcarnitines, suggesting CACT or carnitine palmitoyltransferase-2 (CPT2) deficiency.

RESULTS

The mutation analysis identified homozygous IVS2-10T>G in the SLC25A20 gene in both patients, confirming the diagnosis of CACT deficiency. The IVP assay revealed increased C16, C16:1, but decreased C2 with improvement by bezafibrate in the cultured fibroblasts. The short-term clinical trial of bezafibrate in Patient 1 did not show clinical improvement, and died after starting the trial for 6 months.

CONCLUSION

This splicing mutation has been identified in other Asian populations indicating a possible founder effect. IVP assay of cultured fibroblasts could determine a response to bezafibrate treatment. A long-term clinical trial of more enrolled patients is required for evaluation of this therapy.

Fat-soluble vitamins and plasma and erythrocyte membrane fatty acids in chylothorax pediatric patients receiving a medium-chain triglyceride-rich diet

Post-operative chylothorax can be cured by a medium-chain triglyceride (MCT)-rich diet. However, there is concern that an MCT-rich diet results in clinical and biochemical deficiencies in fat-soluble vitamins and fatty acids. We compared fat-soluble vitamins status and fatty acids status before and after administration of an MCT-rich diet. Nine children with congenital heart disease developed chylothorax after cardiac surgery. Blood samples were drawn from each subject twice, first prior to administration of an MCT-rich diet and secondly when the chylothorax was clinically cured and the MCT diet discontinued. Both blood samples were analyzed for retinol and 25-hydroxy vitamin D concentrations, the ratio of α-tocopherol to total lipids (α-TE/TL), coagulogram, and the fatty acid composition in plasma and erythrocyte membrane phospholipids. In spite of a decrease in the α-TE/TL ratio (3.78 ± 0.89 vs 2.36 ± 0.44 mg/g, p<0.05), this decrease did not reach the deficiency cut-off level. Linoleic acid in both plasma and erythrocyte membrane lipids decreased significantly (25.25 ± 8.06 vs 14.25 ± 2.88%, and 11.19 ± 2.15 vs 6.89 ± 2.45%, respectively). Administration of an MCT-rich diet for treatment of postoperative chylothorax caused a reduction in vitamin E status and linoleic acid, but without any symptoms of deficiency.

Micronutrient deficiencies in obese Thai children

We reported the cases of 3 obese children who presented variously with costochondral beading, numbness of both hands and feet, and hypochromic-microcytic anemia. Serum ascorbic acid concentration, erythrocyte thiamin pyrophosphate effect, and serum hepcidin concentration were done to investigate these symptoms, respectively, with findings of ascorbic acid insufficiency, thiamin deficiency, and iron deficiency anemia from poor iron absorption due to a hyper-inflammatory state, respectively. This report indicated that obese children not only have energy excess but may also risk being micronutrient deficiencies; therefore, weight management with special attention to an adequate intake of vitamins and minerals should be provided.

Anal fissures in infants may be a pathognomonic sign of infants with cow's milk allergy

OBJECTIVE

To study the association between analfissures and cow's milk allergy (CMA) in infants. METHODS AND METHOD: In a prospective study, 72 confirmed cases of CMA in infants were examined for anal fissure by pediatricians with five years' experience. A positive finding was defined as when an anal fissure was detected by at least two out of three examiners.

RESULTS

Of infants with CMA with and without gastrointestinal GI symptoms, 79% and 83% had anal fissures, respectively The prevalence of anal fissure in these infants is significantly higher than in normal infants.

CONCLUSION

Anal fissure may be a pathognomonic sign of cow's milk allergy in infants.

Lower prevalence of atopic dermatitis in breast-fed infants whose allergic mothers restrict dairy products

OBJECTIVE

To study the prevalence of atopic dermatitis in exclusively breast-fed infants of allergic mothers who were placed either on liberal diets or on dairy-product-restricted diets.

MATERIAL AND METHOD

Infants aged 0 to 4 months old, who were exclusively breast-fed and whose mothers had a history of allergic disease, were the subjects of the present study. The mothers were randomized into two groups; mothers in a control group were on liberal diets, while mothers in an intervened group were on dairy product-restricted diets. Infants of both groups were examined for atopic dermatitis at seven days, one month, and four months of age.

RESULTS

There were 32 and 30 infants in the control and intervened groups, respectively. Eight infants in the control group and two infants in the intervened group developed atopic dermatitis by the age of four months. The prevalence of atopic dermatitis in the intervened group was significantly lower than that in the control group (6.67% vs. 25%, p < 0.05).

CONCLUSION

Dairy product restriction in allergic mothers results in decreasing prevalence of atopic dermatitis in 4-month-old infants who were exclusively breast-fed.

Growth of infants with cow's milk allergy fed chicken-based formula

BACKGROUND

The recommended formulas for treatments of cow's milk allergy (CMA) in infants are hydrolyzed protein-based and amino acid-based formulas. However they are not always affordable. Furthermore, some patients are still allergic to these formulas. Therefore, chicken-based formula has been innovated and used as an alternative formula to treat CMA in these infants.

OBJECTIVE

To assess the growth of infants with CMA who consumed chicken-based formula compared to normal infants.

MATERIAL AND METHOD

A prospective study was performed in 34 infants aged 3 to 24 months diagnosed as CMA at Siriraj Hospital. All subjects consumed the chicken-based formula for at least three months. The growth parameters were recorded.

RESULTS

Manifestations occurred in dermatological (78.60%), respiratory (67.9%), and gastrointestinal (53.6%) systems. Mean (+/-SD) chicken-based formula intake was 77 (+/-39.6) kcal/kg/d Weight gains are higher (35.7%), equal (10.8%), and lower (53.5%) than those of normal infants. In addition, length gains were higher (38%), equal (5%), and lower (57%) than those of normal infants. However, the difference of weight and length in chicken-basedfed, cow s milk-allergic infants, and normal infants were not statistically significant (p = 0.141, p = 0.192). None of these infants had severe complications.

CONCLUSION

Growth parameters of infants fed with chicken-based formula are not diferent from those of normal infants.

Chicken-based formula is better tolerated than extensively hydrolyzed casein formula for the management of cow milk protein allergy in infants

The effective treatment of cow milk allergy in infants consists of elimination of cow milk protein and the introduction of formulas based on an extensively hydrolyzed protein formula or an amino acid-based formula. However, about 10% of these infants are still allergic to an extensively hydrolyzed protein formula and an amino acid-based formula is very expensive. We conducted a study to verify whether the new chicken-based formula will be better tolerated than an extensively hydrolyzed protein formula for the treatment of cow milk allergy in infants. One hundred infants, diagnosed with cow milk allergy by double-blind, placebo-controlled food challenge tests, were enrolled in a double-blind, randomized, cross-over study to compare a response to an extensively hydrolyzed protein formula and the chicken-based formula. Subjects were randomly given one of the two formulas for 2 weeks. There was a 2-week washout period of taking an amino acid-based formula before being switched to the other formula for another 2 weeks. If the subjects showed allergic symptoms during the 2 weeks of test formula, they would be announced as intolerance or allergic to that formula. Sixty seven of 80 confirmed subjects agreed to enroll their infants. Fifty-eight subjects completed the study. Twenty and 33 infants were tolerant whereas and 38 and 25 infants were intolerant to an extensively hydrolyzed protein formula and the chicken-based formula, respectively. The chicken-based formula showed significantly better tolerance than an extensively hydrolyzed protein formula in the management of cow milk allergy in infants.

n-3, but not n-6 lipid particle uptake requires cell surface anchoring

Omega-3 (n-3) fatty acids are emerging as bioactive agents protective against cardiovascular disease. However, their cellular delivery pathways are poorly defined. Here we questioned whether the uptake of n-3 triglyceride-rich particles (TGRP) is mediated by cell surface proteoglycans (PG) using LDL receptor (LDLR)+/+ and LDLR-/- cell models. LDLR+/+ but not LDLR-/- cells showed higher n-6 over n-3 TGRP uptake. Removal of cell surface proteins and receptors by pronase markedly enhanced the uptake of n-3 but not n-6 TGRP. Lactoferrin blockage of apoE-mediated pathways decreased the uptake of n-6 TGRP by up to 85% (p<0.05) but had insignificant effect on n-3 TGRP uptake. PG removal by sodium chlorate in LDLR+/+ cells substantially reduced n-3 TGRP uptake but had little effect on n-6 TGRP uptake. Thus, while n-6 TGRP uptake is preferentially mediated by LDLR-dependent pathways, the uptake of n-3 TGRP depends more on PG and non-LDLR cell surface anchoring.

Congenital chylous ascites: the roles of fibrin glue and CD31

A 6-month-old male infant who presented with abdominal distension and congenital chylous ascites was diagnosed. He was initially refractory to conservative therapy, and then was completely cured with ligation of megalymphatics and fibrin glue application. Immunoperoxidase staining for CD31 on the biopsied peritoneal tissues highlighted the lining cells of lymphatic spaces, which indicated lymphangiectasia.

CONCLUSION

This case emphasizes the effectiveness of lymphatic ligation of the retroperitoneal megalymphatics in conjunction with fibrin glue application to cure congenital lymphangiectasia.

Whole gastrointestinal transit time is associated with clinical severity and nutritional status of HIV-infected children

BACKGROUND

Malnutrition and malabsorption are common consequences in pediatric human immunodeficiency virus (HIV) infection. The gastrointestinal tract is a major site affected by HIV Rapid gastrointestinal transit time may contribute to malabsorption.

OBJECTIVE

To determine whether the whole gastrointestinal transit time (WGTT) correlates with disease stages or degrees of malnutrition in HIV-infected children.

MATERIAL AND METHOD

Forty HIV-seropositive children, at various stages of disease, and thirty seronegative age-matched controls, aged between 1 mo and 3 yr, were enrolled in the present study. The body weight, length, or height and the WGTT were assessed Then the WGTT of children in different stages of HIV disease and in different degrees of malnutrition were compared with those of the control group.

RESULTS

The mean ages were 15.5 and 14.3 mo in HIV-infected and control groups respectively. A greater degree of malnutrition was found in HIV-infected children with more advances HIV clinical symptoms. Compared to controls, WGTT was most rapid in severely symptomatic acquired immunodeficiency syndrome (AIDS) patients (Category C) (14.32 +/- 3.88 versus 7.22 +/- 3.17 h; p < 0.01) but not in asymptomatic, mildly and moderately symptomatic children. Accelerated WGTT in HIV-infected children was also significantly associated with a higher degree of malnutrition.

CONCLUSION

Malnutrition is clearly related to the progression ofHIV disease. Accelerated WGTT is associated with HIV seropositivity, severe clinical symptoms, and higher degrees of malnutrition.

Fatty acid composition in breast milk from 4 regions of Thailand

BACKGROUND

DHA contents in breast milk varied upon maternal dietary intakes.

OBJECTIVE

To study DHA contents in breast milk in Thai lactating women from four diferent regions of Thailand.

MATERIAL AND METHOD

20 mL of hind milk from 40 lactating women from Bangkok, Chantaburi, Tak, and Surin were collected and analyzed for fatty acids contents by gas chromatography Dietary intake of lactating women after delivery until the present study was assessed by a food frequency questionnaire. Then, the average DHA intake was estimated from the diets by using the reference data.

RESULTS

DHA contents in breast milk of mothers from Surin were higher than those from other areas. There were no correlations between history of DHA intake and DHA contents in breast milk.

CONCLUSION

DHA contents in breast milk vary from region to region of the country. Local dietary intake and genetics might explain this contrast.

CD36 and proteoglycan-mediated pathways for (n-3) fatty acid enriched triglyceride-rich particle blood clearance in mouse models in vivo and in peritoneal macrophages in vitro

Because the mechanisms of (n-3) fatty acid-enriched triglyceride-rich particle [(n-3)-TGRP] uptake are not well characterized, we questioned whether (n-3)-TGRP are removed via "nonclassical" pathways, e.g., pathways other than an LDL receptor and/or involving apolipoprotein E (apoE). Chylomicron-sized model (n-3)-TGRP labeled with [3H]cholesteryl ether were injected into wild-type (WT) and CD36 knockout (CD36-/-) mice at low, nonsaturating and high, saturating doses. Blood clearance of (n-3)-TGRP was determined by calculating fractional catabolic rates. At saturating doses, blood clearance of (n-3)-TGRP was slower in CD36-/- mice relative to WT mice, suggesting that in part CD36 contributes to (n-3)-TGRP uptake. To further examine the potential nonclassical clearance pathways, peritoneal-elicited macrophages from WT and CD36-/- mice were incubated with (n-3)-TGRP in the presence of apoE, lactoferrin, and/or sodium chlorate. Cellular (n-3)-TGRP uptake was measured to test the roles of apoE-mediated pathways and/or proteoglycans. ApoE-mediated pathways compensated in part for defective (n-3)-TGRP uptake in CD36-/- cells. Lactoferrin decreased (n-3)-TGRP uptake in the presence of apoE. Inhibition of cell proteoglycan synthesis by chlorate reduced (n-3)-TGRP uptake in both groups of macrophages, and chlorate effects were independent of apoE. We conclude that although CD36 is involved, it is not the primary contributor to the blood clearance of (n-3)-TGRP. The removal of (n-3)-TGRP likely relies more on nonclassical pathways, such as proteoglycan-mediated pathways.

Fatty acid supplied as triglyceride regulates SRE-mediated gene expression as efficiently as free fatty acids

Sterol regulatory element binding proteins (SREBPs) are key transcription proteins that bind to sterol regulatory elements (SRE) of genes essential for cellular cholesterol and fatty acid homeostasis. Polyunsaturated fatty acids (PUFA) strongly inhibit SREBP processing at post-transcriptional levels. We questioned if delivering PUFA as part of a triglyceride (TG) molecule would have similar effects and efficiency as free non-esterified PUFA. CHO cells stably transfected with an SRE-promoter linked to the luciferase reporter gene were incubated for 8-24 h with linoleic acid (LA) complexed to BSA (molar ratios 0.5-4:1), VLDL-sized trilinolein emulsions (TL, 25-200 microg/ml), and chylomicron-sized soy oil emulsions in the presence and absence of apoE. Effects of LA and TL on decreasing SRE-luciferase activity were similar and dose and time dependent. Both TL and LA significantly and rapidly (<or=2-12 h) reduced SRE-mediated gene expression by up to 75%. At equal fatty acid concentrations, SRE inhibition by TL was as effective as LA. ApoE addition increased inhibition by TL. Inhibition of gene expression was highly correlated to cell TG accumulation. We conclude that TG like fatty acids are rapid and efficient modulators of SRE-mediated gene expression.

Comparisons of a chicken-based formula with soy-based formula in infants with cow milk allergy

OBJECTIVE

To determine whether chicken-based formula can replace soy-based formula in infants with cow milk allergy.

SUBJECTS AND METHODS

Thirty-eight infants with cow's milk allergy, aged between 2-24 months of age were randomized to receive either chicken-based formula or soy-based formula for 14 days.

RESULTS

In the group of soy-based formula, 12 out of 18 infants had evidence of intolerance and could not continue with the formula. However, only 4 out of 20 infants in the chicken-based formula group had evidence of clinical intolerance. All other 16 infants were fed the chicken-based formula with success. The number of infants who were intolerant to chicken formula was significantly lower than the number of those fed soy-based formula (p = 0.009).

CONCLUSION

Chicken-based formula can be used more effectively than soy-based formula in infants with cow milk allergy.

Fructose malabsorption in Thai adult

Fructose malabsorption has not been well-defined in Thai populations but there has been increasing consumption of fructose-fortified drinks.

OBJECTIVES

To assess the incidence of fructose malabsorption and intolerance in Thai normal subjects as well as the facilitating effect of glucose on fructose absorption.

METHODS

Twenty-five gram of fructose was ingested by 77 subjects (37 men, 40 women; mean age 26 and 31 y, range 20-50 y and 21-50 y for men and women, respectively). Measurement of breath-H(2) levels after fructose ingestion in each subject up to 2 h was performed. Those who showed fructose malabsorption were later given 25 g of each glucose and fructose and second tests of breath-H(2) tests were done.

RESULTS

Fructose malabsorption was found in eleven females with a significant rise in average breath-H(2) level at 30, 60, 90, and 120 min (p< 0.001), whereas none of the males had an abnormal breath-H(2) test. Only 1 of the 11 females with increased breath H(2) had gastrointestinal symptoms. In all the fructose malabsorbers, excess breath-H(2) reverted to normal when the fructose solution was mixed and administered with 25 g glucose (p< 0.001).

CONCLUSION

The incidence rate of fructose malabsorption was 11 of 77 subjects but these were female. One of the 11 had gastrointestinal symptoms. It was found that an equal amount of glucose would abolish fructose malabsorption.

Relative risks of becoming overweight and obese in children after 6 years in secondary school

The authors carried out a longitudinal study of bodyweights of secondary-school children from Grade VII to Grade XII. Initial data of weight for height at Grade VII showed that the prevalences of overweight boys and girls were 13.6% and 9.9% and of obesity of boys and girls 26.8% and 13.5%, respectively. However, when these children were at Grade XII the prevalences of overweight of boys and girls were 14.0% and 10.5% and of obesity of boys and girls were 15.0% and 10.8%, respectively. The relative risks of becoming overweight of boys and girls at Grade XII who were already overweight at Grade VII were 1.5 and 4.0 respectively, and the relative risks of obesity in boys and girls at Grade XII who were already obese at Grade VII were 1.4 and 4.6, respectively. The present study showed that without any nutritional intervention those children, especially girls who were overweight and obese were more likely to maintain their bodyweights throughout the 6-year period in secondary school.

Lactose intolerance in Thai adults

Lactose intolerance is common in Thai adults who ingest cow's milk but its incidence has not been clearly defined The authors evaluated 45 volunteers (15 males, 35 females), aged 21-31 yrs old, who drank one 240-ml box of milk daily. A Lactose tolerance test was performed using a breath-hydrogen test (BHT) after oral intake of 25 g of lactose dissolved in 250 ml of water The presence of gastrointestinal symptoms of lactose intolerance, flatulence, abdominal pain and diarrhea, were recorded Twenty-one subjects (47%) were categorized as lactose malabsorbers and intolerant, two subjects (4%) were malabsorbers but tolerant, and 22 of 45 (49%) were absorbers and tolerant. The incidence of lactose malabsorption was, thus, 51%; symptoms of intolerance were found in 21 of the 23 malabsorbers, making the incidence of lactose intolerance 47%. In the lactose malabsorbant and intolerant group, the more breath-hydrogen (H) the more symptoms observed All subjects who had a negative breath-H2 test had no symptoms. The breath-H2 test should be used as a standard method to evaluate lactose absorption and lactose tolerance. The incidence of lactose intolerance has decreased from the past and the symptoms are not so severe that the people limit the consumption of milk since it is a major source of food containing good quality of protein and calcium.

High plasma branched-chain amino acids:aromatic amino acids ratio in children on the ketogenic diet: a mechanism in controlling epilepsy

BACKGROUND

The authors proposed that ketogenic diets will produce an increase in the ratio of branched chain amino acids (BCAAs) and aromatic amino acids (BCAAs) in plasma of children who are on the diets.

SUBJECTS AND METHOD

A sample of plasma amino acids sample before initiation of fasting and on day 10 of the dietary treatment was obtained in patients with refractory epilepsy who were newly admitted for initiation of ketogenic diet. Plasma amino acids were determined by high performance liquid chromatography equipment.

RESULTS

There are 20 patients with refractory epilepsy participating in this study. Outcomes of ketogenic diet therapy were satisfactory. Nineteen cases out of 20 cases had a significantly higher ratio of plasma BCAAs:ARAAs during ketogenic diets than before the diet (P < 0.001).

CONCLUSION

The ketogenic diets produced an increased ratio of plasma BCAAs:ARAAs. Whether the increased ratio of plasma BCAAs:ARAAs plays an important role in controlling epilepsy is yet to be elucidated.

Prevention of antibiotic-associated diarrhea in infants by probiotics

Probiotics administration has been claimed to prevent antibiotic-associated diarrhea. The investigators thus conducted a double blind, placebo controlled study of providing probiotics to infants and children with severe bacterial infections and receiving broad spechum antibiotics. The results of the study showed that the group receiving probiotics had fewer diarrheal episodes (37.5%) than the control group (80%), although the numbers were too small for statistical analysis. In conclusion, probiotics administration to patients receiving high doses of broad spectrum antibiotics may prevent the occurrence of antibiotic-associated diarrhea. A further study with a larger number is required.

Comparison of the nutrient content of fresh fruit juices vs commercial fruit juices

OBJECTIVE

To compare the types and quantities of carbohydrate, electrolytes, pH and osmolarity of fresh fruit juices and commercial fruit juices.

MATERIAL AND METHOD

Forty kinds of fresh fruits available in Thai markets were analyzed for types and quantities of carbohydrate, electrolyte, pH and osmolarity and compared with previously obtained data for commercial fruit juices.

RESULTS

Most fresh fruit juices did not contain sucrose, whereas, commercial fruit juices mostly have sucrose in the range of 3-112 g/L. Although both fruit juices were acidic (pH varied from 3.6-6.7 and 3.2-5.8 of fresh juice and commercial juice), fresh fruit juices had a more neutral pH than commercial fruit juices. Apple, guava, orange, pear, and pineapple juices from commercial fruit juices had a high osmolarity compared with fresh fruit juices. All types of fresh fruit juices contained less sodium than commercial ones, whereas, most fresh fruit juices contained more potassium, phosphorus, and magnesium than commercial fluids.

CONCLUSION

The nutrient content of fresh fruit juices and commercial fruit juices from the same kinds of fruits are not the same, possibly due to the manufacturing process. Therefore, physicians should know the composition of fruit juices in order to advise patients properly.