Evaluation of microcomputer nutritional teaching games in 1,876 children at school

OBJECTIVE

We evaluated in a prospective study microcomputer nutritional teaching games and their contribution to the children's acquisition of nutritional knowledge and improvement of eating habits.

MATERIAL AND METHODS

One thousand eight hundred seventy-six children aged 7-12 years took part in this study at school. All 16 schools of the same school district were randomized into two groups: games group and control group, both receiving conventional nutritional teaching by their teachers. The children in the games group played computer games during the conventional nutritional teaching period (2 hours a week for 5 weeks). At completion of the study, dietetic knowledge and dietary records were evaluated in both groups.

RESULTS

Dietary knowledge tests results were better in the games group (p<0.001). The children in the games group had a significantly better balanced diet for an energy intake of about 1900 kilocalories: more carbohydrate (46.4 +/- 0.2% vs 45.7 +/- 0.2%, p<0.05), less fat (37.1 +/- 0.1% vs 37.6 +/- 0.2%, p<0.05), less protein (16.5 +/- 0.1% vs 16.7 +/- 0.1%, p<0.05), less saccharose (11.5 +/- 0.1% vs 12.2 +/- 0.2%, p<0.001), more calcium (p<0.001) and more fiber (p<0.05). The games group had a better snack at 10 a.m., a less copious lunch and less nibbling (p<0.001).

CONCLUSION

The children in the games group had slightly but significantly better nutritional knowledge and dietary intake compared to children in the control group. Using our micro computer nutritional teaching games at school provides an additional and modern support to conventional teaching.

Factors associated with glycemic control. A cross-sectional nationwide study in 2,579 French children with type 1 diabetes. The French Pediatric Diabetes Group

OBJECTIVE

To determine on a large scale the multiple medical and nonmedical factors that influence glycemic control in the general population of children with diabetes, we performed a nationwide French cross-sectional study.

RESEARCH DESIGN AND METHODS

We enrolled 2,579 patients aged 1-19 years with type 1 diabetes of > 1 year's duration. The study was center based: 270 centers were identified, 206 agreed to participate, and 147 included at least 90% of their patients. Questionnaires were completed by physicians interviewing patients and family, and HbA1c measurements were centralized. To identify explanatory variables for HbA1c level and frequency of severe hypoglycemia, we performed multiple regression analysis using all the quantitative variables collected and stepwise logistic regression for the qualitative variables.

RESULTS

Mean HbA1c value for the whole population was 8.97 +/- 1.98% (normal 4.7 +/- 0.7% [SD]). Only 19 children (0.7%) had ketoacidosis during the 6 months before the study, whereas 593 severe hypoglycemia events occurred in 338 children (13.8%). Control was better in university-affiliated hospitals and centers following > 50 patients, reflecting the importance of access to experienced diabetologists. Children had a mean of 2.3 injections, allegedly performed 2.8 glucose measurements per day, and were seen an average of 4.6 times per year at the center. In the multiple regression analysis, 94% of the variance of HbA1c was explained by our pool of selected variables, with the highest regression coefficient between HbA1c and age (Rc = 0.43, P < 0.0001), then with daily insulin dosage per kilogram (Rc = 0.28, P < 0.0001), mother's age (Rc = 0.26, P < 0.0001), frequency of glucose measurements (Rc = 0.21, P < 0.0001), and diabetes duration (Rc = 0.14, P < 0.0001). Logistic regression identified quality of family support and dietary compliance, two related qualitative and possibly subjective variables, as additional explanatory determinants of HbA1c. The frequency of severe hypoglycemia was 45 per 100 patient-years and correlated with diabetes duration, but not with HbA1c levels or other variables.

CONCLUSIONS

Although overall results remain unsatisfactory, 33% of studied French children with type 1 diabetes had HbA1c < 8%, the value obtained in Diabetes Control and Complications Trial adolescents treated intensively. Diabetes management in specialized centers should be encouraged.

Fatty acid composition of adipocyte membrane phospholipids and stored triglycerides in infants receiving total parenteral nutrition

Fatty acid (FA) composition of membrane phospholipids (PL) and stored triglycerides (TG) from adipose tissue was studied in eight infants aged 1 to 4 months receiving total parenteral nutrition (TPN) since birth. During this period, essential fatty acid (EFA) intake consisted exclusively of soybean oil emulsion administered by intravenous route (Intralipid 20%) representing 301 +/- 88 mg/kg/24 hr of linoleic acid and 58 +/- 18 mg/kg/24 hr of alpha-linolenic acid, or 2.3 +/- 0.6% and 0.4 +/- 0.1%, respectively, of total energy intake. The results were compared with those of eight control infants of the same age receiving orally a normal milk diet with an intake of 660 +/- 260 mg/kg/24 hr of linoleic acid and 101 +/- 35 mg/kg/24 hr of alpha-linolenic acid, or 4.5 +/- 0.7% and 0.7 +/- 0.3%, respectively, of total energy intake. Although their EFA intake was significantly lower (p less than 0.01) and administered only parenterally, after 1 to 4 months the infants receiving TPN still had a membrane phospholipid FA pattern of adipose tissue which was not significantly different from that of normal children of the same age. In stored adipocyte TG, the percentage of linoleic acid was significantly lower (p less than 0.01) in infants receiving TPN. This is probably of nutritional importance as at this stage of life the child builds up its stores of EFA. The proportion of the other fatty acids in adipocyte TG was not significantly modified.

[Influence of oral taurine supplementation on the intraduodenal concentration and conjugation of bile acids in full-term newborn infants]

We studied the effects of oral taurine supplementation on bile acids conjugation and duodenal bile salt concentrations in infants. Seventeen infants receiving enteral artificial nutrition were investigated. At the beginning of the study they were 6 to 14 weeks old, in good nutritional state, without malabsorption, protein-losing enteropathy and liver or infectious diseases. After at least 8 days of a stable, taurine-free regimen the infants received oral taurine supplementation (36-45 micromol/kg.24 h) for 8 days. Bile acids were measured before and after each supplementation period in bile samples obtained by duodenal tubing, using enzymatic methods and colorimetry. According to the initial plasma taurine levels before supplementation, the infants were divided into two groups: I) plasma taurine levels less than 60 mumol/l (mean 47 +/-5 mumol/l, n = 8); II) plasma taurine levels greater than 70 mumol/l (mean 77 +/- 2 mumol/l, = 9). After 8 days of taurine supplementation a significant increase of plasma and urinary taurine (P less than 0.01),total duodenal bile salt concentrations (P less than 0.05), total duodenal tauroconjugates (P less than 0.05),taurocholate (P less than 0.01), taurochenodeoxycholate (P less than 0.05), and glycocholate (P less than 0.01), duodenal concentrations, and a significant decrease of the glycoconjugate/tauroconjugate ratio (P less than 0.05), were observed, but only in group I. in group II infants we only noted a significant increase of urinary taurine (P less than 0.01), and of duodenal total tauroconjugates (P less than 0.05). This study shows that the biliary effects of an oral taurine supplementation depends on taurine status and that in taurine-depleted infants intakes of exogenous taurine higher than 45 mumol/kg. 24 h are perhaps necessary for optimal bile salt effects.

Metabolic utilization of linoleic acid from fat emulsion in infants during total parenteral nutrition

The metabolic utilization of linoleic acid (C18:2w6) from intravenous (iv) soybean oil emulsion via its conversion to higher homologues and prostaglandin biosynthesis was studied in 21 infants. The infants were of normal birth weight, in good clinical and metabolic condition, and aged from 1-4 months. They all received total parenteral nutrition after birth for more than 1 month; the only lipid was provided by iv Intralipid 20%, at levels approximating 350 mg/kg/24 h of linoleic acid (2.5% of the infants' total daily energy intake). Study of the fatty acids of plasma and erythrocyte phospholipids in these infants, compared to healthy controls of the same age (N = 26), showed that 350 mg/kg/24 hr of C18:2w6 supply resulted in normalization of erythrocyte phospholipid fatty acid distribution. This was particularly true of the higher homologues of C18:2w6 (C18:3w6, C20:3w6, and C20:4w6). This suggested that delta 6 and delta 5 desaturation activities are normal in these conditions with this C18:2w6 supply. These results were confirmed by the study of 24-hr urinary excretion of prostaglandins PGE1 and PGE2. With 350 mg/kg/24 hr of C18:2w6 supply their urinary levels were not significantly different from those observed in normal children of the same age receiving an equivalent oral C18:2w6 intake.

[Distribution of expenses (personnel, consumption, procedures) in a pediatric unit in a university hospital center]

A study has been undertaken in a unit of pediatric gastroenterology and nutrition. The unit also deals with general pediatric emergencies. The purpose of this study was to calculate the cost of hospitalization and the distribution of the cost between the different components: personnel expenses (medical and non-medical staff), cost of products used (enteral and parenteral nutrition included), cost of medicotechnical intervention. The study was carried out over a period of 28 days and included 117 hospitalized children. Only the expenses directly linked to the patient's care were taken into account. The exact time spent with each patient by every category of staff, the quantity of products and the treatment given had to be carefully recorded. The results reveal the share of the cost which goes to non-medical staff (about 60%), except when pathological cases need frequent and detailed investigations. Once the budget has been determined, department heads are required to play administrative role and this study underlines the process of cost build-up and thus enables a selective intervention in one sector or another of hospital expenses.

Plasma phospholipid fatty acids and urinary excretion of prostaglandins PGE1 and PGE2 in infants during total parenteral nutrition, with continuous or sequential administration of fat emulsion

During total parenteral nutrition, using an identical supply of fat emulsion (350 mg/kg/24 hr) to correct essential fatty acid deficiency in children, the efficacy of two methods of administration was studied: continuous over 24 hr, or discontinuous 3 hr/day. At the beginning of the study, all the infants (1-4 months old) had proven essential fatty acid deficiency. After at least 1 month of one of the two nutritional protocols (continuous or discontinuous), plasma phospholipid fatty acid composition and PGE1 and PGE2 urinary excretion were measured. The results obtained indicate better utilization of the fat emulsion when it is administered almost every day, in continuous infusion over 24 hr (1 g/kg/24 hr of Intralipid 20%).