The effects of birth weight and postnatal linear growth retardation on blood pressure at age 11-12 years

STUDY OBJECTIVE: To determine the effects of birth weight and linear growth retardation (stunting) in early childhood on blood pressure at age 11-12 years. DESIGN: Prospective cohort study. SETTING: Kingston, Jamaica. Participants: 112 stunted children (height for age < -2 SD of the NCHS references) and 189 non-stunted children (height for age > -1 SD), identified at age 9-24 months by a survey of poor neighbourhoods in Kingston. MAIN RESULTS: Current weight was the strongest predictor of systolic blood pressure (beta= 4.90 mm Hg/SD weight 95 percent CI 3.97, 5.83). Birth weight predicted systolic blood pressure (beta= -1.28 mm Hg/SD change in birth weight, 95 percent CI -2.17, -0.38) after adjustment for current weight. There was a significant negative interaction between stunting in early childhood and current weight indicating a larger effect of increased current weight in children who experienced linear growth retardation in early childhood. There was no interaction between birth weight and current weight. The increase in blood pressure from age 7 to age 11-12 was greater in children with higher weigth at age 11-12 and less in children with higher birth weight and weight at age 7. CONCLUSIONS: Birth weight predicted systolic blood pressure in Jamaican children aged 11-12. Postnatal growth retardation may potentiate the relation between current weight and blood pressure. Greater weight gain between ages 7 and 11 was associated with a greater increase in systolic blood pressure. The relation between growth and later blood pressure is complex and has prenatal and postnatal components. (AU)

Rapid weight gain and benign intracranial hypertension in an AIDS patient on treatment with highly active anti-retroviral therapy (HAART)

We present the case of a 30 year old woman with HIV/AIDS who experienced a 47 percent weight gain over a period of a year after commencing treatment with highly active anti-retroviral therapy (HAART) and went on to develop benign intracranial hypertension (BIH). She was not on any other medication associated with BIH. Although weight gain has been reported in patients on treatment with protease inhibitors, such gains have been minimal to moderate. We are unaware of any previous report of this degree of weight gain or BIH in a patient on protease inhibitors.(Au)

Breast-feeding and weight change in newborns in Jamaica

This study was conducted to examine weight change of breast-fed infants during the first week and through the first 24 days of life, and to evaluate the effect of breast-feeding factors and maternal characteristics on early weight change in infants. The weights of 21 infants were recorded on day 1 (day of birth), and on days 3, 7, 10, 17, and 24, and the data analysed to evaluate weight change over the period. Multiple regression analysis was used to assess whether birth weight as well as maternal and breast-feeding factors were significant predictors of weight on day 24. Nineteen of the 21 infants gained weight between days 1 and 3, and 20 infants gained weight between days 3 and 7. All infants gained weight over the 24-day period and their weights at day 7 and day 24 were significantly different (P <0.05 and P <0.01, respectively) from their birth weights. Multiple linear regression analysis showed that significant (P < 0.01) predictors of weight gain by day 24 included birth weight, mother's educational level, whether the baby cried before feeding, and length of feeding time periods. This is the first study of weight change in the early days and weeks of life of exclusively breast-fed newborn infants in Jamaica. The infants showed significant weight gain during the study period and weight gain was affected by certain maternal and breast-feeding factors. (AU)

High prevalence of obesity in Curacao: data from an interview survey stratified for socio-economic status - abstract

The aim of this paper is to report the prevalence of obesity and abdominal fatness in different socioeconomic classes in Curacao. In 1993/1994 a health interview survey (the Curacao Health Study) was carried out among a random sample (n = 2248, response rate = 85 percent) of the adult non-institutionalized population of Curacao. We analyzed the association between body mass index (BMI) and socioeconomic status (SES) as well as the relationship between waist-hip ratio (WHR) and SES by logistic regression models for men and women separately. The overall prevalence of obesity among women peaked at age 46 to 55 years (OR 4.195 percent CI 2.6 - 6.6) and between 56 to 65 (OR 1.7 95 percent CI 1.0 - 3.1) years in men. Women of lower SES are approximately twice as much at risk of being obesed compared to women of higher SES (OR 2.4 95 percent CI 1.7 - 3.4) for the low SES group. The percentage of participants with an at risk WHR (cut off point 0.80 for women and 0.95 for men) is more than three times higher among women than among men (62.2 percent versus 20.4 percent). WHR increased significantly with age among both genders. Compared to women of higher SES, the lower SES women have a three times higher risk of a WHR exceeding th cut off point (OR 3.0 95 percent CI 2.0 - 4.5). The overall prevalence of obesity was much higher than in Spain, Brazil and the Netherlands. The high prevalence of obesity in Curacao justifies action and research on the prevention of obesity in Curacao. (AU)

Cross-cultural differences in maternal evaluation of children's body shapes

OBJECTIVE: This study investigated cultural variation in mothers attitudes to children's body shape. METHOD: One hundred and thirty-one mothers from five cultural groups attending a pediatric clinic were approached, and data obtained from 114. Background information was obtained, including weight and height for themselves and their children. Mothers completed the Eating Attitudes Test (EAT-26) and rated drawings of children for attractiveness and health, using Likert scales, scored 1-7. RESULTS: Mothers from the different cultural groups and their children had similar average body weight. However, UK mothers found slimmer girls attractive compared to mothers from South Asia, the Mediterranean or the Caribbean regions, and sub-Saharan Africa (P<.05). The differences occurred within the mid-range (median scores for all ethnic groups 4-5). South Asian mothers presented to the pediatric clinic with more worries about their children not gaining weight and growth (p>.01). DISCUSSION: These findings have implications for understanding cultural variation in the acquisition of attitudes to body shape, and these attitudes influence medical seeking help (AU).

Nutrition supplementation in patients with HIV infection

OBJECTIVE: To evaluate the use of high-energy, high protein, oral, liquid, nutrition supplementation and nutrition counselling on the weight status of patients infected with the human immuno-deficiency virus (HIV) with and without secondary infections. DESIGN: prospective, descriptive, intervention trial. Follow-up clinic visits were scheduled every 1 to 3 weeks for at least 6 weeks to monitor weight, gastrointestinal symptoms, number of supplements consumed, and incidence of secondary infections. SUBJECTS/SETTING: community-based, HIV-infected patients, with and without acquired immunodeficiency syndrome (AIDS) defining illness, who were receiving outpatient medical care at Deaconess Hospital, 17 patients were evaluated. INTERVENTION: dietary counselling consisted of recommendations to consume a high protein diet (1.5 g/kg ideal body weight); select foods that minimize gastrointestinal complications; and at least one high-energy, high-protein, oral, liquid, nutrition supplement daily. MAIN OUTCOME MEASURES: Energy intake from the supplements and weight change over time in relation to whether a secondary infection occurred. STATISTICAL ANALYSIS: Means, standard deviations, and frequency. RESULTS: At the time of entry to the study, the patients with pre-existing weight loss (16 of 17) were 14 ñ 8 percent below their usual body weight. On average, patients consumed 11 ñ 4 supplements per week for 6 ñ 3 weeks. The majority (12 out of 17) were able to gain or maintain weight. Overall weight gain was 1.1 ñ 2.2 kg. Only 5 of 17 patients lost weight, 4 of whom developed a secondary infection during the study (i.e, after enrollment in the study). All of those who developed a secondary infection were classified as having AIDS and had lower mean CD4 counts at baseline than those who did not develop a secondary infection. Although those who developed a secondary infection had a higher incidence of weight loss, their consumption of oral supplements per week was greater than that of those without a secondary infection. APPLICATIONS/CONCLUSIONS: In patients with HIV infection and in the early stages of AIDS without a secondary infection, weight gain and/or maintenance was achieved with a high-energy, high-protein, oral, liquid, nutrition supplement in conjunction with nutrition counselling. The majority of patients who developed a secondary infection, however, lost weight despite the use of supplements and counselling (AU)

The management of severe obesity: an alternative approach - abstract

At least a quarter of the total adult population is overweight and even more could be considered clinically obese. Particularly in the case of severe or morbid obesity, with its major attendant health risks and problems, medical management has been inadequate and grossly unsatisfactory. A new and alternative approach to the management of obesity involves the process of Thermogenesis. Thermogenesis refers to the body's ability to produce heat from consumed and stored calories. More specifically it refers to thermogenesis in brown adipose tissue (B.A.T.), an organ specializing in turning calories into heat. A number of drugs have thermogenesis stimulating properties, but their side effect profiles have made them unsuitable for clinical use. A combination of phytochemicals (herbal substances) have been found to be effective and safe in the treatment of obesity by modifying the thermojetic response. The mechanisim of action of these substances and their clinical application are presented along with a few case histories to demonstrate their use (AU)

Community based, effective, low cost approach to the treatment of severe malnutrition in rural Jamaica

Moderate and severe malnutrition are endemic in much of the developing world and in association with pockets of deprivation in the developed world. The cost in terms of individual and social development is high. The principles of effective management are clearly documented. A low cost, community based treatment programme for moderately and severely malnourished children under three years of age was established at a health center in rural Jamaica. Children were followed up monthly and defaulters were rigorously recalled. Management consisted of carefully delivered dietary advice, antibiotics, anthelminthics and vitamin supplements. All children improved and the response of 36 children, who were treated in the first year, showed an accelerated weight gain. There was a significant increase in the weight for age, at 1.9 percent per month over six months, which exceeds the rate reported with food supplementation programmes and nutrition rehabilitation centers. (AU)

Biological evaluation of protein quality of sorghum as affected by insect infestation

Protein quality of sorghum grains having 25, 50 and 75 percent infestation caused by mixed population of Trogoderma granarium Everts and Rhizopertha dominica Fabricius was biologically evaluated by rat growth and nitrogen balance studies. Feeding of diet containing insect infested sorghum grains (50 and 75 percent) resulted in marked decrease in food intake, protein intake, gain in body weight, food efficiency ratio, protein efficiency ratio, nitrogen consumption, nitrogen absorption, biological value, net protein utilization, dry matter digestibility, net protein retention and protein retention efficiency. These parameters showed negative association with insect infestation levels. However, 25 percent level of grain infestation did not affect these parameters significantly (AU)

Management of severe childhood malnutrition

In developing countries, severe childhood malnutrition arises most often against a background of socio-economic depriviation. Restriction in food intake, during the first two years of life when nutritional demands for growth are high is associated with faltering growth. Infection, poor nutrient intake and a hostile physical environment produce repeated episodes of faltering followed by poor catch up growth, and often leads to severe malnutrition. Therapy calls for vigorous treatment of infection and administration of feeds n graded amounts starting with maintenance requirements and subsequently feeding to appetite. Energy-dense feeds in the period of rapid weight gain shortens the recovery period by making possible faster rates of gain. Rehabilitation is complete when the child is eating a mixed diet appropriate for age, and the parents are comfortable with basic concepts of nutrition, hygiene and home economics. (Summary)

Effect of zinc on lean tissue synthesis during recovery from malnutrition

During recovery from severe wasting, malnourished children gain weight at greatly accelerated rates. To determine if additional zinc added to their basal therapeutic diets increased the retention of lean tissue and stimulated protein metabolism, we studied three groups of children taking either the basal diet alone or the basal diet supplemented with either 76 mumol (5 mg) or 153 mumol (10 mg) Zn/kg diet. The zinc-supplemented children gained similar weight and consumed the same amount of diet as the unsupplemented children. Zinc supplementation resulted in a greater net absorption of nitrogen and a higher rate of protein turnover, as estimated from urinary ammonia 15N enrichment after oral [15N] glycine. We conclude that additional zinc affected the composition of newly synthesized tissue and intermediary nitrogen metabolism (AU)

The effect of the level of dietary protein, carbohydrate and fat on urea kinetics in young children during rapid catch-up weight gain

The kinetics of urea metabolism were measured in children recovering from severe malnutrition. For a period of up to 10 d they receive one of four diets which provided 711 kj (170 kcal)/kg per d. Two groups received a diet with a high protein:energy (P:E) ratio of 10.6 percent (HP), enriched with either fat (HP/F) or maize starch and sucrose HP/C). Two groups received a diet with a low P:E ratio of 8.8 percent (LP), enriched with either fat (LP/F) or maize starch and sucrose (LP/C). The rate of weight gain on the HP diets was significsntly greater than on the LP diets. There was no difference in urea production between any of the four diets: HP/F 1.23 (se 0.12), HP/C 1.37 (se 0.14), LP/F 1.64 (se 0.22) LP/C 1.15 (se 0.15) mmol nitrogen/kg per h. On the HP diets urea excretion was 0.77 (se0.07) mmol N/kg per h, 61 percent of production. There was significantly less urea excreted in the urine on diet LP/C than on LP/F (0.36 (se0.05) and 0.64 (se 0.04)mmol N/kg per h respectively). A significantly greater percentage of the urea production was hydrolysed on the LP diets (61 percent) compared with the HP diets (39 percent), with the consequence that 50 percent of urea-N produced was available for synthetic activity on the LP diets compared with 30 percent on the HP diets. The increase in the urea hydrolysed on the LP diets was equivalent in magnitude to the decreased intake of N, so that overall intake plus hydrolysis did not differ between the LP and HP diets. Crude N balance was similiar on diets HP/F, HP/C and LP/C, but was significantly reduced on diet LP/F. These results show that there is an accommodation in urea kinetics during rapid catch-up weight gain, which becomes evident when the P:E ratio of 8.8 percent, protein is limiting for catch-up growth. When the intake has a P:E ratio of 8.8 percent the pattern of urea kinetics can be modified by the relative proportion of fat and carbohydrate in the diet. The measurement of urea kinetics provides a useful approach to the definition of the adequacy of the protein in the diet. (AU)

Changes in red cell insulin receptors during recovery from severe malnutrition

Red cell insulin binding was studied in 13 Jamaican children (age range 4-24 months), while malnourished (MAL), during early recovery (GI), late recovery (GII), and after anthropometric recovery (REC). The rate of weight gain (RW), the energy intake (EN), and the protein intake (PR) were monitored at each phase of the study. Four-hour fasting blood samples were used, and the insulin binding characteristics were investigated in the physiological range of insulin concentrations (16.7-1670 pM). Analyses of variance were used to examine differences in the variables measured at the four phases. Red cell-specific insulin binding (SB) was lower in MAL than in GI (P<0.001) and in (GII) (P=0.026). SB in REC and MAL were not significantly different. Insulin receptor affinity (K) was also lower in MAL than in GI (P<0.001), GII (P<0.001), and REC (P=0.012). The insulin receptor number (S) appeared to be high in malnutrition and to decrease as recovery progressed; however, the decrease was not significant. Children with fever demonstrated high insulin binding. Plasma insulin (IN) rose during recovery, and was significantly higher in GII than in MAL (P=0.01). There was no difference in plasma glucose (G) at any phase of the study. The interrelationships among the variables measured were investigated longitudinally using multiple regression analyses. SB was positively associated with S (P=0.032), EN (P=0.029), and PR (P=0.0076). S was negatively associated with K (P<0.001). The associations of S and K with PR were positive and approached significance (P = 0.09 and P = 0.07 respectively). RW was positively associated with PR (P<0.001), and with EN (P=0.001). There were no significant relationships between G and any of the other variables longitudinally. However, correlations of the variables within phases demonstrated that in MAL, G was negatively associated with SB (P<0.05) and with K (P<0.05); but in REC, G was positively associated with SB (P<0.05). These results demonstrated that in severe malnutrition, the red cell insulin receptor affinity was low. During catch-up growth when protein and energy intakes were increased, both insulin receptor affinity and specific insulin binding were also increased. The negative relationship between insulin binding and plasma glucose during malnutrition may be related to carbohydrate intolerance (AU)

Evaluation of a diet for use in the rehabilitation of severely malnourished children

The recovery diet used at the Tropical Metabolism Research Unit, although correcting some of the abnormalities associated with malnutrition, has for several years been known to be unsuitable for this purpose. The standard regime is deficient in several vitamins, minerals, trace elements and even water; rehabilitation on this diet results in some abnormalities in blood biochemistry and an inadequate rate of lean tissue deposition with an excessive accumulation of adipose tissue. In addition, the preparation and dispensation of the feeds is difficult as several additions have to be made. The need was therefore seen for a diet which would contain the nutrients lacking in the standard regimen, promote rapid growth of normal composition, and which could be easily prepared and dispensed. The test diet proposed for this purpose was fed to eight severely malnourished children throughout recovery, and the data collected were compared with that on several children previously recovered on the standard regimen. The results showed that although the test diet, MGM, was of a lower energy density than the standard diet, the energy intake was similar on both diets. The test children therefore compensated for the reduced energy density by increasing their volume of intake. Blood biochemistry of the children on the test diet was found to improve. They experienced no additional oxidant stress and their antioxidant status improved. Plasma concentrations of the trace elements zinc, copper and selenium increased during the period of rehabilitation. Recovery on the test diet resulted in a weight and height gain, cost of growth and rate of weight gain similar to that on the standard diet. The diet was found to be well absorbed, and the biochemistry of the blood improved. Other advantages are: the feeds are easily prepared, as all nutrients, vitamins and minerals are contained in the milk powder, and it is necessary only to add water. The risk of errors which are sometimes introduced due to weighing is therefore minimized. Energy content of the feed is 100 kcal/100g, thus providing for ease in calculation of prescribed intake, and energy content of feed taken. The test diet was found to be an improvement over the existing ward regimen, and with its easy preparation and dispensation was found to be suitable for use in hospitals, rehabilitation centres, and for rehabilitation in the home (AU)

The relationship of red cell insulin binding to rate of weight gain during recovery from malnutrition - abstract

Chronic nutrient inadequacy, as exemplified by marasmus and kwashiorkor provides a model for insulin-binding studies. Red cell insulin receptors were studies in infants (age range 4 to 24 months) whilst malnourished and at 3 different stages of anthropometric recovery (60-84, 85-95, and 96-110 percent weight-for-height (EWH)). Four-hour fasting blood samples (3 ml) were used. Washed red cells (concentration 0.75 - 1.5x10 Esp 9/ml) were incubated at 15§C for 180 min in the presence of a constant amount of tracer (A[14] - I[125] - insulin, 16.6 - 1680 pM, 7 different concentrations). Non-specific binding was assessed by the radioactive insulin bound in 10,000 x the physiological range of insulin concentration. From the competitive binding curve, total binding, affinity and number of receptor sites were calculated by Scatchard analysis. Specific insulin-binding was expressed as the per cent of total A[14] -I[125]-insulin added at a cell concentration of 4x10Exp9/ml. Red cell specific insulin-binding (SB) in malnutrition (rate of weight change, (RWC) - 2.05ñ1.9 (10) g/kg/d) was 4.2ñ0.8 (12) percent. This was significantly less than at all three phases of recovery (p<0.01). At 60-84 percent EWH(RWC ñ 11.7ñ0.9 (20)), SB was 8.6ñ1.2 (20) percent: at 96 -110 percent EWH (RWC ñ 0.95ñ1.1 (11)), SB was 8.8ñ1.4 (11) percent. A significantly (p<0.01) lower affinity of insulin for its receptor was shown in malnutrition, 0.9ñ0.2 (12) (Kx10Exp-8 M) than at other phases of recovery, 1.8ñ0.1 (24), 1.6ñ0.2 (20), and 1.4ñ0.4 (11) respectively. There were no significant changes in the number of receptor sites during malnutrition or during the catch-up growth phases. There was a highly significant positive correlation between rate of weight change and specific insulin-binding, (r= 0.45, p<0.0001 (67) as compared with plasma insulin concentration (r=0.33, p<0.01). Specific insulin-binding was also significantly correlated with the affinity of insulin for its receptor 9 r=0.28) p<0.05 (67)). Preliminary Results suggest that decreased protein, but not the carbohydrate or fat content of the diet, was associated with reduced insulin receptor affinity. Chronic nutritional inadequacy alters the affinity of the red cell receptor for insulin, leading to decreased binding, and this is quickly reversed early in rehabilitation. Decreased insulin-binding may be related to the carbohydrate intolerance of severe malnutrition (AU)

Plasma zinc levels throughout pregnancy: a study in Jamaican women, with relevant aspects of nutrition

In a prospective study plasma zinc levels were determined by atomic absorption spectrophotometry in 135 Jamaican women over a two year period. A total of 1237 such determinations were made at fixed intervals throughout pregnancy. Each patient was investigated at 15, 20, 25, 30, 35 and 38 weeks gestation, in labour, and once in the early and in the late puerperium. Zinc being an essential trace element with a wide physiological role in many aspects of metabolism, supplementary studies on the relationship between zinc, folic acid, vitamin A, dietary intake in general, taste acuity and weight gain in pregnancy were undertaken. Results show that plasma zinc levels are lowered during pregnancy, moreso during the second trimester. The levels rise significantly during labour and then fall rapidly towards normal during the puerperium. Daily dietary zinc intake was of the order of 8-10 mg/day (the RDA for pregnancy being 15 mg/day) while protein intake averaged 67 g/day (the RDA being 80-90 g/day). Average weight gain in pregnancy was 12 kg. Plasma vitamin A and red cell folate levels were within normal range in all patients, indicating that there was no state of zinc deficiency interfering with the absorption of these vitamins. Clinical observations and laboratory investigations revealed no signs of any dietary deficiency among the patients. Viewed together, all the facets of this study suggest that the pattern of fall of plasma zinc in pregnancy is a normal physiological change not related to socio-economic status, parity or age. It is concluded that the lowered plasma zinc observed in pregnancy does not reflect a state of true zinc deficiency nor even a state of inadequate dietary zinc intake; it is most likely due to the heavy demand for zinc in the developing fetal tissues and by the expanding maternal blood volume (AU)