Oral choline supplementation in children with intestinal failure.

Choline deficiency leads to steatohepatitis, elevated transaminases, susceptibility to septic shock, and an increased risk of central catheter thrombosis. Children with intestinal failure (IF) are at risk for choline deficiency. In an unblinded, open-label study, we studied 7 children with IF on parenteral nutrition, measured their plasma free choline level, and, if low, supplemented enterally with adequate intake (AI) doses of choline. Four to 6 weeks later we remeasured their plasma free choline. Unlike adults, infants did not respond to oral choline supplementation at AI doses. Additionally, we have calculated plasma free choline percentiles versus age for normal children.

High prevalence of overweight and obesity in homeless Baltimore children and their caregivers: a pilot study.

CONTEXT: In the past, nutritional deficiencies were common among homeless families. Because obesity is currently a major public health issue in the United States, it is possible that obesity has supplanted nutritional deficiencies as the "new malnutrition" of the homeless. OBJECTIVE: To perform a pilot study to determine the nutritional status of homeless caregivers and their children in the Baltimore City, Maryland. DESIGN: Determination of weight, height, and body mass index (BMI) (weight in kg/height in m2) of all subjects and correlation with demographic variables. SETTING: Six homeless shelters and transitional houses in Baltimore City. PATIENTS: Thirty-one caregivers and 60 children. MAIN OUTCOME MEASURES: Relationship between caregiver BMI and child BMI and comparison of our data to National Health and Nutrition Examination Survey (NHANES) norms. RESULTS: Forty-two percent of the children (25 of 60) had a BMI-for-age classifying them as at risk for overweight (18%) or overweight (23%). None were underweight. One hundred percent of girls and 88% of boys under age 7 years were in the normal range for BMI. There were no caregivers in the underweight range for BMI. Seventy-seven percent were either overweight (26%) or obese (51%). When the weight categories of the largely African-American homeless Baltimore caregivers and their children were compared with national data from NHANES 1999-2002 for both African-American poor and nonpoor adult females and children, the Baltimore subjects had the lowest proportion in the healthy range and the highest proportion in the obese (adults) and overweight (children) categories. Caregiver BMI correlated with child BMI: r = 0.43, P = .0002. CONCLUSION: Our data suggest that overweight and obesity are the major forms of malnutrition in homeless families.