Vitamin K in preterm breastmilk with maternal supplementation.

Six healthy lactating mothers who gave birth to preterm infants at a median post conceptional age of 29.5 (range 26-30) weeks were given 2.5 mg phylloquinone (vitamin K1) orally daily for 2 weeks beginning at a median postconceptional age of 31.5 (range 28-32) weeks. Phylloquinone was measured in the breastmilk daily for 14 d. Trough plasma phylloquinone concentrations were also determined on four occasions. Phylloquinone levels in the breastmilk increased from a baseline of 3 +/- 2.3 ng ml(-1) to 22.6 +/- 16.3 ng ml(-1) (mean +/- SD) after the first dose (p < 0.05); a gradual increase was noted until phylloquinone levels reached a plateau of 64.2 +/- 31.4 ng ml(-1) after the sixth daily dose.

Pharmacokinetics of tiaprofenic acid in normal rabbits and rabbits subjected to joint immobilisation.

In a previous study, tiaprofenic acid (TA) was administered daily over a 30-day period at 5 and 10 mg/kg of body weight subcutaneously (s.c.) to animals with arthritis induced by immobilisation. The 10 mg/kg dose exacerbated the loss of proteoglycan from joint cartilage but the 5 mg/kg dose showed protective effects on articular cartilage. These results led us to investigate the concentration of TA achieved in synovial fluid of both the immobilised and non-immobilised rabbit joints after single s.c. doses of 5 or 10 mg/kg. The half-lives of elimination of TA from the synovial fluids of the immobilised joints were 1.27 and 1.07 h after the 5 and 10 mg doses, respectively, and 0.66 and 0.39 h in the non-immobilised contralateral joints. Clearances from synovial fluid to plasma were found to be 0.41 and 0.55 ml/h/kg from the immobilised joints after the 5 and 10 mg doses, respectively, and 0.11 and 0.25 ml/h/kg from the non-immobilised contralateral joints. The peak concentration of TA achieved in synovial fluid of immobilised knee joints after a single s.c. injection of 10 mg/kg was approximately two times greater than the concentrations achieved after administration of 5 mg/kg by the same route and two to six times greater than the levels achieved after oral administration of TA at 600 mg/day in humans.

Digestibility of boiled and oven-dried cassava in infants and small children.

Boiled fresh cassava or oven-dried cassava flour provided 50% of the energy and less than 10% of the protein in diets of convalescent malnourished infants; casein was added to complete 8% of energy as protein, and vegetable oil (soybean-cottonseed) was added to make 20% of energy as fat. Despite high wet weights of feces (172 +/- 42 and 214 +/- 41 g/d), their dry weights (20 +/- 3 and 22 +/- 2 g/d) and their energy (6.9 +/- 0.7 and 7.6 +/- 0.5% of intake) and nitrogen (17 +/- 3 and 20 +/- 3% of intake) contents were low, and their fat content (4.4 +/- 1.3 and 5.2 +/- 1.2% of intake) was very low. Cassava is a surprisingly effective source of energy which interferes little or not at all with digestion of added protein and fat in weaning diets. For its safe use, it is important that home or industrial processing almost completely eliminate its potential hydrocyanic acid content, and that a good quality protein supplement be consumed regularly in nutritionally adequate amounts.

Relationship of train-of-four ratio to twitch depression during pancuronium-induced neuromuscular blockade.

The relationship of train-of-four (TOF) ratio to the depression of the first twitch (TD) was investigated in 16 patients given pancuronium in doses insufficient to eliminate the fourth response in the train. In ten patients the block was allowed to spontaneously recover (Group 1) and in six it was reversed with neostigmine (Group 2) once maximum depression of TOF ratio had occurred. Maximum depression of the first response occurred in 6.5 +/- 4.3 min (mean +/- SD). Maximum depression of the TOF ratio was not present until 28.0 +/- 11.0 min. TOF ratio was usually still decreasing when recovery of TD had begun. However, once the TOF ratio began to recover, the recovery rates for TD and TOF ratio were similar in both the spontaneously recovering and the reversed groups. TOF ratio at complete TD recovery was 74.9 +/- 15.7 and 86.2 +/- 15.4% for the two groups. A kinetic analysis yielded significantly different elimination rate constants for the two effects from the "effect compartment." These findings suggest that these two effects of pancuronium are exerted at different sites.

Digestibility and utilization of protein and energy from Nasha, a traditional Sudanese fermented sorghum weaning food.

Whole grain sorghum flour was fermented into Nasha, a traditional Sudanese food, and freeze-dried or drum-dried. It was cooked and fed to convalescent malnourished infants and small children as 61% of total diet calories and all of 6.4% protein calories, with (Lys+) and without lysine supplementation to 3% of protein. Apparent absorptions of nitrogen were 73 +/- 5 and 74 +/- 6% of intake, significantly (P less than 0.01) less than those from preceding (Cas-1, 86 +/- 3%) and following (Cas-2, 85 +/- 3%) isonitrogenous casein diets. Apparent retentions of nitrogen from Nasha (26 +/- 10%) were significantly lower than those from Lys + (34 +/- 9%, P less than 0.05), Cas-1 (35 +/- 11%, P less than 0.01) or Cas-2 (49 +/- 9%, P less than 0.01). Retentions from Cas-2 were higher than those from Cas-1 or Lys + (P less than 0.01). Fecal wet and dry weights were higher (P less than 0.02) during both Nasha diets and Cas-2 than during Cas-1. Fecal energy and carbohydrate were significantly (P less than 0.01) higher from either Nasha diet than from either casein diet; fecal fat was not different. Two children received drum-dried Nasha without further cooking; digestibilities were not different from those of the cooked product but biological value was much lower. When properly cooked and consumed along with small amounts of a good source of lysine, Nasha is a satisfactory weaning food.

The effect of decortication and extrusion on the digestibility of sorghum by preschool children.

The effect of decortication and extrusion on the apparent protein quality and digestibility of sorghum (S. vulgare) was evaluated in comparative balance studies in nine children 7-24 months of age. Sorghum provided (as kilocalories) 8% protein and 62% carbohydrate in the study diet. Lysine was supplemented to 3% of protein. Casein provided 6.4% protein kilocalories in the control diet. A mixture of sucrose, dextrimaltose and cornstarch provided carbohydrate. Both diets contained 30% fat kilocalories as soybean-cottonseed oil blend. Balance studies were carried out during the last 6 days of three 9-day dietary periods: control-sorghum-control. Apparent N absorption from sorghum was 81 +/- 4% and did not differ from control. Apparent N retention, 21 +/- 6%, was expectedly lower than the preceeding control (27 +/- 8%, P less than 0.05) and following control (33 +/- 7%, P less than 0.01) values. The control values differed significantly from each other (P less than 0.05). Fecal weights and energy losses showed only minor differences between the two diets. These data contrast sharply with previous results obtained with whole-grain sorghum and suggest that the use of decortication and low cost extrusion processing can markedly improve the apparent protein quality and digestibility of sorghum.

Protein quality and oil digestibility of Lupinus mutabilis: metabolic studies in children.

The nutritional quality of lupins (Lupinus mutabilis) for infants and children was evaluated in two sets of balance studies. In the first the digestibility and protein quality of diets based on lupin flour, with and without methionine supplementation, were compared with those of a control diet consisting of casein, sucrose and vegetable oil. Apparent nitrogen absorption from lupin flour (81.8 and 84.3% of intake) was slightly but significantly less than that during casein control periods (87.2 and 86.8% of intake, P less than 0.05 and less than 0.001). Apparent nitrogen retention from unsupplemented lupin (15.6 +/- 5.8% of intake) was significantly less than that from casein in the corresponding control periods (29.8 +/- 4.9%, P less than 0.001); a small but significant (P less than 0.05) increase in nitrogen retention was observed during the control period following the lupin diet when compared with that preceding it. Methionine supplementation of lupin produced a marked improvement in apparent nitrogen retention (to 22.2 +/- 6.9%, P less than 0.05). In the second set of studies the digestibility of lupin oil was compared with that of a blend of soybean and cottonseed oils (50:50). Excretion of fecal fat (9.8 +/- 3.0% of intake) and fecal energy (6.7 +/- 1.2% of intake) with the diet containing lupin oil were similar to those observed with the control diet. Both the protein quality and oil digestibility of Lupinus mutabilis are very similar to those from soybeans processed in a similar manner. For certain countries the lupin could be a valuable source of protein and edible oil for human consumption.

Plasma free amino acids in children consuming lupin protein with and without methionine supplementation.

Plasma free amino acids were measured in the fasting state and 3 and 4 hours postprandially in children after 9 days consumption of diets in which lupin provided all of 6.4-6.7% protein kcal, either with supplementation of 2% (grams/gram protein) DL-methionine (L & Met, n = 9) or with an isonitrogenous amount of urea (L & U, n = 10). Fasting concentration of total amino acids (TAA) and of essential amino acids (TEAA) and the TEAA:TAA molar ratio did not differ between diets. Fasting Met concentration (15 +/- 4 mumol/liter) and the Met:TEAA ratio (0.021 +/- 0.005) were markedly depressed after 9 days of L & U. Supplementation with Met caused an expected increase of Met concentration (25 +/- 6 mumol/liter) and the Met:TEAA molar ratio (0.039 +/- 0.007) and a profound decrease of Thr concentration (119 +/- 28 to 77 +/- 22 mumol/liter) and Thr:TEAA (0.165 +/- 0.027 to 0.124 +/- 0.028). Postprandially after L ", Met and Met: TEAA did not change from their low fast ing values. After L rMet, Met and Met:TEAA increased significantly relative to fasting values. Threonine concentration increased but the Thr:TEAA ratio decreased significantly (0.124 +/- 0.028 to 0.111 +/- 0.027). These studies confirm Met as the first-limiting amino acid in lupin protein and suggest that Thr becomes limiting when Met is provided in adequate amounts.

Prolonged consumption by infants of wheat-based diets with and without casein or lysine supplementation.

Infants consumed 75% of calories as 82% extraction wheat flour with satisfactory short-term protein and energy digestion. Protein needs, represented by N retentions from casein, probably were not satisfied. Long-term (3+ months) studies in four infants showed that 50% calories and 80% protein from wheat (casein added to 8% protein calories) supported weight gain and linear growth more than expected. Prolonged feeding of 75% calories and 100% protein from wheat attempted in three infants. In the oldest (15.5 months), digestibility and growth was satisfactory; in one, despite good digestion, weight gain and growth was inadequate and serum albumin fell until 0.2% lysine was added; and in another, weight gain was satisfactory but albumin fell to 3.25 g/dl and growth was inadequate. In six other infants, lysine addition during the 2nd of 3 months was associated with significant increase in N retention and weight gain and stabilization of albumin; lysine withdrawal resulted in significant decrease in weight gain with no effect on N retention or albumin; growth was barely adequate during 3-month study. Serum cholesterol fell only when dietary protein was inadequate. It is practically impossible for unsupplemented wheat to satisfy protein needs of infants and most small children.

[Digestibility and protein quality of quinua: comparative study of quinua (Chenopodium Quinoa) seed and flour in children]. / Digestibilidad y calidad proteínica de la quinua: estudio comparativo, en niños, entre semilla y harina de quinua.

Based on the hypothesis that the digestibility of quinua seed is the limiting factor in the utilization of nutrients from this staple, two quinua-based diets were prepared using quinua seeds and quinua flour. Theses diets were offered to children recovering from malnutrition. The digestibility and protein quality of the quinua diets were compared to those of a casein control diet by analyzing the children's metabolic balance. Results showed that digestibility of the quinua diets were compared to those of a casein control diet by analyzing the children's metabolic balance. Results showed that digestibility of the quinua seed is the limiting factor in the protein and energy utilization, and that milling improves significantly the digestibility of fat and carbohydrates. Findings also confirmed that the protein quality of quinua seeds is adequate for human consumption.

Nutritive value of brown and black beans for infants and small children.

A precooked, instantized mixture of brown and black beans, with and without 0.3% DL-methione added, served as the only source of protein in the diets of 10 recovered malnourished infants and children 10 to 42 months of age. At 6.4 to 5.7% dietary protein calories stool wet weights were twice as high, apparent N absorption significantly lower (65.6 +/- 5.9 versus 87.5 +/- 2.3% of intake), and apparent N retention much lower (9.8 +/- 6.1 versus 34.5 +/- 10.2% of intake) than during preceding and following isocaloric and isonitrogenous casein-based diets. The addition of methionine resulted in minimal improvement in N retention and a highly suggestive increase in fasting plasma free methionine. Prolonged feeding of the methionine-enriched beans at 8.0 to 10.9% protein calories supported satisfactory growth and serum albumin levels in two of three children, not so in the smallest one, in whom repeated balance studies demonstrated no decrease over time in stool wet weight and on marginal improvement in N absorption and retention. The poor digestibility of the protein in these beans is the first-limiting factor in its utilization by infants and small children.

Nutritive value of elemental formula with reduced osmolality.

The osmolality of an elemental formula was reduced from 627 to 338 mOsm/kg H2O by replacing dextrose with corn syrup solids, reducing the content of casein hydrolysate, and replacing a portion of the medium-chain triglycerides with corn oil. In three convalescent malnourished infants, the protein quality of the formula was compared at isonitrogenous levels with that of a casein-sucrose-vegetable oil formula and was found to be at least as high: in all three nitrogen retention was higher than during a preceding casein period, and in one of the three it was also higher than during a following casein period. The levels of postprandial plasma amino acids suggested that threonine might be the first-limiting amino acid. Four severely malnourished infants received the formula as their only food during initial rehabilitation. The formula was well tolerated and supported satisfactory weight gain, linear growth, and serum protein regeneration.

[Tolerance and digestibility of Peruvian "common foods" in malnourished infants]. / "Alimentos comunes" peruanos. Tolerancia y digestibilidad en infantes desnutridos.

Six diets were prepared based on commonly used Peruvian foods, mainly of vegetable origin, which were offered to eight infants (mean age: 12.8 +/- 8.2 months) recovering from malnutrition. The purpose of this study was to evaluate the acceptability, tolerance and digestibility of the diets in question. Five were prepared with a potato and wheat base (noodle) and the sixth with a quinua-oats base. The acceptability and tolerance was satisfacotry, allowing maintenance of an adequate calorie and protein intake in all patients except one. On the quinua-oats based diet, the mean apparent absorption of nitrogen and fat was significantly lower (P less than 0.05) than in the case of the other diets. The increase in height coefficient (height age/chronological age X 100) and weight/age proved to be adequate during the study, except in the three youngest patients. The authors consider that this type of diets (potato-wheat based) can be recommended for infant feeding after the first year of life, and that the quinua-oats based diet still needs a more thorough evaluation prior to recommending its use.

Plasma amino acids of infants consuming soybean proteins with and without added methionine.

Fasting plasma free amino acids were determined in 54 convalescent malnourished infants: seven infants while consuming a diet based on isolated soybean protein, containing 4.0% to 5.3% of dietary metabolizable energy (calories) as protein (A), 20 at 6.4% to 6.7% protein calories (B), 23 at 6.4% to 6.7% protein calories with added DL-methionine (C), and four with 8.0% to 12.3% protein calories (D). There were no differences in total amino acid concentration (TAA) among the four groups; the molar fraction of essential amino acids (EAA:TAA) was lower for group A; there were no differences among the four groups in Lys:EAA or 1/2 cystine:EAA ratios or in Met concentration. Met:EAA was higher in C than B, with considerable overlap of individual values. In 10 of 13 infants who were represented in both B and C, Met concentration and Met:EAA ratio were higher in group C. Fasting plasma AA levels are not consistently reliable for field or clinical assessment of dietary Met adequacy. Fasting and postprandial (3- and 4-hour) plasma AA were determined in 29 infants: in 12 the preceding diet and the test meal were both Met-deficient with less than 6.7% protein calories (E), in five the preceding diet was milk-based but the test meal was Met-deficient at less than 6.7% (F), in five the preceding diet and test meal were based on isolated soybean protein at less than 6.7% with DL-Met added (G), and in seven the test meal was soy-based with greater than 9.0% protein calories (H). Plasma Met concentration and Met:EAA fell significantly at 3 and 4 hours in groups E and F, but not in groups G and H, suggesting that a postprandial fall in Met:EAA ratio can be used to identify dietary Met deficiency in field situations.