Vitamin A provision for preterm infants: are we meeting current guidelines?

BACKGROUND: Preterm infants have reduced liver stores of vitamin A at birth compared to term born infants. Current guidelines recommend an intake of 700-1500 IU/kg/day vitamin A, and there is evidence to support higher doses for infants with significant lung disease. The importance of appropriate early nutrition for preterm infants is increasingly becoming apparent. OBJECTIVES: To examine whether preterm infants admitted to a UK neonatal unit received the currently recommended amounts of vitamin A during the first 4 weeks of life, and to identify the feeding patterns associated with optimal vitamin A intake. DESIGN: Retrospective case note review. SETTING: UK tertiary neonatal unit. POPULATION: 36 preterm infants with a median gestation of 30 weeks (range 26-33 weeks) and median birth weight of 1305 g (range 880-1800 g). MAIN OUTCOME MEASURE: Mean daily total intake of vitamin A in each of the first 4 weeks of life. RESULTS: Despite a policy of introducing intravenous lipid supplemented with fat soluble vitamins on day 2, only four infants (11%) consistently met the recommended daily intake of vitamin A during the first 2 weeks of life. Adequacy of vitamin A intake in the first 2 weeks of life was not predicted by gestation or pattern of feeding. CONCLUSION: Recommendations for intravenous vitamin A supplementation in parenterally fed preterm infants require revision. Intravenous lipid with added fat soluble vitamins should be started as soon as possible after birth, and consideration given to early oral vitamin A supplementation in those infants tolerant of enteral feeds.

Dietary modifications, nutritional supplements and alternative medicine in paediatric patients with inflammatory bowel disease.

BACKGROUND: Data on use of complementary and alternative medicine in children with inflammatory bowel disease are scarce. AIM: To assess prevalence, predictors and parental attitude to the use of complementary and alternative medicine in a paediatric population with inflammatory bowel disease in the west of Scotland. METHODS: Questionnaire survey encompassing alternative therapists, nutritional supplements and dietary modifications used in the management of inflammatory bowel disease was used. Demographics, disease and treatment data were also collected. RESULTS: 86 guardians completed the survey. 61% had used at least one type and 37% were using complementary and alternative medicine recently. The most common types were probiotics (44%) and dairy-free diet (28%). Higher parental education and young parental age were predictors of complementary and alternative medicine use. An increased number of oral steroid courses and prior use of complementary and alternative medicine for other health reasons were associated with use of alternative therapists. Personal recommendation and to complement conventional medicine were the main reasons for using complementary and alternative medicine. 48% judged complementary and alternative medicine at least partially effective. 86% agreed that doctors should be supportive of use. 89% would give complementary and alternative medicine to their children. CONCLUSIONS: Use of complementary and alternative medicine was higher in children with IBD than in adults with the same disease. The gastrointestinal nature of the disease could explain the high use of nutritional supplements and dietary modifications in this survey.

Influences of vermicomposts on field strawberries: part 2. Effects on soil microbiological and chemical properties.

The effects of applications of food waste and paper waste vermicomposts on some soil chemical and biological properties were evaluated in field plots planted with strawberries. Six-week old strawberries (Fragaria ananasa, var. Chandler) were transplanted into 4.5 m(2) raised beds under a plastic tunnel structure measuring 9.14 x 14.6 x 3.6 m. Vermicompost were applied at rates of 5 or 10 t ha(-1) supplemented with inorganic fertilizers to balance fertilizer recommendations for strawberries of 85-155-125 kg NPK ha(-1). Effects of vermicomposts on strawberry growth and yields have been reported previously [Arancon, N.Q., Edwards C.A., Bierman P., Welch, C., Metzger, J.D., 2004. The influence of vermicompost applications to strawberries: Part 1. Effects on growth and yield. Bioresource Technology 93:145-153]. Total extractable N, NH(4)-N, NO(3)-N and orthophosphates did not differ significantly between treatments, except on the last sampling date (harvest date) in which significantly greater amounts of NH(4)-N, NO(3)-N and orthophosphates (P

Absorption and excretion of conjugated flavonols, including quercetin-4'-O-beta-glucoside and isorhamnetin-4'-O-beta-glucoside by human volunteers after the consumption of onions.

Flavonols are polyphenols found ubiquitously in plants and plant-products. Flavonols, particularly quercetin, are potent antioxidants in vitro and their intake has been associated inversely with the incidence of coronary heart disease. The aim of this study was to investigate the accumulation in plasma and excretion in urine of flavonol glucosides following ingestion of lightly fried onions. Five healthy volunteers followed a low-flavonoid diet for 3 days. On day 4, after an overnight fast, subjects were given 300 g of lightly fried yellow onions which contain conjugates of quercetin and isorhamnetin, including quercetin-3,4 '-diO-beta-glucoside, isorhamnetin-4'-O-beta-glucoside and quercetin-4'-O-beta-glucoside. Blood collection was carried out at 0 min, 0.5, 1.0, 1.5, 2, 3, 4, 5 and 24h after the supplement. In addition, subjects collected all their urine for 24h following the onion supplement. Isorhamnetin-4'-O-beta-glucoside and quercetin-4 '-O-beta-glucoside accumulated in plasma with maximum levels, defined as proportion of intake, of 10.7+/-2.6% and 0.13+/-0.03% respectively. The time of the quercetin-4'glucoside peak plasma concentration was 1.3+/-0.2 h after the ingestion of onions while a value of 1.8+/-0.7 h was obtained for isorhamnetin-4'-glucoside. Excretion in urine, as a proportion of intake, was 17.4+/-8.3% for isorhamnetin-4'-O-beta-glucoside and 0.2+/-0.1% for quercetin-4'-O-beta-glucoside. Possible reasons for the accumulation and excretion of isorhamnetin-4'-glucoside in proportionally much higher amounts than quercetin-4'-glucoside are discussed. It is concluded that flavonols are absorbed into the bloodstream as glucosides and minor structural differences affect markedly both the level of accumulation and the extent to which the conjugates are excreted.

Caecal and faecal short-chain fatty acids and stool output in rats fed on diets containing non-starch polysaccharides.

The exact mechanisms by which non-starch polysaccharides increase stool output are unknown. In the present study the hypothesis that the site of fermentation and short-chain fatty acid (SCFA) accumulation is related to the action of non-starch polysaccharides (NSP) on stool output was tested. The basal diet (45 g NSP/kg) of forty-three male Wistar rats was supplemented with 50 g/kg of either guar, karaya, tragacanth, gellan, xanthan or ispaghula for 28 d. A further twenty-three rats were maintained on the basal diet for the same time period. Faeces were then collected over 2 d and caecal contents obtained post-mortem. Caecal and faecal wet and dry weights and SCFA were measured. Each supplement had a different effect on the caecal and faecal contents but they appeared to fall into three groups when compared with the basal diet. In group 1, guar gum affected only caecal SCFA. It had no effect on stool output or faecal SCFA. In group 2, karaya increased caecal SCFA and tragacanth, karaya and xanthan increased faecal SCFA and faecal water. In group 3, ispaghula and gellan had no consistent effect on caecal or faecal SCFA concentrations but increased total faecal SCFA output and increased faecal wet and dry weight. Although the knowledge that SCFA are rapidly absorbed in the large intestine has led us to believe that they play no role in determining faecal output, these results suggest that in some cases where NSP are slowly fermented, and increase faecal SCFA, the role of the SCFA may need to be reassessed.

The effects of ispaghula on rat caecal fermentation and stool output.

The colonic fermentation of ispaghula, a mucilage from Plantago ovata composed mainly of arabinoxylans, and its effects on stool output and caecal metabolism were investigated. Four groups of eight rats were fed on a basal diet (45 g non-starch polysaccharides/kg) for 28 d. The diet was then supplemented with ispaghula (g/kg; 0, 5, 15 or 50) for 28 d. Ispaghula increased stool dry weight and apparent wet weight but faecal water-holding capacity (amount of water held per g dry faecal material at 0.2 mPa) was unchanged. The extent of faecal drying in the metabolism cages was measured for rats fed on the basal diet and 50 g ispaghula/kg diet. At the faecal output levels encountered, only an 8% loss of wet weight would be predicted over 24 h and this was independent of diet. Faecal short-chain fatty acid (SCFA) concentration did not change but SCFA output increased. The molar proportion of SCFA as propionic acid increased and faecal pH was reduced. Values from pooled faecal samples suggested that approximately 50% of the ingested ispaghula was excreted by the 50 g ispaghula/kg diet group. Diaminopimelic acid (a constituent of bacterial cells) concentrations fell but output was unchanged indicating no change in bacterial mass. Similar changes were seen in the caecal contents but caecal pH and SCFA were unaffected. Ispaghula increased both caecal and colonic tissue wet weight and colonic length. Our results suggest that ispaghula is partly fermented in the rat caecum and colon, and loses its water-holding capacity. However, it is still an effective stool bulker and acts mainly by increasing faecal water by some unknown mechanism.

Immunochemiluminometric assays (ICMA) specific for growth hormone releasing hormone 1-44 NH2 and 1-40 OH.

We describe specific two-site immunochemiluminometric assays able to directly measure human growth hormone-releasing hormone 1-44 NH2 and 1-40 OH concentrations in unextracted plasma. A common N-terminal antibody was purified from polyclonal rabbit antisera to growth hormone-releasing hormone 1-44 NH2 on a growth hormone-releasing hormone 1-29 NH2 linked affinity column and labelled with chemiluminescent acridinium ester. C-terminal specific monoclonal antibodies to growth hormone-releasing hormone 1-44 NH2 and 1-40 OH were raised in Balb/C mice and used as solid phase antibodies. Assay of fasting specimens from normal individuals gave medians (and ranges) of 23 pg/ml (2-200) and 30 pg/ml (3-134) for growth hormone-releasing hormone 1-44 NH2 and 1-40 OH, respectively. Samples from a series of acromegalics showed that most have values in the normal range though median values were higher, 56 pg/ml for growth hormone-releasing hormone 1-44 NH2 (P < 0.001) and 52 pg/ml for 1-40 OH (P < 0.001). Using these assays it will be possible for the first time to directly study the physiology and pathophysiology of these two peptides.

Comparison of the effects of ispaghula and wheat bran on rat caecal and colonic fermentation.

The effects of ispaghula and wheat bran on the contents of the caecum and proximal and distal colon of the rat were investigated to identify any differences that might account for their effects on colonic motility. Rats fed diets supplemented with 5% ispaghula and 10% wheat bran for 28 days were killed and the contents of the gut collected. Caecal and colonic content wet and dry weight and short chain fatty acid (SCFA) content were measured. In additional in vitro fermentations in batch cultures of mixed rat caecal bacteria with ispaghula and bran, SCFA production was monitored over 24 hours. Both ispaghula and wheat bran increased faecal weight but ispaghula was more effective. Ispaghula resulted in greater and more liquid contents, with a characteristic pattern of SCFA production (higher propionic acid) maintained throughout the colon. In contrast, wheat bran affected only the caecum and faeces. SCFA content and wet and dry weight in the proximal and distal colon were unaffected by wheat bran. Caecal butyrate was characteristically higher in wheat bran fed rats but ispaghula produced higher butyrate in the distal colon. In contrast, ispaghula seemed to be fermented more quickly in vitro than wheat bran. Thus, wheat bran has a portion that is rapidly fermented and an inert residue that may stimulate motility. Ispaghula seems to be fermented throughout the colon but maintains a high water content which dilutes the luminal contents.

Dietary fiber: in vitro methods that anticipate nutrition and metabolic activity in humans.

Gravimetric measurement of dietary fiber (DF) gives no indication of the biological function of any particular fiber. This study describes simple methods based on dialysis and fermentation that enable a hierarchy of fibers to be described for each of the major actions of fiber along the gastro-intestinal tract: nutrient absorption, sterol metabolism, cecal fermentation, and fecal bulking. These results were compared with previous metabolic studies with the same fiber isolates in humans. DF that modifies nutrient absorption can be identified by using dialysis studies, whereas identifying DF that modifies sterol metabolism, cecal fermentation, and fecal weight requires formulas that incorporate dialysis and fermentation results. Results from dialysis and fermentation predicted the action of wheat bran, pectin, guar, gum arabic, carboxymethylcellulose, gellan, tragacanth, xanthan, and karaya in humans and generated anomalous results for karaya and tragacanth. These methods could form the basis of techniques that would enable a screening of novel and processed fibers before studies in animals, including humans.

Prediction of response to endocrine therapy in pronounced cyclical mastalgia using dynamic tests of prolactin release.

Many of the endocrine agents currently used to treat symptomatic benign breast disease modify the action or secretion of prolactin. We have compared the responses to hormonal therapy with dynamic assessment of prolactin control in 29 patients with cyclical mastalgia and in 7 patients with non-cyclical mastalgia. The tests of prolactin release used were direct stimulation by TRH or dopaminergic blockade by domperidone. These were carried out before treatment in the mastalgic patients and also in 22 age-matched asymptomatic controls. The response to treatment was assessed using a special pain chart and visual linear analogue scale. Patients with cyclical mastalgia could be divided into two groups: those in whom the peak prolactin release was exaggerated (greater than 4000 mU/l) and those in whom the prolactin release was less marked and similar to control subjects and patients with non-cyclical mastalgia. Patients in the cyclical mastalgia group with a high peak prolactin release responded to hormonal treatment significantly more frequently (90%) than those with a normal prolactin release (50%). Basal prolactin levels did not correlate with the response to treatment. In the non-cyclical mastalgia group, no patient had peak prolactin release greater than 4000 mU/l and none responded to therapy. This study indicates that dynamic tests of prolactin release in cyclical mastalgia may be useful in predicting the subsequent satisfactory response to endocrine therapy if a high peak prolactin release is induced.