Impaired fat deposition in pregnancy: an indicator for nutritional intervention.

Unselective dietary supplementation of pregnant mothers can have adverse effects. It is essential to predict which mothers are nutritionally at risk and would benefit from supplementation. Preliminary studies indicated that mothers who increased their triceps skinfold by less than or equal to 20 micron during the second trimester were nutritionally at risk of having a small baby. In this study anthropometric indicators were explored in 81 Asian mothers living in Birmingham. Single (distance) measurements (eg, weight at 28 wk, etc) were not effective predictors. Changes in measurements of the arm during the second trimester were predictive, and triceps skinfold remained the most effective predictor of poor fetal growth. This measurement probably reflects the balance of energy intake minus energy expenditure during the critical second trimester when the mother would normally be laying down extra fat in anticipation of later fetal demands.

Nonlipid formula components and fat absorption in the low-birth-weight newborn.

The relationship between nonlipid formula components and fat absorption in newborns is largely uninvestigated. Two formulas of identical fat blend but different protein quality and acid-base properties were fed to two groups of babies from birth and during 3-5 d balance periods in the third week of life. Babies receiving a formula of higher acidity containing predominantly curd protein absorbed a significantly lower percentage of their fat and nitrogen intake than babies receiving a curd-and-whey protein formula (fat absorptions of 73 +/- 11.0 and 85 +/- 8.0%, means +/- SD, p less than 0.04; N absorptions of 90 +/- 3.0 and 93 +/- 1.0%, p less than 0.03, respectively). The feces of the curd-formula babies contained a smaller proportion of long-chain, saturated fatty acids and a larger proportion of shorter-chain and unsaturated fatty acids. Fatty acid type and triglyceride structure are not the only factors influencing fat absorption in newborns. Other formula components may need modification to achieve maximum fat absorption.

Phenylglycine derivatives as new pharmacological tools for investigating the role of metabotropic glutamate receptors in the central nervous system.

The possible roles of G-protein coupled metabotropic glutamate receptors in central nervous function are currently the focus of intensive investigation. The complexity of effects produced by agonists at these receptors probably reflects the activity of a range of sub-types. The metabotropic glutamate receptors first described are linked to phospholipase C, mediating phosphoinositide hydrolysis and release of Ca2+ from intracellular stores. A substance generally considered to be a selective agonist for these receptors is (1S,3R)-1-aminocyclopentane-1,3-dicarboxylic acid (ACPD). This substance not only stimulates phosphoinositide hydrolysis, but also inhibits cyclic AMP formation. A family of metabotropic glutamate receptors, incorporating both phospholipase C- and adenylcyclase-linked sub-types has been cloned. Various effects of metabotropic glutamate receptor agonists on membrane ion fluxes and synaptic events have been reported, including neuronal depolarization and/or excitation, hyperpolarization, inhibition of Ca(2+)-dependent and voltage-gated K+ currents, potentiation of N-methyl-D-aspartate-induced responses, depression of synaptic excitation and either induction or augmentation of long-term potentiation. To clarify the role of metabotropic glutamate receptors in central nervous activity and to aid the characterization of the various receptor types that may be involved, a range of highly selective agonists and antagonists is required. To date, currently available antagonists such as L-2-amino-3-phosphonopropionate and L-aspartic acid-beta-hydroxamate appear to be unselective and insufficiently potent. We report here the actions of three phenylglycine derivatives, the particular agonist and/or antagonist properties of which may help to elucidate the roles of metabotropic glutamate receptors in central nervous activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Distinctive aspects of metabolism and nutrition in infancy.

OBJECTIVES: The effects of genes, the stage of development, and the environment on various metabolic processes in infancy are described. Some themes discussed cross these three boundaries. CONCLUSIONS: Certain substances not normally regarded as essential may become conditionally essential if their precursors are limited in the diet or, alternatively, if the processes of conversion are reduced in activity because of abnormal gene function, or developmental immaturity. Diet is a clear environmental influence but, because the nature of the diet is closely related to age, it is a developmental influence as well. Certain nutrients are followed from the diet, via the gut and intermediary metabolism through to individual tissues and the whole body. The relationships of diet, metabolism and brain function have attracted considerable investigation in recent years. In the right environment, with the correct genes, the processes of development will be smooth and without undue metabolic disturbance. Considerable variation can be accommodated within the elasticity of the systems, but some changes may lead to temporary, or even permanent, malfunction.

Hydrolysed protein formulas: thoughts from the Isle of Wight meeting.

The meeting held on the Isle of Wight on 3 March 1995 was organised to discuss some of the recent evidence concerning the use of hydrolysed milk formulas not only in the treatment of cow's milk allergy but also in programmes designed to reduce or prevent other atopic disease. These products and their prophylactic use in particular have generated an amount of controversy firstly when they were introduced as a starting formula in the United States and secondly in Europe where paediatric, allergy and nutrition groups have issued various statements on their use (ESPGAN, 1993; Bjorksten, 1994; ESPACI, 1993; Bindels & Boerma, 1994). The Isle of Wight meeting did not attempt to produce a concensus statement. Nor is this paper an attempt to summarise or bring together the views expressed. Rather it reflects the views of the authors tempered by experience and the evidence presented at the meeting. Seven questions are explored.

Diet and faecal flora in the newborn: nucleotides.

Breast milk contains nucleotide salts that are only present in minimal amounts in modern infant formulas prepared from cows' milk. Nucleotides have been suggested as cofactors for the growth of bifidobacteria in vitro. Bifidobacteria are found to be more numerous in the faeces of breast fed babies compared with those of formula fed babies. Faecal flora were examined at 2 weeks of age in 32 babies who from birth had been fed a whey based formula supplemented with nucleotide monophosphate salts, 33 babies fed an unsupplemented formula, and 21 breast fed babies. Faecal flora were also examined at 4 weeks, and 7 weeks but with fewer babies in each group. Most differences were found at 2 weeks of age when more babies fed the nucleotide supplemented formula were colonised with Escherichia coli and more had E coli as the dominant organism in their faecal flora. Fewer of these babies were colonised with bifidobacteria. The counts of bifidobacteria and enterococci were reduced in the nucleotide supplemented group but bacteroides accounted for a higher percentage of the total flora in this group of babies. Supplementation of a formula with nucleotide salts did not make the faecal flora closer to that of breast fed infants as the growth of bifidobacteria was discouraged. While there may be arguments to support the addition of nucleotides to infant formula the results of this study do not support their addition for the enhancement of bifidobacteria in the faecal flora.

Low plasma taurine and later neurodevelopment.

Dietary taurine intake may explain the benefits of both breast milk and preterm formula to neurodevelopment. Low plasma neonatal taurine was associated with lower scores on the Bayley mental development index at 18 months and the WISC-R arithmetic subtest at 7 years. Currently it is not mandatory to add taurine to infant formulas.

A critical assessment of plasma alkaline ribonuclease as an indicator of protein nutritional status in infancy.

Plasma alkaline ribonuclease (RNase) was measured at birth and during infancy to assess its usefulness as an indicator of protein nutritional status. Cord blood enzyme activity did not indicate intra-uterine protein malnutrition in the less well-grown babies. Differences in enzyme activity were found which related to the quality of the dietary protein fed to both preterm and term light for gestational age babies. Higher activity on day 7 in those infants fed a predominantly curd protein formula suggested that this was less well utilised than a curd and whey protein formula. Serial enzyme measurements in four infants with metabolic disease showed how the enzyme activity altered in response to changes in the quantity of dietary protein. These results are critically discussed.

Faecal flora in the newborn. Effect of lactoferrin and related nutrients.

Bifidobacteria, lactobacilli and staphylococci are the predominant organisms in the faeces of breast fed babies whereas in formula fed babies coliforms, enterococci and bacteroides predominate. In vitro studies suggest that the mechanisms responsible are probably related to the acid base properties of the formula and 'immunological' proteins such as lactoferrin and sIgA. In human babies however the addition of bovine lactoferrin to an infant formula has little effect on the faecal flora and does not move it in the direction of the breast fed baby. There are various possible explanations of this lack of effect, e.g., inactivation of the lactoferrin when it is added to a formula, and immunological responses in the intestine to a foreign protein. We consider the most likely explanation is that other factors necessary for the optimum activity of lactoferrin were not present or in inappropriate concentration, e.g. sIgA, lysozyme, citrate, bicarbonate. If human lactoferrin is added to an infant formula it may be these other factors will require attention if the lactoferrin is to have a significant effect. An iconoclastic interpretation which cannot be completely excluded is that the hypothesis of lactoferrin bacteriostatic activity is based on in vitro studies and is not a reflection of what happens in babies. The faecal flora of a breast fed baby is very different from that of a baby receiving either cow's milk or a modern infant formula (Figure 1). Among breast fed babies bifidobacteria lactobacilli and staphylococci are the predominant organisms, whereas in formula fed babies the predominant organisms are enterococci, coliforms, and bacteroides (1).

Nutrition in the 1980s.

The 1970s were a decade of achievement in child nutrition in Britain. Substantial changes in infant feeding practices occurred and they were followed by measurable improvements in child health. The 1980s have not maintained this momentum. Infant nutrition is often still seen solely in terms of the breast/bottle debate. Doubtful practices, such as the use of skimmed milk and goats' milk early in life, have become more common. Many weanlings still experience frank nutritional deficiencies. For the 1990s there are 3 priorities: effective continuing measurements of the state of nutritional health in British children are required; among the many methods for promoting nutritional wellbeing health education is vital but professionally we need to deliver the same not conflicting messages; mechanisms for applying any method must acknowledge that nutrition is only one aspect of child health to be promoted and that other agencies such as the food industry and central government can make a valuable contribution when we all act in concert.

Nutrition in adolescence.

This review discusses five questions concerning nutrition in adolescence. Do adolescents have special nutritional needs? What are the recommended dietary intakes? What do adolescent schoolchildren eat? What nutritional disorders occur at this age? The prevalence of iron deficiency anaemia, rickets, coeliac disease, iodine deficiency, dental caries, weight disorders, zinc deficiency and pellagra are discussed. What is the role of school meals or other food supplementation programmes?

Food and microbiological problems in the newborn: data and practice.

We have reviewed the relationships of food, nutrition and feeding practices to various infections in the newborn. Tentative conclusions are made: (a) the initial use of human milk (raw or pasteurized) continues to offer advantages in the care of babies in intensive care; (b) attempts to mimic the microbiological effects of breast milk by manipulation of the composition of infant formulas have so far achieved little success, but this is a rapidly developing field; (c) we are wary of the widespread use of breast milk "fortifiers" until there is evidence that they do not adversely affect the protective properties of breast milk; (d) the doubtful advantages of nasojejunal feeding need to be weighed against the increased bacterial contamination of the upper small bowel; (e) systems monitoring in milk kitchens and the handling of feeds in the neonatal unit are an integral part of comprehensive neonatal care; (f) to limit nosocomial infection, particular attention to the faecal-food-oral route is necessary since there is potential for multiplication of initial contamination of food.

Protein nutrition, faecal flora and iron metabolism: the role of milk-based formulae.

This paper explores the role of milk-based formulae in achieving four aspects of nutritional health in infants and toddlers: in the suckling, to mimic the amino acid metabolism and the faecal flora of a breast-fed baby; in the weanling, to achieve adequate protein intakes in later infancy and beyond and to achieve satisfactory haemoglobin concentrations in the early toddler years. Milk-based formulae have two roles in infant nutrition: as so-called breast milk substitutes and as a safety net during the weaning period; the latter role may be the more important.

In the last analysis: archetypal themes in the analysis of an elderly patient with early disintegrative trauma.

Aspects of the analysis of an elderly patient with early disintegrative experiences are described: separation anxiety, an internalized attack upon vitality, and the fear of dependency were prominent features of the transference/countertransference relationship, while the search for meaning as death drew nearer continued to be the central theme. The patient's many dreams reveal a wealth of images whose complex interlinkings provided evidence of a heightened and energized individuation process aiming at the integrity of personality.