High-fat semielemental diet in the treatment of protracted diarrhea of infancy.

The capacity for greater fat absorption relative to carbohydrate absorption in protracted diarrhea of infancy was studied in a developed and a developing country (Buffalo, NY, and Bangkok, Thailand). Fifty patients with protracted diarrhea in the first year of life (defined as liquid stools of more than 20 mL/kg per day with more than a 14-day duration) were randomly assigned to receive either a standard semielemental diet (Pregestimil) or a high-fat semielemental diet that contained 40% more fat. The increased fat was largely in the form of medium-chain triglycerides, with the new diet providing 60% of the fat as medium-chain triglycerides compared with 40% in the standard diet. Tolerance to both diets was good in both studies. Both groups showed adequate weight gain and an improvement in anthropometric and biochemical parameters. The patients receiving the high-fat diet showed no initial weight loss, however, and their weight gain was initiated earlier. Cumulative weight gain was also higher in the group receiving the high-fat semielemental diet. Fecal fat analyses were performed after 1 week of therapy. There was no difference observed in the coefficient of fat absorption between the groups receiving the two formulas, indicating that infants with protracted diarrhea may be able to tolerate a higher fat intake than is normally provided. As carbohydrate intolerance is known to be a complicating factor when using semielemental enteral feeds for infants with protracted diarrhea, a higher-fat semielemental diet may be the most appropriate way to provide adequate caloric intake.

Effect of thyroxine on the maturation of cholecystokinin (CCK) receptors in pancreatic acini of neonatal rats.

Neonatal rat pancreata are not responsive to stimulation by cholecystokinin (CCK) and this has been shown to be due partly to low binding of CCK to pancreatic acinar cells of rats at this age. The effect of thyroxine on the maturation of CCK receptor binding and enzyme secretion is studied. One-day-old rat pups were injected daily with thyroxine (0.1 microgram/g of body weight) for 3 days and killed on day 5. Control littermates were injected with normal saline at the same volume and schedule as the thyroxine group. The pancreatic weight and amylase activity were significantly higher in pups from the thyroxine group. Amylase release after stimulation with various concentrations of CCK was also higher in the thyroxine group. The maximal binding to [125I]BH-CCK-8 was significantly higher in dispersed acini from the thyroxine group when compared to the control group (5.2 vs. 2.0%). Analysis of binding data showed that the higher binding was due to a higher maximal binding capacity in the thyroxine group (1.1 +/- 0.41 vs. 5.2 +/- 1.4 fmol/mg of protein). Thyroxine, therefore, induces a precocious maturation of the secretory function of the pancreatic acini, specifically by modulating the maximal binding capacity of the high-affinity binding sites.

Vitamin D deficiency, pancreatic and small intestinal enzyme development in rats.

Maternal vitamin D deficiency has been shown to lead to reduced body weights in developing rat pups. To evaluate the effects of vitamin D deficiency alone both in dams and pups during the perinatal age on the ontogeny of gastrointestinal enzymes, female weanling rats (3 weeks of age) were divided into three groups. Groups I and II were fed a control (vitamin-D-replete) diet. Group II were fed a vitamin-D-deficient diet. Six weeks afterward they were mated with normal male rats while continuing on their respective diets until sacrifice. Only rats that delivered their pups on the same day from each group were brought into the study. Litter sizes of groups I and II were adjusted to 10, while group III was adjusted to 13 such that the rate of growth paralleled that of group II. At 19 days after birth, all dams and pups were sacrificed. There were no differences in the calcium and phosphorus contents in breast milk obtained from dams of each group. The serum calcium concentration of pups from group II (vitamin-D-deficient) was lower than the other groups. Body weights of pups from groups II and III were significantly lower than those of group I. The mucosal weight, total mucosal protein, mucosal DNA, sucrase, and maltase activities from groups II and III were similar, but lower than group I. Pancreatic weight, total pancreatic protein, DNA, amylase, and lipase activities from groups II and III were also similar, but lower than group I. Vitamin D deficiency was confirmed in both dams and pups from group II.(ABSTRACT TRUNCATED AT 250 WORDS)

Phorbol ester attenuates cholecystokinin-stimulated amylase release in pancreatic acini of rats.

12-O-tetradecanoylphorbol 13-acetate (TPA) and cholecystokinin octapeptide stimulate amylase secretion in dispersed pancreatic acini, presumably acting via the activation of protein kinase C. In this study, we examined TPA pretreatment on the subsequent response of rat pancreatic acini to secretagogues. Acini exposed to TPA (3 X 10(-7) M) at 37 degrees C reduced the subsequent amylase secretion as stimulated by cholecystokinin octapeptide and carbachol, but not by A23187 or VIP. The optimal effect was obtained after 5 min of preincubation with TPA. Longer incubation did not result in greater attenuation. The degree of attenuation was dependent on the concentration of TPA used in the pretreatment. Maximal effect was seen at TPA concentrations of 10(-7) M and higher. Preincubation with TPA resulted in alterations of the dose response of pancreatic acini to cholecystokinin octapeptide. A decrease in amylase secretion was obtained at optimal and suboptimal but not at supraoptimal concentrations of cholecystokinin octapeptide. The peak response to cholecystokinin octapeptide, furthermore, was shifted almost 1 log unit to the right, suggesting a decrease in cholecystokinin binding of the acini following TPA treatment. Binding studies demonstrated a reduction in the specific binding of 125I-labelled cholecystokinin octapeptide to acini following TPA treatment. Analysis of binding data revealed a decrease in affinity and binding capacity of the high-affinity component. No significant change in the binding capacity was detected with the low-affinity component, but a great increase in its affinity was observed. This suggests that the attenuation effect by TPA on the cholecystokinin octapeptide response in rat pancreatic acini in vitro is at the receptor level.

Asthma in Thai children: a study of 2000 cases.

Two thousand Thai children with asthma were studied prospectively. Boys were more frequently affected than girls, with the ratio of 1.54:1. Fifty percent of patients developed their first attacks within the first 2 years of life. Attacks during the night were common and the seasons in which attacks usually occurred were the winter and the rainy season. Viral respiratory infections were the most common precipitant of attacks. The majority of the cases (61.25%) were moderately severe, while 29.15% of cases were mild and 9.60% of cases were very severe. Among our patients, 32.45% had been hospitalized with asthma and 6.85% had received corticosteroid treatment for asthma. In this study, 63.15% of cases had asthma associated with other allergic diseases, and 79.25% had family history of allergic diseases. Absolute blood eosinophil counts of less than 500 cells/mm3 were found in 39.8% of patients. Positive skin tests to important antigens were noted in 93.7% of cases, and these were house dust, epidermals, house dust mite, molds, weeds, cockroach, grasses, kapok, and foods.

Ontogenic changes in serum immunoglobulins and C3 in vitamin-D deficient and malnourished rats.

In both protein energy malnutrition and vitamin D deficiency, defects in some immunological functions have been noted, but the effects on complement and immunoglobulin concentrations have not been evaluated. We assessed the effects of malnutrition and vitamin D deficiency on immunoglobulins and C3 in rats in early postnatal life during weaning and early adulthood using the rocket immunoelectrophoresis technique. In well-nourished rats, the serum levels of IgG increased from 88.5 +/- 10.2 mg/dl in the newborn period to 883.4 +/- 104.8 mg/dl at weaning (day 19). The adult levels, 1,325.9 +/- 60.8 mg/dl, were attained by 35 days of age. Serum IgA was not detectable by our method until 20 days of age (1.1 +/- 0.2 mg/dl) and reached adult levels (13.4 +/- 3.2 mg/dl) by day 35. IgM was detectable in the serum of pups at 5 days of age (0.4 +/- 0.07 mg/dl), increased to 27.5 +/- 6.9 mg/dl at weaning and approached adult levels (93.7 +/- 9.9 mg/dl) at day 35. C3 levels at birth were only 36% of adult levels and did not change during the suckling period. They then increased to levels comparable to those of adults at the age of 35 days. Serum immunoglobulins and C3 in malnourished rats were not significantly different from age-matched control pups. In pups born to dams fed a vitamin-D-deficient diet from 3 weeks of age, only the serum IgG and C3 levels were significantly lower than those of normal pups at day 1 (IgG level: 65.2 +/- 6.1 vs. 88.5 +/- 10.2 mg/dl; C3 level: 20.3 +/- 6.9 vs. 36.2 +/- 3.1% of an adult level; p less than 0.005). Thus the increased susceptibility of malnourished young animals to infection does not appear to be related to a lowering of serum immunoglobulin and complement concentrations.

Urticaria in Thai children.

In this study, 142 patients under 12 years of age with the diagnosis of urticaria accompanied or not by angioedema were examined. In all 72.6% of the patients were under 6 years of age. Boys and girls were equally affected, 13.4% of the cases had chronic urticaria, 56.3% had a previous history of urticaria, 88.0% had generalized urticaria, and about half of the cases had associated angioedema. The causes of the urticaria were identified or suspected in 32.4% of the cases. Drugs, foods, insect bites and stings, infections and cold were the most common or associated precipitating agents in that order. Histories revealed 27.5% of the cases had records of other allergic diseases, and 76.1% had allergic diseases in the family. Dermographisms were found in 16.2% of the cases, and 22.5% of cases had eosinophilia. The means of IgE levels in both acute and chronic urticaria were within normal limits, and there was no statistically significant difference between the two groups. Skin testing was of little practical value in evaluating the etiology of the urticaria. Clinical trials of drugs for symptomatic treatment revealed that clemastine, ketotifen and hydroxyzine gave approximately equally high response rates. All these three medications gave significantly greater response rates than chlorpheniramine.