Insufficient energy and nutrient intake in children with motor disability.

AIM: Children with motor disabilities are at increased risk of compromised bone health due to impaired weight bearing. Poor nutritional status may be an additional risk factor. The aim of this study was to evaluate energy and nutrient intakes in children with motor disability. PATIENTS AND METHODS: Fifty-four children with motor disability (cerebral palsy in 59%) were included. Three-day food diaries were collected and analysed. The results were compared with recommended dietary allowances for age and sex. RESULTS: The median age was 10.9 years. The median energy intake was 76% of the recommendation and <80% in 57% of children. Of the total energy, 17% was from protein, 32% from fat and 50% from carbohydrates. The medians were for calcium intake 142% and for vitamin D intake 76% of the recommendation; serum 25-hydroxy-vitamin D concentrations were low (median 46 nmol/L). Children with low energy intake were shorter and lighter and had more severe motor disability than children with sufficient energy intake. CONCLUSION: Insufficient energy and nutrient intake is common in children with motor disability. This may have adverse health effects especially when associated with low vitamin D intake. Energy and vitamin D supplements should be considered.

Alphacalcidol oral pulses normalize uremic hyperparathyroidism prior to dialysis.

Alphacalcidol oral pulse therapy was given for secondary hyperparathyroidism to 22 children (mean age of 5.6 years) with renal insufficiency. At the beginning of the study, the glomerular filtration rate was < 50% of normal, serum intact parathyroid hormone (PTH) was > 100 ng/l and the serum phosphate and calcium concentrations were within the normal range. Alphacalcidol (0.5-3.0 micrograms) was given orally thrice weekly in the evening and adjusted according to PTH, ionized calcium and phosphate concentrations. Serum PTH (mean +/- SEM) decreased significantly from a pre-treatment level of 393 +/- 81 ng/l to 122 +/- 34 ng/l after 12 months, and stabilized at this level. Mean vitamin D metabolite concentrations were within the normal range. 1,25-Dihydroxyvitamin D did not increase during therapy, while PTH decreased. The estimated creatinine clearance remained almost unchanged (20 +/- 3 and 21 +/- 6 ml/min per 1.73 m2). Growth remained low normal (height standard deviation score -1.8 +/- 0.3 initially and -1.7 +/- 0.4 12 months later) and bone mineral density did not decrease. We concluded that feedback regulation of PTH with oral alphacalcidol pulse therapy is effective in the treatment of hyperparathyroidism in children with renal failure prior to dialysis.

Follow-up of nutritional status and dietary survey in children with cow's milk allergy.

The nutritional status of children with cow's milk allergy was followed during an elimination diet in 19 children (9 boys and 10 girls) beginning at the mean age of two years (range 0.6-4.1 years). The cow's milk allergy had been verified in hospital by a challenge test at a mean age of 0.9 years (range 0.2-1.9 years). Weight, height and laboratory indices to test protein, mineral and vitamin status were measured at three follow-up visits at three-month intervals. In addition to cow's milk allergy all these children had some other food allergies, and six of the 19 children were allergic to soy protein. Only two of the 19 children were given a soy-based formula. In the diets of the other children, cow's milk was replaced by increasing amounts of other foodstuffs and supplementary calcium. At the beginning of the study the relative heights of the children were slightly retarded (-0.6 SD) and remained unchanged during follow-up (-0.8 SD at the end of the study). The relative weights were found to be decreased during follow-up (p less than 0.05). There was a significant reduction in serum prealbumin values; eight of the 19 children showed abnormally low values. Low serum zinc values were seen in 12 children. Serum iron concentration was low in two children and two had high serum alkaline phosphatase values. Seven-day food recording indicated that dietary intake of energy was below the recommendation in some children, but protein intake was high. Some children had low intakes of riboflavin.(ABSTRACT TRUNCATED AT 250 WORDS)

Beneficial effects of palatable guar and guar plus fructose diets in diabetic children.

This randomized cross-over study evaluates the effects of extended, guar and guar + fructose diets on the metabolic balance of children with insulin-dependent diabetes mellitus (IDDM). We studied 22 children; mean age 12.2 years, mean duration of diabetes 4.4 years. The diet was supplement for three weeks with guar in palatable form (5% of daily carbohydrate intake) and with guar + fructose (1 g of fructose/kg body weight, max 30 g/d) for another three weeks. A control group (8 children, mean age 12.3, duration of diabetes 4.3 years) followed the same experimental protocol without guar supplementation. The metabolic balance was assessed by glucosuria index (per cent of tests with less than 1% glucosuria from all urine tests) and measurements of red cell glycohaemoglobin A1c (HbA1c). Serum total and HDL-cholesterol, C-peptide, pancreatic and enteroglucagon were also measured. HbA1c decreased during guar (p less than 0.001) and guar + fructose diet (p less than 0.001). The glucosuria index improved (p less than 0.02) and the serum total cholesterol concentration decreased (p less than 0.02) during the experimental guar diets. Guar in acceptable form and quantity in the diet appears to improve metabolic control of diabetic children.

Elimination diets in the treatment of secretory otitis media.

The significance of elimination diets in the treatment of secretory otitis media (SOM) and the usefulness of the cytotoxic leucocyte test (CLT) in the planning of elimination diets were investigated. Sixty-seven children with SOM were tested with CLT and treated with or without elimination diets in addition to the established SOM-treatment. After two years of observation in patients with multiple CLT-reactions (50) there was an almost significant difference (P less than 0.06) in the cure rates and a significant difference (P less than 0.02) in the percentages of therapeutic failures between those treated with (32) and those treated without (18) elimination diets. No marked difference was found between patients, who did not have multiple CLT-reactions (17) and were treated without diets and patients who were treated with diets for multiple CLT-reactions (32). It was concluded that elimination diets are needed in the treatment of SOM for those patients who have multiple reactions in the CLT and that the CLT is useful in the planning of these elimination diets.

The occurrence and origin of DDT in human milk.

Gas chromatography has been applied for the analysis of organochlorine compounds of 49 samples of human milk. The average total DDT (2,2-bis(4-chlorophenyl)1,1,1-trichloroethane) content in human milk was found to be 0.058 mg/kg (1.57 mg/kg milk fat, with a range of 0.54-4.00 mg/kg). Thirty-four cases contained traces of dieldrin, but the content of dieldrin reached 0.008 mg/kg in only one milk sample. The average content of PCB (polychlorinated biphenyls) was 0.024 mg/kg of human milk, with a range of 0.011-0.054 mg/kg (0.65 mg/kg of milk fat with a range of 0.33-1.10 mg/kg). The ratio of DDT metabolites/DDT varied from 1.1 to 7.8 (mean 2.8). Studies were also made of the effect of the weight, weight loss, diet, smoking habits and parity of the nursing mother upon the content of organochlorine compounds in human milk. A significant positive correlation was observed between the DDT content of human milk fat and cigarette smoking. The average daily intake of total DDT for Finnish breastfed babies was calculated to be 0.0093 mg/kg, 1.9 times more than the daily intake of 0.005 mg/kg indicated by FAO/WHO as the acceptable value.