Nutritional intake evolution in adolescent sporting boys over the last two decades.

UNLABELLED: The AIM of the study was to evaluate the nutritional trends in young elite male soccer players, attending national soccer league at RFC Bruges over the last two decades. At the start of each season, players and parents are instructed about normal healthy nutrition and fluid intake by dieticians. METHODS: Since 1983, dieticians perform dietary habit surveys in the adolescent player groups. They instruct players and parents how to record all food and fluid intake during 3 days, a training-day, a match-day and an off -day. It is asked to do the recordings when players and parents are together and parents are asked to supervise the recording. Intakes are calculated using the Becel institute nutrition software (BINS), Becel, 2003. RESULTS: A significant decrease of energy intake/m2 is observed over the last 20 years. Body composition, measured as age-matched body mass index remained at median levels for the population during this period. An important modification of dietary content towards the recommended daily intakes is observed. Fat, saturated fat and cholesterol intake decreased dramatically. Carbohydrate intake increased. CONCLUSIONS: A positive evolution towards the recommended dietary composition is observed over the years. However, the decrease in caloric intake without influence on the body mass index could suggest that these elite male footballers have a decreased physical activity as compared to 20 years ago.

The effect of zinc supplements in cystic fibrosis patients.

AIM: To study the effect of Zn supplements in cystic fibrosis (CF) on disease evolution. METHODS: A retrospective study of all CF patients treated with Zn supplements (January 2002 to December 2004). Data from patient files for the year before and the first year of supplementation were compared. The controls were CF patients with normal serum Zn and without Zn supplementation. RESULTS: 21 patients (7 females), median age 8.9 (interquartile range 13.1) years, received 5 mg/kg Zn sulfate/day (maximum 150 mg). The number of infections decreased from 3 (1.25) to 2 (2.0) (tied p < 0.02) and the forced expiratory volume in 1 s (FEV(1)) increased from 72.0 (38.4) to 76.5 (52)% (p < 0.02). Energy intake improved (92.3 (14.5) to 117.0 (28.5)%; tied p < 0.02), as did weight for height (W/H; 90 (9.4) to 94 (8.5)%; tied p = 0.043). In the CF control patients the number of infections (2.0 (2.0)), energy intake (116 (43.3)%) and nutritional status remained stable (W/H 99 (17.2)%), but pulmonary function decreased significantly (DeltaFEV(1) loss of 2.0 (8.0)%). There was a significantly different evolution for the change in forced vital capacity (p < 0.004) and DeltaFEV(1) (p < 0.001) between supplemented and control patients. CONCLUSIONS: Analysis of the clinical data on Zn supplementation in CF showed beneficial effects in Zn-deficient CF patients. These results must be confirmed in a prospective double-blind randomized control trial.

Oral DHA supplementation in DeltaF508 homozygous cystic fibrosis patients.

AIM: The aim of this study was to evaluate whether the previously observed changes in the fatty acid profile, as a result of DHA supplementation, could be maintained during longer study trials and to observe its effect on the clinical outcome of cystic fibrosis (CF) patients. METHOD: A year-long double-blind placebo-controlled study was performed in DeltaF508 homozygous CF patients above the age of 6. Clinical data, including pulmonary function and number of infections, were collected. Blood for the determination of the fatty acid (FA) composition of serum phospholipid, vitamin E, liver enzymes, immunoglobulins, erythrocyte sedimentation rate and coagulation was drawn at the beginning and then every 6 months after the start of the study. RESULTS: Seventeen patients were included; one dropped out. The treatment group was supplemented with an algal DHA-rich oil and the control group with sunflower seed oil. There was no difference between the control and treatment groups for W/H%, caloric intake, FEV1% and FVC% at the start of the study and after 1 year of supplements. The phospholipid FA composition did not change in the control group. The treatment group had a significant increase in DHA and eicosapentaenoic acid (EPA) concentration. A concomitant decrease of dihomo-gammalinolenic acid, arachidonic acid, 22:5 n-6 and Mead acid was observed. The laboratory results showed no changes in vitamin E level, liver enzymes, albumin, erythrocyte sedimentation rate and IgG concentration in either the placebo or the intervention group. CONCLUSION: Although DHA-rich oil shifted the serum phospholipid FAs to a less pro-inflammatory profile, no conclusive clinical improvement could be observed so far.

Serum zinc concentrations in cystic fibrosis patients aged above 4 years: a cross-sectional evaluation.

AIM: Assess the risk of zinc (Zn) deficiency in the older cystic fibrosis (CF) population. METHOD: Cross-sectional investigation of all CF patients above the age of 4 followed at the Ghent University center between 2002 and 2003. Data on age, weight, height z-score, pancreatic and pulmonary functions, chronic Pseudomonas infection, and CF transmembrane conductance regulator (CFTR) mutations were collected. Serum Zn, vitamins (vit) A and E, retinol-binding protein (RBP), albumin, sedimentation rate, total IgG, and cholesterol were determined. Serum Zn was compared with a local healthy control group (Van Biervliet et al., Biol Trace Elem Res 94:33-40, 2003) and with literature data (Hotz C, et al. Am J Clin Nutr 78:756-764, 2003). RESULTS: 101 patients (median age 16 years) were included. There was no difference in serum Zn concentration between CF patients and controls. In CF patients no difference in serum Zn concentration between pancreatic-sufficient or pancreatic-insufficient patients was seen. Serum Zn was not associated to nutritional status or height z-score. A significant association serum Zn to serum albumin (p < 0.0005) and to vit A (p < 0.01) was seen. No associations of serum Zn to serum vit E, RBP, cholesterol, or CFTR were present, but there is a significant association serum Zn to forced vital capacity (p < 0.01). Serum Zn was not associated to inflammatory parameters or chronic Pseudomonas infection. CONCLUSION: Comparison of CF patients with local controls revealed no significant differences. However, because persisting steatorrhea increases Zn loss (Easley et al., J Pediatr Gastroenterol Nutr 26:136-139, 1998) and 12.6% of our population has a serum Zn below the p value of 2.5 of the NHANES II study (Hotz C, et al. Am J Clin Nutr 78:756-764, 2003), there could remain an increased risk of Zn deficiency in some CF patients. Furthermore, the association with pulmonary function needs more investigation.

An absence of cutaneous neurofibromas associated with a 3-bp inframe deletion in exon 17 of the NF1 gene (c.2970-2972 delAAT): evidence of a clinically significant NF1 genotype-phenotype correlation.

Neurofibromatosis type 1 (NF1) is characterized by cafe-au-lait spots, skinfold freckling, and cutaneous neurofibromas. No obvious relationships between small mutations (<20 bp) of the NF1 gene and a specific phenotype have previously been demonstrated, which suggests that interaction with either unlinked modifying genes and/or the normal NF1 allele may be involved in the development of the particular clinical features associated with NF1. We identified 21 unrelated probands with NF1 (14 familial and 7 sporadic cases) who were all found to have the same c.2970-2972 delAAT (p.990delM) mutation but no cutaneous neurofibromas or clinically obvious plexiform neurofibromas. Molecular analysis identified the same 3-bp inframe deletion (c.2970-2972 delAAT) in exon 17 of the NF1 gene in all affected subjects. The Delta AAT mutation is predicted to result in the loss of one of two adjacent methionines (codon 991 or 992) ( Delta Met991), in conjunction with silent ACA-->ACG change of codon 990. These two methionine residues are located in a highly conserved region of neurofibromin and are expected, therefore, to have a functional role in the protein. Our data represent results from the first study to correlate a specific small mutation of the NF1 gene to the expression of a particular clinical phenotype. The biological mechanism that relates this specific mutation to the suppression of cutaneous neurofibroma development is unknown.

Serum alpha-tocopherol and selenium in Belgian infants and children.

Previous studies showed low selenium (Se) concentrations in Belgian children. Serum alpha-tocopherol, retinol, total cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol, selenium (Se), and thiobarbituric acid-reactive substances were examined. In order to obtain further information on the Se status in Belgian children, Se, alpha-tocopherol, retinol, and lipid concentrations were examined and signs of peroxidative lipid damage were evaluated in a subgroup. The study was performed in 524 children (0-14 yr old) during vaccination campaigns. Three age groups were analyzed: 0-1, 1-4, and 4-14 yr. In 87 of them, where sufficient amounts of serum were available, analysis of thiobarbituric acid-reactive substances was done. Infants have high serum alpha-tocopherol concentrations: (23.2 micromol/L [median and interquartile range: 18.6-30.2]) and low Se concentrations (0.37 mol/L [0.27-0.47]). Se concentrations rise significantly during the first 4 yr (p < 0.0001) (Mann-Whitney U-test, tied p-values): 0.70 micromol/L (0.59-0.82); in the 4-14 yr olds, it was 0.75 micromol/L (0.67-0.86). These values remain low compared to results coming from other parts of the world. Alpha-tocopherol concentrations decrease significantly after infancy (p < 0.0001). The ratio alpha-tocopherol/total cholesterol is higher in infants. This is induced by the high vitamin E content of infant formulas. Signs of serum lipid peroxidation could not be detected by analysis of serum malondialdehyde concentrations. High alpha-tocopherol concentrations, as those observed in infant serum lipids, could be one of the protective mechanisms from the peroxidative lipid damages, sometimes observed in a low-Se status.

Helix-helix interactions in reconstituted high-density lipoproteins.

In this work we calculated the ionic interactions between adjacent amphipathic helices of apo A-I and apo A-IV. The calculation of the electrostatic potential around the helices helps identify the charged residues susceptible to form salt bridges between adjacent helices. An estimation of the stability of the different pairs of helices is derived from the calculation of the energy of interaction between contiguous helices at a water/lipid interface after energy minimization. The most stable energetic conformation corresponds to the 17-residue helices oriented anti-parallel and separated by a stretch of 5 residues in an extended beta-strand conformation, as calculated through the 'stereo alphabet' calculation procedure. In a pair of helices, the hydrophobic faces are directed towards the lipid core of the discoidal phospholipid-apolipoprotein complex and the hydrophobic lipid-protein interactions are major determinants for the stability of the complex. Interactions between polar residues located on the opposite face of the helix and water molecules can also contribute to the overall energy of the system. Finally, salt bridge formation between residues of opposite charge along the edge of the helical segments contribute to the cooperativity of the phospholipid-apolipoprotein complex formation. The mode of assembly of the amphipathic helical repeats of the apolipoproteins around the edge of a discoidal complex is therefore determined both by the hydrophobic character of the residues and by the charge complementarity along the edge of the helices which increases the structural stability and determines the relative orientation of the helices.(ABSTRACT TRUNCATED AT 250 WORDS)

Dietary nucleotides enhance plasma lecithin cholesterol acyl transferase activity and apolipoprotein A-IV concentration in preterm newborn infants.

The activity of lecithin cholesterol acyl transferase (LCAT), a key enzyme in lipoprotein metabolism, is low in newborn preterm infants. It has been suggested that a normal gastrointestinal function might be necessary to induce a postnatal increase of LCAT activity because apoproteins A-I and A-IV (apoA-I and apoA-IV) synthesized in considerable amounts in the intestine are known activators of LCAT. Dietary nucleotides have been reported to enhance intestinal growth and maturation; therefore, we hypothesized that nucleotide supplementation to formulas for preterm infants may influence LCAT activity. To investigate this hypothesis, two groups of preterm infants were fed either a nucleotide-free formula or a nucleotide-supplemented formula during the first month of life. The plasma LCAT activity, plasma levels of apoA-I and apoA-IV, plasma cholesteryl esters, and plasma fatty acid composition of cholesteryl esters and phospholipids were then determined. Infants receiving nucleotides had higher LCAT activities and apoA-IV levels than those receiving the nucleotide-free formula for a few weeks. The changes in apoA-IV levels were highly correlated with those of the LCAT activities. However, there were no significant correlations between changes in LCAT activity and plasma cholesteryl esters or phospholipids. These findings indicate that nucleotide supplementation to formulas for preterm infants may improve dietary lipid tolerance by enhancing plasma LCAT activity, probably as a result of an increase in apoA-IV plasma concentrations; they also suggest that nucleotides may enhance apoA-IV synthesis in the intestine during the neonatal period.

Diet and the essential fatty acid status of term infants.

Long-chain polyunsaturated fatty acids with 20 and 22 carbon atoms (LCPs) seem to play an important role during the rapid development of the infant brain in the late fetal and early postnatal period. These LCPs are integral constituents of biological membranes and they are involved in the regulation of functional properties like fluidity, permeability and activity of membrane-bound enzymes. Human milk contains LCPs in an amount of 0.5-3 wt% of total fatty acids, whereas commercially available infant formulae are almost free of them. Recently, several clinical trials, primarily with preterm infants, have reported that the content of LCPs in the blood and a functional parameter like visual acuity correlate with the content of LCPs in the diet. In this clinical trial we studied the effect of different diets on the fatty acid pattern of plasma and erythrocyte lipids of healthy term infants during the first 3 months of life. Breast-fed infants were compared with formula-fed babies who received a commercially available formula without LCPs or a new experimental formula enriched with LCPs that was similar to human milk. The results indicate that the introduction of milk feeding leads to marked differences in the blood lipid composition during the first months of life, independent of the feeding regimen. Secondly, the supplementation of a formula with LCPs seems to result in a blood lipid composition similar to infants fed with human milk. This supports the hypothesis that the newborn term infant has a limited desaturating capacity and depends on an exogenous supply of LCPs during the first months of life.

Serum cholesterol, cholesteryl ester, and high-density lipoprotein development in newborn infants: response to formulas supplemented with cholesterol and gamma-linolenic acid.

Healthy newborn infants were either breast-fed or randomly designated to receive a standard formula, formula plus cholesterol, or formula plus gamma-linolenic acid at birth. At 0, 7, and 30 days of life, the following variables were measured: cholesteryl esters (cholesteryl arachidonate, cholesteryl oleate, cholesteryl palmitate, and cholesteryl linoleate), high-density lipoprotein (HDL) cholesterol, apoproteins (A-I, A-II, B, C-II, C-III, and E), and the cholesterol and apoprotein A-I content of the HDL subfractions HDL-2b, HDL-(2a + 3a), and HDL-(3b + 3c). Breast-fed infants had higher serum levels of cholesterol, cholesteryl oleate, cholesteryl palmitate, cholesteryl arachidonate, and HDL-2b than had formula-fed infants. Addition of gamma-linolenic acid to formula raised cholesteryl-arachidonate levels, and cholesterol and gamma-linolenic acid raised serum HDL-2b levels compared with those produced by unsupplemented formula. Our data suggest that both exogenous cholesterol and gamma-linolenic acid contribute to the maturation of HDL particles associated with human milk consumption in newborn infants. They may also promote adequate delivery of cholesterol and arachidonic acid to the developing brain.

Catalytic triad residue mutation (Asp156----Gly) causing familial lipoprotein lipase deficiency. Co-inheritance with a nonsense mutation (Ser447----Ter) in a Turkish family.

We studied the molecular basis of familial Type I hyperlipoproteinemia in two brothers of Turkish descent who had normal plasma apolipoprotein C-II levels and undetectable plasma post-heparin lipoprotein lipase (LPL) activity. We cloned the cDNAs of LPL mRNA from adipose tissue biopsies obtained from these individuals by the polymerase chain reaction and directional cloning into M13 vectors. Direct sequencing of pools of greater than 2000 cDNA clones indicates that their LPL mRNA contains two mutations: a missense mutation changing codon 156 from GAU to GGU predicting an Asp156----Gly substitution and a nonsense mutation changing the codon for Ser447 from UCA to UGA, a stop codon, predicting a truncated LPL protein that contains 446 instead of 448 amino acid residues. Both patients were homozygous for both mutations. Analysis of genomic DNAs of the patients and their family members by the polymerase chain reaction, restriction enzyme digestion (the GAT----GGT mutation abolishes a TaqI restriction site), and allele-specific oligonucleotide hybridization confirms that the patients were homozygous for these mutations at the chromosomal level, and the clinically unaffected parents and sibling were true obligate heterozygotes for both mutations. In order to examine the functional significance of the mutations in this family, we expressed wild type and mutant LPLs in vitro using a eukaryotic expression vector. Five types of LPL proteins were produced in COS cells by transient transfection: (i) wild type LPL, (ii) Asp156----Gly mutant, (iii) Ser447----Ter mutant, (iv) Gly448----Ter mutant, and (v) Asp156----Gly/Ser447----Ter double mutant. Both LPL immunoreactive mass and enzyme activity were determined in the culture media and intracellularly. Immunoreactive LPLs were produced in all cases. The mutant LPLs, Asp156----Gly and Asp156----Gly/Ser447----Ter, were devoid of enzyme activity, indicating that the Asp156----Gly mutation is the underlying defect for the LPL deficiency in the two patients. The two mutant LPLs missing a single residue (Gly448) or a dipeptide (Ser447-Gly448) from its carboxyl terminus had normal enzyme activity. Thus, despite its conservation among all mammalian LPLs examined to date, the carboxyl terminus of LPL is not essential for enzyme activity. We further screened 224 unrelated normal Caucasians for the Ser447----Ter mutation and found 36 individuals who were heterozygous and one individual who was homozygous for this mutation, indicating that it is a sequence polymorphism of no functional significance. Human LPL shows high homology to hepatic triglyceride lipase and pancreatic lipase.(ABSTRACT TRUNCATED AT 400 WORDS)

Quantification of lipoprotein(a) in dried blood spots and screening for above-normal lipoprotein(a) concentrations in newborns.

Lipoprotein(a) [Lp(a)] is considered an additional, independent, and largely genetically determined risk factor for the development of premature coronary heart disease. Analogous with increased Lp(a) concentrations that represent an additional risk factor in adults, above-normal concentrations of Lp(a) can be detected in five- to seven-day-old newborns. We describe a simple enzyme-linked immunosorbent assay for measuring Lp(a) in dried blood spots collected by heel-prick in five- to seven-day-old infants. Lp(a) could be quantitatively recovered from blood spots. We chose a cutoff value of 100 mg/L for identifying the newborns at risk, based on the Lp(a) distribution in 180 such infants.

Lipoprotein(a) profiles and evolution in newborns.

Plasma Lp(a) concentrations in newborns were quantified by a specific and sensitive ELISA assay and their evolution was followed between birth and 6 months. The influence of the diet on Lp(a) levels was also investigated. Moreover, the high sensitivity of the assay enabled the localisation of the Lp(a) fraction in the lipoprotein profile obtained after plasma separation by gel chromatography. Lp(a) levels are low at birth and rise significantly between 0 and 7 days post partum; in this newborn population, a continuous rise of the mean Lp(a) levels was observed until 180 days, in contrast with the apo B concentration that plateaus after 7 days. An early screening enabled the detection of newborns with elevated Lp(a) levels compared to the mean value of their age group. A further follow-up of some cases at 16 months confirmed the high Lp(a) levels measured in the infants and at least one of the parents. The investigation of the lipoprotein profiles as a function of the age of the newborn enabled an estimation of the size and distribution of the Lp(a) lipoprotein in four infants. At birth, Lp(a) particles were larger than LDL and tend to become more heterogeneous with increasing age of the newborn. We could not observe any statistically significant influence of the nutritional factors on the plasma Lp(a) concentrations at any age.

Apolipoprotein and lipid composition of plasma lipoproteins in neonates during the first month of life.

In this study the lipid and apoprotein profiles were investigated in newborns at 0, 7, and 30 days of life. The plasma lipoproteins were separated both by ultracentrifugation and gel filtration in order to compare the patterns obtained by the two techniques. At birth, the apo E concentration is comparable to that measured in adults, but its distribution among lipoproteins is significantly different as more than 80% of the plasma apo E belongs to high-density lipoproteins (HDL). At 7 and 30 days the plasma apo E concentrations are close to the values at birth, but a significant redistribution occurs from HDL to very low-density lipoproteins. By analogy with apo B, the plasma apo CIII concentration is low at birth and increases between 0 and 7 days by a factor of about two. Plasma triglycerides increase significantly during the first week of life so that the apo CIII increase is most pronounced in very low-density lipoproteins. These lipoproteins therefore become enriched in apo E, apo CIII and triglycerides between 0 and 7 days. At birth, a distinct HDL fraction, enriched in apo E, apo AII and cholesterol (HDLE), could be detected. To compensate for the low LDL levels, this HDLE fraction might function as an additional source for cholesterol delivery to peripheral tissues via the apo (B, E) receptor. At later age, low-density lipoprotein synthesis is enhanced, apo E is transferred to very low-density lipoproteins, and cholesterol delivery via the HDLE becomes less important.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of dietary factors on the plasma lipoprotein composition and content in neonates.

Previous studies have shown that the cholesterol and apoprotein concentrations in newborn plasma are dependent on the degree of saturation (polyunsaturated/saturated fatty acids ratio) of the dietary fats. In the present study we compare the influence on the lipoprotein patterns of breast-feeding and of two adapted formulae with a similar P/S ratio in 30 infants. The lipoprotein distribution and composition were investigated by density-gradient ultracentrifugation at days 0, 7 and 30. The lipoprotein patterns were quite comparable at 0 and 7 days in the three groups. We found low VLDL and LDL and relatively elevated HDL concentrations with a high percentage of HDL2. A significant increase of both VLDL and LDL was observed between 0 and 7 days. The VLDL concentration in the breast-fed infants subsequently decreased between 7 and 30 days to a value close to that measured at birth. The infants receiving an adapted formula had significantly higher VLDL and lower LDL at 30 days compared to breast-fed children. HDL concentrations were not significantly different whereas the HDL2 percentage was significantly lower in the infants receiving the adapted formulae. These data further support the hypothesis that the lipoprotein patterns in infants are sensitive to the type of nutrition and that breast-feeding induces specific lipoprotein patterns compared to adapted milk formulae.

Multiple renal oncocytoma and bilateral cystic kidney.

A 10-year-old by, suffering from multiple bilateral renal oncocytomas and cystic kidney disease is presented. This case is the first to be observed at this age.