Effects of a new amino acid, rice glucose polymer-based, and commercial amino acid-based formulas on growth and protein status of infants with cow's milk protein allergy.

BACKGROUND: Infants with cow's milk protein allergy (CMPA) are at risk for nutrient inadequacy and impaired growth. OBJECTIVE: To evaluate the effect of a new amino acid-based formula (nAAF) compared with commercial amino acid-based formula (cAAF) on growth and protein status of cow's milk protein (CMP)-allergic infants and to compare their growth with those of healthy infants. METHODS: Infants less than 6 months of age with CMPA were enrolled in the nAAF or cAAF groups. Healthy infants fed breast milk (BM) or infant formula (IF) were controls. They remained on their formula/milk until day 28 of the study. Anthropometric evaluation was performed at birth, day 0 and day 28 of the study and calculated to z-scores of weight-for-age (WAZ), length-for-age (LAZ) and head circumference-for-age (HAZ). Plasma amino acids, albumin, urea nitrogen, and creatinine were assessed for infants with CMPA on day 0 and day 28. RESULTS: The nAAF and cAAF groups did not differ in increases in WAZ [regression coefficient (95%CI): 0.088 (-0.619, 0.796), p = 0.791], LAZ [0.045 (-0.789, 0.880, p = 0.909], and HAZ [-0.645 (-2.082, 0.793), p = 0.337] between day 0 and day 28. The increases in WAZ and LAZ during 28 days in the nAAF group did not differ from the controls. The changes in the blood chemistry values, except albumin, were not different between CMPA groups. CONCLUSIONS: The nAAF, similar to the cAAF, supports growth and protein status for infants with CMPA, and it might be used as a substitute for the cAAF.

The benefits of a novel chicken-based oral nutritional supplement for older adults: A double-blind randomized controlled trial.

BACKGROUND AND OBJECTIVES: A considerable proportion of older adults are lactose intolerant. The aim of this study was to investigate the clinical safety, efficacy, and tolerability of a chicken-based oral nutritional supplement (ONS). METHODS AND STUDY DESIGN: Double-blind randomized controlled trial. Subjects in the intervention group received chicken-based ONS, and those in the control group received a similarly flavored oral fluid placebo. All subjects were followed-up every two months for a total of 6 months. RESULTS: Thirty-eight older adults aged ≥70 years were recruited. The mean age and BMI were 81.5±5.6 years and 19.6±2.5 kg/m2. At the end of this trial, there was no statistically significant change in sarcopenia-related variables in the intervention group. However, the higher-level physical activity (PA) group within the intervention group had a significantly improved usual gait speed (UGS) compared to the lower-level PA group (p=0.04). The adjusted mean differences in UGS between the high and low level PA groups in the intervention and placebo groups were 0.149 m/sec and 0.083 m/sec, respectively. Significant difference was observed for changes in two bone markers between the intervention and placebo groups. CONCLUSIONS: The chicken-based ONS evaluated in this study was well-tolerated. No improvement of sarcopenia-related components was shown by the study ONS. Up to nearly an 80% increase in adjusted mean difference in UGS between the high and low level PA groups was observed in the nutritional intervention group compared to the zero-protein calorie placebo group. Significant improvement in age-related bone resorption was the earliest advantage of taking our ONS.

Fat-soluble vitamins and plasma and erythrocyte membrane fatty acids in chylothorax pediatric patients receiving a medium-chain triglyceride-rich diet.

Post-operative chylothorax can be cured by a medium-chain triglyceride (MCT)-rich diet. However, there is concern that an MCT-rich diet results in clinical and biochemical deficiencies in fat-soluble vitamins and fatty acids. We compared fat-soluble vitamins status and fatty acids status before and after administration of an MCT-rich diet. Nine children with congenital heart disease developed chylothorax after cardiac surgery. Blood samples were drawn from each subject twice, first prior to administration of an MCT-rich diet and secondly when the chylothorax was clinically cured and the MCT diet discontinued. Both blood samples were analyzed for retinol and 25-hydroxy vitamin D concentrations, the ratio of α-tocopherol to total lipids (α-TE/TL), coagulogram, and the fatty acid composition in plasma and erythrocyte membrane phospholipids. In spite of a decrease in the α-TE/TL ratio (3.78 ± 0.89 vs 2.36 ± 0.44 mg/g, p<0.05), this decrease did not reach the deficiency cut-off level. Linoleic acid in both plasma and erythrocyte membrane lipids decreased significantly (25.25 ± 8.06 vs 14.25 ± 2.88%, and 11.19 ± 2.15 vs 6.89 ± 2.45%, respectively). Administration of an MCT-rich diet for treatment of postoperative chylothorax caused a reduction in vitamin E status and linoleic acid, but without any symptoms of deficiency.

Anal fissures in infants may be a pathognomonic sign of infants with cow's milk allergy.

OBJECTIVE: To study the association between analfissures and cow's milk allergy (CMA) in infants. METHODS AND METHOD: In a prospective study, 72 confirmed cases of CMA in infants were examined for anal fissure by pediatricians with five years' experience. A positive finding was defined as when an anal fissure was detected by at least two out of three examiners. RESULTS: Of infants with CMA with and without gastrointestinal GI symptoms, 79% and 83% had anal fissures, respectively The prevalence of anal fissure in these infants is significantly higher than in normal infants. CONCLUSION: Anal fissure may be a pathognomonic sign of cow's milk allergy in infants.

Lower prevalence of atopic dermatitis in breast-fed infants whose allergic mothers restrict dairy products.

OBJECTIVE: To study the prevalence of atopic dermatitis in exclusively breast-fed infants of allergic mothers who were placed either on liberal diets or on dairy-product-restricted diets. MATERIAL AND METHOD: Infants aged 0 to 4 months old, who were exclusively breast-fed and whose mothers had a history of allergic disease, were the subjects of the present study. The mothers were randomized into two groups; mothers in a control group were on liberal diets, while mothers in an intervened group were on dairy product-restricted diets. Infants of both groups were examined for atopic dermatitis at seven days, one month, and four months of age. RESULTS: There were 32 and 30 infants in the control and intervened groups, respectively. Eight infants in the control group and two infants in the intervened group developed atopic dermatitis by the age of four months. The prevalence of atopic dermatitis in the intervened group was significantly lower than that in the control group (6.67% vs. 25%, p < 0.05). CONCLUSION: Dairy product restriction in allergic mothers results in decreasing prevalence of atopic dermatitis in 4-month-old infants who were exclusively breast-fed.

Growth of infants with cow's milk allergy fed chicken-based formula.

BACKGROUND: The recommended formulas for treatments of cow's milk allergy (CMA) in infants are hydrolyzed protein-based and amino acid-based formulas. However they are not always affordable. Furthermore, some patients are still allergic to these formulas. Therefore, chicken-based formula has been innovated and used as an alternative formula to treat CMA in these infants. OBJECTIVE: To assess the growth of infants with CMA who consumed chicken-based formula compared to normal infants. MATERIAL AND METHOD: A prospective study was performed in 34 infants aged 3 to 24 months diagnosed as CMA at Siriraj Hospital. All subjects consumed the chicken-based formula for at least three months. The growth parameters were recorded. RESULTS: Manifestations occurred in dermatological (78.60%), respiratory (67.9%), and gastrointestinal (53.6%) systems. Mean (+/-SD) chicken-based formula intake was 77 (+/-39.6) kcal/kg/d Weight gains are higher (35.7%), equal (10.8%), and lower (53.5%) than those of normal infants. In addition, length gains were higher (38%), equal (5%), and lower (57%) than those of normal infants. However, the difference of weight and length in chicken-basedfed, cow s milk-allergic infants, and normal infants were not statistically significant (p = 0.141, p = 0.192). None of these infants had severe complications. CONCLUSION: Growth parameters of infants fed with chicken-based formula are not diferent from those of normal infants.

Whole gastrointestinal transit time is associated with clinical severity and nutritional status of HIV-infected children.

BACKGROUND: Malnutrition and malabsorption are common consequences in pediatric human immunodeficiency virus (HIV) infection. The gastrointestinal tract is a major site affected by HIV Rapid gastrointestinal transit time may contribute to malabsorption. OBJECTIVE: To determine whether the whole gastrointestinal transit time (WGTT) correlates with disease stages or degrees of malnutrition in HIV-infected children. MATERIAL AND METHOD: Forty HIV-seropositive children, at various stages of disease, and thirty seronegative age-matched controls, aged between 1 mo and 3 yr, were enrolled in the present study. The body weight, length, or height and the WGTT were assessed Then the WGTT of children in different stages of HIV disease and in different degrees of malnutrition were compared with those of the control group. RESULTS: The mean ages were 15.5 and 14.3 mo in HIV-infected and control groups respectively. A greater degree of malnutrition was found in HIV-infected children with more advances HIV clinical symptoms. Compared to controls, WGTT was most rapid in severely symptomatic acquired immunodeficiency syndrome (AIDS) patients (Category C) (14.32 +/- 3.88 versus 7.22 +/- 3.17 h; p < 0.01) but not in asymptomatic, mildly and moderately symptomatic children. Accelerated WGTT in HIV-infected children was also significantly associated with a higher degree of malnutrition. CONCLUSION: Malnutrition is clearly related to the progression ofHIV disease. Accelerated WGTT is associated with HIV seropositivity, severe clinical symptoms, and higher degrees of malnutrition.

Fatty acid composition in breast milk from 4 regions of Thailand.

BACKGROUND: DHA contents in breast milk varied upon maternal dietary intakes. OBJECTIVE: To study DHA contents in breast milk in Thai lactating women from four diferent regions of Thailand. MATERIAL AND METHOD: 20 mL of hind milk from 40 lactating women from Bangkok, Chantaburi, Tak, and Surin were collected and analyzed for fatty acids contents by gas chromatography Dietary intake of lactating women after delivery until the present study was assessed by a food frequency questionnaire. Then, the average DHA intake was estimated from the diets by using the reference data. RESULTS: DHA contents in breast milk of mothers from Surin were higher than those from other areas. There were no correlations between history of DHA intake and DHA contents in breast milk. CONCLUSION: DHA contents in breast milk vary from region to region of the country. Local dietary intake and genetics might explain this contrast.

Reconfirmation of improved tolerance to a new amino acid-based formula by infants with cow's milk protein allergy.

BACKGROUND AND OBJECTIVES: Reasons for intolerance to commercial amino acid-based formulas (cAAF) in infants diagnosed with cow's milk protein allergy (CMA) remain unknown. We assume that minute amounts of proteins, presenting in the glucose polymers derived from corn starch (cGPs), can elicit the intolerance to the cAAFs observed in some infants with CMA. By replacing cGPs with glucose polymers derived from rice starch (rGPs), a new amino acid-based (nAAF) formula has been shown to be better tolerated than an existing cAAF. This study was carried out to corroborate the superiority of nAAF over a different commercially available cAAF. METHODS AND STUDY DESIGN: Infants with CMA aged less than 4 months underwent a double-blind, placebo-controlled food challenge. They consumed each of the 2 test formulas for 14 days before switching to the other one. Following the 28-day challenge period, infants consumed the tolerated formula for 4 weeks as an at-home open challenge. RESULTS: Out of 36 infants who completed the study, 18 were intolerant to the cAAF, seven of whom (38.8%) were also intolerant to the nAAF. Eleven of the 18 infants who were intolerant to the cAAF tolerated the nAAF (p<0.01). CONCLUSIONS: This study reconfirms that substitution of rGPS for cGPs in the amino acid-based formula improves tolerance of young infants with CMA.

Improved Tolerance to a New Amino Acid-Based Formula by Infants With Cow's Milk Protein Allergy.

BACKGROUND: Prevalence and severity of cow's milk protein allergy (CMA) in infants are increasing. A proportion of infants with CMA still elicit signs and symptoms of CMA while ingesting commercial amino acid-based formulas (AAFs). We propose that protein in glucose polymers (GPs) derived from corn starch in the AAFs might be the cause of intolerance to AAF in some infants. We thus have produced small molecules of GPs from rice starch, eliminating the protein fraction from them, and subsequently used them as the sole source of carbohydrate in a new amino acid-based formula (NAAF). METHODS: The efficacy of the NAAF was compared with that of an AAF in a double-blind, placebo-controlled food challenge (DBPCFC) in young infants with CMA aged <4 months. Infants consumed each formula for 14 days before switching to the other one. If no respiratory, dermatologic, and gastrointestinal symptom occurred, it was considered tolerance. After the challenge, infants consumed the tolerated formula for 4 weeks to prove real tolerance to that formula. RESULTS: Of 46 infants, 23 were intolerant to the AAF, of whom 7 (30.4%) were also intolerant to the NAAF. Sixteen of the 23 infants who were intolerant to the AAF could tolerate the NAAF ( P < .05). The minimal important difference of decreasing percentage of intolerance to the NAAF was 34.8% compared with the infants who were intolerant to the AAF. CONCLUSION: The NAAF is better tolerated than a commercially available AAF for the management of infants with CMA.

Relative risks of becoming overweight and obese in children after 6 years in secondary school.

The authors carried out a longitudinal study of bodyweights of secondary-school children from Grade VII to Grade XII. Initial data of weight for height at Grade VII showed that the prevalences of overweight boys and girls were 13.6% and 9.9% and of obesity of boys and girls 26.8% and 13.5%, respectively. However, when these children were at Grade XII the prevalences of overweight of boys and girls were 14.0% and 10.5% and of obesity of boys and girls were 15.0% and 10.8%, respectively. The relative risks of becoming overweight of boys and girls at Grade XII who were already overweight at Grade VII were 1.5 and 4.0 respectively, and the relative risks of obesity in boys and girls at Grade XII who were already obese at Grade VII were 1.4 and 4.6, respectively. The present study showed that without any nutritional intervention those children, especially girls who were overweight and obese were more likely to maintain their bodyweights throughout the 6-year period in secondary school.

Increasing risks of becoming obese after 6 years in primary school: comparing the relative risks among some schools in Bangkok, Saraburi and Sakolnakorn.

The authors carried out a retrospectively study of bodyweights of primary-school children from Grade I to Grade VI in 4 schools from Bangkok, one school from Saraburi and data of school children from a district in Sakolnakorn with a six year follow-up period. In the cohort there were 437 children from Bangkok, 225 children from Saraburi and 633 children from Sakolnakorn. Initial data show that prevalence of obesity at grade I in schools from Bangkok, Saraburi and Sakolnakorn were 16%, 23% and 4%, respectively. However, when these children were in grade VI, the prevalence of obesity increased to 31%, 30% and 9%, respectively. Relative risks of becoming obese at grade VI in children who were overweight and obese at grade I are 3 and 5 fold in Bangkok, 2 and 3 fold in Saraburi, 6 and 12 fold in Sakolnakorn, respectively. The present study shows that prevalence of obesity increased at quite dramatic rates during the primary school period in these study groups.

Carnitine-acylcarnitine translocase deficiency: Two neonatal cases with common splicing mutation and in vitro bezafibrate response.

BACKGROUND: Mitochondrial fatty acid oxidation (FAO) disorders are among the causes of acute encephalopathy- or myopathy-like illness. Carnitine-acylcarnitine translocase (CACT) deficiency is a rare FAO disorder, which represent an energy production insufficiency during prolonged fasting, febrile illness, or increased muscular activity. CACT deficiency is caused by mutations of the SLC25A20 gene. Most patients developed severe metabolic decompensation in the neonatal period and died in infancy despite aggressive treatment. PATIENTS AND METHODS: We herein report the clinical findings of two unrelated cases of CACT deficiency with mutation confirmation, and in vitro bezafibrate responses using in vitro probe acylcarnitine (IVP) assay. Patients 1 and 2 are products of nonconsanguineous parents. Both patients developed cardiac arrest at day 3 of life but survived the initial events. Their blood chemistry revealed hypoglycemia and metabolic acidosis. The acylcarnitine profiles in both patients demonstrated increased long-chain acylcarnitines, suggesting CACT or carnitine palmitoyltransferase-2 (CPT2) deficiency. RESULTS: The mutation analysis identified homozygous IVS2-10T>G in the SLC25A20 gene in both patients, confirming the diagnosis of CACT deficiency. The IVP assay revealed increased C16, C16:1, but decreased C2 with improvement by bezafibrate in the cultured fibroblasts. The short-term clinical trial of bezafibrate in Patient 1 did not show clinical improvement, and died after starting the trial for 6 months. CONCLUSION: This splicing mutation has been identified in other Asian populations indicating a possible founder effect. IVP assay of cultured fibroblasts could determine a response to bezafibrate treatment. A long-term clinical trial of more enrolled patients is required for evaluation of this therapy.

Prevention of antibiotic-associated diarrhea in infants by probiotics.

Probiotics administration has been claimed to prevent antibiotic-associated diarrhea. The investigators thus conducted a double blind, placebo controlled study of providing probiotics to infants and children with severe bacterial infections and receiving broad spechum antibiotics. The results of the study showed that the group receiving probiotics had fewer diarrheal episodes (37.5%) than the control group (80%), although the numbers were too small for statistical analysis. In conclusion, probiotics administration to patients receiving high doses of broad spectrum antibiotics may prevent the occurrence of antibiotic-associated diarrhea. A further study with a larger number is required.

Lactose intolerance in Thai adults.

Lactose intolerance is common in Thai adults who ingest cow's milk but its incidence has not been clearly defined The authors evaluated 45 volunteers (15 males, 35 females), aged 21-31 yrs old, who drank one 240-ml box of milk daily. A Lactose tolerance test was performed using a breath-hydrogen test (BHT) after oral intake of 25 g of lactose dissolved in 250 ml of water The presence of gastrointestinal symptoms of lactose intolerance, flatulence, abdominal pain and diarrhea, were recorded Twenty-one subjects (47%) were categorized as lactose malabsorbers and intolerant, two subjects (4%) were malabsorbers but tolerant, and 22 of 45 (49%) were absorbers and tolerant. The incidence of lactose malabsorption was, thus, 51%; symptoms of intolerance were found in 21 of the 23 malabsorbers, making the incidence of lactose intolerance 47%. In the lactose malabsorbant and intolerant group, the more breath-hydrogen (H) the more symptoms observed All subjects who had a negative breath-H2 test had no symptoms. The breath-H2 test should be used as a standard method to evaluate lactose absorption and lactose tolerance. The incidence of lactose intolerance has decreased from the past and the symptoms are not so severe that the people limit the consumption of milk since it is a major source of food containing good quality of protein and calcium.

High plasma branched-chain amino acids:aromatic amino acids ratio in children on the ketogenic diet: a mechanism in controlling epilepsy.

BACKGROUND: The authors proposed that ketogenic diets will produce an increase in the ratio of branched chain amino acids (BCAAs) and aromatic amino acids (BCAAs) in plasma of children who are on the diets. SUBJECTS AND METHOD: A sample of plasma amino acids sample before initiation of fasting and on day 10 of the dietary treatment was obtained in patients with refractory epilepsy who were newly admitted for initiation of ketogenic diet. Plasma amino acids were determined by high performance liquid chromatography equipment. RESULTS: There are 20 patients with refractory epilepsy participating in this study. Outcomes of ketogenic diet therapy were satisfactory. Nineteen cases out of 20 cases had a significantly higher ratio of plasma BCAAs:ARAAs during ketogenic diets than before the diet (P < 0.001). CONCLUSION: The ketogenic diets produced an increased ratio of plasma BCAAs:ARAAs. Whether the increased ratio of plasma BCAAs:ARAAs plays an important role in controlling epilepsy is yet to be elucidated.

Comparison of the nutrient content of fresh fruit juices vs commercial fruit juices.

OBJECTIVE: To compare the types and quantities of carbohydrate, electrolytes, pH and osmolarity of fresh fruit juices and commercial fruit juices. MATERIAL AND METHOD: Forty kinds of fresh fruits available in Thai markets were analyzed for types and quantities of carbohydrate, electrolyte, pH and osmolarity and compared with previously obtained data for commercial fruit juices. RESULTS: Most fresh fruit juices did not contain sucrose, whereas, commercial fruit juices mostly have sucrose in the range of 3-112 g/L. Although both fruit juices were acidic (pH varied from 3.6-6.7 and 3.2-5.8 of fresh juice and commercial juice), fresh fruit juices had a more neutral pH than commercial fruit juices. Apple, guava, orange, pear, and pineapple juices from commercial fruit juices had a high osmolarity compared with fresh fruit juices. All types of fresh fruit juices contained less sodium than commercial ones, whereas, most fresh fruit juices contained more potassium, phosphorus, and magnesium than commercial fluids. CONCLUSION: The nutrient content of fresh fruit juices and commercial fruit juices from the same kinds of fruits are not the same, possibly due to the manufacturing process. Therefore, physicians should know the composition of fruit juices in order to advise patients properly.