Clinical manifestations of nutritional copper deficiency in infants and children.

A series of reports in the 1960s highlighted nutritional copper deficiencies in infants and children recovering from malnutrition in Peru; since that time, a cascade of additional cases in premature infants, in patients receiving total parenteral nutrition, and in those receiving special diets or unmodified cow milk have been reported. The identification by Danks that Menkes syndrome, a genetically determined defect in copper absorption and utilization, is responsible for the observed clinical manifestations provided further insight into the physiopathologic effects of copper deficiency. New information on the metabolism and physiologic role of copper, plus the identification of additional copper metalloenzymes and improvement in how to determine copper status, has fueled interpretation and speculation on how and why the classic signs of copper deficiency occur, as well as on the possible effects of mild deficiencies. Also under scrutiny are potential interactions between other elements and the effects of other elements, even when given in acceptable amounts, on copper status. There should be no constraints in thinking on other possible effects of impaired copper status in humans. I review some of the history of nutritional copper deficiency in infants and children and attempt to interpret some of the clinical manifestations in light of newly acquired information.

Fecal characteristics in healthy young adults consuming defined liquid diets or a free-choice diet.

Fat and nitrogen absorption and fecal characteristics were studied in 10 healthy, young adults who ingested a free-choice diet for 12 days and then isocaloric amounts of one of two nutritionally complete liquid defined formula diets during a succeeding 12-day period. Apparent fat absorption was 98 to 99% of intake with both defined formula diets and 95% of intake on the free-choice diet. Nitrogen digestibility was determined during the liquid diet period, and averaged 95 to 98% of intake. There were no statistically significant differences between the liquid diets and the free-choice diets with respect to fecal wet or dry weight, transit time, or stool frequency. Individual stool weights averaged 83 to 96 g on the free-choice or liquid formula diets and were comparable to other values reported in the literature. These results support the theory that a critical volume of feces must accumulate in the colon before defecation occurs, regardless of diet composition.

Blood glucose rise after lactose tolerance testing in infants.

Lactose tolerance tests are used clinically to screen children and infants. It is assumed that absorption of a lactose challenge in infants would occur in a predictable pattern prior to weaning. Twenty-one infants from 3 to 12 months of age were studied. The maximum blood glucose rise over fasting levels ranged from 11.0 to 62.0 mg/100 ml; the mean was 32.6 mg/100 ml. Six infants had a maximum rise of less than 20 mg/100 ml. Eleven infants (52%) had a maximum rise of greater than 30 mg/100 ml. Signs of intolerance were not noted in any subject. Weight and length were normally disturbed. Results indicate the variance in glucose rise existing within a population of infants growing normally and consuming milk. Gastric emptying, digestion, and absorption may influence the blood glucose rise after a lactose test. Established glucose levels used as an index to lactose absorption in older children and adults may not accurately reflect lactase activity in infants.

Evaluation of two iron-fortified, milk-based formulas during infancy.

OBJECTIVE: Compare milk-based, iron-fortified formulas containing 7.4 and 12.7 mg/L iron and breast-feeding during the first year of life. DESIGN: Partially randomized, double-blind trial: non-breast-fed infants randomly assigned to receive one of two coded formulas, identical except for iron content; infants discontinuing breast-feeding between 1 and 8 weeks of age randomly assigned to a formula late-start group. SETTING: Five general community pediatric practices in Missouri, Indiana, Illinois, and Pennsylvania. PARTICIPANTS: Sample of 347 healthy, term infants, enrolled within 1 week after birth; 172 included in statistical analyses. OUTCOME MEASURES: Length, weight, and indicators of formula intolerance recorded at clinic visits; formula consumption, bowel movements, stool consistency, and other tolerance indicators recorded by parents on daily and weekly report forms; hemoglobin, hematocrit, and serum ferritin, iron zinc, and copper measured at 6 and 12 months. RESULTS: No significant differences between formula-fed groups in growth, attrition, formula consumption, bowel movements, hematocrit, hemoglobin level, and serum iron, zinc, and copper levels (P > .05); first 6-month weight and length changes of the breast-fed group significantly less than in both formula-fed groups (P < .008); serum ferritin level of the formula-fed, high-iron group significantly higher than that of the low-iron and breast-fed groups (P < .008), although all groups' values were normal; no apparent differences between formula groups in formula tolerance and stool characteristics but data were not analyzed statistically. CONCLUSIONS: Milk-based formulas containing either 7.4 or 12.7 mg/L iron support normal growth and iron status of healthy, term, normally fed infants during the first year and both are well tolerated and accepted.

Occurrence of Listeria monocytogenes in food in Chile.

Out of 2145 food samples analysed 77 were found contaminated with Listeria monocytogenes in Santiago, Chile. Samples were: 603 ice-cream (3.5% contaminated), 256 soft cheese (0.8%), 155 hard cheese (0%), 229 baby milk bottles (0%), 634 processed meat products (3.6%) and 268 crustaceous shellfish (11.6%). Three different isolation media were used: for 318 samples, Modified McBride Agar (MMA), Lithium chloride Phenylethanol Moxalactam agar, and Polymyxin Acriflavine Lithium chloride Ceftazidime Aesculin Mannitol agar; for 1827 samples MMA was replaced by Listeria Selective Agar Oxford Formulation. Isolates were classified as follow: serovar 1/2a (25 isolates), serovar 4b (20), serovar 1/2b (19), serovar 3b (7), serovar 1/2c (2), untypable (4). A high variety of phagovars was detected although 52% of strains was untypable.

Long-term nutritional support as an adjunct to chemotherapy for breast cancer.

In recent years, the concept of nutritional support as a part of a comprehensive cancer management program has gained increasing acceptability. However, little data is available in regard to the effect of nutritional support programs on the chronic disease state represented by recurrent or persistent cancer that characterizes patients undergoing systemic chemotherapy. In 1977 we undertook to study this problem in a randomized prospective study designed to evaluate the effects of long-term (12 months) enteral nutritional support in a group of ambulatory breast cancer patients undergoing a standard cytotoxic chemotherapy treatment program, in an adjuvant or therapeutic setting. The results of this study suggest that patients with breast cancer are overweight as compared to the general population and that any significant change in initial body weight, either a gain or a loss, is associated with an increased risk of recurrent disease. Data are presented which show little or no correlation between standard parameters of nutritional assessment and risk of disease recurrence and/or response to chemotherapy. These data also suggest that until we better understand the relationship between tumor and host in breast cancer patients, we offer nutritional support programs only in situations where there are specific clinical indications for such interventions.

Growth and tolerance studies of a new infant formula.

A new routine infant formula has been developed and clinically tested. The clinical study reported here involved 337 normal newborns cared for by six private pediatric group practices. Infants were examined regularly by the investigators until six months of age. Serum biochemistries, hematology, and growth and tolerance variables were compared to infants fed control formulas and to reported values for breast-fed infants. This new formulation compared favorably, in all areas studied here, to controls and previously reported values.

Nutritional balance studies: evaluation of a premature infant formula.

A 24 kcal/oz (81 kcal/100 ml) premature infant formula (Enfamil Premature Formula) with moderately high mineral content (117 mg Ca/100 ml and 58 mg P/100 ml) and a protein content of 3 g/100 kcal was evaluated in sixteen 3-day balance studies at 10 and 21 days of age in nine premature infants with birth weights from 1,200 to 1,400 g. Growth rates were similar to in utero rates, and the formula was well accepted and tolerated. Calcium retention (62.5%) was similar to in utero accretion, and phosphorus retention was only slightly lower. Nitrogen retention was high without the development of metabolic acidosis or abnormal serum urea nitrogen levels.