Transition of care between paediatric and adult gastroenterology. Assessment of growth and nutrition

Appropriateness of Essentials Trace Metals in Commonly Consumed Infant Formulae in Nigeria

BACKGROUND

Mothers who feed their children with infant food have increased have over the years leaving a large percentage of children who consume other types of liquid food for supplementation or as alternatives.

AIM

Determining the levels of essential trace metals in these formulae with the aim of ascertain their appropriateness is considered important.

METHODS

Iron, zinc, manganese, chromium and cobalt in 26 infant formulae purchased from Port Harcourt city, Nigeria were determined by Atomic Absorption Spectrophotometry. The estimated daily intake EDI and percentage of EDI to the recommended daily allowance of these essential trace metals were used in the exposure assessment.

RESULTS

The highest mean concentration of Mn, Cr and Co was found in the milk based (0.15 ± 0.09 mg/kg), (0.61 ± 0.70 mg/kg), (0.12 ± 0.32 mg/kg) compared to the cereal based and cereal mix based but the differences was also not significant. The EDI of chromium in the infant formulae exceeded the RDA.

CONCLUSION

Infant formulae may add to the chromium body burden of infants in Nigeria.

Trace elements in starter infant formula: dietary intake and safety assessment

The aim of this study was to investigate the concentrations of five essential (Fe, Mn, Zn, Cu and Se) and four non-essential/toxic elements (Cr, Cd, Ni and Pb) in 35 different starter infant formulas (0-6 months) sold in Italy. In addition, a safety assessment of these trace elements was carried out, by comparing the estimated daily intake (EDI) with the adequate intake (AI) and the provisional tolerable daily intake (PTDI), with a view to provide information on the metal distribution patterns and health risk to infants arising from the consumption of these products. The concentrations were determined by using inductively coupled plasma mass spectrometry after microwave digestion. The concentrations expressed in geometric mean ± geometric standard deviation of Fe (6.17 ± 1.61 mg/L), Zn (6.21 ± 1.31 mg/L), Cu (416.4 ± 1.21 μg/L), Mn (121.5 ± 1.85 μg/L) and Se (13.27 ± 1.67 μg/L) were within legal limits. In spite of this, the mean EDIs of Fe (4.81 mg/day) and Mn (94.75 μg/day) were many times higher than the recommended AI, especially for Mn. Chromium, Ni, Cd and Pb concentrations were not detectable in 11, 37, 57 and 66% of the samples, respectively. Considering the overall sample, the GM ± GSD of these elements were 4.80 ± 5.35 μg/L for Cr, 1.02 ± 11.65 μg/L for Ni, 0.21 ± 14.83 μg/L for Cd and 0.14 ± 17.13 μg/L for Pb. The mean EDIs were far below the respective PTDI. When the safety assessment was based on the 75° percentile level of each elements, all EDIs remained well below the PTDI, with the exception of Cd, whose EDI approached (74.7%), albeit remaining below the PTDI. In conclusion, our results and the increased awareness on the potential risks of excessive Mn and Fe for infants support that an urgent scientific-based definition of the appropriated levels of fortification in formulas is required. Moreover, regular monitoring of all the stages of production of infant formulas is essential in order to limit toxic metal contamination.

Calcium to phosphorus ratio, essential elements and vitamin D content of infant foods in the UK: Possible implications for bone health

Adequate intake of calcium and phosphorus in the appropriate ratio of 1-2:1 (Ca:P), in addition to magnesium and vitamin D, is vital for bone health and development of infants. In this feasibility study, the ratio of Ca:P in conjunction with vitamin D and other essential elements (Cu, Fe, K, Mg, Na, and Zn) in a range of commercial infant food products in the UK was investigated. The elemental analysis was carried out using inductively coupled plasma optical emission spectrometry, and vitamin D levels were determined using an enzyme-linked immunosorbent assay. The quantitative data were further evaluated, based on a standardised menu, to measure the total daily intake of an infant aged 7-12 months against the Reference Nutrient Intake. The results from the study show that the Ca:P ratio of the infant's total dietary intake was within the recommended range at 1.49:1. However, the level of intake for each of the nutrients analyzed, with the exception of sodium, was found to be above the Reference Nutrient Intake, which warrants further investigation in relation to both micronutrient interactions and in situations where the intake of fortified infant formula milk is compromised. Finally, as the study is the first to include consumption of infant snack products, the level of total calorie intake was also calculated in order to assess the total daily estimated energy intake; the results indicate that energy intakes exceed recommendations by 42%, which may have implications for obesity.

Nutritional status and dietary intake of children with acute leukaemia during induction or consolidation chemotherapy

BACKGROUND

The assessment of nutritional status among paediatric patients is important for the planning and execution of nutritional strategies that strive to optimise the quality of life and growth among sick children. The present study aimed to evaluate the nutritional status and dietary intake among children with acute leukaemia.

METHODS

This cross-sectional study included 53 paediatric patients aged 3-12 years old, who were diagnosed with either acute lymphoblastic leukaemia or acute myelogenous leukaemia and were undergoing chemotherapy treatments (induction or consolidation phase). Patients were matched for sex, age (±6 months) and ethnicity with healthy children as controls. Weight, height, body mass index, waist circumference, mid-upper arm circumference, triceps skinfold thickness, mid-upper arm muscle area and fat area were determined. Dietary intake was assessed using 3-day food records.

RESULTS

Anthropometric variables were generally higher among patients compared to controls, although the differences were not statistically significant (P > 0.05). The prevalence of overnutrition among patients according to body mass index-for-age, waist circumference-for-age, mid-upper arm circumference-for-age and triceps skinfold-for-age were 24.5%, 29.1%, 17.0% and 30.2%, respectively. Mean energy [5732 ± 1958 kJ (1370 ± 468 kcal) versus 6945 ± 1970 kJ (1660 ± 471 kcal), P < 0.01], protein (50.0 ± 19.7 g versus 62.3 ± 22.3 g, P < 0.01) and fat (43.6 ± 18.9 g versus 58.3 ± 16.7, P < 0.001) intakes of patients were significantly lower than controls.

CONCLUSIONS

The prevalence of being overweight and obesity in children with acute leukaemia was higher despite lower energy intake compared to controls. Studies assessing physical activity, the complex interaction and the effects of treatment drugs are warranted to better manage malnutrition among paediatric patients.

Elemental content of commercial 'ready to-feed' poultry and fish based infant foods in the UK

The study reported herein was conducted in order to establish the concentration of 20 essential and non-essential elements in a representative range of commercial infant foods in the UK targeted for infants aged between 6-12 months. The primary objective of this study was to examine the nutritive values and safety of such complementary infant foods on the UK market in relation to dietary and safety guidelines. Quantitative analyses were conducted on eight different products representing four popular brands (poultry and fish based) of ready to-feed infant foods currently on sale in the UK. Six essential elements, namely: calcium, iron, magnesium, potassium, sodium and zinc were determined by ICP-OES. The concentrations of six essential trace elements (selenium, molybdenum, cobalt, copper, chromium, manganese) and eight non-essential, potentially toxic, elements (arsenic, barium, nickel, cadmium, antimony, lead, mercury, aluminium) were determined by ICP-MS due to the higher sensitivity required. The total daily intakes of essential and trace elements from the consumption of such products were then estimated, based on the results of this study, and were referenced to the Recommended Nutrient Intake (RNI) values and safety guidelines for 6-9 months old children. Based on these comparisons the concentration of essential, except for potassium, and trace elements were found to be inadequate in meeting the RNI. In terms of the risk of exposure to toxicity, the concentration of toxic elements in ready to feed products analysed in this study, were not considered to be of concern. These results suggest that commercial complementary infant foods on the UK market may not contain minimum levels of minerals required for labelling declaration of micronutrient content (Commission Directive 2006/125/EC). This provides opportunities and scope for product optimisation to improve their nutritive value.

The right thing at the right time: why ostensive naming facilitates word learning

The current study examines how focusing children's attention immediately after fast mapping improves their ability to retain novel names. Previous research suggests that young children can only retain novel names presented via referent selection if ostensive naming is provided and that such explicit naming works by increasing children's attention to the target and decreasing their attention to the competitor objects (Horst and Samuelson, 2008). This explanation of the function of ostensive naming after referent selection trials was tested by drawing 24-month-old children's attention to the target either by illuminating the target, covering the competitors, or both. A control group was given a social pragmatic cue (pointing). Children given social pragmatic cue support did not demonstrate retention. However, children demonstrated retention if the target object was illuminated, and also when it was illuminated and the competitors simultaneously dampened. This suggests that drawing children's attention to the target object in a manner that helps focus children's attention is critical for word learning via referent selection. Directing attention away from competitors while also directing attention toward a target also aids in the retention of novel words.

Growth in children and adolescents with sickle cell disease in Yemen

BACKGROUND

Physical growth is known to be impaired in children with sickle cell disease (SCD) and the prevalence and severity vary with geographical location. The factors which contribute to this sub-optimal growth are poorly understood.

OBJECTIVES

To describe the growth status of children and adolescents with SCD in Yemen using the new WHO reference values and to assess correlation of growth indicators with disease severity and with haematological and biochemical parameters.

METHODS

A cross-sectional study of children <16 years with SCD was conducted at Al-Wahda General Teaching Hospital, Aden. Anthropometric measurements of weight, length/height, mid-upper-arm circumference (MUAC) and body mass index (BMI) were collected. Disease severity was assessed using a severity index (SI) score.

RESULTS

A total of 102 children (56 male) were included and their mean age was 7.2 years (range 6 months to 15 years). Low weight, height and BMI-for-age Z-scores (<-2 SD) were observed in 45%, 54% and 35% of children, respectively. Regression analyses indicated an association of low height-for-age with male gender (p=0.02), low weight-for-age and weight-for-height with increased age (both p<0.001), low weight-for-age with raised alkaline phosphatase (p=0.04), and low BMI with reduced plasma albumin (p=0.04). There was no correlation between growth deficits and SI or anaemia severity.

CONCLUSION

Growth is severely impaired in children and adolescents with SCD in Yemen. Growth monitoring and nutritional support should be included in their comprehensive care package.

Growth status in children and adolescents with sickle cell disease

OBJECTIVES

To assess the BMI status of children and adolescents with sickle cell disease (SCD) and determine if zBMI status during adolescence is predicted by gender, childhood zBMI status, disease genotype, and healthcare utilization (emergency department visits or hospitalizations).

STUDY DESIGN

Medical chart reviews were conducted on 133 patients followed through a regional Comprehensive Sickle Cell Center to obtain anthropometric measures and healthcare utilization data. Gender-specific BMI z-scores were calculated based on Centers for Disease Control (CDC) norms using Epi Info NutStat Software and SPSS generated syntax. Data were summarized categorically across two time periods for each participant: childhood (age 6-12 years) and adolescence (age 13-18 years).

RESULTS

Males were three times more likely to be underweight in adolescence compared to CDC norms, whereas females were three times more likely to be obese in adolescence. In addition, regression analyses indicated that BMI in adolescence was predicted by gender, average weight in childhood, and the average number of emergency department visits.

CONCLUSIONS

Children with SCD generally exhibit normal growth during childhood and adolescence, although 5-10% are at risk for poor growth or obesity. Prevention and intervention efforts should consider gender, average weight in childhood, and healthcare utilization factors.