Catch-up growth in children

Lesion level-dependent systemic muscle wasting after spinal cord injury is mediated by glucocorticoid signaling in mice

An incomplete mechanistic understanding of skeletal muscle wasting early after spinal cord injury (SCI) precludes targeted molecular interventions. Here, we demonstrated systemic wasting that also affected innervated nonparalyzed (supralesional) muscles and emerged within 1 week after experimental SCI in mice. Systemic muscle wasting caused muscle weakness, affected fast type 2 myofibers preferentially, and became exacerbated after high (T3) compared with low (T9) thoracic paraplegia, indicating lesion level-dependent ("neurogenic") mechanisms. The wasting of nonparalyzed muscle and its rapid onset and severity beyond what can be explained by disuse implied unknown systemic drivers. Muscle transcriptome and biochemical analysis revealed a glucocorticoid-mediated catabolic signature early after T3 SCI. SCI-induced systemic muscle wasting was mitigated by (i) endogenous glucocorticoid ablation (adrenalectomy) and (ii) pharmacological glucocorticoid receptor (GR) blockade and was (iii) completely prevented after T3 relative to T9 SCI by genetic muscle-specific GR deletion. These results suggest that neurogenic hypercortisolism contributes to a rapid systemic and functionally relevant muscle wasting syndrome early after paraplegic SCI in mice.

Not water, sanitation and hygiene practice, but timing of stunting is associated with recovery from stunting at 24 months: results from a multi-country birth cohort study

OBJECTIVES

To measure the role of water, sanitation and hygiene (WASH) practices on recovery from stunting and assess the role of timing of stunting on the reversal of this phenomenon.

DESIGN

Data from the MAL-ED multi-country birth cohort study was used for the current analysis. Generalised linear mixed-effects models were used to estimate the probability of reversal of stunting with WASH practice and timing of stunting as the exposures of interest.

SETTING

Seven different countries across three continents.

PARTICIPANTS

A total of 612 children <2 years of age.

RESULTS

We found that not WASH practice but timing of stunting had statistically significant association with recovery from stunting. In comparison with the children who were stunted at 6 months, children who were stunted at 12 months had 1·9 times (β = 0·63, P = 0·03) more chance of recovery at 24 months of age. And, children who were stunted at 18 months of age even had higher odds (adjusted OR = 3·01, β = 1·10, P < 0·001) of recovery than children who were stunted at 6 months. Additionally, mother's height (β = 0·59, P = 0·04) and household income (β = 0·02, P < 0·05) showed statistically significant associations with the outcome.

CONCLUSIONS

The study provided evidence for the role of timing of stunting on the recovery from the phenomenon. This novel finding indicates that the programmes to promote linear growth should be directed at the earliest possible timepoints in the course of life.

Interactions between Growth of Muscle and Stature: Mechanisms Involved and Their Nutritional Sensitivity to Dietary Protein: The Protein-Stat Revisited

Childhood growth and its sensitivity to dietary protein is reviewed within a Protein-Stat model of growth regulation. The coordination of growth of muscle and stature is a combination of genetic programming, and of two-way mechanical interactions involving the mechanotransduction of muscle growth through stretching by bone length growth, the core Protein-Stat feature, and the strengthening of bone through muscle contraction via the mechanostat. Thus, growth in bone length is the initiating event and this is always observed. Endocrine and cellular mechanisms of growth in stature are reviewed in terms of the growth hormone-insulin like growth factor-1 (GH-IGF-1) and thyroid axes and the sex hormones, which together mediate endochondral ossification in the growth plate and bone lengthening. Cellular mechanisms of muscle growth during development are then reviewed identifying (a) the difficulties posed by the need to maintain its ultrastructure during myofibre hypertrophy within the extracellular matrix and the concept of muscle as concentric "bags" allowing growth to be conceived as bag enlargement and filling, (b) the cellular and molecular mechanisms involved in the mechanotransduction of satellite and mesenchymal stromal cells, to enable both connective tissue remodelling and provision of new myonuclei to aid myofibre hypertrophy and (c) the implications of myofibre hypertrophy for protein turnover within the myonuclear domain. Experimental data from rodent and avian animal models illustrate likely changes in DNA domain size and protein turnover during developmental and stretch-induced muscle growth and between different muscle fibre types. Growth of muscle in male rats during adulthood suggests that "bag enlargement" is achieved mainly through the action of mesenchymal stromal cells. Current understanding of the nutritional regulation of protein deposition in muscle, deriving from experimental studies in animals and human adults, is reviewed, identifying regulation by amino acids, insulin and myofibre volume changes acting to increase both ribosomal capacity and efficiency of muscle protein synthesis via the mechanistic target of rapamycin complex 1 (mTORC1) and the phenomenon of a "bag-full" inhibitory signal has been identified in human skeletal muscle. The final section deals with the nutritional sensitivity of growth of muscle and stature to dietary protein in children. Growth in length/height as a function of dietary protein intake is described in the context of the breastfed child as the normative growth model, and the "Early Protein Hypothesis" linking high protein intakes in infancy to later adiposity. The extensive paediatric studies on serum IGF-1 and child growth are reviewed but their clinical relevance is of limited value for understanding growth regulation; a role in energy metabolism and homeostasis, acting with insulin to mediate adiposity, is probably more important. Information on the influence of dietary protein on muscle mass per se as opposed to lean body mass is limited but suggests that increased protein intake in children is unable to promote muscle growth in excess of that linked to genotypic growth in length/height. One possible exception is milk protein intake, which cohort and cross-cultural studies suggest can increase height and associated muscle growth, although such effects have yet to be demonstrated by randomised controlled trials.

The Epidemiology of Stunted Growth in Refugee Patients with Chronic Burn Injuries

The aim of this study is to identify the prevalence of stunted growth in Syrian refugee children with chronic burn injuries and to compare it to other children (±burn) of similar socioeconomic status. This is a retrospective medical chart review conducted on 142 Syrian refugee children (≤18 years of age) who have sustained war-related and nonwar-related chronic burn injuries between 2014 and 2020. Stunted growth was measured using the height-for-age z score. The majority of burn injuries were among children below 5 years of age. The prevalence of stunting was 9.2% in our sample, with an overall mean z-score of -0.491 (SD = 1.1). There was no statistically significant difference in z-scores between males and females. The majority of stunted patients are those who sustain their burn injuries at an early age. Early management of burn injuries is key in preventing adverse outcomes associated with stunting. Further research, planning, funding, and targeted interventions are required by stakeholders to alleviate the burden of stunting in the pediatric refugee population, along with the health and economic consequences that it entails.

Effect of nutritional supplement formula on catch-up growth in young children with nonorganic faltering growth: a prospective multicenter study

BACKGROUND/OBJECTIVES

Inadequate nutrition in infants and young children affects physical growth and neurocognitive development. Therefore, early nutritional intervention is important to promote catch-up growth in young children with faltering growth. The aim of this study was to evaluate the effect of nutritional supplementation with a pediatric concentrated and balanced nutritional supplement formula on promoting growth and improving nutritional status in children with nonorganic faltering growth.

SUBJECTS/METHODS

Children aged 12–36 months whose body weight-for-age was < 5^th percentile on the Korean Growth Charts were enrolled. Children born premature or having organic diseases were excluded. Children were instructed to consume 400 mL of formula per day in addition to their regular diet for 6 months. Pediatricians and dietitians educated the parents and examined the subjects every 2 months. Anthropometric parameters were measured at baseline and at 2, 4, and 6 months, and laboratory tests were done at baseline and 6 months. The good consumption group included children who consumed ≥ 60% of the recommended dose of formula.

RESULTS

Total 82 children completed the 6-month intervention. At baseline, there were no significant differences in all variables between the good consumption and poor consumption groups. Weight and weight z-scores were significantly improved in the good consumption group compared to the poor consumption group at the end of the intervention (P = 0.009, respectively). The good consumption group showed a significant trend for gaining weight (P < 0.05) and weight z-score (P < 0.05) compared to the poor consumption group during 6 months of formula intake. The concentration of blood urea nitrogen was significantly increased in the good consumption group (P = 0.001).

CONCLUSIONS

Nutritional supplementation with a concentrated and balanced pediatric nutritional formula along with dietary education might be an effective approach to promote catch-up growth in children with nonorganic faltering growth.

In utero and peripubertal metals exposure in relation to reproductive hormones and sexual maturation and progression among girls in Mexico City

There is increasing evidence that several metals are endocrine disrupting chemicals (EDCs). In utero development and adolescence are critical windows of susceptibility to EDC exposure. With the exception of a few heavy metals, few human studies have evaluated the impact of metal exposure on pubertal development. Our aim was to investigate measures of in utero and peripubertal metal exposure in relation to reproductive hormone levels and sexual maturation and progression among girls from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) cohorts. We measured urinary concentrations of aluminum (Al), arsenic (As), barium (Ba), cadmium (Cd), cobalt (Co), copper (Cu), iron (Fe), manganese (Mn), molybdenum (Mo), nickel (Ni), antimony (Sb), selenium (Se), and zinc (Zn) in samples collected from women during their third trimester of pregnancy and from their female children at 8-13 years (n = 132). We measured serum testosterone, estradiol, dehydroepiandrosterone sulfate (DHEA-S), inhibin B, and sex hormone-binding globulin (SHBG) at age 8-13, and assessed Tanner stages for sexual maturation (breast, pubic hair development, and menarche status), at two time points (8-13, 14-18 years). We used linear regression to independently examine in utero and peripubertal metal concentrations as predictors of peripubertal hormones. In a longitudinal analysis using generalized estimation equations, we evaluated Tanner stage and menarche progression in relation to individual in utero and peripubertal metal concentrations. We found that higher in utero Zn was associated with increased inhibin B. Several metals at 8-13 years were associated with higher DHEA-S and estradiol, while Ni was positively but Cu was negatively associated with testosterone. In utero Ni, Al, and Cd were associated with slower progression of breast development after adjustment for child age and BMI z-score. For example, an IQR increase in in utero Al exposure was associated with 0.82 times lower odds of progressing to a higher Tanner stage for breast development per year (95% CI: 0.68, 0.99). Peripubertal concentrations of Ba and Al were also associated with being at a higher pubic hair Tanner stage and menarche at 8-13, but lower odds of progressing to the next stage at 14-18 years. We used Bayesian kernel machine regression (BKMR) to model the joint effect of multiple metals while accounting for correlated exposures, as well as potential non-linear relationships between metals and outcomes of interest, which yielded results similar to individual analyses. These findings suggest that female reproductive development may be vulnerable to the effects of metal exposure, and using both Tanner stages and hormone levels may provide clues about underlying mechanisms in two sensitive periods of development.

Different levels of cardiometabolic indicators in multiple vs. singleton children

BACKGROUND

We aimed to compare cardiometabolic indicators in singletons and multiples at age 7 and explore the birthweight mediation effect.

METHODS

We studied 5431 singletons and 103 sets of multiples from Generation XXI birth cohort. Anthropometric measurements, body composition, and fasting blood samples were obtained. Age- and sex-specific z-scores were calculated (additionally height-specific for blood pressure). Adjusted regression coefficients and respective 95% confidence intervals [β (95%CI)] were computed using path analysis.

RESULTS

Multiples had lower weight [- 0.419 (- 0.616;-0.223)], height [- 0.404 (- 0.594;-0.213)], BMI [- 0.470 (- 0.705;-0.234)], fat mass index [- 0.359 (- 0.565;-0.152)], waist circumference [- 0.342 (- 0.537;-0.147)], and waist-to-height ratio [- 0.165 (- 0.326;-0.003)] z-scores. These results were explained by the indirect effect via birthweight, which was also negative and significant for all the aforementioned cardiometabolic indicators, while no direct effect was present. There were also significant indirect effects regarding fat-free mass index, glucose, insulin, and blood pressure, though the total effects were not significant, due to the balance between direct and indirect effects. The only significant direct effect was regarding diastolic blood pressure [- 0.165 (- 0.302;-0.028)].

CONCLUSIONS

At age 7, multiples presented better cardiometabolic indicators explained by lower weight at birth, except for the lower blood pressure which was independent of an effect via birthweight.

Efficacy of F-100, diluted F-100, and infant formula as rehabilitation diet for infants aged < 6 months with severe acute malnutrition: a randomized clinical trial

PURPOSE

To assess the efficacy and safety of F-100, diluted F-100 (F100D), and infant formula (IF) for dietary management in the rehabilitation phase of severe acute malnutrition (SAM) of infants aged under 6 months (u6m).

METHODS

Double-blind randomized clinical trial was conducted to assess the efficacy and safety of F-100, F-100D, and IF at the Nutrition Rehabilitation Unit, icddr,b. Infants (n = 153) u6m with SAM were enrolled and randomly assigned to any of the three diets after stabilization. Two ml blood was collected on study days 1, 3, and 7 for measuring serum electrolytes, creatinine and osmolality, urine samples for specific gravity and osmolality creatinine ratio. Renal Solute Load (RSL) and Potential Renal Solute Load (PRSL) were calculated. Infants were discharged when gained 15% of the admission bodyweight or had edema-free weight-for-length Z-score ≥ - 2.

RESULTS

Infants fed F-100 and F-100D had higher weight gain than infants who received IF. Mean difference between F-100 and IF was 4.6 g/kg/d (95% CI 1.5-7.6, P = 0.004) and between F-100D and IF was 3.1 g/kg/d (95% CI 0.6-5.5, P = 0.015). Total energy intake from study diet and breast milk was significantly higher in infants fed F-100 compared with other two diets (P = 0.001 in each case). RSL was highest in infants fed F-100 but serum sodium showed no sign of elevation. Urinary specific gravity and serum sodium values were within normal range.

CONCLUSIONS

F-100 can be safely used in the rehabilitation phase for infants  u6m with SAM and there is no need to prepare alternative formulations.

Metabolic adaptations during negative energy balance and their potential impact on appetite and food intake

This review examines the metabolic adaptations that occur in response to negative energy balance and their potential putative or functional impact on appetite and food intake. Sustained negative energy balance will result in weight loss, with body composition changes similar for different dietary interventions if total energy and protein intake are equated. During periods of underfeeding, compensatory metabolic and behavioural responses occur that attenuate the prescribed energy deficit. While losses of metabolically active tissue during energy deficit result in reduced energy expenditure, an additional down-regulation in expenditure has been noted that cannot be explained by changes in body tissue (e.g. adaptive thermogenesis). Sustained negative energy balance is also associated with an increase in orexigenic drive and changes in appetite-related peptides during weight loss that may act as cues for increased hunger and food intake. It has also been suggested that losses of fat-free mass (FFM) could also act as an orexigenic signal during weight loss, but more data are needed to support these findings and the signalling pathways linking FFM and energy intake remain unclear. Taken together, these metabolic and behavioural responses to weight loss point to a highly complex and dynamic energy balance system in which perturbations to individual components can cause co-ordinated and inter-related compensatory responses elsewhere. The strength of these compensatory responses is individually subtle, and early identification of this variability may help identify individuals that respond well or poorly to an intervention.

Association of blood leukocyte DNA methylation at LINE-1 and growth-related candidate genes with pubertal onset and progression

Puberty is a developmentally plastic phase. Variations in pubertal tempo have implications for the risk of later adult diseases. Influences on pubertal tempo have been widely discussed, but the underlying biological mechanisms remain unclear. Epigenetic modifications are known to regulate development processes; they could play an important role in affecting pubertal outcomes. We conducted a population-based analysis to investigate the association of peripubertal blood DNA methylation at LINE-1 and growth-related candidate genes with pubertal onset and progression in healthy adolescents. The analytic sample included 114 males and 129 females aged 10 to 18 years. DNA methylation at growth-related candidate loci IGF2, H19, HSD11B2, as well as LINE-1 repetitive elements were quantified. Cox survival and ordinal regression models were used to examine sex- and locus-specific associations of epigenetic markers with pubertal development using physician-assessed Tanner stages and self-reported menarche, adjusted for covariates. Among boys, DNA methylation at H19 was associated with later pubarche. HSD11B2 methylation was associated with earlier onset of pubic hair and genitalia development and slower pubertal progression. IGF2 was associated with later onset of genital development. Among girls, LINE-1 methylation was associated with later onset of breast development. For each percent increase of methylation at H19, there was 5% increased odds in the earlier onset of breast development. DNA methylation of IGF2 was associated with earlier onset of pubic hair. DNA methylation at genes known to influence early-life growth may also influence pubertal outcomes.

Systemic signalling and local effectors in developmental stability, body symmetry, and size

Symmetric growth and the origins of fluctuating asymmetry are unresolved phenomena of biology. Small, and sometimes noticeable, deviations from perfect bilateral symmetry reflect the vulnerability of development to perturbations. The degree of asymmetry is related to the magnitude of the perturbations and the ability of an individual to cope with them. As the left and right sides of an individual were presumed to be genetically identical, deviations of symmetry were traditionally attributed to non-genetic effects such as environmental and developmental noise. In this review, we draw attention to other possible sources of variability, especially to somatic mutations and transposons. Mutations are a major source of phenotypic variability and recent genomic data have highlighted somatic mutations as ubiquitous, even in phenotypically normal individuals. We discuss the importance of factors that are responsible for buffering and stabilizing the genome and for maintaining size robustness and quality through elimination of less-fit or damaged cells. However, the important question that arises from these studies is whether this self-correcting capacity and intrinsic organ size controls are sufficient to explain how symmetric structures can reach an identical size and shape. Indeed, recent discoveries in the fruit fly have uncovered a conserved hormone of the insulin/IGF/relaxin family, Dilp8, that is responsible for stabilizing body size and symmetry in the face of growth perturbations. Dilp8 alarm signals periphery growth status to the brain, where it acts on its receptor Lgr3. Loss of Dilp8-Lgr3 signaling renders flies incapable of detecting growth perturbations and thus maintaining a stable size and symmetry. These findings help to understand how size and symmetry of somatic tissues remain undeterred in noisy environments, after injury or illnesses, and in the presence of accumulated somatic mutations.

Health Status and Anthropometric Changes in Resettled Refugee Children

BACKGROUND

Recently the United States has experienced an increase in refugees. Pediatric refugees are at risk for health and nutrition problems. Literature on longitudinal change in nutritional status of resettled pediatric refugees is scant.

OBJECTIVE

The present study reports the health and nutritional status of pediatric refugees and tracks changes in nutritional status.

METHODS

Data were extracted retrospectively from the records of a community health center in Buffalo, NY. Two cohorts of refugees (0-18 years) were selected. Cohort A was followed during 5 years and consisted of 225 subjects whose initial visit occurred between January 1, 2007 and December 31, 2009. The 199 subjects in cohort B had an initial visit between January 1, 2013 and December 31, 2013 and were followed for 1 year. Cohort B was chosen because vitamin levels were available only for this group. Descriptive and anthropometric data, infectious disease status, and initial vitamin and hemoglobin levels were recorded. Height-for-age (HFA) z scores and body mass index (BMI) z scores were computed. Longitudinal changes were analyzed.

RESULTS

The cohorts A and B differed in country of origin and infectious disease burden. On arrival, both cohorts exhibited HFA z scores reflecting short stature. BMI z scores were normal. HFA and BMI z scores increased during 5 years and 1 year for cohorts A and B, respectively. Anemia, vitamin D deficiency, and lead toxicity were identified.

CONCLUSIONS

Resettled pediatric refugees were short. Some were stunted. Catch-up growth, however, occurred. There were increases in HFA and BMI z scores. Vitamin D deficiency, anemia, and lead toxicity were documented.

Sufficient Protein Quality of Food Aid Varies with the Physiologic Status of Recipients

Protein quality scores use the amino acid (AA) requirements of a healthy North American child. AA requirements vary with physiologic status. We estimated AA requirements for healthy North American children, children with environmental enteric dysfunction, children recovering from wasting, and children with an acute infection. The protein quality of food aid products was then calculated to determine whether it was sufficient in all these groups, and we found that it may not be adequate for all of them. Physiologic status is important when assessing the protein quality of food aid. Rates of weight gain from 8 published trials treating children with moderate acute malnutrition were abstracted, and protein quality scores from the corresponding food aid products were calculated with the use of the digestible indispensable amino acid score (DIAAS). Two DIAAS values were calculated, one in healthy children aged 1-3 y as a reference population and the other in malnourished children aged 1-3 y as a reference population. These data were used to calculate the best fit regression line between weight gain and protein quality. The slope of the regression line was greater when malnourished children were used as a reference population than when healthy children were used (0.128; 95% CI: 0.118, 0.138 compared with 0.097; 95% CI: 0.090, 0.105 measured in g · kg-1 · d-1 · DIASS U-1). These findings suggest that adjusting AA requirements for physiologic status may more accurately estimate the minimum protein quality of food aid products.

Nutrition, infection and stunting: the roles of deficiencies of individual nutrients and foods, and of inflammation, as determinants of reduced linear growth of children

The regulation of linear growth by nutritional and inflammatory influences is examined in terms of growth-plate endochondral ossification, in order to better understand stunted growth in children. Linear growth is controlled by complex genetic, physiological, and nutrient-sensitive endocrine/paracrine/autocrine mediated molecular signalling mechanisms, possibly including sleep adequacy through its influence on growth hormone secretion. Inflammation, which accompanies most infections and environmental enteric dysfunction, inhibits endochondral ossification through the action of mediators including proinflammatory cytokines, the activin A-follistatin system, glucocorticoids and fibroblast growth factor 21 (FGF21). In animal models linear growth is particularly sensitive to dietary protein as well as Zn intake, which act through insulin, insulin-like growth factor-1 (IGF-1) and its binding proteins, triiodothyronine, amino acids and Zn2+ to stimulate growth-plate protein and proteoglycan synthesis and cell cycle progression, actions which are blocked by corticosteroids and inflammatory cytokines. Observational human studies indicate stunting to be associated with nutritionally poor, mainly plant-based diets. Intervention studies provide some support for deficiencies of energy, protein, Zn and iodine and for multiple micronutrient deficiencies, at least during pregnancy. Of the animal-source foods, only milk has been specifically and repeatedly shown to exert an important influence on linear growth in both undernourished and well-nourished children. However, inflammation, caused by infections, environmental enteric dysfunction, which may be widespread in the absence of clean water, adequate sanitation and hygiene (WASH), and endogenous inflammation associated with excess adiposity, in each case contributes to stunting, and may explain why nutritional interventions are often unsuccessful. Current interventions to reduce stunting are targeting WASH as well as nutrition.

Advances in the nutrition of preterm infants

The greatly improved survival rate of infants born both preterm and low birth weight (LBW) has led to the subsequent growth and development of these infants becoming an important focus for research. Preterm infants begin life with, or acquire as a result of their prematurity, greater morbidity than term born babies, growth deficits, an increased risk of developmental delay and an increased risk of later adult diseases compared with appropriate for gestational age (AGA) term born babies.

Research in recent decades has confirmed that there are marked differences in the nutritional requirements of preterm LBW infants compared with their AGA term born counterparts, both in the neonatal period and probably for all of infancy. In addition to the increased requirement for energy and protein, preterm LBW infants demonstrate a greatly increased requirement for some of the mineral elements, particularly iron, zinc and calcium, when compared with the needs of term AGA infants. In the UK, feeding practices for preterm infants in neonatal units and throughout infancy after hospital discharge are variable and many questions remain as to the optimal nutritional regimen for preterm LBW infants (and for subgroups of these infants) at different stages of infancy. There is some concern that the 2002 World Health Organization recommendations on infant feeding may be applied to all infants, including preterm infants, without consideration of their special nutritional needs, which may further compromise their growth and development.

A brief résumé of the work of prominent researchers in the field of preterm infant nutrition in the UK, notably Lucas, Cooke and Fewtrell, is included in the review, together with information from papers published by the authors of the review. The review concludes with a summary of the generally accepted recommendations on feeding preterm LBW infants after hospital discharge and information on some practical help available to the parents of these children and to health workers in the field.

Assessment of caprine corpora lutea growth, progesterone concentration, and eNOS expression: effect of a compensatory gain model

The experiment was conducted to evaluate corpus luteum (CL) growth, progesterone (P4) concentration, and endothelial nitric oxide synthase (eNOS) expression in nutrient stair-step fed goats. Female goats (n = 32) that exhibited at least 2, normal, consecutive estrous cycles were randomly assigned to either the control or stair-step fed group. In the control group, goats were fed ad libitum (100% of nutrient requirement for goats). The goats in the stair-step group were fed 70% of the control consumption for the first 42 d and 130% for the later 42 d during 4 consecutive estrous cycles (84 d). Blood and luteal samples were collected on days 3, 8, 13, and 18 of the estrous cycle to determine concentration of glucose, insulin, P4, luteal growth, and eNOS expression. Luteal growth was determined using fresh CL weight, DNA content, DNA and protein concentrations, and cell proliferation (labeling index of Ki-67). During realimentation phase at 4 h, glucose and insulin concentrations were greater (P < 0.05) in stair-step fed goat than those in control goats. Fresh CL weight, DNA content, protein concentrations, and labeling index of Ki67 on day 8 of the estrous cycle in the stair-step group were greater (P < 0.05) than that in the control group. Protein for eNOS was located in the capillaries of CL throughout of the estrous cycle in both groups. Greater serum P4 concentrations and eNOS protein (P < 0.05) were observed in the stair-step fed goats on day 3 (1.83 ng/mL and 6.79%) compared with the control goats (0.98 ng/mL and 6.02%) and on day 8 (5.15 ng/mL and 7.88%) compared with the control goats (4.54 ng/mL and 7.07%). These data demonstrate that luteal growth, progesterone concentration, and eNOS protein were partially affected by nutrient compensatory gain in goats.

Protein Quality and Growth in Malnourished Children

BACKGROUND

Protein quality refers to the amounts and ratios of essential amino acids in a food. Two methods most commonly used for determining protein quality are the protein digestibility-corrected amino acid score (PDCAAS) and the digestible indispensible amino acid score (DIAAS).

OBJECTIVE

To use existing literature to compare different amino acid profiles and PDCAAS and DIAAS scores in individuals with acute inflammation and to assess their relationship with weight gain in children with severe acute malnourished (SAM).

METHODS

A series stable isotope studies were previously conducted in children with SAM and acute infection, and these data were reviewed with respect to protein synthesis. Eleven published treatment trials for SAM with different therapeutic foods were analyzed to examine the relationship between protein quality scores with weight gain (g/kg/d). Protein scores were calculated with the PDCAAS and DIAAS amino acid reference patterns. A DIAAS score adjusted for the higher weight gain expected in malnourished children was also used. Bivariate correlation analysis was used to examine this relationship.

RESULTS

The protein kinetic data supported the hypothesis that a balance of amino acids that matches the composition of acute-phase proteins maximizes amino acid synthesis. Protein quality scores were highly correlated with the rate of weight gain in recovery from SAM, and the DIAAS scoring system adjusted for the higher expected weight gain had the strongest correlation with the observed weight gain.

CONCLUSION

Protein quality scores must account for physiologic status so that they better match with needs and thus better promote health.

Short children with a low midupper arm circumference respond to food supplementation: an observational study from Burkina Faso

BACKGROUND

The management of children with moderate acute malnutrition (MAM) is based on food supplementation in outpatient programs. When midupper arm circumference (MUAC) is used as the sole admission criterion, it is common practice to exclude children with lengths <67 cm from treatment. The WHO calls for research to determine the treatment effect among children with MAM included by MUAC and aged ≥6 mo with lengths <67 cm.

OBJECTIVE

We hypothesized that among children given supplementary feeding based on an MUAC of 115-124 mm as the sole criterion, there would be no difference in growth rate between children <67 cm and those ≥67 cm in length at program admission.

DESIGN

This was an observational study nested in a randomized trial that investigated the effectiveness of new formulations of corn-soy blend and lipid-based nutrient supplements. Children aged 6-23 mo were included if their MUAC was between 115 and 124 mm but with a weight-for-height z score (WHZ) ≥-2. This cohort was divided into 2 groups by length at admission: <67 cm ("short") and ≥67 cm ("long"). Linear mixed-effects models and regression models were used to compare gains in weight and MUAC while adjusting for intervention, season, sex, age, and site.

RESULTS

Weight-gain velocity (expressed as g · kg(-1) · d(-1)) and MUAC-gain velocity (expressed as 0.01 mm · cm(-1) · d(-1)) were not different between short and long children. Weight-gain velocity was slightly higher in the shortest quartile of length (P = 0.03), whereas there was no effect modification by stunting across length quartiles (P = 0.32).

CONCLUSIONS

We found no evidence of a difference in percentage of weight gain or weight-gain velocity during supplementary feeding in short or long children aged 6-23 mo. We recommend a policy change to include children <67 cm in supplementary feeding programs if their MUAC is between 115 and 124 mm and their WHZ is ≥-2. This could benefit millions of children currently excluded from supplementary feeding. This trial was registered at www.controlled-trials.com as ISRCTN42569496.

Developing food supplements for moderately malnourished children: lessons learned from ready-to-use therapeutic foods

Ready-to-use therapeutic foods (RUTFs) are solid foods that were developed by changing the formulation of the existing liquid diet, F-100, recommended by the World Health Organization (WHO) for the rapid catch-up phase of the treatment of children suffering from severe acute malnutrition (SAM). The resulting products proved highly effective in promoting weight gain in both severely and moderately wasted children and adults, including those infected with HIV. The formulation of the existing RUTFs, however, has never been optimized to maximize linear growth, vitamin and mineral status, and functional outcomes. The high milk content of RUTFs makes it an expensive product, and using lower quantities of milk seems desirable. However, the formulation of alternative, less expensive but more effective versions of RUTF faces difficult challenges, as there are uncertainties regarding the effect in terms of protein quality, antinutrient content, and flatulence factors that will result from the replacement of current dairy ingredients by less expensive protein-rich ingredients. The formulation of alternative RUTFs will require further research on these aspects, followed by efficacy studies comparing the future RUTFs to the existing formulations.

Compensatory growth following transient intraguild predation risk in predatory mites

Compensatory or catch-up growth following growth impairment caused by transient environmental stress, due to adverse abiotic factors or food, is widespread in animals. Such growth strategies commonly balance retarded development and reduced growth. They depend on the type of stressor but are unknown for predation risk, a prime selective force shaping life history. Anti-predator behaviours by immature prey typically come at the cost of reduced growth rates with potential negative consequences on age and size at maturity. Here, we investigated the hypothesis that transient intraguild predation (IGP) risk induces compensatory or catch-up growth in the plant-inhabiting predatory mite Phytoseiulus persimilis. Immature P. persimilis were exposed in the larval stage to no, low or high IGP risk, and kept under benign conditions in the next developmental stage, the protonymph. High but not low IGP risk prolonged development of P. persimilis larvae, which was compensated in the protonymphal stage by increased foraging activity and accelerated development, resulting in optimal age and size at maturity. Our study provides the first experimental evidence that prey may balance developmental costs accruing from anti-predator behaviour by compensatory growth.

Wasting and Stunting—Similarities and Differences: Policy and Programmatic Implications

Wasting and stunting are often presented as two separate forms of malnutrition requiring different interventions for prevention and/or treatment. These two forms of malnutrition, however, are closely related and often occur together in the same populations and often in the same children. Wasting and stunting are both associated with increased mortality, especially when both are present in the same child. A better understanding of the pathophysiology of these two different forms of malnutrition is needed to design efficient programs. A greatly reduced muscle mass is characteristic of severe wasting, but there is indirect evidence that it also occurs in stunting. A reduced muscle mass increases the risk of death during infections and also in many other different pathological situations. Reduced muscle mass may represent a common mechanism linking wasting and stunting with increased mortality. This suggests that to decrease malnutrition-related mortality, interventions should aim at preventing both wasting and stunting, which often share common causes. Also, this suggests that treatment interventions should focus on children who are both wasted and stunted and therefore have the greatest deficits in muscle mass, instead of focusing on one or the other form of malnutrition. Interventions should also focus on young infants and children, who have a low muscle mass in relation to body weight to start with. Using mid-upper-arm circumference (MUAC) to select children in need of treatment may represent a simple way to target young wasted and stunted children efficiently in situations where these two conditions are present. Wasting is also associated with decreased fat mass. A decreased fat mass is frequent but inconsistent in stunting.

Fat secretes multiple hormones, including leptin, which may have a stimulating effect on the immune system. Depressed immunity resulting from low fat stores may also contribute to the increased mortality observed in wasting. This may represent another common mechanism linking wasting and stunting with increased mortality in situations where stunting is associated with reduced fat mass. Leptin may also have an effect on bone growth. This may explain why wasted children with low fat stores have reduced linear growth when their weight-for-height remains low. It may also explain the frequent association of stunting with previous episodes of wasting. Stunting, however, can occur in the absence of wasting and even in overweight children. Thus, food supplementation should be used with caution in populations where stunting is not associated with wasting and low fat stores.

Growth faltering and recovery in children aged 1-8 years in four low- and middle-income countries: Young Lives

OBJECTIVE

We characterized post-infancy child growth patterns and determined the incidence of becoming stunted and of recovery from stunting.

DESIGN

Data came from Young Lives, a longitudinal study of childhood poverty in four low- and middle-income countries.

SETTING

We analysed length/height measurements for children at ages 1, 5 and 8 years.

SUBJECTS

Children (n 7171) in Ethiopia, India, Peru and Vietnam.

RESULTS

Mean height-for-age Z-score (HAZ) at age 1 year ranged from -1·51 (Ethiopia) to -1·08 (Vietnam). From age 1 to 5 years, mean HAZ increased by 0·27 in Ethiopia (P < 0·001) and decreased among the other cohorts (range: -0·19 (Peru) to -0·32 (India); all P < 0·001). From 5 to 8 years, mean HAZ increased in all cohorts (range: 0·19 (India) to 0·38 (Peru); all P < 0·001). Prevalence of stunting (HAZ<-2·0) at 1 year ranged from 21 % (Vietnam) to 46 % (Ethiopia). From age 1 to 5 years, stunting prevalence decreased by 15·1 percentage points in Ethiopia (P < 0·001) and increased in the other cohorts (range: 3·0 percentage points (Vietnam) to 5·3 percentage points (India); all P ≤ 0·001). From 5 to 8 years, stunting prevalence decreased in all cohorts (range: 5·0 percentage points (Vietnam) to 12·7 percentage points (Peru); all P < 0·001). The incidence of becoming stunted between ages 1 to 5 years ranged from 11 % (Vietnam) to 22 % (India); between ages 5 to 8 years, it ranged from 3 % (Peru) to 6 % (India and Ethiopia). The incidence of recovery from stunting between ages 1 and 5 years ranged from 27 % (Vietnam) to 53 % (Ethiopia); between ages 5 and 8 years, it ranged from 30 % (India) to 47 % (Ethiopia).

CONCLUSIONS

We found substantial recovery from early stunting among children in four low- and middle-income countries.

Nutritional management and follow up of infants and children with food allergy: Italian Society of Pediatric Nutrition/Italian Society of Pediatric Allergy and Immunology Task Force Position Statement

Although the guidelines on the diagnosis and treatment of food allergy recognize the role of nutrition, there is few literature on the practical issues concerning the nutritional management of children with food allergies.

This Consensus Position Statement focuses on the nutritional management and follow-up of infants and children with food allergy.

It provides practical advices for the management of children on exclusion diet and it represents an evidence-based consensus on nutritional intervention and follow-up of infants and children with food allergy.

Children with food allergies have poor growth compared to non-affected subjects directly proportional to the quantity of foods excluded and the duration of the diet. Nutritional intervention, if properly planned and properly monitored, has proven to be an effective mean to substantiate a recovery in growth.

Nutritional intervention depends on the subject’s nutritional status at the time of the diagnosis.

The assessment of the nutritional status of children with food allergies should follow a diagnostic pathway that involves a series of successive steps, beginning from the collection of a detailed diet-history.

It is essential that children following an exclusion diet are followed up regularly.

The periodic re-evaluation of the child is needed to assess the nutritional needs, changing with the age, and the compliance to the diet.

The follow- up plan should be established on the basis of the age of the child and following the growth pattern.

Measuring catch-up growth in malnourished populations

BACKGROUND AND AIM

Numerous recent studies measure catch-up growth by regressing adult or pre-adolescent height on early childhood height. Using simple statistical theory and data from a healthy and well-nourished population, this paper shows that these tests are uninformative about the extent of catch-up growth. The study also provides new empirical evidence on pubertal catch-up growth using longitudinal data for rural Tanzania.

SUBJECTS AND METHODS

The 1970 British Cohort Study is used to demonstrate the flaws in the recent literature using regression techniques to study catch-up growth. The data for the empirical analysis come from the Kagera Health and Development survey-a longitudinal study spanning two decades. The final sample includes 540 children whose heights are measured in early childhood and in adulthood. Catch-up growth is measured as the change in height-for-age z-score over time.

RESULTS

The mean HAZ-score in the cohort improves from -1.86 in early childhood to -1.20 in adulthood. Without catch-up growth, children would have been 4.5-5 centimetres shorter adults. Graphical analysis shows that most of this catch-up growth takes place in puberty.

CONCLUSION

Catch-up growth after early childhood is possible. Puberty seems to offer an opportunity window for recovery.

Activity participation intensity is associated with skeletal development in pre-pubertal children with developmental coordination disorder

PURPOSE

This study aimed (1) to compare the skeletal maturity and activity participation pattern between children with and without developmental coordination disorder (DCD); and (2) to determine whether activity participation pattern was associated with the skeletal development among children with DCD.

MATERIALS AND METHODS

Thirty-three children with DCD (mean age: 7.76 years) and 30 typically developing children (mean age: 7.60 years) were recruited. Skeletal maturity was assessed with the Sunlight BonAge system. Motor ability was evaluated by the Movement assessment battery for Children-2 (MABC-2). Participation patterns were evaluated using the Children Assessment of Participation and Enjoyment assessment. Analysis of variance was used to compare the outcome variables between the two groups. Multiple regression analysis was performed to examine the relationship between skeletal development, motor performance and activity participation intensity in children with DCD.

RESULTS

The DCD group had significantly delayed skeletal development, lower MABC-2 derived scores, and participated less intensely in various types of physical activities than their typically developing peers. After accounting for the effects of age and sex, activity participation intensity score remained significantly associated with delay in skeletal development, explaining 28.0% of the variance (F(change1, 29)=11.341, p=0.002).

CONCLUSION

Skeletal development is delayed in pre-pubertal children with DCD. Limited activity participation intensity appears to be one of the contributing factors.

Children who recover from early stunting and children who are not stunted demonstrate similar levels of cognition

Stunting is associated with adverse cognitive development in childhood and adolescence, fewer years of schooling, decreased productivity, and reduced adult stature. Recovery from early stunting is possible; however, few studies explore whether those who demonstrate linear catch-up growth experience long-term cognitive deficits. Using longitudinal data on 1674 Peruvian children from the Young Lives study, we identified factors associated with catch-up growth and assessed whether children who displayed catch-up growth have significantly lower cognition than children who were not stunted during infancy and childhood. Based on anthropometric data for children 6-18 mo of age and again for the same children when they were 4.5-6 y of age, we categorized participants as not stunted, stunted in infancy but not childhood (catch-up), stunted in childhood, and stunted in infancy and childhood. Children who had grandparents in the home, had less severe stunting in infancy, and had taller mothers were more likely to demonstrate catch-up growth by round 2. Children who experienced catch-up growth had verbal vocabulary and quantitative test scores that did not differ from children who were not stunted (P = 0.6 and P = 0.7, respectively). Those stunted in childhood as well as those stunted in infancy and childhood scored significantly lower on both assessments than children who were not stunted. Based on findings from this study, policy makers and program planners should consider redoubling efforts to prevent stunting and promote catch-up growth over the first few years of life as a way of improving children's physical and intellectual development.

Hospital based nutrition rehabilitation of severely undernourished children using energy dense local foods

OBJECTIVE

To examine the catch up growth in severely wasted children using energy dense local foods at a hospital based nutrition rehabilitation unit.

DESIGN

Retrospective cohort.

SETTING

In-patient ward at a tertiary care government pediatric hospital in Hyderabad.

PATIENTS

Children with severe malnutrition (n=309) admitted to nutrition ward from January 2001 to December 2005.

INTERVENTION

A diet based on energy dense local foods along with multivitamin-multimineral supplements.

MAIN OUTCOME MEASURES

Catch up growth (g/kg/day) during each week of hospital stay.

RESULTS

Mean age of the children was 25 months (range 2-60). Their baseline weight for height (WHZ) Z score was -4.1. Mean weight gain was moderate (5g/kg/day) and baseline WHZ score had a significant negative relationship to the weight gain. The prevalence of morbidities was high and the commonest morbidity was fever. Weight gain was higher by almost 40% in the absence of morbidities in any week.

CONCLUSIONS

The diet based on local energy dense foods was found to be suitable for the nutrition rehabilitation of severely malnourished children though the rate of weight gain was moderate.

Can optimal combinations of local foods achieve the nutrient density of the F100 catch-up diet for severe malnutrition?

OBJECTIVES

F100 is a fortified milk-based food used as a standard therapy for severe malnutrition. Our aim was to assess whether optimal combinations of local foods in Ghana, Bangladesh, and Latin America could achieve the nutrient density levels of F100 and, if that was unachievable, to identify the key limiting nutrients.

MATERIALS AND METHODS

In all of the analyses, a published list of population-specific foods (n = 59) and maximum food portions were used. The nutrient densities of individual foods were calculated to identify nutrient-dense foods and potential limiting nutrients. The feasibility of formulating diets that achieved the nutrient density of F100, for each region individually and for all regions combined, was explored by the use of linear programming analysis (4 models), which minimized the total grams of food while respecting model constraints on diet energy and nutrients, phytate:zinc molar ratio, and maximum food portion sizes.

RESULTS

For vitamin E, riboflavin, zinc, and copper, fewer than 5 foods achieved the nutrient density of F100. All 4 linear programming model solutions were unfeasible, indicating that in all regions, community-based home-prepared rehabilitation diets for severely malnourished children will not achieve the nutrient densities of F100. In model solutions, the densities of vitamin E, riboflavin, zinc, copper, calcium, thiamin, and niacin were unachievable, indicating they are potential key problem nutrients.

CONCLUSIONS

Optimal combinations of local foods are unlikely to achieve the nutrient density of F100, especially for vitamin E, riboflavin, thiamin, niacin, zinc, calcium, and copper. Before home-prepared rehabilitation diets with nutrient densities lower than those of F100 are promoted, it is important to establish their clinical efficacy.

Energy requirements of infants

OBJECTIVE

To estimate the energy requirements of infants from total energy expenditure and energy deposition during growth.

DESIGN

Energy requirements during infancy were estimated from total energy expenditure measured by the doubly labelled water method and energy deposition based on measured protein and fat gains.

SETTING

Database on the total energy expenditure and energy deposition of infants was compiled from available studies conducted in China, Chile, Gambia, Mexico, The Netherlands, UK, and USA.

SUBJECTS

Healthy, term infants.

RESULTS

Total energy requirements (kJ day(-1)) increased with age and were higher in boys than girls due to differences in weight. Energy requirements decreased from 473 kJ kg(-1) per day for boys and 447 kJ kg(-1) per day for girls at 1 month of age to 337 kJ kg(-1) per day for boys and 341 kJ kg(-1) per day for girls at 6 months of age, and thereafter tended to plateau. Energy deposition as a percentage of total energy requirements decreased from 40% at 1 month to 3% at 12 months of age. These estimates are 10-32% lower than the 1985 FAO/WHO/UNU recommendations which were based on observed energy intakes of infants.

CONCLUSIONS

Recommendations for the energy intake of infants should be revised based on new estimates of total energy expenditure and energy deposition.

Role of compensatory mammary growth in epigenetic control of gene expression

To better understand the role of nutrition in regulating mammary gland development and lactation, we designed a novel stair-step compensatory nutrition regimen that is a unique combination of dietary energy restriction and realimentation (refeeding) phases; the basic concept of this regimen is to exploit the biological nature of the compensatory growth phenomenon in concert with one or more hormone-sensitive allometric phases of mammary development (i.e., peripuberty through gestation). Nutritionally induced compensatory growth during different developmental stages before first parturition positively affects mammary development and life-long lactation performance. This permanent enhancement of mammary gland growth and lactation potential strongly suggests a possible mechanistic link between nutritionally induced compensatory growth, epigenetic control of mammary gene expression, and metabolic imprinting. We hypothesize that compensatory-directed metabolic imprinting once set during late pregnancy prior to the first parturition persistently maintains and exerts its adaptive response on mammogenesis and galactopoiesis (i.e., maintenance and/or enhancement of milk secretion). The ability to influence heritable genes regulating milk synthesis may be used to improve the quality and quantity of milk (e.g., infant health, the secretion of certain immunoglobulins or growth factors) as well as the longevity of lactation.

Adequate feeding and the usefulness of the respiratory quotient in critically ill children

OBJECTIVE

We determined incidences of underfeeding and overfeeding in children who were admitted to a multidisciplinary tertiary pediatric intensive care and evaluated the usefulness of the respiratory quotient (RQ) obtained from indirect calorimetry to assess feeding adequacy.

METHODS

Children 18 y and younger who fulfilled the criteria for indirect calorimetry entered our prospective, observational study and were studied until day 14. Actual energy intake was recorded, compared with required energy intake (measured energy expenditure plus 10%), and classified as underfeeding (<90% of required), adequate feeding (90% to 110% of required), or overfeeding (>110% of required). We also evaluated the adequacy of a measured RQ lower than 0.85 to identify underfeeding, and an RQ higher than 1.0 to identify overfeeding.

RESULTS

Ninety-eight children underwent 195 calorimetric measurements. Underfeeding, adequate feeding, and overfeeding occurred on 21%, 10%, and 69% of days, respectively. An RQ lower than 0.85 to identify underfeeding showed low sensitivity (63%), high specificity (89%), and high negative predictive value (90%). An RQ higher than 1.0 to indicate overfeeding showed poor sensitivity (21%), but a high specificity (97%) and a high positive predictive value (93%). Food composition, notably high-carbohydrate intake, was responsible for an RQ exceeding 1.0 in the overfed group.

CONCLUSION

Children admitted to the intensive care unit receive adequate feeding on only 10% of measurement days during the first 2 wk of admission. The usefulness of RQ to monitor feeding adequacy is limited to identifying (carbohydrate) overfeeding and excluding underfeeding.

Paediatric consequences of fetal growth restriction

The evidence for outcome following fetal growth restriction (FGR) has previously been inferred from studies, based on babies who were born small for gestational age (SGA). Great care is required when evaluating studies in this area due to a number of potential confounders. It does appear, however, that FGR is associated with an increased risk of poor neurological outcome. This includes an increased risk of cerebral palsy in babies greater than 32 weeks' gestation. Below 32 weeks, the effects of prematurity appear to negate the effects of FGR. FGR is also associated with cognitive deficit and behaviour problems. Babies with poor prenatal head growth appear to have a worse cognitive outcome. However, the role of 'fetal brain sparing' remains unclear, as impaired cognitive outcome is still evident in babies with appropriate head growth. Recent studies, which have identified FGR more accurately using fetal growth standards, have found an increased incidence of major intracranial injury and other adverse neonatal outcomes, which had previously been thought to occur less frequently in FGR babies. FGR is also associated with poor postnatal growth. The majority of children with FGR demonstrate catch-up growth in the first 2 years of life. Children who fail to demonstrate catch-up growth have a high risk of long-term growth problems. There is evidence of impaired growth hormone activity in some children with FGR who have persistent poor growth in the postnatal period.

Home based therapy for severe malnutrition with ready-to-use food

BACKGROUND

The standard treatment of severe malnutrition in Malawi often utilises prolonged inpatient care, and after discharge results in high rates of relapse.

AIMS

To test the hypothesis that the recovery rate, defined as catch-up growth such that weight-for-height z score >0 (WHZ, based on initial height) for ready-to-use food (RTUF) is greater than two other home based dietary regimens in the treatment of malnutrition.

METHODS

HIV negative children >1 year old discharged from the nutrition unit in Blantyre, Malawi were systematically allocated to one of three dietary regimens: RTUF, RTUF supplement, or blended maize/soy flour. RTUF and maize/soy flour provided 730 kJ/kg/day, while the RTUF supplement provided a fixed amount of energy, 2100 kJ/day. Children were followed fortnightly. Children completed the study when they reached WHZ >0, relapsed, or died. Outcomes were compared using a time-event model.

RESULTS

A total of 282 children were enrolled. Children receiving RTUF were more likely to reach WHZ >0 than those receiving RTUF supplement or maize/soy flour (95% v 78%, RR 1.2, 95% CI 1.1 to 1.3). The average weight gain was 5.2 g/kg/day in the RTUF group compared to 3.1 g/kg/day for the maize/soy and RTUF supplement groups. Six months later, 96% of all children that reached WHZ >0 were not wasted.

CONCLUSIONS

Home based therapy of malnutrition with RTUF was successful; further operational work is needed to implement this promising therapy.

COMPLEX GROWTH RATE EVOLUTION IN A LATITUDINALLY WIDESPREAD SPECIES

The simultaneous effects of selective agents acting on somatic growth rates, their interactions, and their interactions with local environmental conditions that vary across a species' geographic range are potentially complex and poorly known. This is particularly true of viviparous ectotherms whose offspring may be adapted to the gestation environment provided by their mothers. We studied multiple sources of growth rate variation in a widespread, viviparous reptile, including the effect of the maternal environment on growth following parturition. Females in early pregnancy were collected from replicate populations close to the tropical and temperate margins of this species' range. These females completed gestation in either of two different, common environments designed to simulate the thermal and photoperiod environments at the sampling locations. Our experiments revealed complex growth rate evolution between the northern and southern extremes of Eulamprus quoyii's geographic range and local adaptation of growth rates to maternal environments. Unique to this study was the manifestation of these growth rate differences, entrained in utero, but expressed following parturition and maintained through to maturity despite the presence of compensatory growth. In addition to providing the most complete picture to date of the evolution of somatic growth in a viviparous ectotherm, our study suggests that understanding local adaptation to maternal gestation environments, in terms of both mean growth rates and growth rate reaction norms, could change our understanding of how growth rates have evolved in other viviparous ectotherms. Indeed, such local adaptation may provide a selective advantage in the evolution of viviparity.

The impact of a nutrition education programme on the anthropometric nutritional status of low-income children in South Africa

OBJECTIVE

The study determined the impact of a community-based nutrition education programme, using trained community nutrition advisors, on the anthropometric nutritional status of mixed-race children aged between 2 and 5 years.

DESIGN AND SETTING

The programme was implemented over two years in four study areas in the Free State and Northern Cape Provinces. Two control areas were included to differentiate between the effect of the education programme and a food aid programme that were implemented simultaneously. Weight-for-age, height-for-age and weight-for-height were summarised using standard deviations from the NCHS reference median. For each of the indicators, the difference in the percentage of children below minus two standard deviations from the reference NCHS median in the initial and follow-up surveys was determined.

SUBJECTS

Initially 536 children were measured and, after two years of intervention, 815.

RESULTS

Weight-for-age improved in all areas, but only significantly in boys and girls in the urban study area, and in boys in one rural study area. No significant improvement in height-for-age occurred in any area. Weight-for-height improved significantly in the urban study area.

CONCLUSION

The education programme in combination with food aid succeeded in improving the weight status of children, but was unable to facilitate catch-up growth in stunted children after two years of intervention.

Nutritionally directed compensatory growth enhances heifer development and lactation potential

The objectives of this study were 1) to examine the interactive influence of a compensatory nutrition regimen and lasalocid supplementation on dairy heifer growth performance and 2) to document the extent to which compensatory growth sustains lactation potential over the first two lactation cycles. Twelve Holstein heifers, weighing an average of 160 kg (about 6 mo of age) were randomly assigned to treatments arranged in a 2 x 2 factorial design. Treatment variables were two dietary regimens (control and stair-step compensatory nutrition) and two levels of lasalocid (0 and 200 mg/d). The control heifers were fed a diet containing 12% crude protein (CP) and 2.35 Mcal of metabolizable energy (ME) per kilogram of dry matter. The stair-step compensatory nutrition heifers were subjected to a phased nutrition regimen and reared according to an alternating 3-2-4-3-4-2-mo schedule. The first stair-step (prepubertal phase) consisted of energy restriction [17% CP and 2.35 Mcal/kg of ME] for 3 mo followed by realimentation (12% CP and 3.05 Mcal/kg of ME) for 2 mo. The second step (puberty and breeding) consisted of energy restriction for 4 mo followed by realimentation for 3 mo. The third step (gestation period) was energy restriction for 4 mo concluding with realimentation for 2 mo. Dry matter intake of heifers during the restriction phase was limited to 70% of the control intake. Heifers were given ad libitum access to a high energy density diet during realimentation to allow compensatory development. Stair-step heifers supplemented with lasalocid had the highest efficiency of growth (body weight gain/dry matter intake), suggesting synergistic metabolism of lasalocid with compensatory growth action. Compensatory growth induced during the last trimester enhanced metabolic status by increasing circulating insulin and decreasing triglyceride levels. Heifers on the stair-step regimen had a significant increase in milk yield during the first (21%) and second (15%) lactation cycles. These results support our thesis that compensatory growth induced during an allometric growth phase improves mammary development and energy and protein metabolic status of dairy heifers.

Deferred costs of compensatory growth after autumnal food shortage in juvenile salmon

Growing animals are often able to offset the effects of periods of reduced food availability by subsequently undergoing a phase of elevated compensatory or 'catch-up' growth. This indicates that growth rates are not normally maximized even when food is not limiting, suggesting that fast growth may be costly. Here, we show experimental evidence of a long-term deferred cost of compensatory growth after a period of food shortage. Juvenile salmon subjected to a short-lived low-food regime in autumn subsequently entered a hyperphagic phase, leading to complete restoration of lipid reserves and partial recovery of lost skeletal growth relative to controls. However, several months later they entered a prolonged phase of poorer performance (despite food now being freely available), so that by the following spring they were substantially smaller than controls and had lower lipid reserves for their body size. The incidence of sexual maturation in males the following breeding season was also reduced. Salmon thus appear to trade off the benefits of short-term restoration of fat stores prior to winter against long-term performance.

Supplemental vitamin A improves anemia and growth in anemic school children in Tanzania

We conducted a randomized controlled trial of the effects of dietary supplements on anemia, weight and height in 136 anemic school children from a low socioeconomic background in Bagamoyo District schools in Tanzania. The aim of the current study was to investigate the impact of dietary supplements on anemia and anthropometric indices of anemic school children. The supplements were vitamin A alone, iron and vitamin A, iron alone or placebo, administered in a double-blinded design for 3 mo. All supplements were provided with local corn meals. Hemoglobin concentration, body weight and height were measured at baseline and at follow-up after supplementation. Vitamin A supplementation increased the mean hemoglobin concentration by 13.5 g/L compared with 3.5 g/L for placebo [P < 0.0001, 95% confidence interval (CI) 6.19-13.57), the mean body weight by 0.6 kg compared with 0.2 kg for placebo (P < 0.0001, 95% CI 0.19-0.65) and the mean height by 0.4 cm compared with 0.1 cm for placebo (P = 0.0009, 95% CI 0.08-0.42). However, the group of children who received combined vitamin A and iron supplementation had the greatest improvements in all indicators compared with placebo (18.5 g/L, P < 0.0001, 95% CI 14.81-22.23; 0.7 kg, P < 0. 0001, 95% CI 0.43-0.88 and 0.4 cm, P < 0.0001, 95% CI 0.22-0.56 for hemoglobin, weight and height, respectively). It is likely that vitamin A supplementation may have a useful role in combating the problems of vitamin A deficiency and anemia, as well as in improving children's growth, in developing countries.

Possible relevance of abnormal fatty acid metabolism in undernutrition: the relationship between oleic acid and growth

Energy, protein, essential fatty acids, vitamins and minerals are all necessary for normal growth and development of children. In undernutrition, there is evidence for abnormal fatty acid metabolism. High levels of oleic acid and low levels of docosahexaenoic acid in plasma phosphatidylcholine have been associated with weight-for-age Z-score shifts to the left (increased prevalence of underweight) and vice versa (reduced prevalence of underweight). An alternative hypothesis is proposed, which describes a possible physiological mechanism whereby omega3 fatty acids contribute to growth. High blood oleic acid levels under conditions of undernutrition are proposed to be an adaptation to conserve glucose in the form of glycogen. Replacement with docosahexaenoic acid under conditions of adequate nutrition enhances membrane functioning so that glucose and energy become available for muscle formation.

Feeding preterm infants after hospital discharge: effect of diet on body composition

Our purpose in this study was to examine whole body composition, using dual energy x-ray absorptiometry (DEXA) during dietary intervention in preterm infants (< or = 1750 g birthweight, < or = 34 wk gestation). At discharge, infants were randomized to be fed either a preterm infant formula (discharge-6 mo; group A) or a term formula (discharge-6 mo; group B), or the preterm formula (discharge-term) and the term formula (term-6 mo; group C). Nutrient intake was measured between each clinic visit. To measure body composition, DEXA was used at discharge, term, 12 wk, 6 mo, and 12 mo corrected age. The data were analyzed by ANOVA. At discharge, no differences were noted in patient characteristics between groups A, B, and C. Although energy intakes were similar, protein and mineral intakes differed between groups (A > C > B; p < 0.0001). During the study, weight gain and LM gain were greater in group A than B. At 12 mo, weight, LM, FM, and BMM but not % FM or BMD were greater in group A than B. However, the effects of diet were confined to boys, with no lasting effects seen in girls. In summary, therefore, DEXA was precise enough to detect differences in whole body composition during dietary intervention. Increased weight gain primarily reflected an increase in LM and is consistent with the idea that the preterm formula more closely met protein and/or protein-energy needs in rapidly growing preterm male infants.