Carnitine in severely disabled patients: relation to anthropometric, biochemical variables, and nutritional intake

BACKGROUND

Carnitine plays a pivotal role in a variety of cellular functions. Carnitine deficiency often occurs in severely disabled patients, especially under valproic acid administration. However, the possible causative factors underlying carnitine deficiency have not been fully identified. The present study aimed at clarifying the association of various anthropometric and biochemical variables, including dietary intake of carnitine, with carnitine levels in severely disabled patients.

METHODS

Twenty-six severely disabled patients (mean age: 14.1 years; s.d. 7.8) were enrolled. Plasma carnitine levels were evaluated by an enzyme cycling assay. Estimation of the dietary intake of carnitine was made based on dietary records over a 3-day period.

RESULTS

Plasma total and free carnitine levels in patients were significantly lower than those in controls obtained from the previous report. However, the ratios of free carnitine to total carnitine did not change significantly. Free carnitine levels were well correlated with a nutritional intake of carnitine. Administration of not only valproic acid but also other anti-epileptic drugs was found to cause a significant decrease of free carnitine levels after adjusting the nutritional intake of carnitine. Among various anthropometric or biochemical variables, albumin and uric acid showed a significant correlation with free carnitine levels.

CONCLUSIONS

Physicians should be aware of the fact that severely disabled patients are at risk for carnitine deficiency even in the absence of valproic acid administration, and pay more attention to the nutritional intake of carnitine.

Longitudinal study of thinness from birth to early childhood: the association with parental thinness

AIM

Epidemiological research on thinness, particularly in early childhood, is limited. This study tracked thin children aged 5 years back to birth, compared them with normal-weight children and investigated the relationship with parental thinness.

METHODS

We enrolled 2678 children (50.5% boys) aged 5 years and attending kindergarten or nursery in the Nara Prefecture of Japan. The children's height and weight at birth, 1.5 years and 3.5 years, were obtained from mother-child health records. Child thinness was defined as having a body mass index (BMI) of less than the fifth percentile of the reference values for Japanese children, and parental thinness was defined as a BMI of <18.5.

RESULTS

The overall prevalence of thinness at 5 years of age was 4%, with no significant difference between genders. At every age, weight z-scores and BMI percentiles were significantly lower in thin children than normal-weight children. The increment in weight z-scores between birth and the age of 1.5 years was significantly lower in thin children. The only parental link was paternal thinness and thinness in boys.

CONCLUSION

Careful observation of body weight from birth is important to reduce thinness at 5 years of age. Paternal thinness may be a risk factor for thinness in boys.

Longitudinal nutritional assessment in acute lymphoblastic leukemia during treatment

BACKGROUND

A nutritional assessment of pediatric patients with cancer is important to improve their outcome. The number of longitudinal nutritional studies during treatment, however, is limited. The purpose of this study was to investigate the longitudinal changes in anthropometric measures and serum albumin level during chemotherapy in patients with acute lymphoblastic leukemia (ALL).

METHODS

We retrospectively reviewed the charts of 23 patients (19 boys, four girls) with ALL from April 2007 to March 2010. The median age at diagnosis was 4.5 years. Bodyweight, height, and serum albumin levels were measured at the start and the end point of each chemotherapy phase.

RESULTS

At diagnosis, two patients (8.7%) were underweight and five patients (21.7%) were overweight according to body mass index z-score, while five patients were underweight and three (13.0%) were overweight according to Waterlow score. The prevalence of malnourished patients did not change significantly throughout chemotherapy by either assessment. The absolute scores in either assessment were significantly reduced at the sanctuary treatment phase. Low serum albumin (<3.2 g/dL) was found in two patients at diagnosis. Mean albumin decreased significantly at the induction and the re-induction phases.

CONCLUSIONS

Given that nutritional status under a similar chemotherapeutic regimen as assessed by anthropometric measures and albumin level differed among patients, careful observation of the nutritional status and intervention may be necessary at different phases of chemotherapy.