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Biomedical subjects

K H Brown

Publications and source records attributed to K H Brown.

At least 73 records · Page 4Linked to original sources
PubMed1994

Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomised intervention study in Honduras.

In developing countries, the age at which breastfed infants are first given complementary foods is of public health importance because of the risk of diarrhoeal disease from contaminated weaning foods, and the potential risk of growth faltering if foods are inappropriately delayed. To evaluate whether there are any advantage of complementary feeding prior to 6 months, low-income primiparous mothers who had exclusively breastfed for 4 months were randomly assigned to one of 3 groups: continued exclusive breastfeeding to 6 months (EBF) (n = 50); introduction of complementary foods at 4 months with ad libitum nursing from 4-6 months (SF) (n = 47); and introduction of complementary foods at 4 months, with maintenance of baseline nursing frequency from 4-6 months (SF-M) (n = 44). Baby foods in jars were provided to the SF and SF-M groups from 4 to 6 months. Subjects were visited weekly and provided with lactation guidance; at 4, 5, and 6 months measurements were made of infant intake and breast milk composition. At 4 months, breast milk intake averaged 797 (139) g per day (no difference among groups). Between 4 and 6 months, breast milk intake was unchanged in EBF infants (+6) but decreased in the SF (-103), and SF-M (-62) groups (p < 0.001). Change in total energy intake (including solid foods) and infant weight and length gain did not differ significantly between groups. Weight and length gain from 4-6 months were comparable to those of breastfed infants in an affluent USA population. The results indicate that breastfed infants self-regulate their total energy intake when other foods are introduced. As a result, there is no advantage in introducing complementary foods before 6 months in this population, whereas there may be disadvantages if there is increased exposure to contaminated weaning foods.

Adult↗
PubMed1994

Mosaic triple trisomy in amniocytes from a phenotypically and karyotypically normal fetus.

We report the detection of a mosaic triple trisomy, 46,XY/49,XY,+13,+20,+21, in two amniotic fluid specimens obtained from a pregnancy that yielded a normal infant. Traditional cytogenetic methods failed to detect the abnormal cell lineage in fetal blood, foreskin, amnion, umbilical cord, and three different biopsies of the chorion. In addition, fluorescence in situ hybridization study of cells from a buccal smear showed no evidence of cells with three copies of chromosome 20.

Amniocentesis↗
PubMed1994

The relationship between infants' preceding appetite, illness, and growth performance and mothers' subsequent feeding practice decisions.

Data from a longitudinal study of 153 low-income Peruvian infants were used to examine (i) whether infant characteristics such as appetite, illness and past growth performance are related to subsequent changes in their feeding practices (e.g. addition of non-human milks, solid foods, weaning), and (ii) whether this relationship depends on maternal characteristics such as feeding exposure and experience (MFEE). With one exception, infants were breastfed from birth. Feeding practices during the first month of life were related to practices throughout infancy. Most mothers changed their practices once (61%) or twice (34%) from birth to 6 months. Low weight gains from 1 to 2 (P < 0.003) and 2 to 3 (P < 0.04) months were identified as significant predictors of feeding changes during the following months, using logistic regression models that also adjusted for MFEE, infant gender, previous practice, and previous practice change. The interaction between past weight gain and MFEE (objective ii) was not statistically significant in the logistic regression models. However, when analyzed separately, the relationships between low weight gains and subsequent feeding changes were observed for high but not low MFEE mothers. The prevalences of anorexia and infection (diarrhea, respiratory, and/or fever), and poor length gain during the previous month were not related to subsequent changes in feeding practices. These results suggest that poor growth influences feeding practices from 2 to 4 months, when exclusive breastfeeding is recommended.

Appetite↗
PubMed1994

Comparison of a rice-based, mixed diet versus a lactose-free, soy-protein isolate formula for young children with acute diarrhea.

A randomized clinical trial was completed to compare the efficacy of a mixed diet composed of locally available foods versus a lactose-free, soy-based formula for the management of young Mexican children with acute diarrhea and dehydration. A total of 87 patients between 5 and 36 months of age received either a blended mixed diet containing rice, chicken, carrots, beans, and vegetable oil (group MD) or a soy formula (group SF) immediately after standard oral rehydration therapy. The initial clinical characteristics of the patients in each group were similar, as were their stool outputs during the first 6-hour period of rehydration before the diets were offered. There were six treatment failures, all of which were in group SF (p < 0.01). The stool outputs of children in group MD and in group SF were 82 +/- 55 versus 112 +/- 88 gm/kg per day, respectively, on day 1 (p = 0.037), and 48 +/- 33 versus 66 +/- 55 gm/kg per day on day 2 (p = 0.109). The duration of diarrhea among those in group MD was significantly reduced compared with those in group SF (29 vs 67 hours; p < 0.001). We conclude that the mixed diet resulted in improved clinical outcomes compared with the lactose-free, soy protein isolate formula.

Administration, Oral↗
PubMed1994

Dietary management of acute diarrheal disease: contemporary scientific issues.

Contemporary issues in the dietary management of children with acute diarrhea include the optimal timing of introduction of foods during illness, the appropriate use of milk-containing treatment regimens and mixed diets containing common staple foods, and the proper use of specific micronutrient supplements. Results of recent clinical trials indicate that children should be fed continuously during illness with their usual diets. Most young children fed exclusively with non-human milks can continue to consume these products. However, the subgroup of patients with more severe diarrhea and dehydration may have a slightly increased rate of complications and would, therefore, benefit from close supervision or a modification of their diet. Breastfed infants should continue to nurse at the breast during diarrhea. Treatment of anorexia consists of correction of the underlying metabolic derangements and antimicrobial therapy when indicated. Despite the previous focus of dietary management during diarrhea, attention to convalescent feeding is also necessary to assure complete nutritional recovery following illness.

Acute Disease↗
PubMed1994

Evaluation of a maize-cowpea-palm oil diet for the dietary management of Nigerian children with acute, watery diarrhea.

A randomized clinical trial was carried out to compare a locally available maize-cowpea-palm oil diet (group MCP) with a commercially produced lactose-free, soy protein isolate formula (group SF) for the dietary management of 69 Nigerian boys, 6-24 months of age, hospitalized for acute, watery diarrhea. Although the treatment groups were generally similar initially, the children in group SF had slightly lower mean weight-for-age z scores (p = 0.08), lower serum bicarbonate levels (p = 0.04) and greater stool outputs during the period of rehydration before the diets were initiated (p = 0.01). Rates of treatment failure in group MCP (5.7%) and group SF (8.8%) were similar (p = 0.67). There were no significant differences in the adjusted mean stool outputs by study group on days 1-5, but the children in group SF had slightly lower fecal weights on day 6 (p = 0.05). Children in group MCP had a substantially reduced duration of liquid stool excretion (estimated median duration 42 h versus 140 h; p < 0.001). On the other hand, children in group SF consumed considerably more of their diet, had greater net absorption of macronutrients and greater rates of weight gain than those in group MCP. We conclude that children can safely consume the MCP diet during acute, watery diarrhea without increasing their risk of treatment failure or augmenting stool output. However, the diet may not be adequate as a sole source of nutrients beyond the period of acute illness.

Acute Disease↗
PubMed1994

Indicators for monitoring the growth of peruvian infants: weight and length gain vs attained weight and length.

OBJECTIVES: To determine appropriate indicators and age intervals for growth monitoring in this population, the relationship between monthly weight and length indicators and nutritional status at 12 months was evaluated among 102 low-income Peruvian infants. METHODS: Cutoffs for defining adequate vs slow growth were obtained from published reference data, and sensitivities and specificities of each indicator were calculated. RESULTS: Low weight gain in early infancy, especially from 1 to 2 months, is useful for predicting low weight at 1 year (sensitivity = 81%, specificity = 65%, 25th percentile cutoff). Use of actual weight at 2 months, however, produces comparable results (sensitivity = 86%, specificity = 57%, 50th percentile cutoff). Monthly length gains were weak predictors of low length for age. Neither weight nor length gains accurately predicted the opposite form of undernutrition. Nonhuman milk consumption before 4 months and poor appetite from 3 to 12 months were related to low early weight gain and subsequent undernutrition. CONCLUSIONS: Growth monitoring programs in this population should enroll infants at birth, monitor actual weight, promote exclusive breast-feeding and delayed introduction of nonhuman milk, and provide specific feeding advice to mothers of infants with frequently depressed appetite.

Body Height↗
PubMed1994

Nutritional status as a predictor of child survival: summarizing the association and quantifying its global impact.

By pooling the results from five previously published prospective studies, we have obtained estimates of the relative risks of mortality among young children 6-24 months after they had been identified as having mild-to-moderate or severe malnutrition. These risk estimates, along with global malnutrition prevalence data, were then used to calculate the total number of young-childhood deaths "attributable" to malnutrition in developing countries. Young children (6-60 months of age) with mild-to-moderate malnutrition (60-80% of the median weight-for-age of the reference population) had 2.2 times the risk of dying during the follow-up period than their better nourished counterparts (> 80% of the median reference weight-for-age). Severely malnourished young children (< 60% of the reference median weight-for-age) had 6.8 times the risk of dying during the follow-up period than better nourished children. Each year approximately 2.3 million deaths of young children in developing countries (41% of the total for this age group) are associated with malnutrition. The comparability of studies, methods used to derive pooled values, potentially confounding factors that may influence risk estimates, and the validity of the results are discussed. Child survival programmes should assign greater priority to the control of childhood malnutrition.

Body Weight↗
PubMed1994

Within- and between-individual variation in energy intakes by low-income Peruvian infants.

OBJECTIVES: (i) To examine the components of variation in infant energy intake. (ii) To calculate the precision of estimates of energy intake from different sources. (iii) To estimate the number of dietary studies required to estimate true energy intake with varying degrees of precision. DESIGN: Energy intakes were determined from monthly 12-h observations with test-weighing of breastmilk and all foods consumed. Variance components were evaluated by pooling results of studies performed when infants were 1-4, 5-8 and 9-12 months old. SETTING: Pueblo Joven Huáscar, a low-income, peri-urban community in Lima, Peru. SUBJECTS: 124 infants who were enrolled at birth and followed monthly. RESULTS: Within-to-between infant variance ratios were > 1.0 for total energy and energy from solid foods, and < 1.0 for energy from breast- and non-human milks during the 4-month periods examined. Total energy and energy from breastmilk were estimated to within 13-24% of infants' true intake. Non-breastmilk energy was estimated to within 19-143% of true intake. Four dietary studies per age period are required to estimate total energy and breastmilk energy consumption with 20-30% precision. At least 16 studies are required to estimate infants' average energy intake from solid foods from 5-8 months with 30% precision. CONCLUSIONS: The degree of precision achieved during assessment of infants' usual energy intake changes with age and composition of the diet. Thus, the number of dietary studies required to obtain a fixed level of precision differs according to these characteristics.

Breast Feeding↗
PubMed1994

Use of nonhuman milks in the dietary management of young children with acute diarrhea: a meta-analysis of clinical trials.

OBJECTIVE: To assess the effects of continued feeding of nonhuman milks or formulas to young children during acute diarrhea on their treatment failure rates, stool frequency and amount, diarrheal duration, and change in body weight. METHODS: A total of 29 randomized clinical trials of 2215 patients were identified by computerized bibliographic search and review of published articles. Data were abstracted and analyzed using standard meta-analytic procedures. RESULTS: Among studies that compared lactose-containing milk or formula diets with lactose-free regimens, those children who received the lactose-containing diets during acute diarrhea were twice as likely to have a treatment failure as those who received a lactose-free diet (22% vs 12%, respectively; P < .001). However, the excess treatment failure rates occurred only in those studies that included patients whose initial degree of dehydration, as reported by authors, was severe, or that were conducted before 1985, when appropriate diarrhea treatment protocols were first widely accepted. Among studies of patients with mild diarrhea, all but one of which were completed after 1985, the overall treatment failure rates in the lactose groups were similar to the rates in the lactose-free groups (13% vs 15%). These results suggest that children with mild or no dehydration and those who are managed according to appropriate treatment protocols, such as that promoted by the World Health Organization, can be treated as successfully with lactose-containing diets as with lactose-free ones. The pooled information from studies that compared undiluted lactose-containing milks with the same milks offered at reduced concentration concluded that (1) children who received undiluted milks were marginally more likely to experience treatment failure than those who received diluted milk (16% vs 12%, P = .05), (2) the differences in stool output were small and of limited clinical importance, and (3) children who received the undiluted milk diets gained 0.25 SD more weight than those who received the diluted ones (P = .004). In addition, as with the previous set of studies, there were no differences in the pooled treatment failure rates between the respective groups in those studies of mildly dehydrated patients conducted after 1985 (14% vs 12%). CONCLUSIONS: The vast majority of young children with acute diarrhea can be successfully managed with continued feeding of undiluted nonhuman milks. Routine dilution of milk and routine use of lactose-free milk formula are therefore not necessary, especially when oral rehydration therapy and early feeding (in addition to milk) form the basic approach to the clinical management of diarrhea in infants and children.

Acute Disease↗
PubMed1993

Descriptive and normative ethics: class, context and confidentiality for mothers with HIV.

This descriptive analysis reports on how institutional imperatives and professional assessments define, constrain, and even override normative claims for confidentiality in health care for mothers with HIV/AIDS. The analysis draws upon interviews with seventy-two health, social work, administrative, research, and advocacy professionals who work with mothers and infants with HIV/AIDS in nine sites in the U.S. and Puerto Rico and upon three analytical focus groups involving multidisciplinary groups of practitioners, lawyers, social scientists, and ethicists. Decisions regarding confidentiality for mothers with HIV/AIDS are likely to be influenced by (1) the relative lack of authority over information flow granted by medical institutions and professionals to patients and (2) professionals' class-based assumptions about mothers' needs for confidentiality and the consequences of withholding or disclosing information. Two normative conclusions for confidentiality practice in health care are drawn from and rooted in the descriptive findings of the research. First, if confidentiality practice is to be an expression of patient autonomy and rights, according to the principles generally held in medical settings, patients' control over information must be increased. Second, to avoid discrimination in the practice of confidentiality, decisions should be based on individual circumstances, not stereotypical generalities about social class.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Evaluation of a face-to-face weaning food intervention in Kwara State, Nigeria: knowledge, trial, and adoption of a home-prepared weaning food.

This paper reports on the evaluation of a pilot intervention which used nutrition education techniques to introduce a fortified, home-prepared weaning food (eko ilera, or 'pap for health') in 12 communities in Kwara State, Nigeria, from June to August, 1988. The recipe added toasted cowpea flour, red palm oil, and sugar to increase the energy and protein density of the traditional maize or sorghum starch porridge used for weaning from 38 to 85 kcal and 0.8 to 2.0 g protein per 100 g. A stratified, random sample of participating (n = 295) and non-participating (n = 301) mothers from the same communities were interviewed from 2 to 8 weeks following the completion of the intervention, and their rates of knowledge, trail, and adoption of eko ilera were evaluated. Of the participating mothers, 57% (95% CI: 51%, 63%) knew the modified recipe, 48% (43%, 54%) tried it, and 17% (12%, 21%) adopted it with the intention of using it in the future. Only 2% (1%, 7%) of non-participating mothers knew about the recipe. Multivariate analyses indicated that the mothers' level of education and their perception of the cost and length of preparation time of the recipe were significantly associated with its adoption. The intervention was successful in using face-to-face nutrition education methods to introduce eko ilera to mothers in this region of Nigeria and to encourage its trial and adoption.

Child Nutrition Sciences↗
PubMed1993

Effect of dietary viscosity on energy intake by breast-fed and non-breast-fed children during and after acute diarrhea.

To determine the effect of dietary viscosity on energy consumption by young children, 56 Peruvian children 9-20 mo of age with acute diarrhea were randomly assigned to either a liquid or semisolid diet, with or without added amylase to reduce viscosity. Intakes of the study diet, breast milk, and other foods were measured for 2 consecutive d during and again after illness. Total 24-h energy intake (chi +/- SD) during diarrhea, 349.4 +/- 121.8 kJ/kg (83.6 +/- 29.1 kcal/kg) was 18% less than intake after recovery, 428.9 +/- 141.0 kJ/kg (102.6 +/- 33.7), P < 0.001. In the ANOVA breast-fed children consumed significantly less total energy (P = 0.008) and energy from the study diet (P = 0.02) than non-breast-fed children. Breast milk intake did not change with illness. There was no significant relationship between viscosity of the study diet and either total energy intake or intake of energy from the study diet. Energy intake by these children was primarily determined by health status and breast-feeding practice, not by dietary viscosity.

Acute Disease↗