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PubMed2006

Short bowel syndrome and intestinal transplantation in children.

PURPOSE OF REVIEW: This review summarizes recent knowledge and clinical practice for pediatric patients suffering extensive intestinal resection causing short bowel syndrome. This condition requires the use of parenteral nutrition, as long as intestinal failure persists, and may be, in some selected cases, an indication for intestinal transplantation. RECENT FINDINGS: Biological evaluation of intestinal failure is becoming possible with the use of plasma citrulline as a marker of intestinal mass. Few epidemiological data are available; some indicate an increased incidence of short bowel syndrome-related gastroschisis and persistent high incidence of necrotizing enterocolitis. Morbidity and mortality data in pediatric patients with short bowel syndrome are limited, while long-term outcome is better documented from recently reported cohorts. Non-transplant surgery is one of the best options for patients with unadapted short bowel syndrome. Isolated liver transplantation may be avoided. The use of trophic factors for enhancing mucosal hyperplasia still remains disappointing. SUMMARY: The management should include therapies adapted to each stage of intestinal failure, based on a multidisciplinary approach in centers involving pediatric surgery, pediatric gastroenterology, parenteral nutrition expertise, home-parenteral nutrition program, and liver-intestinal transplantation experience. If managed appropriately, the prognosis of short bowel syndrome is excellent, with limited indications for intestinal and/or liver transplantation. Timing for patient referral in specialized centers remains an issue.

Biomarkers↗
PubMed2002

HIV-associated histories, perceptions, and practices among low-income African American women: does rural residence matter?

OBJECTIVES: This study compared HIV-associated sexual health history, risk perceptions, and sexual risk behaviors of low-income rural and nonrural African American women. METHODS: A cross-sectional statewide survey of African American women (n = 571) attending federally funded Special Supplemental Nutrition Program for Women, Infants, and Children clinics was conducted. RESULTS: Adjusted analyses indicated that rural women were more likely to report not being counseled about HIV during pregnancy (P =.001), that a sex partner had not been tested for HIV (P =.005), no preferred method of prevention because they did not worry about sexually transmitted diseases (P =.02), not using condoms (P =.009), and a belief that their partner was HIV negative, despite lack of testing (P =.04). CONCLUSIONS: This study provided initial evidence that low-income rural African American women are an important population for HIV prevention programs.

AIDS Serodiagnosis↗
PubMed1992

Effect of social class and nutrient intake on height and plasma insulin-like growth factor in Andean Equadorian children.

The purpose of this study was to assess the validity of insulin-like growth factor (IGFI) determination as an index of nutritional status and growth in Equadorian schoolboys. Plasma IGFI was measured in 144 healthy boys, 9 years old, who were classified by their social class in four groups: 1 (n = 29); 2 (n = 49); 3 (n = 28); 4 (n = 8). Children in groups 1 and 2, of the lower socio-economic class, had significantly reduced caloric and protein intakes compared to children in groups 3 and 4 (P less than 0.01). Mean heights were significantly lower in groups 1 and 2 (P less than 0.001 and less than 0.05, respectively). The mean plasma IGFI in group 1 was 561 +/- 64 mU/ml and significantly lower than that in groups 2-4 (872 +/- 75, 986 +/- 94, and 1238 +/- 190 mU/ml in groups 2, 3 and 4, respectively) (P less than 0.01). The effect of caloric and nitrogen supplementation was studied in 36 children taken from groups 1 and 2 combined, and divided into three subgroups; they were given (1) an animal protein supplement of 18 g/day with 860 kcal/day (n = 12), (2) a vegetable protein supplement of 17.8 g/day based on a traditional Andean food with 862 kcal/day (n = 12), and (3) a placebo (n = 12). The IGFI levels increased significantly after 7 and 14 days in both subgroups 1 and 2. These results demonstrate that plasma IGFI reflects the nutritional status and responds to a short-term diet supplementation. It may provide a reliable means of assessing the effect of nutritional programs intended to improve the growth of children in underdeveloped countries.

Body Height↗
PubMed1993

Commercial frozen meals: a cost-effective alternative for home-delivery in feeding programs for the elderly?

The costs of eight commercial and eight congregate-site frozen meals were compared in this study. Only half of the congregate-site meals were cheaper on a per ounce basis. The average cost per ounce of all eight congregate-site meals was only one cent less than that of the commercial meals. Preference data, collected previously from elderly participants, indicated significantly higher preference for four of the eight commercial meals. Commercial meals with the highest preference ratings also were less costly per ounce than the corresponding congregate-site meals. Results suggest that commercial frozen meals could be a cost-effective alternative for nutrition programs offering home-delivered meals.

Aged↗
PubMed2004

Health care providers' attitudes toward current food safety recommendations for pregnant women.

Semistructured interviews were conducted with 23 health care professionals who work with pregnant women in a preliminary study to understand health care providers' attitudes regarding current food safety recommendations for pregnant women and interest in education and patient materials on food safety during pregnancy. Only 8 of 23 interviewed currently provided food safety information to their pregnant clients. Limited understanding of food safety issues and limited time with patients were barriers to providing such information. Based on their contact time with patients, background, and interest in food safety issues, nurses, visiting nurses, and Special Supplemental Nutrition Program for Women, Infants and Children professionals should be targeted as conveyers of food safety information to pregnant women.

Attitude of Health Personnel↗
PubMed1990

Defining undernutrition for public health purposes in the United States.

Lack of consistency among definitions of undernutrition used for different public health purposes in the United States hinders an effective diagnosis of the problem and the design of interventions to prevent and treat undernutrition. No single-case definition of undernutrition is appropriate for all purposes. These purposes include surveillance of the prevalence of undernutrition in the population, epidemiological research on risk factors and consequences of undernutrition within population subgroups and communities, and screening, monitoring and evaluation of nutritional programs. We recommend that a cut-off of -2.0 SD (2.3 percentile) for weight-for-age, height-for-age, and weight-for-height on National Center for Health Statistics (NCHS) reference growth charts be used to estimate and monitor the prevalence of undernutrition in the United States, in accordance with guidelines of the World Health Organization. Epidemiological research on population-based risk factors for undernutrition and its functional consequences is required to identify the appropriate nutritional indicator and cut-off for screening and monitoring and evaluation of interventions.

Anthropometry↗
PubMedDate not supplied

[Aspects of prenatal development of muscle and adipose tissue: principles, regulation, and influence of maternal nutrition].

During pregnancy the developing embryo/foetus is completely dependent on the supply with nutrients and the removal of metabolic by-products through the maternal organism. Therefore, each lasting inadequate nutrient supply may have serious consequences for foetal development. As a kind of "nutritional programming" resulting adaptive changes may be maintained until or manifested at adult age. Intrauterine growth retardation (IUGR) may cause problems in animal health and result in poor animal performance. The relationships between prenatal development and the postnatal phenotypic appearance of muscle and fat are insufficiently investigated. The present paper provides selected aspects of the prenatal development of skeletal muscle (myogenesis) and adipose tissue (adipogenesis), refers to the importance of interactions between both tissues and is focussed on the influence of maternal nutrition on these processes.

Adipogenesis↗
PubMed1998

Hunger in midwestern inner-city young children.

OBJECTIVE: To determine the characteristics of hunger in young children who attend ambulatory pediatric clinics in a midwestern city. DESIGN: Consecutive sample. SETTING: Ambulatory pediatric clinics of an inner-city teaching hospital. PARTICIPANTS: English-speaking caregivers of 2578 children younger than 5 years. MAIN OUTCOME MEASURE: Structured survey measures of hunger, family characteristics, assistance program use, child feeding practices, and anthropometrics. RESULTS: In this population, 171 (6.6%) were hungry, and 842 (32.7%) were at risk for hunger. Hunger status was associated with increased age (P<.001), decreased maternal education level (P=.013), maternal nonwhite race (P<.002), a history of homelessness (P<.001), and parental unemployment (P<.001). Hunger status was associated with use of Aid to Families with Dependent Children (P<.001) and food stamps (P<.001) but not with participation in The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Results of anthropometrics indicated that mean growth percentiles were no different between hunger categories. CONCLUSIONS: Housing, dietary, and family characteristics are identifiable risk factors for early childhood hunger. Hunger cannot be identified, however, using anthropometrics. It is disconcerting that fewer hungry children and children at risk for hunger participate in WIC compared with other programs. These data suggest the potential for more aggressive identification and intervention at the primary care and social service levels to benefit hungry children.

Anthropometry↗
PubMedDate not supplied

Missouri rural adolescent pregnancy project (MORAPP).

The purpose of this study was to investigate the pregnancy outcomes and services available to adolescent women in Missouri, comparing rural and urban residents. A secondary analysis of a large public use data set obtained from the Missouri Department of Health was done for the 5-year period 1992 to 1996. Data were collected by county, with each of the 114 counties of the state classified as rural or urban. The SAS program was used for analysis. Results demonstrated definite patterns of similarity and dissimilarity among the teen mothers based on residence, when age and race were controlled. There were over 54,000 births to adolescent mothers in the 5-year study period. Among the outcomes of pregnancy studied were: abortion rates, inadequate weight gain, intrauterine growth retardation, and low-birthweight (LBW) infants. Among the services available to the young mothers that were studied were fertility services, WIC (women, infants, and children supplemental nutrition) program, food stamps, and Medicaid coverage for pregnancy and infant care. The outcomes are probably generalizable to Midwestern, rural/urban states similar to Missouri.

Adolescent↗
PubMed1980

Nutrition legislation: strategy for success.

The decision to sponsor legislation should be carefully considered. Participation in the legislative process requires a major commitment of your organization's time and resources. You will need first to define short- and long-term legislative goals and then to draft these concepts into a bill and estimate its cost. You will need to select a sponsor, considering the commitment, staff interest, committee assignment, political party, and connections of the legislator. Next, a coalition of groups must be formed to support your bill and maintain media coverage to ensure public interest in it. Testimony and appearances during committee hearings must be made. Grassroots lobbying and letter-writing campaigns will further consume your organization's energies. A strategy for nutrition legislation can yield satisfying results. In a relatively short time, you can literally turn the tide of nutrition programs and funding within your state. But the price is high. Participation in the legislative process is not for the weak-hearted, the meek, the indecisive, or the uncommitted. You will get out of it what you put into it. Plant a turnip, get a turnip!

Dietetics↗
PubMed1981

Nutrient-cost nomogram: an appropriate technology.

The nutrient-cost concept is important in food and nutrition planning and applied nutrition programs. There is a need to develop a simple and quick method of calculating nutrient-cost values. A nomogram, which provides a new technology, has been devised to do this. The use of the nomogram and its theoretical basis are described.

Cost-Benefit Analysis↗
PubMed2001

Abbreviated report of the WHO Western Pacific Region Workshop on National Plans of Action for Nutrition: key elements for success, constraints and future plans.

A workshop on National Plans of Action for Nutrition: Constraints, Key Elements for Success, and Future Plans was convened and organized by the WHO Regional Office for the Western Pacific in collaboration with the Institute for Medical Research Malaysia and co-sponsored with FAO and UNICEF from 25-29 October 1999. It was attended by representatives of 25 countries in the region and resource persons, representatives from WHO and other international agencies. The objectives of the workshop were to review the progress of countries in developing, implementing and monitoring national plans of action for nutrition (NPANs) in the Western Pacific Region and to identify constraints and key elements of success in these efforts. Most of the countries have NPANs, either approved and implemented or awaiting official endorsement. The Plan formulation is usually multisectotal, involving several government ministries, non-governmental organizations, and international agencies. Often official adoption or endorsement of the Plan comes from the head of state and cabinet or the minister of health, one to six years from the start of its formulation. The NPAN has stimulated support for the development and implementation of nutrition projects and activities, with comparatively greater involvement of and more support from government ministries, UN agencies and non-governmental agencies compared to local communities, bilateral and private sectors and research and academic institutions. Monitoring and evaluation are important components of NPANs. They are, however, not given high priority and often not built into the plan. The role of an intersectoral coordinating body is considered crucial to a country's nutrition program. Most countries have an intersectoral structure or coordinating body to ensure the proper implementation, monitoring and evaluation of their NPANs. The workshop identified the constraints and key elements of success in each of the four stages of the NPAN process: development, operationalization, implementation, and monitoring and evaluation. Constraints to the NPAN process relate to the political and socioeconomic environment, resource scarcity, control and management processes, and factors related to sustainability. The group's review of NPAN identified successful NPANs as those based on recent, adequate and good quality information on the nutritional situation of the country, and on the selection of strategies, priorities and interventions that are relevant to the country and backed up by adequate resources. Continued high level political commitment, a multisectoral approach, and adequate participation of local communities are other key elements for success. The participants agreed on future actions and support needed from various sources for the further development, implementation, monitoring and evaluation of their NPANs. The recommendations for future actions were categorized into actions pertaining to countries with working NPAN, actions for countries without working NPAN and actions relevant to all countries. There was also a set of suggested actions at the regional level, such as holding of regular regional NPAN evaluation meetings, inclusion of NPAN on the agenda of regional fora by the regional organizations, and strengthening of regional nutrition networks.

Guideline Adherence↗
PubMed1997

Continuation of decline in prevalence of anemia in low-income children: the Vermont experience.

OBJECTIVE: To examine whether the prevalence of childhood anemia in white low-income children has continued to decline into the 1990s. DESIGN: An examination of 14 years of hematocrit data from the Centers for Disease Control and Prevention's Pediatric Nutrition Surveillance System in Vermont from 1981 through 1994. SETTING: Public health clinics for the Special Supplemental Nutrition Program for Women, Infants, and Children in Vermont. The same screening method and criteria for identifying and defining anemia and the same quality-assurance procedures were used during the 14 years. The program eligibility criteria were also consistent except for part of 1991 and 1992. MAIN OUTCOME MEASURE: The annual prevalence of anemia. RESULTS: Between 1981 and 1994, the prevalence of anemia halved (from 7.9% to 3.6%, P<.001). For children aged 6 to 24 months, this decline was from 7.8% to 4.6% (P<.001); for children aged 2 to 5 years, the decline was from 7.9% to 3.1% (P<.001). CONCLUSION: The decline in the prevalence of anemia among low-income children observed by the Centers for Disease Control and Prevention's Pediatric Nutrition Surveillance System up to the mid-1980s has continued into the 1990s in Vermont. This finding indicates that iron nutrition in infancy and early childhood is still improving.

Anemia↗
PubMed1975

Renal failure after ruptured aneurysm.

The effectiveness of an intravenous nutritional program plus aggressive dialysis was studied in 32 patients with renal failure following ruptured abdominal aortic aneurysm. Each patient was managed postoperatively with a renal failure fluid regimen, consisting of the eight essential amino acids plus dextrose in conjunction with peritoneal dialysis and hemodialysis. This regimen induced salutary metabolic effects temporarily improving the patient's condition in most instances. No technical or septic complications associated with the intravenous dietary therapy occurred. However, the incidence of recovery of renal function was low, and the overall patient survival was only 12.5%. The experience indicates that although this program has been shown to be efficacious in some patients with acute renal failure, it seems of little benefit in those whose renal failure follows ruptured aortic aneurysm.

Acute Kidney Injury↗
PubMed1997

[Guides for food and nutrition. A didactic proposal].

The nutritional habits are changing, and compromising in a lot of cases the health of the population. A preventive measurement is to educate in the eating manners and the hygienic orientation, since both are essential in order to change eating attitudes and habits. The purpose of these guides was to aid in the training of health workers as well as to orient the Mexican population in improving their eating habits and nutrition. These guides were prepared taking into account the social and cultural characteristics of the population and were based on educational methodology of participation, with the intention of adapting them to each population group. Initially a critical analysis of the diverse material and methods used in nutritional education of urban and rural populations, was carried out and a lack of systematized methods and existent content was observed. Thus, the development of a didactic integral proposal of the nutritional education was considered necessary. The guides contain eleven modules with the most excellent information on nutrition during the life's cycle, hygienic handling and conservation of the foods. Each module contains ideas for the instructors and examples of exercises that they could propose to the population. Didactic units or guides with similar structures were designed conformated by introduction, basic concepts, educational content, bibliography, suggestions for further reading and techniques. The guides were included in a practical manual of easy use designed for health care working with public, including the educationally. The material has been used as an aid in diet and nutrition programs in Mexico and in courses proportionated to general public, where the result of the effectiveness learning index was 89%. The results obtained demonstrate the efficacy of these guides and suggest a longer term prospective study to determine real impact of our proposal.

Feeding Behavior↗
PubMed2003

The thrifty phenotype hypothesis: thrifty offspring or thrifty mother?

Medical research is increasingly focusing on the contribution of nutritional programming to disease in later life. Programming is a process whereby a stimulus during a critical window of time permanently affects subsequent structure, function or developmental schedule of the organism. The thrifty phenotype hypothesis is widely used to interpret such studies, with early growth restriction seen as adaptation to environmental deprivation. However, such permanent adjustment is less beneficial than maintaining flexibility so as to recover from early growth deficits if the environment improves. Thus, the existing thrifty phenotype hypothesis fails to explain why plasticity is lost so early in development in species with extended growth. One explanation is that the developing organism simply cannot maintain phenotypic plasticity throughout the period of organ growth. This article adds a life history perspective, arguing that programming of the offspring may in some species benefit maternal fitness more than it does that of individual offspring. Closing the critical window early in development allows the preservation of maternal strategy in offspring phenotype, which in humans benefits the mother by constraining offspring demand after weaning. The offspring gains by being buffered against environmental fluctuations during the most sensitive period of development, allowing coherent adaptation of organ growth to the state of the environment. The critical window is predicted to close when offspring physiology becomes independent of maternal physiology, the timing of which depends on offspring trait. Because placental nutrition and lactation buffer against short-term environmental fluctuations, maternal strategy is predicted to derive from long-term experience, encapsulated in maternal size and nutritional status. Such an approach implies that public health programmes for improving birth weight may be more effective if they target maternal development rather than nutrition during pregnancy. Equally, aggressive nutritional management of infants born small or pre-term may induce the very environmental fluctuations that are naturally softened by maternal nutrition.

Adaptation, Physiological↗
PubMedDate not supplied

Participation in health promotion programs by the rural elderly.

The Health Care Financing Administration (HCFA) funded a series of demonstration programs to learn about the implications of extending coverage for disease prevention/health promotion services to Medicare beneficiaries. This article examines the use of such services by a rural population under this demonstration program. Individuals enrolled in the demonstration were eligible for specific risk reduction interventions. They were enrolled in one of two groups: (1) a hospital-based group in which hospitals were paid a capitated fee for providing all services and (2) a physician-based group in which physicians were paid fee-for-service for providing each service. Chi-square tests of association as well as logistic regression models were used to assess whether eligibility for services, and use of services by those eligible, varied by group and by sociodemographic characteristics. Forty-one percent were eligible for a nutrition program, 11% for smoking cessation, 2% for alcohol counseling, and 7% for dementia/depression evaluations. Participation in the programs varied across the programs and within programs by gender, education, and group assignment. Older rural Americans will use some disease prevention/health promotion services if they are covered by Medicare. Use will be higher among those with more education. Rural beneficiaries are more likely to use preventive services if encouraged to do so by their doctors rather than by hospital-based programs.

Aged↗
PubMed2000

Randomized diet in the neonatal period and growth performance until 7.5-8 y of age in preterm children.

BACKGROUND: Preterm children are at high risk of poor growth performance. In 2 randomized trials, preterm infants fed preterm formula grew better in the neonatal period than those fed banked donor breast milk or standard term formula. OBJECTIVE: Our objective was to test the hypothesis that for preterm infants, the neonatal period is a critical one for programming growth performance and that early diet influences long-term growth. DESIGN: A total of 926 preterm infants were recruited into 2 parallel, randomized trials of neonatal diet. In trial 1, infants were fed either banked donor breast milk or preterm formula whereas in trial 2, infants were fed either standard term formula or preterm formula. Within each trial, the allocated milk was the sole diet for some infants (study A), whereas for others it was a supplement to maternal breast milk, given when not enough expressed breast milk was available (study B). We followed up 781 of 833 survivors (94%) to age 7.5-8 y. Trained assessors obtained anthropometric measurements according to a standard protocol. RESULTS: Despite significantly better neonatal growth performance in infants fed preterm formula (compared with either banked donor breast milk or standard formula), early diet had no influence on weight, height, head circumference, or skinfold thicknesses at 9 or 18 mo postterm or at age 7.5-8 y. CONCLUSIONS: These findings suggest that the preterm period is not a critical window for nutritional programming of growth, which contrasts with evidence from these trials showing that early diet influences later neurodevelopment.

Body Height↗