Andrew M. Tershakovec

Long-term growth and development in children after home parenteral nutrition

Abstract Growth and development after the cessation of prolonged parenteral nutrition (PN) has not been fully evaluated. Growth, body composition, and nutritional and developmental status were documented in nine children (five boys, four girls) 2 to 6 years old (mean 4.9 ± 1.0 years) who had previously received long-term PN (mean 14.6 ± 11.4 months). PN had been discontinued in all subjects for at least 6 months (mean 3.4 ± 1.4 years); they were receiving oral feedings only. One subject had a significantly low height-for-age, and another had a low percent ideal body weight; five subjects had low total body fat. Serum vitamin A was low in six subjects. Seventy-two–hour fecal fat analysis was abnormal in two of eight subjects. Abnormal bone mineral density was present in four of nine subjects. Psychomotor development was normal in all nine subjects. Two had functional difficulties in swallowing. One or more abnormalities were present in all nine subjects. These findings suggest that children who require prolonged PN in early life are at risk for abnormalities in growth and nutritional status in later childhood; they require long-term dietary, growth, and nutritional monitoring. (J Pediatr 1998;132:461-6)

Age-related changes in cardiovascular disease risk factors of hypercholesterolemic children☆☆☆★★★

OBJECTIVEnTo describe the age-related changes in cardiovascular disease risk factors in young, hypercholesterolemic (HC) children.nnnMETHODSnHypercholesterolemic (n = 227) and nonhypercholesterolemic (NHC) (n = 80) children between the ages of 4 and 10 years were identified. Height, weight, skin-fold and blood pressure measurements, and total cholesterol levels were measured. The HC group also had insulin levels evaluated. The groups were compared by analysis of variance. Simple Spearman correlations evaluated the associations between factors within each group.nnnRESULTSnThe HC and NHC groups had similar mean ages, heights, and weights, both contained 51% girls, and all were white subjects. Percent weight-for-height median, and biceps, triceps, suprailiac and subscapular skin-fold measurements were all larger for the HC group. A significant age interaction demonstrated that the HC groups larger suprailiac and sum of skin-fold measures were expressed in the 8.0- to 9.9-year-old children, but not the 4.0- to 5.9-year-olds. For both groups, systolic blood pressure was associated with the measures of adiposity. For the HC group, insulin levels were also associated with adiposity.nnnCONCLUSIONSnThese results suggest that: (1) children with HC have greater body fat, (2) the expression of the hypercholesterolemia precedes the expression of increased body fat, (3) body fat increases with age, and (4) altered insulin and blood pressure levels are expressed in association with the increased body fat in children with HC. Confirmation with longitudinal data is necessary.

THE GROWTH OF HYPERCHOLESTEROLEMIC CHILDREN DURING DIET INTERVENTION † 511

To evaluate the efficacy and safety of nutrition education for hyperchlesterolemic children, 261 3.9-9.9 year old children with elevated LDL-cholesterol (LDL-C) levels were randomly assigned to an innovative, home-based nutrition education program, standard nutrition counseling, or to an At-Risk Control group. A Not-At-Risk Control group of children with normal cholesterol levels was also recruited (n=81). Height, weight, skinfold measures and dietary intake were evaluated at baseline, 3, 6 and 12 months. At baseline the children were ingesting 29.2-29.9% and 11.1-11.7% calories as fat and saturated fat respectively. The intervention groups demonstrated significant decreases in fat and saturated fat intake after the interventions. At baseline, height z-score (ht-z) and weight z-score (wt-z) were associated with caloric intake, while weight-for-height median (WHM) was associated with fat intake. Wt-z, ht-z, WHM, and the sum of the four skinfolds (total skin) did not vary between the treatment groups over the year. No association between fat intake and wt-z, ht-z, WHM or total skin over time was observed. These results support the safety, with respect to sustaining comparable growth rates, of physician-initiated dietary intervention for hypercholesterolemic children.

ONE YEAR FOLLOW-UP OF NUTRITION EDUCATION FOR HYPERCHOLESTEROLEMIC CHILDREN† 581

The efficacy of an innovative home-based, physician-initiated parent-child autotutorial nutrition education program (PCAT) and of standard nutrition counseling for hypercholesterolemic children were evaluated. Two-hundred-sixty-one 3.9-9.9 year old children with elevated LDL cholesterol(LDL-C) levels were randomly assigned to one of the nutrition interventions, or to an At-Risk Control group. A Not-At-Risk Control group of children with normal cholesterol levels was also recruited (n=81). The change in knowledge of heart healthy foods, dietary intake, and (for the At-Risk groups only) blood lipid levels were evaluated at 3, 6 and 12 months post-baseline. The PCAT group exhibited a significant initial increase in knowledge of heart healthy foods, which was fully retained. The PCAT and Counseling groups lowered their total fat and saturated fat intake throughout the year. The PCAT groups decrease in LDL-C level at 3 months reached borderline significance, when compared to the At-Risk Control group. This trial demonstrated that knowledge and dietary change can be affected and retained via an innovative home-based nutrition intervention for children, though some form of ongoing intervention may be necessary to produce lasting decreases in LDL-C level.

AGE THRESHOLD FOR THE EXPRESSION OF ALTERED BODY COMPOSITION AND INSULIN LEVELS OF HYPERCHOLESTEROLEMIC CHILDREN 424

AGE THRESHOLD FOR THE EXPRESSION OF ALTERED BODY COMPOSITION AND INSULIN LEVELS OF HYPERCHOLESTEROLEMIC CHILDREN 424