Carlos Castillo-Durán

Trace mineral balance during acute diarrhea in infants.

To evaluate the magnitude of copper and zinc losses during acute diarrhea requiring hospitalization, we studied 14 infants, 3 to 14 months of age, and compared them with a control group of 15 infants of similar age, birth weight, and nutritional status. Metabolic balance studies were conducted in the study group during an initial 48 hours (period 1) and on days 6 and 7 after admission (period 2). The control group was studied after recovery from respiratory disease. Copper and zinc content of feces, urine, and food samples was measured by atomic absorption spectrophotometry. Mean (+/- SD) fecal losses were higher for period 1 in the diarrhea group than in control subjects: Cu 55.7 +/- 21.2 versus 28.8 +/- 6.7 micrograms/kg/body weight/day (p less than 0.01); Zn 159.4 +/- 59.9 versus 47.4 +/- 6.4 micrograms/kg/day (p less than 0.0001). For period 2, Zn losses were similar in both groups, but Cu balance remained negative only in the study group. Retention of Zn for the study group went from -21.2 +/- 46.7 in period 1 to 204.5 +/- 103.0 micrograms/kg/day in period 2 (p less than 0.0001), and fecal weight decreased from 70.5 +/- 20.6 in period 1 to 36.8 +/- 20.0 gm/kg/day in period 2. Fecal weight and fecal losses were correlated: r = 0.71 (p less than 0.01) for Cu and r = 0.81 (p less than 0.001) for Zn. Plasma mean Cu and Zn levels were low in period 1 but rose in period 2, especially for Zn. A negative correlation was found between fecal Zn losses and plasma Zn: r = 0.74 (p less than 0.001). We conclude that acute diarrhea leads to Cu and Zn depletion and that plasma levels and Cu balance remain abnormal a week after admission.

Zinc supplementation and growth of infants born small for gestational age

To analyze the effect of zinc supplementation on postnatal growth of infants born small for gestational age, we selected 68 infants at birth and followed them monthly for 6 months. They were randomly assigned to a supplemented group (group S, n = 35) receiving 3 mg of Zn (acetate) per day, or to a placebo (group P, n = 33), in a double-blind study. Weight increments in group S were significantly higher than those in group P at 2 months (p < 0.003); z scores showed catch-up growth only in group S. Length increments were also greater in group S than in group P, ending at 6 months were 64.9 +/- 1.8 versus 63.4 +/- 3.5 cm (mean +/- SD; p < 0.01); changes in z scores for 6 months were -1.28 to -0.66 in group S and -1.43 to -1.47 in group P (p < 0.001). Weight-for-length improved similarly in both groups (z score, -2.2 to +0.2). The increase in weight-for-age was higher in group S girls (p < 0.034), ending at 6 months with -0.13 +/- 0.59, versus -0.52 +/- 0.62 in group S boys, -1.15 +/- 0.49 in group P girls, and -1.05 +/- 0.80 in group P boys (+/- SD). More infants in group P received cow milk-based formula before 4 months because of inadequate weight increments. An additive effect on weight increase was observed between Zn supplementation (p < 0.02), exclusive breast-feeding after 4 months of age (p < 0.001), and gender (p < 0.02). Plasma and hair Zn values showed a downward trend, less marked in group S than in group P. We conclude that Chilean infants born small for gestational age have better weight and linear growth during the first 6 months of life if they receive Zn supplementation.

Fat intake during childhood: metabolic responses and effects on growth

Lipids are considered the most important energy source in the infant diet and are necessary for normal growth and physical activity. Human milk, in which most of the energy is present as fat, provides a relatively high cholesterol intake. Formula provides a much lower cholesterol intake. Infants fed human milk have higher total and LDL-cholesterol concentrations in plasma than do formula-fed infants (P: < 0.05), whereas plasma HDL- and LDL-cholesterol concentrations are lower in formula-fed infants if a formula high in linoleate is fed (P: < 0.05). Infants adapt to the high cholesterol content of human milk through a decrease in cholesterol synthesis; in contrast, the addition of cholesterol to formula does not suppress synthesis. Measurements of serum lipoproteins and LDL-receptor activity suggest that it is the fatty acid content, rather than the cholesterol content, of the diet that regulates cholesterol homeostasis. We studied the effect of total energy, source of energy, and fat on growth indexes of children <6 y of age in Latin America with use of food balance data. With respect to availability of animal fat, a negative relation was evident for being underweight (percentage weight-for-age <2 SDs of the World Health Organization-National Center for Health Statistics standards) and for having a low birth weight; the latter was also negatively related to energy. Wasting (percentage weight-for-height <2 SDs) was not related to dietary factors. These results suggest that diets that provide <22% of energy from fat and that are low in animal fats may restrict growth. The coexistence of early stunting with adult obesity in Latin America creates a dilemma for public nutrition intervention programs.

Las golosinas en la alimentación infantil: Análisis antropológico nutricional

The increasing consumption of junk food and snacks in Chile in recent years and its association with marketing strategies and prevalent diseases, is reviewed. In the context of world economy, junk food is a global phenomenon. The availability of junk food and snacks at low prices and marketing has triggered an evolution of consumption of foods that require neither the structure nor the preparation of a formal meal. Many studies have suggested that the increase in snack consumption is associated with an increase in obesity, tooth decay and other chronic diseases among children and adolescents. The hypothesis suggests a link between the pattern of snack consumption and an increase increase in the energy density of food consumed, a decrease in satiety, passive over consumption, and an increase in obesity. Between 1977 and 1996, the contribution: of snacks to daily energy intake among children between 2 and 5 years increased by 30% in the United States. In each age group in Chile the frequency of non-transmissible chronic diseases is increasing due primarily to a westernized diet that is high in fat, cholesterol, sodium, and sugar and a sedentary lifestyle. Education about junk food consumption and healthy eating habits in the family, starling since childbirth and public policies about healthy lifestyles should be strengthened.The increasing consumption of junk food and snacks in Chile inrecent years and its association with marketing strategies and prevalent diseases, is reviewed. Inthe context of world economy, junk food is a global phenomenon. The availability of junk foodand snacks at low prices and marketing has triggered an evolution of consumption of foods thatrequire neither the structure nor the preparation of a formal meal. Many studies have suggestedthat the increase in snack consumption is associated with an increase in obesity, tooth decayand other chronic diseases among children and adolescents. The hypothesis suggests a link be-tween the pattern of snack consumption and an increase in the energy density of food con-sumed, a decrease in satiety, passive over consumption, and an increase in obesity. Between1977 and 1996, the contribution of snacks to daily energy intake among children between 2and 5 years increased by 30% in the United States. In each age group in Chile, the frequency ofnon-transmissible chronic diseases is increasing due primarily to a westernized diet that is highin fat, cholesterol, sodium, and sugar and a sedentary lifestyle. Education about junk food con-sumption and healthy eating habits in the family, starting since childbirth and public policiesabout healthy lifestyles should be strengthened (Rev Med Chile 2004; 132: 1235-42).(

Zinc Supplementation and Growth of the Fetus and Low Birth Weight Infant

Zinc deficiency limits growth in young children, and in animal models it also affects fetal growth. In animals, the effect of severe zinc deficiency on growth is evident. However, controlled trials of zinc supplementation during pregnancy in humans have not demonstrated consistent effects on weight at birth and/or duration of gestation. Those studies that have identified a positive effect of zinc on fetal growth were performed on low-socioeconomic or migrant groups in industrialized countries or in countries where diet and living conditions are improving. In contrast, in studies conducted either on populations with minimal risk of zinc deficiency or those suffering from multiple and severe nutritional deficiencies, no effects have been found. The potential confounding factors that may help explain the contradictory results include the following: age of pregnant women; presence of digestive diseases, other nutritional deficiencies, phytates or other factors that affect bioavailability; timing and duration of zinc supplementation and compliance with supplements. Few studies of zinc supplementation were conducted on infants that were born small for their gestational age or preterm; in this case, a positive effect on growth was shown. A study of zinc supplementation during pregnancy found reduced risk of diseases (diarrhea or impetigo) in small-for-gestational-age but not preterm infants. A second study demonstrated reduced mortality in small-for-gestational-age infants. We conclude that supplementation trials during human pregnancy do not provide conclusive evidence for a beneficial effect of zinc supplementation despite the experimental evidence that zinc deficiency may retard fetal growth or shorten pregnancy. However, early zinc supplementation in low birth weight or small-for-gestational-age infants reveals an effective improvement in growth, which suggests a prenatal depletion or insufficient zinc intake to support catch-up growth postnatally.

Controlled trial of zinc supplementation in Chilean pregnant adolescents

Objective. The aim of this study was to analyze the effect of zinc supplementation on pregnancy outcome of Chilean adolescents from low socio-economic status (LSES); they often have low zinc intakes which may affect normal growth. Study design. A double blind randomised zinc supplementation trial was conducted with 804 healthy pregnant adolescents of LSES (age 16 ± 1.3 y.). Individuals were randomly assigned to Zn supplemented (S, n = 401) or Placebo (P, n = 403) groups. During the follow-up 297 were excluded. The S group received 20 mg Zn/d and the P group received a placebo, starting before 20 weeks of gestation. Results. On admission, both groups were comparable in age, rate of underweight, gestational age (12.5 vs 12.8 weeks), and dietary zinc intakes (7.3 vs 7.6 mg/d). At delivery, the S group presented a birthweight of 3,319 ± 460 g compared with 3,250 ± 514 g in the P group (NS). The proportion of low birthweight (<2,500 g) in the S group was significantly lower than in the P group (6/249 vs 16/258, p = 0.036). Prematurity rate was lower in S than P (14/249 vs 30/258, p = 0.016). Multiple regressions found a significant effect of maternal nutritional status (p = 0.011) and zinc supplementation (p = 0.05) on birthweight. No effects on pregnancy complications, RBC or plasma alkaline phosphatase were found. Conclusions. Oral zinc supplementation affects favourably the pregnancy outcomes in Chilean adolescents from low socio-economic status.

Phagocytosis and immunoglobulin levels in hypocupremic infants

Abstract Nineteen hypocupremic marasmic infants 5–14 months of age with a normal wt/1gth ratio, were immunologically evaluated during their rehabilitation. The infants were studied 2–3 months after admission to a Closed Nutritional Recovery Center and subsequently after copper supplementation. Two groups were defined: a severely copper deficient group (A), with abnormal copper and ceruloplasmin levels; and a marginal copper deficient group (B), with abnormal plasma copper level and normal serum ceruloplasmin. Immunoglobulin levels were measured by radial immunodiffusion technique and phagocytosis to S. aureus by using autologous and normal homogogous plasma. After copper supplementation plasma copper increased to normal values in both groups of infants. Ceruloplasmin exceeded normal ranges in group A whereas no changes were detected in group B. Serum immunoglobulins were normal and secretory IgA remained low in most of the infants. Phagocytic indices increased in most infants with both types of plasma after copper supplementation in groups A and B (p

Controlled study of early postoperative parenteral nutrition in children.

BACKGROUND/PURPOSE Nutritional support of surgical patients has improved in recent years because of the possibility of modulating catabolism and anabolism, thus enhancing the immune response and repair processes. The objective of this study was to evaluate metabolic effects of early parenteral nutrition (PN) after major surgery. METHODS The authors studied 63 children aged 4 to 14 years with diffuse peritonitis caused by perforated-suppurative appendicitis. They were assigned randomly to a study group (SG, n = 31), which received PN for 5 days, starting 24 to 48 hours after surgery or to a control group (CG, n = 32), that received standard treatment (fluids). Weight, C-reactive protein (CRP), albumin, prealbumin, glycemia, nitrogen balance (NB), and insulinlike growth factor (IGF-I), were evaluated on postoperative days 1, 4, and 6. RESULTS Early nutritional support was associated with a significant improvement in NB and IGF-I (Repeat measures analysis of variance IGF-I, P<.001 and NB P<.01). CONCLUSIONS The authors conclude that early parenteral nutrition has a positive effect on the anabolic response as shown by improved NB and higher IGF-I levels in pediatric patients after major surgery.

Adiposidad visceral y su asociación con lípidos séricos e insulinemis en adolescentes obesas

BACKGROUND Increased visceral or abdominal adipose tissue in children and adults is strongly associated with metabolic and a variety of chronic diseases. AIM To study the association between visceral or external body measurements of adiposity with blood lipids, glucose and insulin levels, in obese female adolescents. MATERIAL AND METHODS In a cross-sectional study, 47 obese female adolescents (body mass index (BMI) >95th percentile) aged 10 to 15 years, were analyzed. Weight, height, BMI, Tanner pubertal stages, skinfold thickness, waist circumference, waist-to-hip ratio, fasting and 120 min post prandial blood glucose, serum insulin, and lipid profile were studied. Visceral fat was assessed by computed tomography at the L4-L5 level, measuring the fat area or the length of a straight drawn line between the spine and the internal border of the rectus abdominus muscle. RESULTS No association between lipid profile and BMI or external body measurements (skinfold thickness, waist circumference, waist-to-hip ratio) was observed. Total serum cholesterol >170 mg/dL was positively associated with the straight line over 63 mm (a cut-off obtained by ROC analysis (RR 2.64; 1.15-6.08). This association was statistically significant in girls in Tanner I + II (n =21; Fisher, p <0.023), but not with Tanner III + IV (n=26) stages. Increased cholesterol (>170 mg/dL) was also positively associated with a serum insulin >17 uU/mL in the Tanner I + II group (Fisher p<0.05), but not with the homeostasis model assessment of insulin resistance (HOMA). CONCLUSIONS No external body measurement of adiposity was associated to increased serum cholesterol in these obese female adolescents. Increased total cholesterol (>170 mg/dL) was associated with visceral fat (evaluated through the straight line spina-rectus abdominus muscle), and also with a serum insulin >17 uU/ml in those teenagers with Tanner I or II pubertal stages.

Studies on the bioavailability of zinc in humans. IX. Interaction of beef-zinc with iron, calcium and lactose

Abstract Three series of zinc absorption experiments using the plasma zinc appearance approach were conducted in healthy volunteers following ingestion of 400 g of cooked beef containing 16 mg of zinc. In the first study, Fe/Zn ratios of 1:1 and 4:1 — but not 7:1 — constituted from 16, 64 and 112 mg of ferous iron from ferrous sulfate, accompanied by ascorbic acid, produced a singificant reduction in the post-beef zinc response. In the second study, 240 ml of cows milk, both with intact lactose and with 90% of the carbohydrate hydrolyzed to glucose and galactose, produced a 63% and 96% reduction respectively in plasma zinc uptake from the standard beef dose. There was no differencial effect of lactose. In the final study, 300 mg of calcium alone, or with 64 mg of ferrous iron, produced a significant reduction in plasma zinc appearance. No deinhibition of the effect of the 4:1 Fe/Zn ratio by the competing calcium was observed.