Haschke F

Interactions between Infections, Malnutrition and Ironnutritional Status in Pakistani Infants A Longitudinal Study

The interactions between infections, malnutrition and poor iron nutritional status in infants at weaning ages are poorly defined. Therefore, four groups of infants from an area with a high incidence of malnutrition (Lahore, Pakistan) were enrolled in a prospective, randomized nutritional intervention study. Between 122 and 365 days of age, the infants from one community received either a milk cereal without iron fortification (n= 29), a milk cereal fortified with ferrous fumarate (7.5 mg/100 g; n= 30), or a milk cereal fortified with ferric‐pyrophosphate (7.5 mg/100 g; n= 27). Forty‐four infants from a neighbouring community did not receive a nutritional supplement and served as the control group. Calculated mean daily energy‐ and protein intake with the cereals was between 259–287 kcal, and 9.6–10.6 g at 12 months of age, respectively. Mean daily iron intake with the fortified cereals was between 4.1–5.1 mg at corresponding age. Nutritional supplementation resulted in significantly lower incidence of malnutrition and heigher weight gain. Incidence of acute diarrhoea was significantly (p<0.05) lower in the supplemented groups. The infants fed the iron‐fortified milk cereals had significantly higher hemoglobin (mean 10.4 vs. 9.8 gdl‐1) and serum ferritin (mean 13.3 vs. 8.5 ngml‐1) values than the infants fed the non‐fortified milk cereals. However, no differences in the incidence of infections were found between the supplemented groups. It is concluded that poor nutritional intake between 122 and 365 days of age substantially contributed to the high incidence of diarrhoea and malnutrition in Pakistani infants.

Iron nutrition and growth of breast- and formula-fed infants during the first 9 months of life.

Feeding of iron (Fe)-fortified (12–15 mg/L) infant formulas is an effective and convenient means to protect infants from Fe deficiency. To study lower levels of Fe fortification of infant formulas (3 or 6 mg/L) compared with those currently in use, we compared Fe intake and Fe nutritional status of three groups of healthy, term infants between 90 and 274 days of age. One group received an Fe-fortified whey-predominant formula (3 mg/ L) and the second group received the same formula with a higher Fe level (6 mg/L). A comparison group was breast-fed at least until 274 days of age. All infants received infant foods and cereals according to European Community recommendations. Mean Fe intake of infants fed formula fortified with 3 mg/L was significantly lower at 183 and 274 days of age (p < 0.05) than that of infants fed formula fortified with 6 mg/L. None of the infants fed the formula fortified with 3 mg/L met the recommended daily allowance value (10 mg) for infants between 6 and 12 months of age. Hemoglobin, hematocrit, mean corpuscular volume, free erythrocyte protoporphyrin, and serum ferritin levels were similar in the formula-fed groups; none of the infants had depleted Fe stores (ferritin < 10 μg/L) at 183 and 274 days of age. Thirteen percent of breast-fed infants had depleted Fe stores at 183 days of age, but only 3% were depleted at 273 days of age, when Fe-fortified beikost was already part of the diet. No influence of Fe nutritional status was found on zinc and copper nutritional status or on growth. We conclude that regular consumption of an infant formula fortified with 3 mg Fe/L, a level substantially below present recommendations, prevents healthy, term infants from developing Fe deficiency during the first 6 months of life. It is preferable that infants 6 months of age and older receive an Fe-fortified formula and a judicious selection of beikost to ensure an adequate dietary intake of Fe.

High Total and Free 1,25‐Dihydroxyvitamin D Concentrations in Serum of Premature Infants

ABSTRACT. We investigated the relationship between serum total and free 1,25‐dihydroxyvitamin D (1,25‐OH2D) and the biochemical regulation of 1,25‐OH2D production in premature infants. We measured 1,25‐OH2D, vitamin D binding protein and related biochemical parameters and calculated the free 1,25‐OH2D index in serum of 17 premature infants (birthweight 810–1700 g; gestational age 31–36 weeks) on two different occasions defined by body weight (Study A: 1750–1850 g, Study B: 2100–2200 g). Dietary calcium (Ca) intake was 1,5 or 2,6 mmol/kg/d, phosphorus (P) intake 1,7 mmol/kg/d and vitamin D intake 1000 IU/d. Biochemical results were similar in infants with different Ca intakes and all were within reference ranges. Concentrations of vitamin D binding protein (Study A 0.15±0.03 g/1, Study B 0.14±0.03 g/1; ± SD) were lower, concentrations of 1,25(OH)2D (Study A 180±67 pmol/1, Study B 216±53 pmol/1) were higher, and consequently the free 1,25‐OH2D index (Study A 6.6±2.7, Study B 8.8±2.6) was 4 to 6 times higher than in previously studied term infants. 1,25‐OH2D and the free 1,25‐OH2D index increased significantly with age and were not correlated with serum P or parathyroid hormone. The data indicate that in premature infants with normal biochemical parameters of Ca and P metabolism elevated concentrations of 1,25‐OH2D signify an increased fraction of free 1,25‐OH2D and that increased production of 1,25‐OH2D is not due to hypophosphatemia or hyperparathyroidism.

Die Herzfrequenz auf submaximalen Belastungsstufen ist nicht repräsentativ für die maximale Leistungsfähigkeit

Fur die sportmedizinische Untersuchung wird haufig die Herzfrequenz auf submaximalen Standardbelastungsstufen (HFsubmax) verwendet. Zweck dieser Studie war es, den korrelativen Zusammenhang zwischen HFsubmax und maximaler Leistungsfahigkeit (LFmax) und damit die Zuverlassigkeit der Schatzung der LFmax aufgrund der HFsubmax im Einzelfalle zu prufen. 36 Kinder einer Hauptschule mit unterschiedlicher korperlicher Belastung im Turnunterricht und unterschiedlichen Training szustanden (TZ) wurden 3mal im Abstand von je 1 Jahr untersucht (98 gultige Tests = n): Spiroergometrie mit erschopfender Belastung, 3 min Stufen und Inkremente von 0,5 Watt/kg Korpergewicht (W/kg/KG). Die Werte fur Alter, relative maximale Sauerstoffaufnahme (( mathop Vlimits^ cdot )O2 max/kg) respektive die relative maximale Wattleistung (Wmax/kg) und die HF bei 1,2 und 3 W/kg KG (HFA, HFB, HFC) wurde mittels einfacher und partieller Korrelationsanalyse untersucht. Fur die korrelative Beziehung von HFA, HFB und HFC zu ( mathop Vlimits^ cdot )O2 max/kg war r = 0,38; zu Wmax/kg war r = 0,46. Wird der Einflus des Alters auf die Korrelation ausgeschaltet, ist der Korrelationsfaktor 0,29 respektive 0,48.

PLASMA ALDOSTERONE ELEVATION DUE TO RENAL SODIUM WASTING IN A BOY WITH CYSTIC FIBROSIS

Elevations of plasma aldosterone (PA) and plasma renin activity (PRA) have been observed in some patients with cystic fibrosis ( I ) . We observed such a patient and studied his aldosterone-renin system under dietary and pharmacologic manipulation. The patients past history was remarkable for an episode of hyponatremic-hypochloremic alkalosis at 8 months of age. PA (100 ng/dl) was elevated but decreased to normal during a subsequent period of dietary salt supplementation. Without salt supplementation, PA became elevated again and remained elevated (5 determinations). None of 10 control children with cystic fibrosis aged 2 to 12 years had elevated PA. At the time of admiss ip the patient was 5 3/12 years old, his weight was 16.5 kg and his height 108 cm. At the beginning of the study and at the end of each dietary period one sample of venous blood was obtained at about 8:OO a.m. with the patient in the supine position and a second sample after the patient had spent 30 min standing. PA and PRA. were determined by radioimmunoassay ( 2 ) . Na and K in serum, sweat and urine were determined by flame photometry. The results are summarized in Fig. 1 . After 3 days of a low Na (10 mmol/d) and a normal K (25 mmol/d) intake, PA and PRA increased and sweat and serum NA decreased somewhat. Urinary Na excretion decreased to very low values. During the next 2 days, during which K intake was increased to 50 mmol/d, PA and PRA remained elevated but urinary Na excretion increased. Despite low urinary Na excretion for 2 days, Na balance during the entire 5-day period with low Na intake was markedly negative. Then a high sodium intake (100 mmol/d) was provided for 5 days. PA decreased but PRA remained elevated. Sweat Na increased indicating that the transport of Na in the sweat glands could be modulated by aldosterone (3, 4). Urinary Na excretion increased sharply