Jane Allen

Obesity and under-nutrition in a tertiary paediatric hospital

Objective:  (i) To determine the prevalence of over‐ and under‐nutrition in both inpatients and outpatients in a tertiary paediatric hospital; (ii) to compare the prevalence of over‐nutrition with that in the Australian community and (iii) to determine whether nutritional status has an impact on length of stay in hospital.

Body composition changes in female adolescents with anorexia nervosa

BACKGROUND Body weight provides limited information about nutritional status of patients with anorexia nervosa (AN). OBJECTIVES Our objectives were to determine body composition (BC) changes, to find clinical predictors and endocrine correlates of total body protein (TBPr) depletion, and to compare results on fat mass (FM) obtained with anthropometry (skinfold measurements) and dual-energy X-ray absorptiometry (DXA) in patients with AN. DESIGN Body weight, body mass index (BMI; in kg/m(2)), BC (with DXA and skinfold measurements), and TBPr [with in vivo neutron activation analysis (IVNAA)] was assessed in 50 AN patients (15.2 y) and 40 healthy sex- and age-matched controls. In 47 AN patients and 22 controls, hormone concentrations were measured. RESULTS In AN patients, body weight (44.4 +/- 5.5 kg), BMI (16.7 +/- 1.6), and FM(DXA) (7.0 +/- 3.4 kg) were lower than in controls. Lean tissue mass by DXA (LTM(DXA)) was similar in AN patients and controls (35.7 +/- 4.3 compared with 35.8 +/- 4.5 kg), but TBPr was 87% of that of controls (8.1 +/- 1.0 compared with 9.2 +/- 1.2 kg; P < 0.001). Cortisol was high, testosterone was unchanged, and estradiol and insulin-like growth factor I were low. Severe protein depletion measured by IVNAA seen in 17 AN patients could not be identified with simpler methods. All except 1 of 26 AN patients with a BMI > 16.5 had normal TBPr. The difference in individual percentage of body fat measured with DXA and skinfold measurements came up to 9%. CONCLUSION The severe protein depletion in 34% of AN patients was not accurately identified by LTM(DXA) or simpler methods, but a BMI > 16.5 indicated normal TBPr. Future studies need to compare DXA and skinfold measurements with a reference technique to assess FM in AN patients.

The effect of gastrostomy tube feeding on body protein and bone mineralization in children with quadriplegic cerebral palsy

Aim  The aim of this study was to investigate the effect of gastrostomy tube feeding on body protein and bone mineralization in malnourished children with cerebral palsy (CP).

Longitudinal analysis of resting energy expenditure in patients with cystic fibrosis.

OBJECTIVE To assess whether elevated resting energy expenditure (REE) in female patients with cystic fibrosis (CF) persists longitudinally during late childhood and puberty. STUDY DESIGN REE and body composition were measured 3 times in 2 years in 86 children with CF. Pubertal status, bacterial colonization, liver disease, pancreatic and pulmonary function, and genotype were determined, and linear mixed model analyses were used to determine predictors and changes in REE longitudinally. RESULTS REE did not change with time allowing for fat free mass, pancreatic insufficiency (PI), or severe mutations. Pulmonary function and liver disease were not significant predictors of REE. Percentage predicted REE compared with control data was higher (P = .002) in female patients with CF (109.5%) and lower in male patients with CF (104%) and persisted with time. In post-menarchal female patients with CF, REE adjusted for fat free mass was 366 kJ/d lower than in pre-menarchal female patients, but still 112% predicted. CONCLUSIONS This longitudinal study demonstrates that REE is elevated in patients with CF with PI and severe mutations. The elevation of percentage predicted REE was greater in female patients than male patients and persisted for 2 years, and during pubertal maturation, independent of pulmonary and liver disease. These results highlight the need for a high-energy diet throughout childhood and adolescence, particularly in female patients with PI.

Outcomes of a nutrition audit in a tertiary paediatric hospital: Implications for service improvement

Objective:  To examine the process of anthropometric assessment of nutritional status in a tertiary paediatric hospital, to identify the barriers and to make recommendations for service improvement.

Nutritional rehabilitation increases the resting energy expenditure of malnourished children with severe cerebral palsy

Aim  The aim of this study was to measure resting energy expenditure (REE) and energy intake in children with quadriplegic cerebral palsy (CP), to relate these to anthropometric measurements, and to determine the influence of nutritional rehabilitation on REE.

Vitamin and mineral deficiencies in the developed world and their effect on the eye and vision.

Vitamin and mineral deficiencies are common in developing countries, but also occur in developed countries. We review micronutrient deficiencies for the major vitamins A, cobalamin (B12), biotin (vitamin H), vitamins C and E, as well as the minerals iron, and zinc, in the developed world, in terms of their relationship to systemic health and any resulting ocular disease and/or visual dysfunction. A knowledge of these effects is important as individuals with consequent poor ocular health and reduced visual function may present for ophthalmic care.

Resting energy expenditure in females with cystic fibrosis: is it affected by puberty?

Objective:The aims of this study were to determine the effect of puberty and the menstrual cycle on resting energy expenditure (REE) in females with cystic fibrosis (CF).Design:Cross-sectional study. All participants had measurements of REE, anthropometry and pubertal staging. The measurements in the postmenarche group were carried out both in the follicular and luteal phases of their menstrual cycle.Setting:CF outpatient clinic at the Childrens Hospital at Westmead.Subjects:Fifty-six females with CF and pancreatic insufficiency (13 postmenarche) were recruited from the hospital clinic and 63 controls (21 postmenarche) were recruited through families and friends of hospital staff.Results:Females with CF had a higher REE than controls (111.6±12.8% of predicted from controls P<0.001). There was a significant effect of menarche on REE with a decrease in the postmenarche −470 kJ/24 h compared with premenarche after adjustment for fat-free mass, fat mass and group (control or CF). There was no difference in REE between the follicular and luteal phases for either CF or controls.Conclusions:Females with CF had raised REE that appeared to be independent of menarche. This study implies all females with CF and pancreatic insufficiency may need more intensive dietary management, owing to raised REE, to maintain growth and nutritional status, and possibly improve survival.Sponsorship:None.

Iron status of young Vietnamese children in Australia

Objective:  The aim of this study was to estimate the prevalence of iron deficiency in Vietnamese children living in Australia and to identify risk factors associated with iron deficiency.

Growth and feeding practices of Vietnamese infants in Australia

Objective: To investigate the growth and feeding practices in first-generation Vietnamese infants living in Australia.Design: Cohort study.Setting: The study was conducted between 1999 and 2002 in Sydney.Subjects: A total of 239 Vietnamese women were recruited randomly from antenatal clinics, and of these 210 were initially seen. During the first year, 20 cases (9.5%) were lost to follow-up. Data were collected at 0.5, 2, 4, 6, 9 and 12 months.Results: Vietnamese infants were significantly longer and heavier than reference data (both P<0.0001). The Vietnamese infants had a significant decline in weight growth with age compared with reference data (P<0.001). The Vietnamese infants had marginally higher s.d. score for ideal weight for length than reference data (P=0.044). There was a significant decline in ideal weight for length with age compared with reference data (P=0.0065). Both parents were significantly shorter (mean s.d. height scores: −1.5±0.8 (mother) and −1.8±0.8 (father)) than reference data (P<0.001). The incidence of breast feeding was 79%, but half of the breast feeding women had stopped breast feeding by 3 months. A total of 162 (79.8%) infants were given infant formula within the first week, of whom 131 (80.1%) were fed infant formula within the first 24 h after birth.Conclusions: Vietnamese infants in this study had growth comparable with reference data despite their parents being shorter than reference data. Breast feeding duration was short with infant formula being introduced early.Sponsorship: Funding was supported in part by the James Fairfax Institute of Paediatric Nutrition and grants from The Financial Market Foundation for Children, The Childrens Hospital Fund at Westmead, Karitane, and The Clive and Vera Ramaciotti Foundations, Australia.