John Patrick

RAPID CORRECTION OF WASTING IN CHILDREN WITH CEREBRAL PALSY

Severe cerebral palsy is often accompanied by wasting. The authors used standard methods for the correction of primary protein energy malnutrition in children with severe cerebral palsy. A randomised controlled trial was used to compare intensive nasogastric tube‐feeding with the best oral feeding that could be achieved. Nasogastric feeding led to highly significant increases in weight. The changes in skinfold thickness and mid‐arm muscle circumference indicated increases in both lean and fat tissue. This study indicates that wasting associated with cerebral palsy can be quickly corrected, so there is no reason why such patients should be exposed to the increased risks associated with wasting.

Leukocyte zinc in the assessment of zinc status.

The problems of assessment of human zinc status are reviewed, with particular emphasis on the limitations to each of the current available measurements. The advantages and limitations of leukocytes are then described. Methods of preparation and potential problems in the assay for zinc are described in detail. The data so-far produced by this method are reviewed.

Erythrocyte membrane lipid alterations in undernourished cerebral palsied children during high intakes of a soy oil-based enteral formula.

Five undernourished children with severe cerebral palsy (CP) were tube-fed sufficient volumes of IsocalTM to allow rapid weight gain. IsocalTM provided, on average, 88% of their daily energy intake for at least 25 days. The purpose of our study was to correct the undernutrition and to analyze the major erythrocyte phospholipids before and after feeding periods for possible feeding and disease-related differences. The fatty acid profiles of erythrocyte membranes from CP children were compared with those from 12 healthy children and with the fatty acid composition of the formula. There were no clinical or biochemical indications of essential fatty acid deficiency. The feeding of a soy oil-based formula increased the proportions of 18∶2n−6 in the phospholipids. The increases occurred predominantly in phosphatidylcholine followed by phosphatidylethanolamine. Despite such large dietary intakes of soy oil, no changes were observed in the phospholipid concentrations of 20∶4n−6, 18∶3n−3, 20∶5n−3, or in the C22n−6 and C22n−3 fatty acids. These findings are consistent with an inhibition of the Δ6 desaturase by high dietary linoleate.

Permanent enteral feeding in cystic fibrosis: Advantages of a replaceable jejunostomy tube

A feeding jejunostomy constructed by the Witzel technique has been used to supplement 12 wasted patients with cystic fibrosis during 260 patient months. None of the patients has stopped the nocturnal feeding once started on the program. The preferred tube was the Entriflex enteral feeding tube, which, when placed without internal fixation, could be easily changed as necessary. There have been no major complications. Minor complications include tube blockage, dislodgement, local infection, and leakage around the tube causing granuloma formation. We have not lost the use of any of the jejunostomies because of inability to replace the tube when it has been dislodged.

The effect of dietary polyunsaturated fat on cation transport and hypertension in the rat

1. Essential hypertension is associated with increased intracellular sodium in both erythrocytes and leucocytes. Reports in the literature indicate that increasing the level of polyunsaturated fat in the diet reduces hypertension. In the present study, spontaneously hypertensive rats (Wistar-Kyoto, which develop systolic blood pressures in excess of 140 mmHg by 8 weeks of age) were fed on high-fat diets (40% energy derived from fat), the fat being maize oil (high in polyunsaturated fatty acids, PUFA) and coconut oil (low in PUFA). 2. Significantly higher blood pressures developed by 110 d of age in the rats fed on a high-PUFA diet, compared with those fed on the low-PUFA diet. 3. In thymocytes, ouabain-sensitive efflux rate constants were significantly lower in the group fed on the high-PUFA diet. Ouabain-insensitive efflux rate constants were unaffected by diet.

Erythrocyte membrane phospholipid fatty acid changes in cerebral palsy patients during nutritional rehabilitation—A response

We are very interested in the suggestions of Dr. Cunnane (1). The whole issue of nutrient supply in relation to growth rate is very important and often misunderstood, so we welcome the opportunity to clarify this point. Although our patients were all very deficient in body mass before treatment, unlike children in the developing world, there was no clinical evidence of deficiency of minor components; in particular, hair, skin and mucous membranes were all healthy. Our treatment regime did not lead to extremely rapid weight gain (30 g/kg/d, or more) but was usually around 10 g/kg/d. At that rate, the enteral feed used, Isocal TM