O. Trocki

The sleep patterns of infants and young children with gastro‐oesophageal reflux

Sleep disturbance in gastro‐oesophageal reflux disease (GORD) in infants and young children has not been systematically studied nor has this manifestation been compared with population norms.

Value of Total Body Potassium in Assessing the Nutritional Status of Children with End‐Stage Liver Disease

Abstract: Malnutrition is a common problem in children with end‐stage liver disease (ESLD), and accurate assessment of nutritional status is essential in managing these children. In a retrospective study, we compared nutritional assessment by anthropometry with that by body composition. We analyzed all consecutive measurements of total body potassium (TBK, n= 186) of children less than 3 years old with ESLD awaiting transplantation found in our database. The TBK values obtained by whole body counting of 40K were compared with reference TBK values of healthy children. The prevalence of malnutrition, as assessed by weight (weight Z score <−2) was 28%, which was significantly lower (chi‐square test, p < 0.0001) than the prevalence of malnutrition (76%) assessed by TBK (<90% of expected TBK for age). These results demonstrated that body weight underestimated the nutritional deficit and stressed the importance of measuring body composition as part of assessing nutritional status of children with ESLD.

Comparison of measured sleeping metabolic rate and predicted basal metabolic rate during the first year of life: evidence of a bias changing with increasing metabolic rate.

Objective: To compare measurements of sleeping metabolic rate (SMR) in infancy with predicted basal metabolic rate (BMR) estimated by the equations of Schofield.Methods: Some 104 serial measurements of SMR by indirect calorimetry were performed in 43 healthy infants at 1.5, 3, 6, 9 and 12 months of age. Predicted BMR was calculated using the weight only (BMR-wo) and weight and height (BMR-wh) equations of Schofield for 0–3-y-olds. Measured SMR values were compared with both predictive values by means of the Bland–Altman statistical test.Results: The mean measured SMR was 1.48 MJ/day. The mean predicted BMR values were 1.66 and 1.47 MJ/day for the weight only and weight and height equations, respectively. The Bland–Altman analysis showed that BMR-wo equation on average overestimated SMR by 0.18 MJ/day (11%) and the BMR-wh equation underestimated SMR by 0.01 MJ/day (1%). However the 95% limits of agreement were wide: −0.64 to +0.28 MJ/day (28%) for the former equation and −0.39 to +0.41 MJ/day (27%) for the latter equation. Moreover there was a significant correlation between the mean of the measured and predicted metabolic rate and the difference between them.Conclusions: The wide variation seen in the difference between measured and predicted metabolic rate and the bias probably with age indicates there is a need to measure actual metabolic rate for individual clinical care in this age group.

Use of Indirect Calorimetry in Nutritional Rehabilitation of Adolescents With Anorexia Nervosa

Abstract LEARNING OUTCOME: To describe how indirect calorimetry can be used to assess the energy needs and monitor the progress of nutritional rehabilitation in adolescents with anorexia nervosa. Predictive equations are not useful in assessing energy needs of malnourished patients with anorexia nervosa. They are often admitted with significant weight loss and reduced resting energy expenditure (REE) in response to semistarvation. During the first few weeks of refeeding and rapid weight gain, REE is significantly increased and remains higher than predicted values until the patients are weight recovered. In order to prescribe energy intake required for weight gain accurately, it is necessary to actually measure REE levels during nutritional rehabilitation. In our institution, all admitted adolescents with anorexia nervosa have their REE assessed by indirect calorimetry within the first three days of admission and every two weeks thereafter until they are completely nutritionally rehabilitated. Preliminary results showed that at admission, mean REE value (n=10, 11–15 years old) was 79±11% (range 61–97%) of predicted values using Schofields formulas. After refeeding REE rose to peak ranging from 120 to 156% of predicted values. The rate of increase in REE varied among patients and could only be explained partially by weight gain. It took about 6–8 weeks before the REE values returned to normal. Patients were generally completely rehabilitated (as measured by acceptable weight and body cell mass) when their REE values were within 100±10% of the predicted values. Both lower and higher than predicted normal REE values can thus be used as an indicator for incomplete nutritional rehabilitation. This results confirmed that at different stages of nutritional rehabilitation, patients had different energy needs for weight gain and weight maintenance, and energy requirements should be based on individual REE measurements.

Measuring Fat Free Mass and Body Cell Mass in Adolescent Girls with Anorexia Nervosa by Bioelectric Impedance Analysis and Total Body Potassium

Abstract An accurate assessment of BCM, the active metabolic component of the body, would provide the dietitian with very useful information for nutritional management of patients. Though BIA, a simple and noninvasive method for estimating body composition, has been shown to be highly correlated with FFM, limited data are available to assess how well BIA estimates BCM in population groups with altered body composition such as patients with anorexia nervosa (AN). The purpose of this study was to determine the level of agreement for FFM and BCM obtained by two body composition measurement techniques, BIA and whole body potassium ( 40 K) counting in patients with AN. Total body potassium (TBK) content was used as the reference method for estimating BCM. In 29 adolescent girls being treated for AN (age 15.4±1.8 y, BMI 16.5±1.8kg/m 2 ), we measured whole body resistance and reactance using BIA at 50kHz and whole body potassium counter on the same day and within the same hour. Mean TBK, and FFM calculated from TBK were 79±12g and 29.7±4.4kg.Estimates of FFM and BCM from BIA were obtained by applying several currently available prediction equations. Estimates of FFM using equations by Davies and Gregory (1991) and Wabitsch et al (1996) were significantly (p

A Comparison of Three Methods For Determining Total Energy Expenditure In Clinical Practice

Abstract Defining energy requirements accurately is a key issue in planning medical nutrition therapy. In patients whose energy imbalances can have serious detrimental consequences, both total energy expenditure (TEE) and energy intake should be measured. Though several methods for measuring TEE are available, they have not been adequately evaluated in clinical settings. The purpose of this study was to evaluate three methods for determining TEE, namely, the doubly labelled water method (DLW), the heart rate monitoring method (HRM) and the factorial method (physical activity record, PAR) in clinical practice. The subjects were free living female adolescents (n=13, age 13.8±1.3 y, BMI 20±4kg/m 2 ) with chronic disease (anorexia nervosa or diabetes mellitus). At the group level, there were no differences among TEE obtained by the three methods (DLW 2488±1214 kcal/day, HRM 2452±780 kcal/day, PAR 2084±484kcal/day) and the predicted requirements (BMR×1.6,2221±206±kcal/day). The PAR underestimated TEE by about 400kcal/day. The mean intake (by food record) was 1889±435kcal/day. At the individual level, the limits of agreement (mean difference ± 2SD) among the methods were poor. Each method has its own advantages and disadvantages in clinical practice. In this population, the HRM method which is simple, noninvasive and inexpensive seems to be the best method for measuring energy expenditure.

Evolving Change in Practice of a Multidisiplinary Eating Disorders Clinic for Children and Adolescents Resulting in Shorter Hospital Length of Stay

Abstract Data has been collected over a six month period for inpatient bed stays and outpatient visits to the Eating Disorders Clinic. These were then compared with a six month period prior to the establishment of the Eating Disorder Clinic. Thirty five patients (21 new) aged 11-16 years, were treated in the six month period following establishment of the clinic, compared with twenty-one patients (7 new) aged 11-16 years over a period prior to establishment. Average length of stay in hospital has been decreased from seven weeks to four weeks. Home Enteral Nutrition is offered as an option for selected patients further reducing hospital inpatient stays. A revised nutrition protocol and Evaluation for Eating Disorders patients have been developed to assist health professionals with assessment. Telemedicine is being used to enhance education of health professionals working in this area.