Cardiac dimensions and function in children with obesity.

BACKGROUND: Obesity can cause alterations in cardiac dimensions and function. Cardiac dysfunction during childhood may affect the quality of life in adulthood. This study evaluated left ventricular (LV) dimensions, systolic function and left ventricular myocardial performance index (LMPI) in children with obesity. METHODS AND RESULTS: Thirty-three obese children with mean age of 9.8 +/- 2.4 years, weight 61.3 +/- 20.8 kg, BMI 29.5 +/- 5.8 kg/m2 and percentage of actual weight to ideal body weight for height (%IBW) 170 +/- 25%, underwent echocardiography to assess LV dimensions, systolic and global functions. There were 2, 14 and 17 children with mild (<or= 140% IBW), moderate (141-160% IBW) and severe obesity (>160%IBW), respectively. The mean ratio of left ventricular end-diastolic dimension (LVEDD) to predicted LVEDD expressed in percentage (%LVEDD) was 98.3 +/- 7.8%, the left ventricular shortening fraction (LVFS) was 37.5 +/- 4.9% and the left ventricular ejection fraction (LVEF) was 67.5 +/- 5.9%. All were within normal range except that 2 children (6%) had mild LV dilatation. The mean LMPI was 0.35 +/- 0.08. However, 11 children (33%) had abnormal LMPI (>0.4). The severity of obese children did not correlate with the global LV dysfunction. CONCLUSION: The left ventricular dimensions and systolic function in children with obesity were essentially normal. LMPI which indicates LV global function was found to be abnormal in 33% of children with obesity and may be used to do early detection of LV global dysfunction.

Cardiac dimensions and function in children with obesity.

BACKGROUND: Obesity can cause alterations in cardiac dimensions and function, and cardiac dysfunction during childhood may affect the quality of life in adulthood. This study was done to evaluate left ventricular dimensions, systolic function, and the left ventricular myocardial performance index in children with obesity. MEHTODS AND RESULTS: Thirty-three obese children whose mean age was 9.8 +/- 2.4 years, weight was 61.3 +/- 20.8 kg, body mass index was 29.5 +/- 5.8 kg/m(2), and percentage of actual weight to ideal body weight for height (% IBW) was 170 +/- 25%, underwent echocardiography for the assessment of left ventricular dimensions, and systolic and global functions. There were 2, 14, and 17 children with mild (< 140% IBW), moderate (141-160% IBW), and severe obesity (> 160% IBW), respectively. The mean ratio of left ventricular end-diastolic dimension to predicted left ventricular end-diastolic dimension expressed in percentage was 98.3 +/- 7.8%, the left ventricular shortening fraction was 37.5 +/- 4.9%, and the left ventricular ejection fraction was 67.5 +/- 5.9%. All were within the normal range, with the exception of two children (6%) who had mild left ventricular dilatation. The mean left ventricular myocardial performance index was 0.35 +/- 0.08. However, 11 children (33%) had an abnormal index (< 0.4). The severity of obesity did not correlate with the global left ventricular dysfunction. CONCLUSION: The left ventricular dimensions and systolic function in children with obesity were essentially normal. The left ventricular myocardial performance index, which is an indicator for left ventricular global function, was found to be abnormal in 33% of the children, and may be used for the early detection of left ventricular global dysfunction.

Factors associated with dual form of malnutrition in school children in Nakhon Pathom and Bangkok.

OBJECTIVE: The present study examined the influence of family characteristics and maternal feeding practices on eating behaviors, food consumption and nutritional status of children living in 6 districts of Nakhon Pathom province and 3 surrounding districts of Bangkok. MATERIAL AND METHOD: One hundred and ninety nine families were enrolled in the present study. Four specific mother-child pair groups were purposively selected: 62 obese child/overweight mother pairs, 49 obese child/ normal weight mother pairs, 37 wasted child/overweight mother pairs, and 51 normal weight child/normal weight mother pairs. Anthropometric measurements were performed on all subjects. Biological data, socioeconomic status, maternal feeding practices, as well as eating and lifestyle behaviors of the children were obtained from mothers and children using structured questionnaires and interviews. RESULT: Most mothers from all groups, 40.8%-62.2%, had a primary education, were non-manual workers, with families containing 4-6 persons per household, and a family income of < or = 20,000 baht per month. Multivariate logistic regression analysis showed that maternal overweight prior to pregnancy (OR11.85, 95%CI 2.16-64.99) child's high birth weight (OR 4.53, 95%CI 1.09-18.73) as well as maternal control over the consumption of high caloric food (OR13.07, 95%CI 4.08-41.86) and large amounts of food consumed by the children (OR12.58, 95%CI 4.30-36.80) were significant factors associated with childhood obesity. Compared to normal weight children, a higher proportion of obese children were not breast-fed and a higher proportion of normal weight mothers controlled the consumption of high caloric food in their obese children. Overweight mothers with wasted children also controlled their children's food intake. Higher proportion of wasted children had a higher snack consumption frequency but lower energy food intake than the normal weight children. CONCLUSION: Understanding the underlying causes of dual form of malnutrition in the households would have implication for policy makers to address and implement a nutrition action plan. It is suggested that a malnutrition, (under and over-nutrition) prevention program must involve strategies within families that focus on providing nutrition education and the powerful guidance to help parents foster appropriate patterns of food choice and eating in their children. Promotion of increased physical activity in children is also essential. These strategies are aimed to promote the optimal child's weight and health.

Modified percutaneous endoscopic gastrostomy tubes: experience in Thai children.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a well-established alternative to open gastrostomy for providing long-term enteral nutrition. Although the commercial PEG tube is available and suitable for the procedure, its cost is relatively high for low socioeconomic people. Therefore, modified PEG tubes have been used in our hospital. OBJECTIVES: To evaluate the outcome and complications of PEG performed in children at Ramathibodi Hospital and compare the results between the commercial PEG and modified PEG tubes. METHOD: All children who had PEG performed at Ramathibodi Hospital, from January 1999 to May 2002, were included in the study. The demographic data, indications for PEG, types of PEG tube, outcomes and complications were retrospectively reviewed. The modified PEG tube was made by connecting a Malecot four-wing catheter to the previously used, re-sterilized distal part of a commercial PEG tube. RESULTS: PEG was performed on 34 children, aged 4 months to 13 years, and successfully placed in 30 children (88.2%). The commercial and modified PEG tubes were used in 20 cases and 10 cases, respectively. Early complications occurring in the first 7 days post-procedure were found in 9 cases (30%) as follow: peritonitis (1 case), peristomal wound infection (7 cases), and subcutaneous emphysema (1 case). Late complications occurring at more than 7 days post-procedure were found in 15 cases (50%) and all were minor problems. There was no difference in complication rates between the 2 types of PEG tubes. CONCLUSION: PEG is safe even in small infants. Minor complications are common but can be simply managed. The modified PEG tube is an alternative for a commercial PEG tube in an unaffordable situation.

Nutritional support in pediatric patients undergoing bone marrow transplantation.

BACKGROUND: Children undergoing bone marrow transplantation (BMT) are prone to develop severe gastrointestinal (GI) complications and metabolic imbalance which consequently impair their nutritional status. Nutritional support is an important adjunctive treatment during BMT. OBJECTIVE: To assess GI complications, metabolic complications and nutritional outcome of children undergoing BMT with nutritional support intervention. METHOD: Retrospective study of 20 children (median age 6.8 years, 11 males) undergoing BMT at Ramathibodi Hospital from March 1995 to July 2000 was conducted. Their medical records were reviewed. RESULTS: The patients underwent autologous (n = 9) and allogenic BMT (n = 11). Median z-scores of weight for age, height for age and weight for height were 0.06 +/- 1.93, -0.55 +/- 1.18 and 0.48 +/- 1.94, respectively. Nineteen patients had vomiting for 9.8 +/- 5.5 days. Eighteen patients developed diarrhea for 9.6 +/- 7.2 days. The durations of vomiting and diarrhea, as a percentage of total hospital days, were 33.5 +/- 16.3 per cent and 30.4 +/- 17.0 per cent, respectively. There were no differences between the patients with autologous and allogenic BMT regarding these durations. All patients needed enteral and/or parenteral nutrition support for 21.0 +/- 7.7 days except for one patient who could take adequate oral intake. The duration of enteral nutrition support was not significantly different between the groups but the duration of parenteral nutrition support was significantly longer in the allogenic group. Metabolic complications were hypokalemia, hypophosphatemia and one case of arrhythmia secondary to hypomagnesemia. All patients developed febrile neutropenia but none developed catheter-related sepsis. The length of hospital stay was 30.5 +/- 10.2 days. The median z-score of weight for height on the day of discharge was 1.08 +/- 2.03. CONCLUSION: Children undergoing BMT usually have GI symptoms of vomiting, diarrhea and mucositis as well as metabolic imbalances such as hypokalemia, hypophosphatemia and hypomagnesemia. Despite these complications, their nutritional status could be restored by proper nutritional support.

Effect of oral vitamin E supplementation in children with cholestasis.

OBJECTIVE: Malabsorption and deficiency of vitamin E are common consequences of chronic cholestasis. The objective of this study was to determine vitamin E status by using plasma vitamin E/total lipid ratio (E/L) in children with cholestasis during supplementation with 20 IU/kg/day and 100 IU/kg/day of oral vitamin E capsule, and 50 IU/kg/day of cold water soluble form (CWSIF) of vitamin E. METHOD: Children with cholestasis who were being supplemented with 20 IU/kg/day of oral vitamin E capsule (dl-alpha-tocopherol) were enrolled into this study. After initial evaluation for vitamin E status and liver function, doses of oral vitamin E supplementation were increased to 100 IU/kg/day for 1 month. Then, supplementation was switched to 50 IU/kg/day of CWS/F vitamin E for 1 month. Vitamin E status was assessed by using plasma E/L after each period of supplementation. RESULTS: Eleven children with biliary atresia, aged between 2 and 18 months, were studied. Their median weight standard deviation score (SDS) was -1.35 and median height SDS was -1.26. The medians of serum direct bilirubin and total bilirubin were 6.5 and 12.9 mg/dl, respectively. Only 2 and 3 out of 9 children had plasma E/L above normal cut-off levels during supplementation with 20 and 100 IU/kg/day of vitamin E capsule, respectively. Additionally, 4 of 9 children had plasma E/L above normal cut-off level after one month's supplementation with 50 IU/kg/day of CWS/F vitamin E. All the responders had serum bilirubin levels less than 4 mg/dl while the remainder with serum direct bilirubin level more than 4 mg/dl had their plasma E/L below normal cut-off levels in spite of any vitamin E supplementation. CONCLUSION: Oral vitamin E supplementation with 20 IU/kg/day and 100 IU/kg/day of vitamin E capsule and with 50 IU/kg/day of CWS/F vitamin E were able to normalize vitamin E status in a few cholestatic children who had serum direct bilirubin levels less them 4 mg/dl. In cases of serum direct bilirubin more than 4 mg/dl, neither of vitamin E supplementations was able to correct the vitamin E deficiency status.

Earlier onset of pubertal maturation in Thai girls.

BACKGROUND: Recent studies in the USA and Hong Kong demonstrated the onset of puberty in girls has shifted toward a younger age. Based upon previous studies on variations of pubertal maturation in Thai girls, the secular trend has also moved toward an earlier age. The latest study in 1995 revealed the mean age of menarche was 12.3 years. OBJECTIVES: To identify the onset of puberty, menarche and pubarche in female children and adolescents in 2 Bangkok schools. METHOD: Three hundred school girls aged 9-19 years were enrolled in the study. Data were collected from January 1997 through December 1999. Assessment of pubertal staging by Tanner's criteria was performed by a trained pediatrician. All were in good physical health and had normal height and weight. The median ages of thelarche, menarche and pubarche were estimated by probit analysis. All other parameters were expressed as mean +/- SD. RESULTS: The median ages of thelarche and pubarche were 9.4 and 11.1 years, respectively. Two hundred and twenty one girls had experienced menstruation. The median age of menarche was 11.2 years, whereas, the mean age was 12.1 years. Most girls reached near final adult height after 14 years old. CONCLUSION: The secular trend in decline of the ages of thelarche (or puberty) and menarche was observed in Bangkok girls. Further study in a larger population including a younger age group is required to define the current reference interval of onset of puberty.

Effect of bifidobacterium Bb12 with or without Streptococcus thermophilus supplemented formula on nutritional status.

Acute diarrhea is a common cause of infant morbidity and mortality. Probiotic supplemented infant formula is one of the effective methods for prevention of rotavirus diarrhea. Other benefits of the probiotics supplemented formula were evaluated by monitoring the growth of the children. A double-blind, placebo-controlled trial was done in 148 children aged 6-36 months. They were divided into 3 groups: the Bb12 group, 51 children received infant formula with Bifidobacteria Bb12 supplement; the Bb12+ST group, 54 children received infant formula with Bb12 and Streptococcus thermophilus supplement; and the control group, 43 children received infant formula without supplement. The mean weight Z-score according to WHO reference standard of the Bbl2 group was -1.8 +/- 0.12, the Bb12+ST group was -1.4 +/- 0.11 and the control group was -1.8 +/- 0.13 at entry. The mean weight Z-score of children after 6 month showed that the children in the Bbl2+ST group had the highest increase in weight which was increased from -1.4 +/- 0.11 to -0.9 +/- 0.12 compared to the Z-score of the Bb12 group which had increased from -1.8 +/- 0.12 to -1.2 +/- 0.13 and in the control group from -1.8 +/- 0.13 to -1.7 +/- 0.25. In terms of the mean height Z-score, the Bb12 group was -2.7 +/- 0.14 to -1.7 +/- 0.16 which was higher than the Bb12+ST group (- 2.2 +/- 0.13 to -1.7 +/- 0.13) but was not different from the control group. However, the mean weight/height Z-score of the Bbl2+ST group had approached the reference standard (Bb12 group -0.1 +/- 0.11 to -0.1 +/- 0.13, Bb12+ST group -0.1 +/- 0.10 to 0.3 +/- 0.17, control group -0.4 +/- 0.12 to -0.1 +/- 0.16). Data showed that children who received the probiotics supplement formula had better growth during the 6 month period.

Vitamin A status in premature infants.

BACKGROUND: Premature infants are at risk of vitamin A deficiency due to inadequate transplacental transport, inadequate storage and increased tissue utilization. Previous studies reported a significant decrease in serum vitamin A levels in premature infants at birth compared to those of full term infants. OBJECTIVE: To determine serial changes of plasma vitamin A status during the first month of life in 19 healthy, very low birth weight premature infants. METHOD: Subjects were fed with premature infant formula and received multivitamin supplementation. Plasma vitamin A concentrations were measured at 7, 14, and 30 days of age. RESULTS: Plasma vitamin A levels at 7,14 and 30 days of age were 24.63 +/- 6.08, 30.97 +/- 5.26 and 30.68 +/- 7.14 microg/dl, respectively. Plasma vitamin A levels at age 7 days were significantly lower than those at 14 and 30 days of life (p < 0.001). Three infants out of 19 (16%) had low plasma vitamin A (<20 microg/dl) at 7 days. At 14 and 30 days of age, all infants had normal plasma vitamin A levels. CONCLUSION: The results suggested that healthy premature infants were prone to subclinical vitamin A deficiency during the first week of life which could be treated by adequate enteral feeding and routine multivitamin supplementation. A high dose of vitamin A supplementation was not necessary in healthy premature infants.