Neurocognitive Functions in Infants with Malnutrition; Relation with Long-chain Polyunsaturated Fatty Acids, Micronutrients Levels and Magnetic Resonance Spectroscopy / 대한소아소화기영양학회지

PURPOSE: Malnutrition may influence neurocognitive development in children by directly affecting the brain structural development, or indirectly by affecting the children's cognition experience. Malnutrition alters the cell numbers, cell migration, synaptogenesis, and neurotransmission due to inadequate availability of necessary micronutrients to support cell growth. We aimed to analyze neurocognitive development in infants with malnutrition and its association with long chain polyunsaturated fatty acids (LC-PUFA), micronutrients levels and magnetic resonance spectroscopy (MRS) findings. METHODS: The study included two groups; group 1, infants with malnutrition (n=24), group 2; healthy infants (n=21). Peripheral blood was obtained from the participants for studying micronutrients and LC-PUFA levels. The neurocognitive development was analyzed by the use of an Ankara Developmental Screening Inventory test. MRS were performed on all infants. RESULTS: All parameters of neurocognitive development and serum calcium (9.6±0.9 mg/dL vs. 10.4±0.3 mg/dL, p < 0.05) and magnesium (2.02±0.27 mg/dL vs. 2.2±0.14 mg/dL, p < 0.05) levels were noted as being low in infants with marked malnutrition. No difference was found in LC-PUFA levels between healthy and malnourished infants. Thalamic choline/creatine levels were significantly high in infants with malnutrition (1.33±0.22 vs. 1.18±0.22, p < 0.05). Total neurocognitive development in infants was positively correlated with serum calcium levels (p < 0.05, r=0.381). CONCLUSION: Calcium supplementation may improve neurocognitive development in malnourished infants.

Frequency and predictors of obesity hypoventilation in hospitalized patients at a tertiary health care institution

Patients with obesity hypoventilation syndrome [OHS] have significant morbidity and mortality. Early diagnosis and treatment is important and there are limited data on its prevalence and predictive factors. The objective of this observational study was to determine the frequency and predictors of OHS in hospitalized patients at a tertiary health care institution. All blood gas analyses of hospitalized adult [age over 18 years] patients were prospectively recruited from the biochemistry laboratory at a tertiary health care center between August 2009 and July 2010. Patients who had hypercapnia [PaCO[2] >/= 45 mmHg] while breathing room air were included and clinical and laboratory data were obtained from hospital records. A standard questionnaire was also filled by face-to-face interview with patients and/or relatives. A total of 9480 patients' arterial blood gases were evaluated and 330 patients [3.4%] who met the selection criteria were included in the analysis during the study period. Hypoventilation was associated with acute diseases in 64.2% and chronic diseases in 35.8% of the patients. Of the chronic hypoventilation patients, 24.4% had OHS. Univariate logistic regression analysis showed that, female gender, body mass index [BMI], smoking, PaO[2], SaO[2] and a PaCO[2]/BMI <1.5 were significantly related to OHS. In multivariate logistic regression analysis, BMI >35 kg/m[2], SaO[2] <91.4% and PaCO[2]/BMI <1.5 were significantly related to OHS. A PaCO[2]/BMI <1.5 was an independent variable strongly predictive of OHS [odds ratio: 36.9, 95% of the confidence interval: 2.75-492.95, P = 0.007]. OHS is a common cause of chronic alveolar hypoventilation. A careful examination PaCO[2]/BMI ratio may prevent misdiagnoses among hypercapnic patients.