Longitudinal study of nutrient and food intakes of white preschool children aged 24 to 60 months.

OBJECTIVE: To determine nutrient and food intakes of 72 white preschool children primarily from families of middle and upper socioeconomic status and to compare children's nutrient intakes with current recommendations. DESIGN: Six in-home interviews were conducted with mothers when children were 24 to 60 months old; at each time mothers provided 3 days of dietary information on the child. Children and mothers independently provided information on the child's favorite and least favorite foods at 42 and 54 months. SUBJECTS: Preschool children (24 to 60 months old) participating in a longitudinal study. STATISTICAL ANALYSES: Mean nutrient intakes were compared with the most recent Recommended Dietary Allowances/Adequate Intakes. Differences over time were tested with repeated-measures analysis of variance; gender differences were determined with t tests. Food frequencies (i.e., percentage of children consuming specific foods) were determined from dietary recalls and food records. Dietary variety was assessed with the Variety Index for Toddlers or the Variety Index for Children. RESULTS: Means were consistently less than the RDA/AI for energy, zinc, folate, and vitamins D and E. Energy, carbohydrate, and fat intakes were highest (P < or = .01) at 60 months. Boys consumed more (P < or = .05) protein (10 g), calcium (197 mg), magnesium (35 mg), and pantothenic acid (0.8 mg) at 60 months than did girls. Foods most commonly eaten were fruit drink, carbonated beverages, 2% milk, and french fries. The vegetable group consistently had the lowest variety scores; vegetables also dominated least favorite foods lists. APPLICATIONS: Parents need to be encouraged to include more sources of zinc, folate, vitamin E, and vitamin D in children's diets. Parents should also encourage their children to eat more vegetables, zinc- and folate-fortified cereals, lean red meats, seafood, vegetable oils, and low-fat milk.

Infant sleep position: A telephone survey of inner-city parents of color.

OBJECTIVE: To assess what positions parents were placing their infants to sleep and their opinion about sleep positioning. DESIGN: A prospective telephone survey of parents of 2-month-old infants with repeated measures at 4 months that began during the second wave of the Back to Sleep campaign in 1994. PARTICIPANTS: African-American, Hispanic, Asian, and American Indian parents from inner cities in the north central United States. RESULTS: Preference for prone positioning existed at both 2 and 4 months (over 40%). Twenty-four percent of parents disagreed with the recommendations of the American Academy of Pediatrics regarding supine or lateral positioning. CONCLUSIONS: Although prone sleep positioning has decreased over the past 5 years, many inner-city parents of color prefer this over supine. The Back to Sleep campaign appears effective in changing attitudes and medical personnel appear influential in promoting risk reductions associated with sudden infant death syndrome. More efforts are clearly needed to convince parents who disagree with and resist recommendations.sleep, infants, SIDS, African-Americans, Back to Sleep (campaign).

Fruit juice intake is not related to children's growth.

BACKGROUND: Excessive fruit juice intake (>12 ounces/day) has been reported to be associated with short stature and obesity in preschool children. OBJECTIVE: To confirm whether excess fruit juice intake was associated with short stature and obesity in preschool children, we assessed growth parameters and fruit juice intake in 105 white children, ages 24 to 36 months. METHODOLOGY: Mothers were interviewed twice by a registered dietitian when children were age 24, 28, or 32 months (interview 1) and when children were age 28, 32, or 36 months (interview 2); interviews were assigned randomly. At each interview mothers provided 3 days of dietary data (one 24-hour recall and a 2-day food record) and the registered dietitian weighed the child and measured his/her height. Dietary data were analyzed using Nutritionist IV software. Each child's body mass index (wt/ht2) and ponderal index (wt/ht3) were calculated for each interview. Growth parameters of children consuming <12 ounces/day 100% fruit juice were compared with those consuming >/=12 ounces/day using the Student's t test, chi2, Fisher's exact test, and mixed model repeated measures analyses (PROC MIXED). RESULTS: Results consistently indicated no statistically significant differences in children's height, body mass index, or ponderal index related to fruit juice intake. Intakes of soda pop were negatively related to intakes of milk and fruit juice although intakes of milk and fruit juice were not related. CONCLUSIONS: The consistent lack of relationship between children's fruit juice intake and growth parameters in our study does not support previous recommendations to limit the intake of 100% fruit juice to <12 ounces/day.

A low-viscosity soluble-fiber fruit juice supplement fails to lower cholesterol in hypercholesterolemic men and women.

This study was designed to determine whether a soluble dietary fiber supplement containing gum arabic and pectin in apple juice would lower serum lipids in 110 hypercholesterolemic men and women. Subjects were stabilized on an American Heart Association Phase I Diet for 8 wk. Those with elevated low density lipoprotein cholesterol levels, despite dietary modification, continued to follow the diet and were randomly assigned to receive 720 mL/d of apple juice containing 0 (control), 5, 9 or 15 g of gum arabic and pectin (4:1 ratio) for 12 wk, followed by a 6-wk apple juice-only washout phase. Serum lipid profiles, body weight and 3-day diet records were collected at 3-wk intervals. No significant differences among groups were observed in serum lipid responses during treatment or washout. During the treatment phase, mean serum total cholesterol and triglyceride concentrations increased by 3.5 and 28.5%, respectively (all groups combined, P < 0.0001). The high density lipoprotein cholesterol level did not change significantly from baseline in any group. During washout, mean total cholesterol concentration rose by an additional 2.4% (P < 0.05) compared with the value at the end of the treatment period, suggesting that the apple juice used to deliver the fiber supplement may have contributed to the adverse changes observed in the serum lipid profile. These findings do not support the hypothesized hypocholesterolemic effect of the gum arabic/pectin (4:1) mixture studied, but do underline the importance of selecting appropriate vehicles for delivery of dietary fiber mixtures.

Radiological manifestations of Legionella/Legionella-like organisms.

The chest radiograph of Legionellosis has been described in many reports. Although some attempted to describe patterns which are specific for Legionella, in fact, the roentgenographic findings in Legionella infection vary widely and depend largely on when in the course of illness the radiograph is obtained. Certain temporal characteristics, however, can serve to enhance the likelihood of the diagnosis of Legionella pneumonitis. Initial focal infiltrates are most commonly poorly marginated with 10% presenting with concomitant pleural effusion. The infiltrates often spread to contiguous lobes eventually becoming bilateral, with incidence of pleural effusions reaching 35%. This progression often occurs despite appropriate antimicrobial therapy and often in the face of clinical improvement. A similar pattern of progression also occurs in immunocompromised individuals; in addition, a high rate of cavitation and hilar adenopathy is seen in this subset of patients. A prolonged resolution phase of up to 6 months is common with rare development of residual densities. Correlating radiographic features with disease severity and mortality have largely been unsuccessful.

The phenomenon of "picky eater": a behavioral marker in eating patterns of toddlers.

OBJECTIVE: To determine if toddlers who were considered "picky eaters" had lower dietary scores than non-picky eaters, and if family environment and socioeconomic status were significantly related to picky eater status and dietary scores. METHODS: An incomplete block design provided two interviews at randomly assigned times (24, 28, 32, or 36 months) of Caucasian mothers from upper socioeconomic (n=74) and lower socioeconomic status (n=44). Using trained interviewers, 6 days of food intake, two administrations of a questionnaire about toddler's eating behavior, and one administration of the Family Environment Scales were collected in the home. MANOVA, discriminant function analysis, and logistic regression procedures were used to determine significant differences between picky and non-picky eater groups. RESULTS: Picky eaters had lower dietary variety (p=.03) and diversity scores (p=.009) than non-picky eaters. Mothers of picky eaters compared to those of non-picky eaters used persuasion (p=.0001) and ranked their child's eating behaviors as more problematic (p=.0001). CONCLUSION: Toddlers perceived by their mothers as picky eaters had significantly lower dietary variety and diversity scores. Parents need information and strategies to increase the number of foods acceptable to their toddlers and to develop a sound feeding plan.

Transitions in infant feeding during the first year of life.

OBJECTIVE: To document ages at which transitions in infant feeding occur, to compare these transitions to literature reports from the 1970s and 80s, and to identify maternal characteristics related to the age of the infant when solid food was first introduced. METHODS: Ninety-eight mother/infant pairs (middle and upper socioeconomic status) participated in the longitudinal study. Using a randomized, incomplete block design, in-home interviews were conducted by trained personnel when infants were 2, 3, 4, 6, 8, 10, and 12 months of age; each mother/infant pair was seen four or five times. Information on food intake, including breast milk/formula, was collected at each interview. Means +/- SD and frequencies were calculated, and least squares analysis of variance was used to develop a predictive model related to the introduction of cereal. RESULTS: Most mothers decided on the initial feeding mode (breastfeeding or formula) prior to pregnancy; 83% breastfed initially although most (76%) totally discontinued breastfeeding by 6 months. Infants' ages varied greatly when each of the seven categories of food was introduced, cereal was added to the infants' diets at a mean age of 3.8 +/- 1.4 (SD) months, juice 4.7 +/- 2.2, fruit 4.9 +/- 1.6, vegetables 5.2 +/- 1.3, mixed foods 7.8 +/- 2.1, table foods 8.2 +/- 2.1, and meat 8.2 +/- 2.1. The multivariate model explained 59% of the variability in ages of infants when cereal (generally the first solid food) was added. Significant variables (p < or = 0.05) were feeding mode, recommendation by the physician, and the interaction between feeding mode and education of the mother. Mother's employment and sibling rank of the infant contributed to the model (p = 0.06 and p = 0.09, respectively). Infants' age when cereal was added was not related to the variables of gender or birth weight. CONCLUSIONS: The finding that the mothers' decision whether or not to breastfeed was made prior to conception supports the importance of population-based education aimed at women in the child-bearing years as well as patient instruction early in the pregnancy. However, the duration of breastfeeding was shorter than was reported in the 1980s. Infants varied greatly in ages when the seven categories of complementary foods were added to their diets. Although recommendations for delaying introduction of solid foods until the infant is 4 to 6 months of age have been in place for more than a decade, about half the mothers in this study did so earlier. Characteristics of mothers who introduced cereal earliest (i.e., mean age of infants < 4 months) were more likely to be formula feeding when cereal was added, to feed cereal via the bottle, to be primiparous, to be employed outside the home, and/or not to cite the physician as a source for guiding the infant's transition to supplemental food.

Longitudinal study of nutrient and food intakes of infants aged 2 to 24 months.

OBJECTIVE: To determine the nutrient and food intakes of healthy, white infants from families of middle and upper socioeconomic status and to compare intakes to current recommendations. DESIGN: Using an incomplete random block design, we interviewed 98 mother-infant pairs longitudinally when infants were 2, 3, 4, 6, 8, 10, 12, 16, 20, and 24 months old. Data obtained included 24-hour dietary recalls, usual food intake, and food likes and dislikes. SETTING: Interviews were conducted in the mother's home by registered dietitians. Subjects resided in two urban areas of Tennessee. SUBJECTS: Of the original 98 subjects, 94 completed the 2-year study. RESULTS: Mean energy and nutrient intakes generally met or exceeded the Recommended Dietary Allowance (RDA). Exceptions were zinc and vitamin D, which were each below 100% of the RDA at 9 of the 10 data points, and vitamin E, which was below the RDA in the infants' second year. Fat intake decreased from more than 40% of energy in the first 6 months to 30% to 32% from 10 to 24 months. One third of the infants drank reduced-fat milks at 12 months and more than half drank them at 24 months. Although infants ate a variety of foods, vegetables often were the least favorite foods. A variety of dairy products provided calcium for the infant but lacked vitamin D. CONCLUSIONS: Several nutritional issues about infant feeding before 2 years of age arose. Low intakes of zinc, vitamin D, and vitamin E were observed. In the second year, low fat intake, use of reduced-fat milks, and dislike of vegetables were areas of concern.

Dietary guidelines for infants: a timely reminder.

The 1995 edition of Dietary Guidelines for Americans has recently been released. In anticipation of the heightened attention that these revised will undoubtedly receive, there is renewed discussion about the need for Dietary Guidelines for Infants. These guidelines would reinforce to parents and nutrition professionals that many diet strategies designed to promote adult health and nutrition are inappropriate for infants and children under the age of two. These guidelines, developed in 1994 by the Gerber Products Company, seek to distinguish the unique dietary needs of this vulnerable population.

Effect of testosterone replacement therapy on the somatotrope responsiveness to GHRH alone or combined with pyridostigmine and on sympathoadrenal activity in patients with hypogonadism.

There is evidence suggesting that androgens influence GH secretion in man. Our aim was to verify whether the GH releasable pool is preserved and influenced by testosterone replacement in male hypogonadism. To this goal, in eight male hypogonadal patients (HP, age 32.2 +/- 5.0 yr; Body Mass Index 23.9 +/- 1.1 kg/m2) before and after 3 months testosterone therapy, we studied the GH response to GHRH (1 microgram/kg iv) alone and combined with pyridostigmine (PD, 120 mg po), a cholinesterase inhibitor which likely inhibits hypothalamic somatostatin release allowing exploration of the maximal somatotrope secretory pool. Sixteen normal subjects (NS, age 30.1 +/- 3.5 yr; Body Mass Index 22.5 +/- 1.8 kg/m2) were studied as controls. The GH response to GHRH in HP was similar to that in NS (AUC, mean +/- SE: 1238 +/- 362 vs 1018 +/- 182 micrograms/L/h). PD potentiated to the same extent the GH response to GHRH in both groups (2092 +/- 807 and 2840 +/- 356 micrograms/L/h). After three month testosterone therapy, in HP the GH responses to GHRH alone (1352 +/- 612 micrograms/L/h) and combined with PD (1948 +/- 616 microgram/L/h) were unchanged. Also IGF-I levels in HP were similar to those in NS (222 +/- 42 vs 210.6 +/- 55.8 micrograms/L) and were unchanged during testosterone replacement (280 +/- 31 micrograms/L). As androgens have been reported to modulate sympathoadrenal activity in the rat, both before and during testosterone replacement, we also measured plasma catecholamine levels. Basal NE (p < 0.05) but not E levels were lower in HP than in NS; testosterone restored basal NE levels to normal without affecting basal E. delta absolute increase of NE and E (p < 0.05 and 0.01 vs baseline, respectively) after PD in HP were similar to those in NS and were unchanged during testosterone replacement. In conclusion, these results demonstrate that the GH releasable pool is preserved in male hypogonadism. As in this condition a reduction of spontaneous GH secretion has been reported, it could be due to neurosecretory dysfunction but not to pituitary impairment. Subtle alterations of sympathoadrenal activity seem to be present in male hypogonadism and reversed by testosterone replacement.

Delayed onset adult respiratory distress syndrome in babesiosis.

Reported herein is a second case of a patient who developed adult respiratory distress syndrome secondary to babesiosis. The features of acute lung injury after babesiosis will be described.

[Hyperprolactinemia in hypothyroidism: effects of L-thyroxine therapy]. / Iperprolattinemia nell'ipotiroidismo: effetti della terapia con L-tiroxina.

It is well known that the pituitary PRL secretion is modified in patients with primary hypothyroidism. The serum PRL is elevated in approximately one third of patients, the others presenting with enhanced PRL release after TRH intravenous (i.v.) administration. The objective of this study was to verify how treatment with L-thyroxine modifies the enhanced PRL response to TRH administration in a group of patients with primary hypothyroidism. Eight female patients aged 28 to 64 (mean age +/- SD = 17.2 +/- 6.0) with primary hypothyroidism were studied. Diagnosis was based on clinical features and plasma FT4 (mean +/- SD = 5.2 +/- 0.9 pmol/l; n.r. 7.7-19.3 pmol/l) and TSH (mean +/- SD = 87.3 +/- 20 mUI/l; n.r. 0.2-5 mUI/l) levels. As controls eleven normal age-matched female subjects were also studied. After an overnight fasting an indwelling catheter was inserted into an antecubital vein of the forearm and kept patient by slow infusion of normal saline solution. After 60' the basal blood sample was collected and 200 mcg of TRH was injected intravenously (0'), further blood samples were taken at 30', 60', 90', 120' and 180'. PRL determinations (n.r. 3-19 ng/ml) of the blood samples obtained were made using fluoroimmunometric assay. Hypothyroid patients underwent a second TRH test after L-thyroxine replacement therapy (100 mcg/day) had led to euthyroidism for at least three months.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of thyroid hormone status on the growth hormone responses to clonidine.

It has been shown that thyroid hormones are positive regulators of GH synthesis and secretion. The serum GH response to stimuli seems to be influenced either by sex or by spontaneous hypothalamic rhythm. The growth hormone responses to clonidine administration (4 micrograms/kg) have been therefore studied in a group of female patients with thyroid disease (seven hyperthyroid and five hypothyroid) before and after the achievement of the euthyroid state. In hyperthyroid patients both basal and clonidine-stimulated GH levels were similar to normal subjects; the achievement of euthyroidism did not modify the GH response to clonidine. Serum GH peaks after clonidine were lower in hypothyroids patients than in hyperthyroids and normal subjects; the GH response to alpha 2-agonist administration did not change during thyroid replacement therapy. The GH response to clonidine was not influenced by the GH secretory status in the preceding hour.

[The T1 time dependence of water measured in normal and neoplastic lung tissues]. / Dipendenza temporale del T1 dell'acqua misurato su tessuti polmonari normali e neoplastici.

The authors determined the time dependence of the average T1 relaxation time for the constitutive water of normal and neoplastic lung tissues. In healthy tissues, the T1 dependence appears strictly as a single decaying exponential function down to a threshold value which is invariant over time. The time change of T1 in neoplastic tissues is represented by monoexponential functions, in the short and long run, with a sudden drop 2 weeks after beginning measurements. Moreover, the time dependence is independent of the examined variant of epidermoid carcinoma. We report the kinetic constants of the in vitro aging of the tissues. The presence of a cooperative process, involving neoplastic lung water, to explain the features of aging changes, is also suggested.

Isolated adrenocorticotropic hormone deficiency secondary to hypothalamic deficit of corticotropin releasing hormone.

A 42-year-old man and a 51-year-old woman with a positive history of weakness and gastrointestinal complaints were shown to have low basal plasma cortisol and ACTH levels, and low daily urinary excretion of free cortisol. An empty sella was found in patient no. 1, while patient no. 2 was hypothyroid. Both patients showed a normal plasma cortisol response to ACTH and an increment in plasma ACTH and lipotropin levels after ovine CRH (oCRH), lysine vasopressin (LVP) and oCRH-LVP stimulation tests. These studies clearly report an isolated idiopathic ACTH deficiency due to a deficit in CRH in two adult subjects.

[The proton relaxation times in normal and neoplastic thyroid tissue. An in vitro study]. / Tempi di rilassamento protonico nel tessuto normale e neoplastico della tiroide. Studio in vitro.

Aim of the work is the in vitro evaluation of normal and tumoral thyroid tissue relaxation times, in order to obtain useful information for MR Imaging in vivo. Water proton high-resolution MR spectra, together with T1 and T2 relaxation times, have been measured in normal and tumoral thyroid tissues. The longitudinal relaxation time T1 was particularly sensitive to pathologic tissue: significant differences (mean: 243 ms) were observed between normal and tumoral tissues, which is a useful finding for the successful application of MR techniques to the detection of tumors in the thyroid gland. The average T1 relaxation time, for each class of examined tumors, correlates qualitatively with the degree of malignancy. On the contrary, the transverse relaxation time T2 was insensitive to pathologic changes in the tissues. The analysis of water proton spectra showed the overall Free Induction Decay constant T2 to allow an easier discrimination than T2 between normal and pathologic thyroid tissue. Thus, T1-weighted sequences probably provide better discrimination than T2-weighted scans in the evaluation of normal and tumoral thyroid tissues.

[Evaluation of dopaminergic activity of the hypothalamus in patients with polycystic ovarian syndrome]. / Valutazione del tono dopaminergico ipotalamico in pazienti con sindrome dell'ovaio policistico.

To evaluate the hypothalamic dopaminergic activity in patients with polycystic ovary syndrome (PCOS), we studied the PRL, TSH, LH and FSH responses to i.m. administration of sulpiride in five euthyroid women affected by PCOS and in five normal women. The mean basal PRL and TSH plasma levels resulted significantly higher (p less than 0.01) in PCOS subjects with respect to normal subjects. The incremental area under PRL and TSH profiles, after sulpiride administration, were significantly lower (p less than 0.05) in PCOS patients than in the control group; no significant variation of LH and FSH plasma levels resulted. Our data suggest a decrease dopaminergic activity in PCOS.

[Changes in the blood levels of adrenal hormones after prolonged physical activity]. / Modificazioni dei livelli plasmatici degli ormoni surrenalici dopo attività fisica protratta.

In order to evaluate the effect of prolonged physical activity on the adrenal cortex we have measured the plasma blood level of dehydroepiandrosterone sulphate (DHEAS), androstenedione (A) and cortisol (C) in ten moderately trained male subjects an hour before and 5-10 minutes after an hour of swimming. Mean plasma levels of DHEAS after physical activity were significantly higher respect to pre-exercise levels. The mean plasma levels of A pre- and post-exercise also demonstrated a significantly difference. Cortisol levels did not increase significantly after this kind of physical activity. These results suggest that prolonged exercise determines an independent activation of the cortical zona reticularis as to that of the zona fasciculata.