Dangerous waters: outbreak of eye lesions caused by fresh water sponge spicules.

PURPOSE: To describe an extremely uncommon outbreak of eye lesions in a specific area of the Brazilian Amazonia. METHODS: Prospective noncomparative case series. Fifty-nine patients who developed eye lesions after swimming in the Araguaia river of Tocantins state in Brazil were examined. A team of ophthalmologists equipped with a slit-lamp, gonioscopic lenses, and indirect ophthalmoscopy performed full eye examination. Analysis of the flora and fauna of the river water was undertaken by a group of experts. RESULTS AND CONCLUSIONS: Eighty-three eyes were affected. The most common lesions were corneal opacities seen in 34 eyes and conjunctival nodules diagnosed in 12 eyes. Severe visual acuity loss was detected in seven children with unilateral anterior chamber lesions. Spicules of the sponge species Drulia uruguayensis and Drulia ctenosclera were found inside three blind eyes that have been enucleated for diagnostic purposes. All eye lesions could be attributed to an outbreak of foreign bodies from fresh water sponges. Organic enrichment of the water resulting from the absence of sanitation probably was the key factor, which initiated a cycle of ecological imbalance that provoked human disease.

Fluorescent serum and urinary advanced glycoxidation end-products in non- diabetic subjects.

INTRODUCTION: Advanced glycoxidation end-products (AGEs) are involved in age-related conditions and diabetic complications. Diet intake contributes to their circulating concentrations. AIM: To measure serum and urinary AGEs in non-diabetic volunteers and relate their concentration to body composition, blood chemistry and dietary ingestion. METHODS: We studied 41 adult men (31 middle-aged adults and 10 elderly). A nutritional assessment including a dietary recall designed for detection of AGE ingestion (specifically carboxymethyl-lysine(CML)), and anthropometric measurements were performed. Also serum lipoproteins, insulin, glucose, leptin and C reactive protein (CRP). AGEs were measured in serum and urine samples using size exclusion chromatography and flow injection assay (FIA); the technical procedures were first employed in 11 heterogeneous diabetics, as positive controls for this methodology. RESULTS: Serum and urinary chromatograms indicated that areas under the curve were not different in younger compared with elderly adults. AGEs did not correlate with dietary intake, body composition, nor metabolic parameters, however they correlated significantly with renal function and CRP concentration. DISCUSSION: In these non-diabetic volunteers, with low CML intake, serum and urinary concentration of AGEs were not related to dietary intake. AGEs were related to renal function and CRP, but not to body composition, lipoproteins, insulin and glucose.

Fluorescent serum and urinary advanced glycoxidation end-products in non- diabetic subjects

Introduction: Advanced glycoxidation end-products (AGEs) are involved in age-related conditions and diabetic complications. Diet intake contributes to their circulating concentrations. Aim: To measure serum and urinary AGEs in non-diabetic volunteers and relate their concentration to body composition, blood chemistry and dietary ingesti¢n. Methods: We studied 41 adult men (31 middle-aged adults and 10 elderly). A nutritional assessment including a dietary recall designed for detection of AGE ingesti¢n (specifically carboxymethyl-lysine(CML)), and anthropometric measurements were performed. Also serum lipoproteins, insulin, glucose, leptin and C reactive protein (CRP). AGEs were measured in serum and urine samples using size exclusion chromatography and flow injection assay (FIA); the technical procedures were first employed in 11 heterogeneous diabetics, as positive controls for this methodology. Results: Serum and urinary chromatograms indicated that areas under the curve were not different in younger compared with elderly adults. AGEs did not correlate with dietary intake, body composition, nor metabolic parameters, however they correlated significantly with renal function and CRP concentration. Discussion: In these non-diabetic volunteers, with low CML intake, serum and urinary concentration of AGEs were not related to dietary intake. AGEs were related to renal function and CRP, but not to body composition, lipoproteins, insulin and glucose.

Lean and fat mass as determinants of muscle strength and insulin sensitivity in Chilean elderly subjects.

PURPOSE: To report the association of lean body mass with nutritional, social and economic factors and its functional consequences in free living healthy elderly subjects. MATERIAL AND METHODS: Healthy elderly subjects of low socioeconomic level were studied. Monthly income, marital status, anthropometric measures and fall risk were assessed. Mini Nutritional Assessment score was calculated. Body composition and bone mineral density were measured by double beam X ray absorptiomentry. Fasting serum lipids, fasting and postprandial insulin and glucose levels were measured. Hand grip, quadriceps and biceps strengths and maximal inspiratory and expiratory pressures were measured. RESULTS: One hundred and nine subjects (56 women), aged 75 +/- 4 years old were studied. Lean body mass was 34.1 +/- 4 and 49.2 +/- 5.4 kg in women and men respectively (p < 0.001), fat mass was 22.8 +/- 7.1 and 20.7 +/- 6.4 kg in women and men respectively (p= NS). Lean body mass correlated with hand grip, quadriceps and biceps muscle strengths in men and with quadriceps and biceps strength in women. Men that exercised regularly had higher quadriceps strength and maximal expiratory pressure. Total body fat correlated positively with fasting and postprandial serum insulin levels. CONCLUSIONS: In this sample, lean body mass is directly related to muscle strength mostly in men. On the other hand, total fat mass is related to serum insulin levels.

Effects of nutritional supplementation and resistance training on muscle strength in free living elders. Results of one year follow.

PURPOSE: To assess the effects of a one year nutritional supplementation and resistance training program on muscle strength and walking capacity in the elderly. MATERIAL AND METHODS: Elderly subjects from two outpatient clinics received a nutritional supplement, that provided 400 Kcal, 15 g/protein and 50% of vitamin DRVs per day. Half the subjects receiving and not receiving the supplement were randomly assigned to a resistance exercise training program with two sessions per week. Every six months, body composition using DEXA, limb muscle strength, maximal inspiratory and expiratory pressures and walking capacity were assessed. RESULTS: One hundred forty nine subjects were considered eligible and 101 (31 supplemented and trained, 28 supplemented, 16 trained and 26 without supplementation nor training) completed the year of follow up. Overall compliance with the supplement was 48 22 % and trained subjects attended 56 21% of programmed sessions. No changes in fat free mass were observed in any of the groups, but fat mass increased from 22.5 7.3 to 23.2 7.3 kg in all groups (p < 0.001). Upper and lower limb strength and walking capacity increased significantly in trained subjects whether supplemented or not. Maximal inspiratory pressure and right hand grip strength increased only in the supplemented and trained group. CONCLUSIONS: Resistance training improved muscle strength and walking capacity.

The impact of nutritional supplementation and resistance training on the health functioning of free-living Chilean elders: results of 18 months of follow-up.

Body composition changes and loss of functionality in the elderly are related to substandard diets and progressive sedentariness. The aim of this study was to assess the impact of an 18-mo nutritional supplementation and resistance training program on health functioning of elders. Healthy elders aged > or = 70 y were studied. Half of the subjects received a nutritional supplement. Half of the supplemented and nonsupplemented subjects were randomly assigned to a resistance exercise training program. Every 6 mo, a full assessment was performed. A total of 149 subjects were considered eligible for the study and 98 (31 supplemented and trained, 26 supplemented, 16 trained and 25 without supplementation or training) completed 18 mo of follow-up. Compliance with the supplement was 48%, and trained subjects attended 56% of programmed sessions. Activities of daily living remained constant in the supplemented subjects and decreased in the other groups. Body weight and fat-free mass did not change. Fat mass increased from 22.2 +/- 7.6 to 24.1 +/- 7.7 kg in all groups. Bone mineral density decreased less in both supplemented groups than in the nonsupplemented groups (ANOVA, P < 0.01). Serum cholesterol remained constant in both supplemented groups and in the trained groups, but it increased in the control group (ANOVA, P < 0.05). Upper and lower limb strength, walking capacity and maximal inspiratory pressure increased in trained subjects. In conclusion, patients who were receiving nutritional supplementation and resistance training maintained functionality, bone mineral density and serum cholesterol levels and improved their muscle strength.

[Biological, familial and metabolic characteristics of infantile and juvenile obesity]. / Características biológicas, familiares y metabólicas de la obesidad infantil y juvenil.

BACKGROUND: Obesity is the most prevalent nutritional disease in people of less than 20 years old. AIM: To report biological, familial and metabolic characteristics in obese children. PATIENTS AND METHODS: A retrospective review of 187 children seen at obesity clinics and that had a complete metabolic study. RESULTS: Ninety five prepuberal and 92 puberal children, aged 8.7 +/- 2.2 and 12.6 +/- 2.2 years old respectively, were studied. Body mass index was over 4 standard deviations in 48.4% of prepuberal children and in 39.1% of puberal children. Paternal obesity was twice more prevalent (30.2%) than in the general population. The daily caloric intake and basal metabolic rate (BMR) were within the normal range; nevertheless there was a positive caloric balance due to minimal physical activity. The mean daily fat intake was normal (26.4 +/- 8.5 and 25.3 +/- 9.1% of total calories in prepuberal and puberal children respectively). The daily fiber intake was under 70% of recommendation. The total cholesterol was over 200 mg/dl in 26.6 and 23.9% of prepuberal and puberal children. LDL cholesterol was over 130 mg/dl in 27.3 and 26.6% and triacylglycerol was over 150 mg/dl in 16.9 and 25% of prepuberal and puberal children respectively. Basal serum insulin was over 20 uIU/ml in 27.7 and 42.2% of prepuberal and puberal children, respectively. Post glucose serum insulin was over 60 uIU/ml in 40 and 63% of prepuberal and puberal children, respectively. CONCLUSIONS: Infantile and juvenile obesity is a chronic disease with a high incidence of metabolic alterations.

Nutritional support in alcoholic cirrhotic patients improves host defenses.

BACKGROUND: Malnutrition is usual in patients with alcoholic liver disease and is associated with a poor outcome. Nutritional support decreases nutrition-associated complications. AIM: To demonstrate that nutritional support in ambulatory alcoholic cirrhotic patients improves host defenses. METHODS: Thirty-one male outpatients with alcoholic cirrhosis CHILD-PUGH B or C were included. Twenty-five subjects completed six months consuming daily a nutritional supplement (Ensure, 1000 Kcal and 35 g protein), in addition to their regular diet. At entrance and every three months, a clinical assessment, nutritional evaluation and indirect calorimetry were performed. Liver function tests and LPS-induced monocyte production of cytokines, salivary secretory IgA, lactulose/mannitol ratio and breath hydrogen tests were also measured in these intervals. Delayed cutaneous hypersensitivity and IgG and IgM antibody response to endotoxin were assessed at entrance and at the end of the study. RESULTS: Patients drank 85% of the provided supplement as an average. REE, total body fat and serum albumin increased, basal breath hydrogen decreased and cellular immunity improved significantly during the follow up period (p< or =0.03). All the other parameters remained unchanged throughout the study. Six patients (16.2%) died during the study, five due to upper gastrointestinal bleeding. CONCLUSION: Nutritional support in alcoholic cirrhotic patients improves nutritional status and cell mediated immunity.

[Nutritional status and energy expenditure in elders of differing socioeconomic level]. / Estado nutritivo y gasto energético en ancianos de distinto nivel socioeconómico.

BACKGROUND: Income and socioeconomic status can influence nutritional status of individuals. Since elders are a more vulnerable group to nutritional deficiencies, socioeconomic status could have a special relevance on nutrition of elderly people. AIM: To assess the influence of socioeconomic status on the nutritional status of elders. MATERIAL AND METHODS: Elders of both sexes of high socioeconomic level and age and sex matched elders of low socioeconomic status were studied. Anthropometry, body composition using double beam X ray absorptiometry, resting energy expenditure using an open circuit indirect calorimeter, routine biochemistry, blood levels of folic acid, vitamin B12 and homocysteine were measured in all subjects. RESULTS: Fourteen female elders of high socioeconomic level, 14 females of low level and 12 males of each level were studied. Mean age of females and males was 71.5 +/- 3.7 and 73.9 +/- 4.2 years old respectively. Males and females of high socioeconomic status were taller than their counterparts of low status. Females of high socioeconomic status had a lower body mass index than their pairs of low status (26.3 +/- 3.8 and 30.2 +/- 5.6 kg/m2 respectively p < 0.02). Men of high economic status had a higher fat mass than their pairs of low level (20.3 +/- 3.5 and 15.1 +/- 5.5 kg respectively, p < 0.005). No differences in resting energy expenditure in women of differing socioeconomic level were observed. Men of high level had a higher energy expenditure that their counterparts of low level (36.0 +/- 4.9 and 32.8 +/- 2.2 Kcal/kg lean body mass/day respectively, p < 0.02). Low level male elders had higher serum total cholesterol and triglycerides. Folic acid, vitamin B12 and homocysteine levels were within normal limits. Dietary intake showed deficiencies in calorie, protein and vitamin intake in all subjects. CONCLUSIONS: In this group of elders, low socioeconomic level did not produce a significant impact on nutritional status.

[Comparative analysis of body composition assessment methods in healthy adult men]. / Análisis comparativo de métodos de evaluación de la composición corporal en varones adultos sanos.

BACKGROUND: The degree of agreement between different methods to assess total body composition is not well known. AIM: To determine the level of agreement for total body fat mass measurement by dual-photon absorptiometry (DEXA), bioelectrical impedance (BIA) and anthropometry using the deuterium dilution method as the gold-standard technique, in normal male volunteers. SUBJECTS AND METHODS: Total body fat mass was measured by DEXA, BIA, anthropometry and deuterium dilution in thirty one healthy men, aged 41.9 +/- 8.6 years old. RESULTS: Mean differences in percentage of total body fat compared with deuterium dilution were 0.3% +/- 2.2, 1.3% +/- 3.4 and 1.8 +/- 2.3% for DEXA1 BIA and anthropometry respectively. DEXA had the lower difference with deuterium dilution and the confidence intervals for this difference (+/- DS) showed that, at the individual level, the maximum difference was 4.4%. CONCLUSIONS: All the methods evaluated gave similar average measurements for total body fat mass, but with different individual variability. In this group of healthy male subjects, DEXA was the best method in terms of agreement with the gold-standard.

[Referred morbidity and the utilization of health services in Brazilian urban areas: methodology]. / Morbidade referida e utilização de serviços de saúde em localidades urbanas brasileiras: metodologia.

The reorganization of the Brazilian health system in the last few years has been based on the decentralization of the services and the integration of preventive and curative medicine, then creating new needs in term of the health information needed for health planning. The planning and administration of a regionalized and integrated health system calls for information about the population's morbidity profile, and the description of the pattern of the utilization of the health services, which can be obtained by means of household health surveys. The methodology utilized in a household health survey carried out in the Metropolitan Area of S. Paulo, Brazil, from July 1989 to June 1990, is described. This survey has some distinct methodological characteristics, such as the sampling process that defined the domains by age and sex, allowing an analysis of populational groups less well represented in the general population, as that of less than one year of age and that of aged people, as well as the use of the results of the latest Brazilian Census in 1991 for adjusting the sample.

Protein quality and urea kinetics in prepubertal Chilean schoolboys.

Urea kinetics were measured non-invasively in 12 Chilean schoolboys aged 8-10 years who were receiving one of two diets, either predominantly animal protein or predominantly vegetable protein. Both the diets provided an equivalent level of gross protein, 1.2 g/kg/day. The study diets were given for 10 days to enable adaptation to take place. On the eighth day a single oral dose of 15N15N-urea, 100 mg, was given and the amount of label excreted as 15N15-urea in urine over the subsequent 48 hours was measured. There was little difference in any aspect of urea kinetics between the two diets with urea production (animal, 173 +/- 50 mgN/kg/day; vegetable 179 +/- 53 mgN/kg/day), urea excretion (animal, 86 +/- 19 mgN/kg/day; vegetable, 105 +/- 13 mgN/kg/day), urea nitrogen hydrolysis (animal, 87 +/- 49 mgN/kg/day; vegetable, 74 +/- 42 mgN/kg/day), and the salvaged urea-nitrogen derived from hydrolysis which returned to urea formation (animal, 12 +/- 5 mgN/kg/day; vegetable, 17 +/- 9 mgN/kg/day) all being similar. A very high proportion of the salvage nitrogen derived from urea hydrolysis was maintained within the metabolic pool, about 80%, which was equivalent to 0.4 g protein/kg/day. This is the first time urea kinetics have been measured in children of this age and shows that 57% of the ura produced is excreted in urine on average with about 43% of the urea-nitrogen being salvaged for further metabolic interaction. It is concluded that the vegetable based protein diet taken habitually by Chilean children is metabolically equivalent in terms of urea kinetics to a diet based upon animal protein at this level of intake, but that high rates of salvage of urea nitrogen are found on both diets.

[Patients with chronic airflow limitation: effects of the inspiratory muscle training with threshold load valve, built with appropriate technology, associated to nutritional support]. / Pacientes con limitación crónica al flujo aéreo: efectos del entrenamiento muscular respiratorio con válvula de carga umbral construida con tecnología apropiada, asociado a apoyo nutricional.

AIM: To assess prospectively the effects of a controlled program of inspiratory muscle training program and nutritional support in patients with chronic obstructive lung disease (COPD). PATIENTS AND METHODS: Twenty-three patients with COPD were randomly assigned into four groups. Group I received a 1000 kcal/day nutritional supplement, given as a casein based enteral nutritional formula; group III was subjected to inspiratory muscle training, using an inexpensive pressure threshold load valve constructed according to the Appropriate Technology principles of the WHO, adjusted at 30% of Maximal Inspiratory Mouth Pressure and received also the nutritional supplement; group IV was trained but did not receive the nutritional supplement and group II was not trained nor supplemented. Patients were studied during three months and monthly, inspiratory muscle function, exercise capacity and anthropometry were measured. RESULTS: A significant improvement in exercise capacity, maximal inspiratory pressure and inspiratory muscle endurance was observed in the four groups throughout the study. Trained subjects had greater improvement in their inspiratory muscle endurance, compared to untrained subjects. Nutritional support had no effect in inspiratory muscle function or exercise capacity. No changes in anthropometric measures were observed. CONCLUSIONS: The pressure threshold load valve used in this study, improved inspiratory muscle endurance and nutritional support had no effect in patients with COPD.

[Biological quality of a milk substitute for school children based on refined flour subjected to enzymatic hydrolysis]. / Evaluación biológica de un sustituto lácteo para el escolar, a base harina de trigo cruda refinada, sometida a hidrólisis enzimática.

The biological quality of an experimental milk substitute based on a raw wheat flour subjected to enzymatic hydrolysis in comparison to a control product based on extruded flours and milk protein was studied in 35 <> female school age children. The girls were fed their customary diet during 2 consecutive 14 and 12 day periods, and randomized to the experimental and control products in a double blind crossover fashion. Apparent absorption of protein, energy, calcium and phosphorus was evaluated. Mean nitrogen intake from the experimental product was significantly lower (223 vs 244 mg/Kg/d p<0.0001). Absorbed nitrogen was also lower (187 vs 203 mg&kg/d p<0.0001). Energy intake and excretion were similar with both products; 96 and 95% of intake was absorbed for experimental and control products respectively. The mean calcium intake was significantly lower than the experimental product (39.7 vs 60.2 mg/kg/d p<0.0001). Absorbed calcium from the experimental product was 50% of control (20.7 vs. 39.5 mg/Kg/d p<0.0001). Phosphorus intake was also lower with the experimental product relative to control (22.0 vs 27.8 mg/Kg/d p<0.0001) and absorbed P was 13.1 vs 16.5 mg/Kg/d respectively. Both products were well tolerated. We conclude that the experimental product based on wheat flour does not differ significantly in protein and energy digestibility but calcium and phosphorus absorption and digestibility are significantly lower limiting its use in school feeding programs.

Controlled trial on nutrition supplementation in outpatients with symptomatic alcoholic cirrhosis.

A controlled trial on nutrition supplementation in ambulatory patients with decompensated alcoholic liver disease was carried out during 1 year. Fifty-one patients were studied; 26 were assigned to an experimental group receiving a daily supplement of 1000 kcal and 34 g of proteins given as a casein-based enteral nutrition product and 25 to a control group receiving one placebo capsule. Patients were examined in a special clinic once a month or more if required. Sixty-eight percent of patients admitted to alcohol ingestion or had alcohol in urine samples on at least one occasion. Dietary recalls showed a significantly higher protein and caloric intake in case patients subjects (p < .0001). Nine patients died during the study, three case patients and six control patients (p = NS). The frequency of hospitalizations was significantly less in the experimental group. This difference was attributed to a reduction in severe infections. Mid-arm circumference, serum albumin concentration, and hand grip strength improved earlier in case patients, although both groups had a significant improvement in these parameters. Bilirubin and aspartate aminotransferase decreased and prothrombin time increased significantly in both groups during the study period, without differences between groups. It is concluded that nutrition support decreases nutrition-associated complications in patients with alcoholic liver disease.

Protective efficacy of a serogroup B meningococcal vaccine in Sao Paulo, Brazil.

Serogroup B Neisseria meningitidis is the most common cause of epidemic meningococcal disease in developed countries. Until recently no vaccine has been available for prevention of infection with this organism. In an attempt to control epidemic serogroup B meningococcal disease in greater Sao Paulo, Brazil, during 1989 and 1990, a Cuban-produced outer-membrane-protein-based serogroup B meningococcal vaccine was given to about 2.4 million children aged from 3 months to 6 years. We have done a case-control study to estimate the efficacy of the vaccine in greater Sao Paulo. Microbiologically confirmed cases of serogroup B meningococcal disease were identified through hospital-based surveillance. Controls were matched by neighbourhood and age. Vaccination status was confirmed by inspection of vaccination cards. Between June, 1990, and June, 1991, 112 patients and 409 matched controls with confirmed vaccine status were enrolled. Estimated vaccine efficacy varied by age: 48 months or older = 74% (95% Cl 16 to 92%), 24 to 47 months = 47% (-72 to 84%), and less than 24 months = -37% (< -100 to 73%). Our results suggest that the Cuban-produced vaccine may be effective for prevention of serogroup B meningococcal disease in older children and adults.

PIP: In 1990, researchers compared data on 112 3 month-6 year old children who received a Cuban produced, outer-membrane-protein-based serogroup B meningococcal vaccine (cases) and lived in greater Sao Paulo, Brazil with data on 409 age and neighborhood matched controls to determine the protective efficacy of the vaccine against serogroup B meningococcal disease (Neisseria meningitidis). Health workers began administering the vaccine in 1989 to control an epidemic of serogroup B meningococcal disease in the area. In fact, in mid-1989 and early 1990, the rates of serogroup B meningococcal disease in 1-6 year old children in Sao Paulo were 2.07/100,000 and 2.3/100,000, respectively. Even though only 44% of serogroup B meningococcal isolates corresponded with the vaccine type strain (B:4:P1:15), many isolates had man of the same serotype or subtype antigens as the vaccine type strain. Thus the vaccine was able to protect against some other serogroup B meningococcal strains other than the vaccine type strain. Vaccine efficacy for 4-year old children was 74%, but was much lower for 24-47 month old children (47%) and 24-month old children (-37%). The change in the log odds ratio for vaccination by age was linear and significant (p=.057). The researchers suggested that poor vaccine efficacy among younger children may reflect a need for more boosting to achieve protective levels of immunity. The results showed that the Cuban-produced vaccine could contribute to control of outbreaks of serogroup B meningococcal disease by protecting older children and adults from the disease. Researchers need to conduct additional studies of the vaccine and other possible serogroup B meningococcal vaccines.

Protein-energy requirements of boys 12-14 y old determined by using the nitrogen-balance response to a mixed-protein diet.

Short-term nitrogen-balance response to graded intakes of a vegetable mixed-protein diet and to a milk-egg protein diet was tested in eight healthy male children aged 12-14 y. They received 72, 104, 136, and 168 mg N.kg body wt-1.d-1 for 10 d while on the mixed diet, and 160 mg N.kg-1.d-1 on the milk-egg diet. The mean regression equation was nitrogen balance = 0.64 (nitrogen intake)-74, all values are in mg N.kg-1.d-1. Apparent digestibility was 86% and 85% for the mixed and milk-egg diets when the subjects received 168 and 160 mg N.kg-1.d-1, respectively. Mean nitrogen intake for satisfactory nitrogen retention for growth on the mixed diet was 147 mg N.kg-1.d-1; the recommended protein allowance to cover 97.5% of the population, which was derived by using a CV of 12.5%, is 1.15 g protein.kg-1.d-1. We conclude that FAO/WHO/UNU recommendations are adequate, at least for short-term nitrogen retention; long-term studies are needed to evaluate the chronic safety of this protein allowance.

[A new cow's milk formula to Complementary Feeding National Program: nitrogen and caloric balance]. / Nueva fórmula láctea para el Programa Nacional de Alimentación Complementaria: balance nitrogenado y calórico.

Nitrogen, fat and energy retention were measured in 10 male infants (mean age = 6.8 mo) recovering from marasmic malnutrition while they were fed with either cow's milk based formula (LP) or a modified cow's milk formula (LPM). Their mean weight for age ratio was 72% and their weight for length ratio was 95% (NCHS standards). They went through two consecutive balance periods of 6 days each (3 d. for adaptation and 3 d. for urine and feces collection) beginning with either formula randomly. Both formulas had 85 kcal/dl with 11% protein calories in LPM and 13% in LP. Energy intake, absorption and relative retention were slightly greater with LPM than LP. Fat intake was greater under LPM than LP (5.4 vs. 4.5 g-kg-d, p < 0.025), which resulted in significant differences in fat absorption (LPM 4.3 vs. LP 3 g-kg-d, p < 0.025). Nitrogen intake was significantly lower under LPM than LP (487 vs. 571 mg-kg-d, p < 0.025) with lower urinary nitrogen excretion for LPM than for LP (304 vs. 417 mg-kg-d, p < 0.001). Apparent nitrogen retention averaged 115 mg-kg-d for LPM and only 69 mg-kg-d for LP (NS). A significant correlation was observed between nitrogen intake and nitrogen retention: r = 0.70 (y = 0.57x -167; p < 0.05) with LPM, and r = 0.77 (y = 0.63x -291, p < 0.01) with LP. A correlation was also found between energy intake and weight gain: r = 0.55 (NS) with LPM, and r = 0.88 (y = 0.26x -26; p < 0.001) with LP.(ABSTRACT TRUNCATED AT 250 WORDS)