Risk factors of malnutrition in children with severe motor and intellectual disabilities.

BACKGROUND: Children with severe motor and intellectual disabilities (SMID) are at a high risk of malnutrition and often require tube feeding to maintain their nutritional status. However, determining their energy requirements is difficult since inadequate dietary intake, severe neurological impairment, respiratory assistance, and cognitive impairment are all factors that affect malnutrition in SMID. AIM: This study investigated the factors affecting malnutrition and identified problems affecting the nutritional status of children with SMID. METHODS: Forty-two children with SMID with oral motor dysfunction who were receiving home medical care at one of four hospitals were enrolled. Their nutritional status was assessed using a 3-day dietary record, anthropometric measurements, and laboratory tests. The clinical findings associated with malnutrition were compared, and a body mass index (BMI) z-score less than -2SD was defined as malnutrition. The relationship between BMI z-score and other potential predictors was also investigated. RESULTS: Thirty-three (79%) children received tube feeding, and 20 (48%) experienced malnutrition. The median age of the malnourished children was older than that of non-malnourished children. Respiratory assistance was significantly correlated with higher BMI z-score, independent of other potential confounders such as nutrition method, muscle tonus, and energy intake. Cholesterol levels were significantly higher in children receiving a standard infant formula beyond 3 years of age than in those who switched to enteral formula before 3 years of age. CONCLUSIONS: Malnutrition in children with SMID was mainly associated with age or respiratory condition. Energy requirements should be regularly re-evaluated with considering these factors.

Food acceptance and anthropometry in relation to 6-n-propylthiouracil sensitivity in Japanese college women.

BACKGROUND AND OBJECTIVES: Differences in anthropometry and food acceptance among tasters and non-tasters of 6-n-propylthiouracil has been well studied in Western countries. However, reports on this issue from Asian countries are still limited. METHODS AND STUDY DESIGN: Healthy Japanese students attending Nara Women's University (n=153) were recruited and classified into 3 groups based on taste sensitivity to a 0.32 mM 6-npropylthiouracil solution as scored on a labeled magnitude scale. Accordingly, the study population consisted of 34 non-tasters, 78 medium-tasters, and 41 super-tasters. Self-reported food intake was assessed using a food frequency questionnaire. Self-reported food preferences were established using a food checklist listing 63 food items. RESULTS: Although subjects in the 6-n-propylthiouracil non-taster group showed a significantly higher body height and weight than subjects in the taster groups, body mass index was comparable among three groups. Intakes of calories, 3 macronutrients, ß-carotene and vitamin C did not differ significantly between groups, but the intake of green and yellow vegetables was significantly lower in the taster groups. Among the 5 factors defined by a factor analysis performed with 277 age- and BMI-matched Japanese female students, the taster groups showed a significantly reduced preference for green and cruciferous vegetables alone. CONCLUSIONS: To the best of our knowledge, this is the first comprehensive report investigating associations between anthropometry, food intake, and food preference in relation to 6-n-propylthiouracil sensitivity in Asian countries. The effect of this tendency towards an aversion to vegetables including cruciferous ones among females on living a healthy life remains to be investigated.

Carnitine in severely disabled patients: relation to anthropometric, biochemical variables, and nutritional intake.

BACKGROUND: Carnitine plays a pivotal role in a variety of cellular functions. Carnitine deficiency often occurs in severely disabled patients, especially under valproic acid administration. However, the possible causative factors underlying carnitine deficiency have not been fully identified. The present study aimed at clarifying the association of various anthropometric and biochemical variables, including dietary intake of carnitine, with carnitine levels in severely disabled patients. METHODS: Twenty-six severely disabled patients (mean age: 14.1 years; s.d. 7.8) were enrolled. Plasma carnitine levels were evaluated by an enzyme cycling assay. Estimation of the dietary intake of carnitine was made based on dietary records over a 3-day period. RESULTS: Plasma total and free carnitine levels in patients were significantly lower than those in controls obtained from the previous report. However, the ratios of free carnitine to total carnitine did not change significantly. Free carnitine levels were well correlated with a nutritional intake of carnitine. Administration of not only valproic acid but also other anti-epileptic drugs was found to cause a significant decrease of free carnitine levels after adjusting the nutritional intake of carnitine. Among various anthropometric or biochemical variables, albumin and uric acid showed a significant correlation with free carnitine levels. CONCLUSIONS: Physicians should be aware of the fact that severely disabled patients are at risk for carnitine deficiency even in the absence of valproic acid administration, and pay more attention to the nutritional intake of carnitine.

Retrospective tracking of young obese children back to birth in Japan: special attention to the relationship with parental obesity.

OBJECTIVE: Childhood obesity is tracked to adulthood at a high rate. However, longitudinal studies of obesity in early childhood remain limited. This study aimed at tracking young obese children back to birth in comparison with normal-weight children, and investigating the relationship with parental obesity. METHODS: A total of 2,678 (1,353 boys) young children attending kindergarten or nursery school in Nara Prefecture, Japan, were enrolled. The present heights and weights of children and parents were obtained by a questionnaire, and children's heights and weights at birth, 1.5, and 3.5 years were obtained from mother-child health notebooks. Using body mass index (BMI), child and parental obesity were defined as >=90th percentile based on the reference values for Japanese children and >=25 (kg/m²), respectively. RESULTS: The overall prevalence of obesity at birth was 10.2%, and decreased to 5.6% at 5 years. In the retrospective tracking, obese children at 5 years exhibited significantly higher weight Z-scores and BMI percentiles consistently from birth than in normal-weight children. The increased velocity of weight gain as judged by their Z-score during three periods; birth-1.5, 1.5-3.5, and 3.5-5 years were significantly associated with an increased risk for the obesity at 5 years of age. Only maternal obesity was found to be associated with daughters' obesity in the analysis of association of parents-children obesity. CONCLUSIONS: It is important to manage body weight from early infancy for reducing the occurrence of obesity at 5 years. Where there is maternal obesity, greater attention may be required, especially for daughters.

Longitudinal study of thinness from birth to early childhood: the association with parental thinness.

AIM: Epidemiological research on thinness, particularly in early childhood, is limited. This study tracked thin children aged 5 years back to birth, compared them with normal-weight children and investigated the relationship with parental thinness. METHODS: We enrolled 2678 children (50.5% boys) aged 5 years and attending kindergarten or nursery in the Nara Prefecture of Japan. The children's height and weight at birth, 1.5 years and 3.5 years, were obtained from mother-child health records. Child thinness was defined as having a body mass index (BMI) of less than the fifth percentile of the reference values for Japanese children, and parental thinness was defined as a BMI of <18.5. RESULTS: The overall prevalence of thinness at 5 years of age was 4%, with no significant difference between genders. At every age, weight z-scores and BMI percentiles were significantly lower in thin children than normal-weight children. The increment in weight z-scores between birth and the age of 1.5 years was significantly lower in thin children. The only parental link was paternal thinness and thinness in boys. CONCLUSION: Careful observation of body weight from birth is important to reduce thinness at 5 years of age. Paternal thinness may be a risk factor for thinness in boys.

Normal taste acuity and preference in female adolescents with impaired 6-n-propylthiouracil sensitivity.

This study was conducted to determine the relationship between 6-n-propylthiouracil sensitivity and taste characteristics in female students at Nara Women's University. Participants (n=135) were screened for 6-npropylthiouracil sensitivity using a taste test with 0.56 mM 6-n-propylthiouracil solution, and the sensitivity was confirmed by an assay for the bitter-taste receptor gene, TAS2R38. Based on the screening results, 33 6-npropylthiouracil tasters and 21 non-tasters were enrolled. The basic characteristics that are thought to influence taste acuity, including body mass index, saliva volume and serum micronutrient concentrations (iron, zinc and copper), were similar between the two groups. In an analysis using a filter-paper disc method, there were no differences in the acuity for four basic tastes (sweet, salty, sour and bitter) between 6-n-propylthiouracil tasters and non-tasters. In addition, the taste preference for the four basic tastes as measured by a visual analogue scale was also comparable between the two groups. This is the first study to demonstrate that 6-n-propylthiouracil nontasters have taste sensitivity for the four basic tastes similar to that in 6-n-propylthiouracil tasters, at least in female adolescents, as measured by the gustatory test using a filter-paper disc method.

Children with Down's syndrome display high rates of hyperuricaemia.

AIM: Several studies show that hyperuricaemia, abnormally high levels of uric acid in the blood, frequently occurs in adult Down's syndrome patients, but paediatric research is scarce. We aimed to clarify its prevalence in paediatric Down's syndrome patients and its association with lifestyle-related laboratory variables and nutritional intake, to consider possible effects in later life. METHODS: We compared 52 Down's syndrome patients, from one to 15 years of age, with age-matched controls. Hyperuricaemia was defined using reference values established for children, as uric acid z-scores of more than 2.0. Nutritional intake was estimated using 3-day dietary records. RESULTS: Hyperuricaemia occurred in 17 Down's patients (32.7%) and was significantly higher in Down's patients than the controls. The prevalence was also significantly higher in males. There were no significant differences between hyperuricaemia-positive and hyperuricaemia-negative patients in terms of age, body mass index standard deviation scores, fasting blood glucose, insulin, homeostasis model assessment-insulin resistance and triglyceride, and purine body intake was similar. There were differences in high-density lipoprotein cholesterol. CONCLUSION: We found high rates of hyperuricaemia from early childhood in Down's syndrome patients. This suggests careful management of Down's syndrome patients, as hyperuricaemia is an independent risk factor for lifestyle-related diseases in adulthood.

Longitudinal nutritional assessment in acute lymphoblastic leukemia during treatment.

BACKGROUND: A nutritional assessment of pediatric patients with cancer is important to improve their outcome. The number of longitudinal nutritional studies during treatment, however, is limited. The purpose of this study was to investigate the longitudinal changes in anthropometric measures and serum albumin level during chemotherapy in patients with acute lymphoblastic leukemia (ALL). METHODS: We retrospectively reviewed the charts of 23 patients (19 boys, four girls) with ALL from April 2007 to March 2010. The median age at diagnosis was 4.5 years. Bodyweight, height, and serum albumin levels were measured at the start and the end point of each chemotherapy phase. RESULTS: At diagnosis, two patients (8.7%) were underweight and five patients (21.7%) were overweight according to body mass index z-score, while five patients were underweight and three (13.0%) were overweight according to Waterlow score. The prevalence of malnourished patients did not change significantly throughout chemotherapy by either assessment. The absolute scores in either assessment were significantly reduced at the sanctuary treatment phase. Low serum albumin (<3.2 g/dL) was found in two patients at diagnosis. Mean albumin decreased significantly at the induction and the re-induction phases. CONCLUSIONS: Given that nutritional status under a similar chemotherapeutic regimen as assessed by anthropometric measures and albumin level differed among patients, careful observation of the nutritional status and intervention may be necessary at different phases of chemotherapy.