Effects of oral nutritional supplementation in the management of malnutrition in hospital and post-hospital discharged patients in India: a randomised, open-label, controlled trial.

BACKGROUND: Hospital malnutrition is a significant problem that still remains under-recognised and under-treated in India. The present study assessed the effects of oral nutritional supplementation (ONS) in conjunction with dietary counselling versus dietary counselling (control) alone in malnourished patients when given in hospital and post-hospital discharge. METHODS: The present study was conducted in nine private and four public hospitals. Patients from various medical wards were screened for malnutrition using modified Subjective Global Assessment (mSGA) and randomised to control (n = 106) or ONS (n = 106) for 12 weeks. Two servings (460 mL) of ONS were prescribed daily, providing 432 kcal, 16 g of protein and 28 micronutrients. The primary outcome was weight gain over 12 weeks. Other outcomes included change in body mass index (BMI), serum pre-albumin, albumin and C-reactive protein levels, energy and nutrient intakes, and handgrip strength at weeks 4, 8 and 12, as well as mSGA score at week 12. RESULTS: The mean age of patients was 39 years. Fifty-five percent were males and 90.3% were moderately malnourished (mSGA score B) at baseline. At week 12, ONS significantly improved certain parameters compared to control: weight (2.0 versus 0.9 kg; P < 0.001), BMI (0.76 versus 0.37 kg m(-2) ; P < 0.001) and energy intake per day (560 versus 230 kcal; P < 0.05). There were no differences in biochemical parameters and mSGA score between groups. Additionally, patients on ONS who were more functionally impaired at baseline had significantly greater weight gain and improved handgrip strength scores than controls. CONCLUSIONS: ONS use throughout hospital stay and post-hospital discharge significantly improved energy intake and weight in malnourished Indian patients. Those patients with poorer functional status at baseline demonstrated the most benefit.

Modulation of the immune system by human milk and infant formula containing nucleotides.

OBJECTIVE: To determine whether human milk and nucleotides added to infant formula at levels present in human milk enhance development of the immune system during infancy. METHODS: A 12-month, controlled, randomized and blinded, multisite feeding trial was conducted on two infant formulas: iron-fortified, milk-based control formula (Control) or the same formula fortified with nucleotides (Nucleotide). The level (72 mg/L) and ratio of individual nucleotides selected were patterned after those available in human milk. A third group fed human milk exclusively for 2 months and then human milk or Similac with iron until 12 months of age also was studied. Response to immunizations was chosen to assess development of the immune system. Infants followed the immunization schedule recommended by the American Academy of Pediatrics in 1991. OUTCOME VARIABLES: Antibody responses were determined at 6, 7, and 12 months of age to Haemophilus influenzae type b polysaccharide (Hib), to diphtheria and tetanus toxoids, and to oral polio virus (OPV) immunizations. RESULTS: Of 370 full-term, healthy infants enrolled, 311 completed the study (107 Control, 101 Nucleotide, 103 human milk/Similac with iron). Intake, tolerance, and growth of infants were similar in all three groups. Compared with the Control group 1 month after the third immunization (7 months of age), the Nucleotide group had a significantly higher Hib antibody concentration (geometric mean concentrations of 7.24 vs 4.05 micrograms/mL, respectively), and a significantly higher diphtheria antibody concentration (geometric mean of 1.77 vs 1.38 U/mL). The significantly higher Hib antibody response in the Nucleotide group persisted at 12 months. The antibody responses to tetanus and OPV were not enhanced by nucleotide fortification. There also was an effect of breastfeeding on immune response. Infants who breastfed had significantly higher neutralizing antibody titers to polio virus than either formula-fed group (1:346 vs 1:169 and 1:192 in the Control and Nucleotide groups, respectively) at 6 months of age. CONCLUSION: Infant formula fortified with nucleotides enhanced H influenzae type b and diphtheria humoral antibody responses. Feeding human milk enhanced antibody responses to OPV. Dietary factors play a role in the antibody response of infants to immunization.

Use of soy fiber in acute diarrhea in infants and toddlers.

Soy fiber has been shown to reduce the duration of watery stools during acute diarrhea caused by bacterial and viral pathogens in underdeveloped countries. A randomized blinded clinical trial was conducted with middle-class American children to assess the efficacy of soy fiber-supplemented infant formula. Stool characteristics, intake, and weight were recorded. Infants > 6 months of age (n = 44) fed soy fiber-supplemented formula (Isomil DF) had a significantly shorter estimated median duration of diarrhea (9.7 hours vs. 23.1 hours) than those fed soy formula (Isomil). The use of fiber-supplemented soy formula may reduce the duration of diarrheal symptoms in U.S. infants more than 6 months of age with acute diarrhea.

Evaluation of the effect of a fiber-enriched formula on infant colic.

Because infants with colic appear to have abdominal pain similar to that of adults with irritable bowel syndrome, who may benefit from the addition of fiber to their diet, we tested whether fiber added to infant formula would alleviate colic. Twenty-seven normal, term infants (aged 2 to 8 weeks; 14 girls) with colic, defined as crying plus fussing for more than 3 hours a day for at least 3 days of a 6-day baseline period, were enrolled. Infants were randomly assigned in 9-day periods to a sequence of placebo (Isomil formula) followed by fiber-supplemented formula (Isomil plus soy polysaccharide) (n = 12) or the reverse (n = 15). Daily diaries of crying, fussing, sleeping, formula, intake, and stooling were kept. Twenty-two infants completed three lactulose breath hydrogen tests at the end of the baseline period and after each study period. The crossover trial was followed by 30 to 35 days of use of the study formula chosen by the parents as most beneficial but unknown to the investigators. Growth was monitored throughout. Serum cholesterol, calcium, phosphate, albumin, iron, and zinc concentrations were measured at the conclusion. There were no significant differences in average daily time spent by the infants in fussing and crying during ingestion of the fiber-supplemented formula. However, parents of 18 of 27 infants chose fiber-supplemented formula as most beneficial in ameliorating symptoms of colic. While the infants were consuming fiber-supplemented formula, stool frequency increased, and breath hydrogen excretion increased significantly, in response to lactulose. Growth and serum biochemical measurements were normal in all infants. Supplementation of infant formula with the level of soy polysaccharide used in this study may have reduced crying and fussing in some infants but did not affect colicky behavior in the majority of infants, who continued to cry and fuss excessively.

Comparative absorption of [13C]glucose and [13C]lactose by premature infants.

Oxidation of orally administered [13C]glucose and [13C]lactose and fecal recovery of malabsorbed substrates were determined in two groups of premature infants. Eighteen studies were performed with six infants at Johns Hopkins Hospital (JHH); 24 studies were performed with nine infants at Columbus Children's Hospital (CCH). The two groups differed in that JHH infants had shorter gestations but were older when studied. Fecal 13C loss after [13C]glucose administration did not differ between the two groups. Compared with glucose, the metabolism of lactose appeared to involve more malabsorption and colonic fermentation in JHH infants than in CCH infants and resulted in higher fecal losses of substrate carbon. Maturation appeared to involve increased proximal intestinal absorption and greater retention of absorbed carbohydrate. Simultaneous absorption of substrate from the small and large intestine may limit the usefulness of breath tests for 13C in the premature infant.

Randomized trial of taurine supplementation for infants less than or equal to 1,300-gram birth weight: effect on auditory brainstem-evoked responses.

Taurine may be important to the developing eye and brain of the small preterm infant. A blinded randomized trial was conducted to determine whether taurine supplementation of healthy infants of less than or equal to 1,300 g birth weight until their discharge from the hospital increases their growth rate, neurobehavioral development, electroretinographic development, or maturation of auditory brainstem-evoked responses. Infants were fed with Similac Special Care as desired, which was prepared to contain less than 5 mg/L of taurine or 45 mg/L of taurine, a concentration similar to that of human milk. Infants who did not receive taurine supplementation (n = 19) and those who did (n = 18) were similar with respect to condition at study entry, caloric intake, and growth rates throughout the study, and electroretinographic findings and scores on the Brazelton Behavioral Assessment Scale at 37 weeks' postmenstrual age. Infants who received taurine supplementation had greater overall plasma taurine concentrations. The group receiving taurine supplementation also had more mature auditory-evoked responses at 37 weeks' postmenstrual age with a modest (0.2 to 0.5 ms) but consistent reduction (P less than .05) in the interval between stimulus and response at two different stimulation rates. Although further study is needed, taurine intake appears to influence auditory system maturation of preterm infants.

Growth and adiposity of term infants fed whey-predominant or casein-predominant formulas or human milk.

Growth, estimated composition of weight gained, and stool patterns of term infants who were fed either a whey-predominant formula or a casein-predominant formula in a random design and of breast-fed infants were compared. All infants (N = 111) were healthy, singleton products of uncomplicated pregnancies. Birth weights and other anthropometric measures in the first few days of life were not different among the three feeding groups. Formula or breast milk was the infants' principal source of energy from birth to age 16 weeks. Average energy intakes of formula-fed infants and change of intakes with age were similar in both groups at all ages. Feeding groups were not significantly different at any age in weight, length, weight or length gain, head circumference, skinfold measurements, upper arm fat area and muscle area, or estimated total body fat. Stools of infants on the whey-predominant formula differed from both the breast-fed and casein-predominant formula groups.

Efficacy of a timed-release antihistamine/decongestant tablet for symptoms of nasal allergy.

In a double-blind study, a timed-release tablet containing carbinoxamine maleate 8 mg and pseudoephedrine hydrochloride 120 mg was compared with placebo for the treatment of signs and symptoms of nasal allergy. Ninety-four adults with rhinitis caused by grass or ragweed allergy were paired according to severity of symptoms and nasal congestion, then assigned randomly to drug or placebo. After baseline measurements were taken, three doses of drug or placebo were given at 12-hour intervals. The active drug was significantly better than placebo in relieving the following symptoms: nasal congestion, nose blowing, sneezing, nasal pruritus, rhinorrhea, ophthalmic pruritus, and sniffles. Improvement over baseline in mean total nasal air flow also was greater in subjects given active drug. The incidence of nonspecific symptoms, including possible drug side effects, was similar between groups. We conclude that the timed-release tablet is safe and effective therapy for the treatment of signs and symptoms of nasal allergy.

Postvaccine era measles epidemiology.

Measles incidence in the United States was calculated from estimates of the United States Immunization Survey for the years 1965 to 1975. These data were examined according to birth cohorts and cross-sectionally by age to determine the effect of live measles virus vaccine on measles epidemiology. The results showed a high rate of infection for children aged 1 year, followed by a decrease in the infection rates for preschool children, with rates increasing agin at ages 5 and 6 years. It was hypothesized that an effective vaccine-induced herb immunity exists in preschool children until they are of school age. When incidence rates were based on susceptible children, the highest rates occurred in the school-aged populations.

Review of training and evaluation studies in expanded functions for dental auxiliaries.

A review of the literature on research in expanded functions for dental auxiliaries is presented. Summaries of each of the training and evaluation studies sponsored by both private and government agencies are given. Wide variation in research methods of these studies and the failure to report important details make it difficult to interpret and use the research findings. Results from all studies indicate that dental auxiliaries can, with the proper training, perform selected reversible and irreversible dental procedures at an acceptable level of quality. Future research should be conducted in private practice settings and in new oral health care delivery systems with various configurations of expanded function dental auxiliaries.

Evaluation of student performance in the four-year study of expanded functions for dental hygienists at the University of Iowa.

A comparison was made of the quality of selected operative and periodontal procedures completed by expanded-function dental hygiene and senior dental students. Each student group included 48 students selected from all academic quartiles of their respective classes. The evaluated operative procedures included a Class II preparation and amalgam restoration and a Class III preparation and composite restoration. Both operative procedures were completed twice, once on a patient and once on a Dentoform. The periodontal procedures were completed on patients and included a periodontal examination, a periodontal treatment plan, and one quadrant of root planing and soft tissue curettage. Three examiners independently rated each student's performance in an examiner-blind situation. Examiners judged numerous criteria for each procedure as satisfactory or unsatisfactory. In addition, an overall rating of excellent, clinically acceptable, or unacceptable was given to each procedure. Comparisons between student groups of the time required to complete procedures showed that dental students completed cavity preparations of all operative procedures and quadrants of root planing and curettage in significantly less time than did dental hygiene students. For restorations, periodontal examinations, and treatment plans, there was no significant difference between student groups in the time required to complete procedures. In general, the results of the study showed that the dental hygiene students were able to perform selected operative and periodontal procedures at a comparable level to that of senior dental students.

Analysis of interpretations of full-mouth and panoramic surveys.

The purposes of this study were to determine differences in interpretation of radiographic findings of full-mouth and panoramic surveys by junior and senior dental students and differences in their interpretive skills. The parameters of interest were caries, incipiencies, lamina dura interruptions, periodontal membrane changes, and periapical bone changes. The questions to be answered regarding the differences between the full-mouth and panoramic surveys were: (1) In which type of radiograph were the most lesions found? (2) In which type of radiograph are the most "non-existing" lesions found? (3) In which type of radiograph are the most lesions undetected? (4) Does the junior or senior dental student demonstrate the most accuracy in his interpretation?