ABSTRACT
OBJECTIVES: The study was designed to evaluate the efficacy, safety, and tolerability of the ketogenic diet (KD) whether classic 4:1 formula or the modified Atkins diet (MAD) in intractable childhood epilepsy. PATIENTS AND METHODS: Anthropometric measurements and serum lipid profile were measured upon enrollment and after 3 and 6 months in 40 patients with symptomatic intractable epilepsy. Fifteen were given MAD diet, ten were kept on classic 4:1 ketogenic liquid formula, and the rest were allowed to eat as desired. RESULTS: The liquid ketogenic formula group showed significantly higher body mass index compared with those who did not receive KD after 6 months. The lipid profile of KD patients was within normal limits for age and sex during the study period. The rate of change of frequency and severity of seizures showed best improvement in ketogenic liquid formula patients followed by the MAD group than the patients on anti-epileptic medications alone. CONCLUSION: The KD whether classic 4:1 or MAD is a tolerable, safe, and effective adjuvant therapy for intractable symptomatic childhood epilepsy with limited adverse effects on the growth parameters and accepted changes in the lipid profile. The liquid ketogenic formula patients showed better growth pattern and significantly more seizure control.
Subject(s)
Diet, Carbohydrate-Restricted/methods , Diet, Ketogenic/methods , Epilepsy/diet therapy , Analysis of Variance , Anthropometry , Body Mass Index , Body Weight , Case-Control Studies , Child, Preschool , Epilepsy/blood , Female , Follow-Up Studies , Humans , Infant , Lipids/blood , Male , Time Factors , Treatment OutcomeABSTRACT
A standard sleep questionnaire was given to the parents of 26 infants with protein-energy malnutrition who underwent polysomnographic evaluation. These investigations were repeated approximately 2 months after enrolment in a nutritional rehabilitation programme based on World Health Organization guidelines. Anthropometric values and serum serotonin levels were also measured. After nutritional rehabilitation there was a significantly higher percentage of non-rapid eye movement (REM) sleep; 2nd REM time, and latency times for sleep and REM sleep increased. Percentages of REM sleep and serum serotonin levels decreased significantly. Protein-energy malnutrition seems to affect the sleep-wake cycle; disturbed serotonin levels may be among the factors responsible.
Subject(s)
Infant Nutrition Disorders/complications , Infant Nutrition Disorders/rehabilitation , Protein-Energy Malnutrition/complications , Protein-Energy Malnutrition/rehabilitation , REM Sleep Parasomnias/etiology , Sleep Disorders, Circadian Rhythm/etiology , Anthropometry , Body Height , Body Weight , Case-Control Studies , Child , Edema/etiology , Egypt , Female , Hemoglobins/metabolism , Humans , Infant , Infant Nutrition Disorders/diagnosis , Nutrition Assessment , Nutritional Support , Polysomnography , Practice Guidelines as Topic , Protein-Energy Malnutrition/diagnosis , REM Sleep Parasomnias/blood , REM Sleep Parasomnias/diagnosis , REM Sleep Parasomnias/epidemiology , Serotonin/blood , Serum Albumin/metabolism , Sleep Disorders, Circadian Rhythm/blood , Sleep Disorders, Circadian Rhythm/diagnosis , Sleep Disorders, Circadian Rhythm/epidemiology , Statistics, Nonparametric , Surveys and QuestionnairesABSTRACT
A standard sleep questionnaire was given to the parents of 26 infants with protein-energy malnutrition who underwent polysomnographic evaluation. These investigations were repeated approximately 2 months after enrolment in a nutritional rehabilitation programme based on World Health Organization guidelines. Anthropometric values and serum serotonin levels were also measured. After nutritional rehabilitation there was a significantly higher percentage of non-rapid eye movement [REM] sleep; 2nd REM time, and latency times for sleep and REM sleep increased. Percentages of REM sleep and serum serotonin levels decreased significantly. Protein-energy malnutrition seems to affect the sleep-wake cycle; disturbed serotonin levels may be among the factors responsible
Subject(s)
Protein-Energy Malnutrition , Serotonin , World Health Organization , Sleep, REMABSTRACT
OBJECTIVE AND DESIGN: The earlier reports of disturbed gastric motility in protein energy malnutrition (PEM) point out to its possible contribution in the difficulties faced during nutritional rehabilitation. This study was thus designed to assess the ultrasonographic gastric emptying time (GET) using 20 ml/kg body weight of both liquid and semisolid meals, in 27 patients suffering from PEM as well as in 15 healthy matching infants to delineate any defect present, its degree in different types of PEM and the effect of nutritional rehabilitation. PATIENTS: The patients were recruited from the in-patient department of Children's Hospital, Ain Shams University, Cairo, Egypt. They were divided into three groups: 10 marasmic infants, 10 marasmic kwashiorkor (marasmic KWO) and seven kwashiorkor (KWO) cases. Ultrasonographic GET assessment was carried out within 72 h of admission and 30+/-7 days after nutritional rehabilitation. RESULTS: The gastric half-emptying time T(1/2) of both liquid and semisolid meals was markedly prolonged in patients with marasmus and marasmic KWO. It was more delayed for the semisolid than the liquid meals. This delay was reversible after nutritional rehabilitation of the patients, indicating that it was secondary to the malnourished status. On the other hand, T(1/2) of both liquid and semisolid meals showed no statistically significant delay in the KWO group and nutritional rehabilitation added no further to the results. CONCLUSION: PEM, especially marasmus and marasmic KWO, causes a delay in GET, which is reversible on nutritional recovery. This must be considered during nutritional rehabilitation of such patients to decrease the duration of their hospitalization and thus decrease the morbidity in PEM.
Subject(s)
Gastric Emptying , Kwashiorkor/physiopathology , Protein-Energy Malnutrition/physiopathology , Stomach/diagnostic imaging , Egypt , Female , Gastric Emptying/physiology , Humans , Infant , Kwashiorkor/diagnostic imaging , Kwashiorkor/rehabilitation , Male , Nutritional Status , Protein-Energy Malnutrition/diagnostic imaging , Protein-Energy Malnutrition/rehabilitation , Stomach/physiopathology , Time Factors , UltrasonographyABSTRACT
To assess the role of enzymatic antioxidants in the pathogenesis of protein energy malnutrition (PEM) and the effect of nutritional rehabilitation, we studied 30 infants with PEM (mean age 10.63 +/- 4.39 months: 10 marasmic; 8 with kwashiorkor; 12 with marasmic kwashiorkor) and 15 controls. All underwent clinical examination and laboratory investigations, including superoxide dismutase (SOD) and glutathione peroxidase (GPx) estimation before and after nutrition rehabilitation. SOD and GPx were significantly lower in all malnourished infants compared to controls, and significantly increased after nutritional rehabilitation. These significant correlations suggest that antioxidants could be introduced during PEM nutritional rehabilitation to decrease morbidity and mortality.
Subject(s)
Antioxidants/metabolism , Infant Nutrition Disorders/enzymology , Infant Nutrition Disorders/rehabilitation , Kwashiorkor/enzymology , Kwashiorkor/rehabilitation , Protein-Energy Malnutrition/enzymology , Protein-Energy Malnutrition/rehabilitation , Anthropometry , Antioxidants/therapeutic use , Case-Control Studies , Egypt/epidemiology , Female , Free Radical Scavengers/blood , Free Radical Scavengers/therapeutic use , Glutathione Peroxidase/blood , Glutathione Peroxidase/deficiency , Glutathione Peroxidase/therapeutic use , Hospitals, Pediatric , Hospitals, University , Humans , Infant , Infant Nutrition Disorders/classification , Infant Nutrition Disorders/epidemiology , Kwashiorkor/classification , Kwashiorkor/epidemiology , Male , Morbidity , Nutrition Assessment , Nutritional Requirements , Nutritional Status , Nutritional Support/methods , Nutritional Support/standards , Practice Guidelines as Topic , Protein-Energy Malnutrition/classification , Protein-Energy Malnutrition/epidemiology , Severity of Illness Index , Superoxide Dismutase/blood , Superoxide Dismutase/deficiency , Superoxide Dismutase/therapeutic use , Treatment OutcomeABSTRACT
To assess the role of enzymatic antioxidants in the pathogenesis of protein energy malnutrition [PEM] and the effect of nutritional rehabilitation, we studied 30 infants with PEM [mean age 10.63 +/- 4.39 months: 10 marasmic; 8 with kwashiorkor; 12 with marasmic kwashiorkor] and 15 controls. All underwent clinical examination and laboratory investigations, including superoxide dismutase [SOD] and glutathione peroxidase [GPx] estimation before and after nutrition rehabilitation. SOD and GPx were significantly lower in all malnourished infants compared to controls, and significantly increased after nutritional rehabilitation. These significant correlations suggest that antioxidants could be introduced during PEM nutritional rehabilitation to decrease morbidity and mortality
Subject(s)
Anthropometry , Antioxidants , Case-Control Studies , Glutathione Peroxidase , Hospitals, Pediatric , Infant Nutrition Disorders , Kwashiorkor , Morbidity , Nutrition Assessment , Nutritional Requirements , Nutritional Status , Nutritional Support , Protein-Energy MalnutritionABSTRACT
Seventy infants and children with bacterial meningitis were studied. All children were treated with ampicillin and chloramphenicol. A significant increase in the cerebrospinal fluid protein concentration determined on admission was found in patients who died as compared to those who survived (P less than 0.05). However, no difference was observed between the admission CSF leukocyte count in those patients who died versus those who survived. From this study, it can be concluded that the determination of CSF protein level on admission is an easy, fast and reliable method that can be used to predict clinical outcomes in acute bacterial meningitis.
