Metabolic disturbances in patients with cerebral palsy and gastrointestinal disorders.

Under nutrition and growth failure are common findings in children with cerebral palsy (CP) and neurologically impairments. Electrolyte and micronutrient abnormalities have also been documented. Gastrointestinal (GI) diseases like gastro esophageal reflux disease (GERD), feeding difficulties and constipation have been associated with increased frequency of these derangements. The goal of this study was to determine the prevalence of malnutrition, metabolic and electrolyte abnormalities in pediatric patients with cerebral palsy and gastrointestinal disorders. A retrospective review of 172 medical records was performed out of which 45 subjects did not have any GI problem, 69 patients had constipation and 58 patients either had GERD, esophagitis, gastrostomy and feeding difficulties. Data collected included: weight, length and body mass index, pre-albumin, albumin, vitamin D, potassium, chloride, bicarbonate, calcium, magnesium (Mg), phosphorus. The results demonstrate a significant difference (p = 0.0126) in the values of albumin in children with CP with GI disorders vs. those without. Additionally, a significant difference (p = 0.0129) was found in Mg levels between CP children with constipation vs. GERD/esophagitis/feeding issues/gastrostomy. Results suggest that children with CP and GI disorders have decreased levels of albumin, but normal pre-albumin. The mechanism for this is not completely clear and although we acknowledge importance of nutritional intake for albumin level support, other mechanisms such as low grade chronic inflammation and increased gut and vascular permeability may play a role. The lower levels of Mg in children with CP and constipation could be secondary to the use of laxatives. Further prospective studies looking at nutritional protein intake, gut and vascular permeability and laxative use in this patient population are important for future optimization of health care management.

Choledochal cysts in African infants: a report of 3 cases and a review of the literature.

Choledochal cysts are relatively rare and are an uncommon cause of cholestasis. Early diagnosis and prompt treatment can prevent complications such as cholangitis, cirrhosis and portal hypertension. This article reviews a rarely reported disease in Africans in whom only 3 cases were documented over the 18 year period in Nigeria. The 3 cases were all females with ages between less than a month and 13 months at presentation. All presented with abdominal swelling with or without jaundice or acholic stools. The use of real-time ultrasonography antenatally and postnatally aided the diagnosis in our patients. Two of the patients presented and were operated and both made full recovery confirming the importance of early surgical intervention. The third patient died, and exemplified the consequences of delayed diagnosis and treatment which occur not uncommonly in developing countries mostly because of sparse and or expensive tertiary health care facilities.

The seroprevalence of Helicobacter pylori in a referral population of children in the United States.

OBJECTIVES: The purpose of this study was to determine the prevalence of serum antibodies directed against Helicobacter pylori (H. pylori) in children referred to children's hospitals or medical centers throughout the United States. METHODS: This multisite cross-sectional prospective study involved 992 children from 12 states using a validated anti-H. pylori IgG enzyme immunoassay. The children were recruited into two groups: those without any GI complaints (non-GI referral, n = 619) and those who were referred for endoscopy because of abdominal pain (GI referral, n = 373). RESULTS: GI referral children had a higher rate of seropositivity (22.5%) than non-GI referral children (14.1%) from the same geographic regions. In both groups, older children were more likely to be seropositive for H. pylori, as were nonwhite children and those with lower socioeconomic status. H. pylori seropositivity rates were higher in GI referral children with four or more household members (relative risk [RR] = 1.47; CI 1.01-2.14). Multivariate analysis controlling for age, ethnicity, and household income, showed that presence of GI symptoms were associated with a nearly 2-fold risk for H. pylori seropositivity (odds ratio = 1.77, CI 1.27-2.47). Epigastric pain (RR = 2.21; CI = 1.33-3.66) and having three or more episodes of abdominal pain in the last 3 months (RR = 0.59, CI = 0.35-0.99) were the only specific symptoms significantly associated with H. pylori seropositivity. CONCLUSIONS: The H. pylori seropositivity rate of GI referral children with symptoms of abdominal pain was significantly higher. H. pylori infection in early childhood was found to be associated primarily with the child's household size and socioeconomic status.

Changes in circulating leptin, leptin receptor, and gonadal hormones from infancy until advanced age in humans.

We determined developmental changes in circulating levels of the soluble leptin receptor (sOB-R), leptin, and gonadal hormones in human subjects. In both sexes the rise in leptin with age was associated with a decline in sOB-R, and age-related changes in both parameters preceded the pubertal rise in gonadal hormones. Leptin levels above 10 ng/ml were a strong predictor of sOB-R concentrations, but this predictive value decreased as leptin declined. In young subjects there were no gender differences in serum leptin, but boys had higher sOB-R levels. In adults neither leptin nor sOB-R changed with age, but serum leptin was higher and sOB-R was lower in women than men. There was a significant negative correlation between sOB-R and leptin in women, but not men. The data suggest that bioavailable leptin in the circulation may be increasing more rapidly during development than indicated by total leptin levels, and that these changes may serve as one of the signals to the central nervous system that metabolic conditions are adequate to support pubertal development. Furthermore, the study provides suggestive evidence that leptin regulates the secretion of its own binding protein, but it also appears that an additional gender-specific, leptin-independent, regulatory mechanism is functional before puberty.

Dietary calcium intake in lactose maldigesting intolerant and tolerant African-American women.

BACKGROUND: The relationship between lactose maldigestion, lactose intolerance, and calcium intake in premenopausal African American women is unknown. OBJECTIVE: To determine how intolerance of lactose and dairy products affects intake of calcium in lactose maldigesting premenopausal African American women. DESIGN: Dietary intake of calcium was assessed in 50 premenopausal lactose maldigesting African American women as determined by the breath hydrogen test. Twenty-six women were lactose intolerant and 24 were lactose tolerant by self-reports. RESULTS: The average intake of calcium in lactose maldigesting and intolerant women was significantly lower than in lactose tolerant women (388 +/- 150 mg/day vs. 763 +/- 333 mg/day, p < 0.0001, t test). Neither group reached the newly established Dietary Reference Intake (DRI) for calcium (1,000 mg/day). Major source of dietary calcium in lactose tolerant women were milk and dairy products (45%), and mixed foods containing calcium from non-dairy sources (30%). In lactose intolerant women, 46% of calcium was from mixed foods and only 12% was from milk and dairy products. Lactose intolerant women had higher body mass index (BMI) than lactose tolerant women (p = 0.008, t test), and calcium intake was negatively associated with BMI (R2 = 0.470). CONCLUSIONS: In African American premenopausal women, lactose tolerance facilitates the dietary intake of calcium when compared with their lactose intolerant counterparts. Low calcium intake is associated with higher BMI.