Immunological considerations on breast vs. formula feeding.

The breast-fed baby is immunologically protected because the food is uncontaminated, because breast milk contains specific and unspecific constituents directed against microorganisms, toxins and food antigens, and because adverse immunological reactions against constituents of breast milk substitutes, as cow's milk proteins, are avoided. It is not known which of the mechanisms are the most important ones. Antiinfectious properties may also serve to protect the mammary gland. The documented lower morbidity of breast-fed compared to artificially fed infants in developing and developed countries is reviewed. Favourable immunological properties of human milk are sensitive to various ways of treatment, e.g. pasteurization. Exclusive breast feeding until several weeks or months of age appears to modify the relative risk of development of subsequent allergic disease, but the literature on this issue is not entirely conclusive. Breast feeding may also reduce the risk of developing other immunological disorders at later age, e.g. celiac disease and ulcerative colitis.

High sugar worse than high sodium in oral rehydration solutions.

The literature on oral sugar-electrolyte mixtures for treatment of acute diarrhoea is reviewed. Several trials have shown that the solution proposed by the WHO for developing countries containing inter alia 90 mmol/l of sodium and 111 mmol/l of glucose is safe for short term oral rehydration. When used in this manner there is no risk for development of hypernatraemia. The surplus base of the solution is not essential and, furthermore, other anions e.g. acetate may be substitute for bicarbonate. Other modifications of the WHO formula have also been successfully tried, e.g. sucrose 4% (117 mmol/l) instead of glucose 2% (111 mmol/l). A somewhat lower concentration of sucrose may, however, prove to be better. Most acute childhood diarrhoeas are not mediated by enterotoxin and thus not of the secretory type, but temporary malabsorption is common. Therefore, the amount of carbohydrate in oral sugar-electrolyte mixtures should be limited. Osmotic diarrhoea due to carbohydrate malabsorption is a more likely cause of hypernatraemia in dehydrated children than too much dietary sodium. In developed countries prepacked oral sugar-electrolyte mixtures are mainly designed for moderately sick children treated at home. There is no reason to raise the carbohydrate content of these mixtures above that of the WHO formula, but the sodium content must be lower. For most situations in home treatment 50 mmol/l of sodium will be adequate.

Ascariasis and malnutrition. A study in urban Ethiopian children.

Treatment of 13 urban Ethiopian children with mild ascariasis did not produce any evidence of improved intestinal morphology and absorption or nutritional status. Ascariasis treatment had no impact on anthropometric measures in an additional study group of 84 children. A review of the literature reveals that the nutritional consequences of ascariasis are uncertain.

PIP: Ascariasis, highly prevalent among children in developing countries, is thought to cause widespread and important morbidity. The role of ascariasis as a contributory factor in the etiology of childhood malnutrition has been illustrated by clinical observation of patients with massive infection; however, systematic evidence and objective information are scanty. The prevalence of ascariasis among Ethiopian children is about 10% in infants, 28% in children 1-2 years old, and 62% in children over 3 years. 2 clinical trials were conducted to determine the effect of the infection on childhood nutrition and to assess the desirability of allocating scarce resources to treatment and control. In a double blind trial, 13 boys with the infection were given piperazine citrate or a placebo syrup. Stool analyses for worm load, fat and nitrogen excretion, and anthropometric measurements, tests for xylose absorption, and jejunal biopsies were conducted. 24 hour dietary recalls were obtained from the mothers. In the 2nd trial, complete information including anthropometric measurements and incidence of morbidity was obtained on 44 infected and 40 uninfected children between the ages of 1-4 as part of a community study. A double blind system of allocating treatment and placebo to underweight infected and noninfected children and normal weight infected and uninfected children was implemented. The results showed that the individual wormload in the children was low. Initial treatment did not result in complete deworming. The nutritional status of the children was unaffected by treatment, although in the community study, a somewhat lower rate of acute morbidity was noted in treated children. The results of other metabolic and functional studies are inconsistent; in some studies, a treatment effect was noted. However, the results of these studies are questionable because intervening factors, such as the presence of infection in the study groups, were not adequately controlled. The results of other community studies are also inconsistent. So far little clear cut epidemiological evidence exists regarding the relative importance of ascariasis in the causation of malnutrition in communities suffering from concommitant infection and other ills of poverty. Clinical evidence suggests that massive infection may result in malnutrition, and treatment of symptomatic ascariasis is justified. At the community level, deworming programs do not have a clear beneficial nutrition effect.

Plasma amino acid response to single test meals in humans. V. Ethiopian preschool children given lowcost protein supplements.

The plasma amino acid response to single test meals was studied in preschool children, aged 9 months--5 years. The amount of protein given in each test meal was 1 g per kg body weight, which represented one-third of the daily intake of the children who were recovering from protein-energy malnutrition. The test meals given was gruels made from wheat mixed with a supplementary weaning food (Faffa or Superamin) or fish protein concentrate (FPC). The plasma amino acid responses were evaluated both as PAA ratios (a modification of the Longenecker and Hause method), and as deltaMR% (percentage change in the postprandial essential amino acid molar ratios according to Graham and Placko). Both evaluation models indicated that lysine, threonine and methionine were the limiting amino acids in the Faffa/wheat diet, and that lysine and threonine were limiting in the Superamin/wheat diet. All essential amino acids seemed to be supplied in adequate amounts in the FPC/wheat diet. These results were in close agreement with the amino acid score of the diets (based on chemical analysis).

The Zellweger syndrome: subcellular pathology, neuropathology, and the demonstration of pneumocystis carinii pneumonitis in two siblings.

The first Scandinavian cases of Zellweger syndrome (ZS) are described. A brother and sister, children of first cousins, had the typical clinical symptoms and pathological findings. Extensive metabolic studies in the boy were negative. Pipecolic acid in the urine was not elevated. Both children died at 14 weeks of age. Two months earlier the girl had suffered severe intestinal bleeding. Both had pneumocystic carinii pneumonia at autopsy although no evidence of immune deficiency had been found in the boy. The girl had used up her visible iron depots while the boy still had abundant but probably physiologic amounts of hemosiderin in the RES. Most of the cerebral abnormalities are unspecfic and possibly related to anoxia or other causes of delayed maturation. The white matter abnormalities in ZS patients may only be quantitatively different from the common "fatty metamorphosis" in infants. Previously reported ultrastructural abnormalities (absence of peroxisomes and very sparse smooth endoplasmic reticulum, as well as mitochondrial abnormalities) which are possibly unique for ZS, are confirmed. It is stressed that these were seen despite phenobarbital treatment which normally stimulates the formation of smooth endoplasmic reticulum.