Growth and metabolism in homozygous sickle cell disease

Growth impairment in homozygous sickle cell (SS) disease emerges as early as age six months but the mechanisms for this deficit are unknown. Analysis of longitudinal growth data suggested that adolescent growth and pubertal maturation of Jamaican SS children was delayed but final height was normal. This observation, delayed skeletal maturation, reduced weight for height, and lower subcutaneous fat reserves are consistent with the hypothesis that chronic childhood malnutrition retards growth in SS children. Competition from erythropoiesis may limit the availability of nutrients for growth and this hypothesis was supported by observations that high fetal haemoglobin levels, which reduce the haemolytic rate and therefore erythropoiesis, were associated with more normal growth, and that reducing erythropoiesis in SS patients with chronic hypersplenism by splenectomy was followed by an acceleration in linear growth. High erythropoietic activity may increase metabolism and the mean resting metabolic rate (RMR) relative to lean body mass of 16 post-pubertal SS adolescent boys was 22% greater than age and sex matched controls with a normal (AA) haemoglobin genotype. Adjusting for the higher visceral to somatic mass ratio of SS boys reduced the increase in RMR in SS disease to 8%. The RMR of prepubertal SS boys was also increased (relative to predicted values) but this increase did not correlate significantly with growth or serum transferrin receptor concentrations (a measure of erythropoietic activity). Faced with higher metabolic demands, SS patients have the option of increasing calorie intake or reducing energy expenditure for physical activity. The physical activity level of SS adolescent boys was 30% lower than age and sex matched AA controls suggesting that either the availability of calories or a poor appetite prevented an energy intake sufficient to maintain physical activity. It is therefore postulated that correction of suboptimal childhood nutrition could benefit the physical and mental development of children with SS disease

A Sustainable Solar Water Heater Design

http://deepblue.lib.umich.edu/bitstream/2027.42/106041/1/me589f13Team881section6projectSWH_report.pd

Promotion of faster weight gain in infants born small for gestational age - Is there an adverse effect on later blood pressure?

Background - Being born small for gestational age is associated with later risk factors for cardiovascular disease, such as high blood pressure. Promotion of postnatal growth has been proposed to ameliorate these effects. There is evidence in animals and infants born prematurely, however, that promotion of growth by increased postnatal nutrition increases rather than decreases later cardiovascular risk. We report the long-term impact of growth promotion in term infants born small for gestational age ( birth weight < 10th percentile).Methods and Results - Blood pressure was measured at 6 to 8 years in 153 of 299 ( 51%) of a cohort of children born small for gestational age and randomly assigned at birth to receive either a standard or a nutrient-enriched formula. The enriched formula contained 28% more protein than standard formula and promoted weight gain. Diastolic and mean ( but not systolic) blood pressure was significantly lower in children assigned to standard compared with nutrient-enriched formula ( unadjusted mean difference for diastolic blood pressure, - 3.2 mm Hg; 95% CI, - 5.8 to - 0.5; P = 0.02) independent of potential confounding factors ( adjusted difference, - 3.5 mm Hg; P = 0.01). In observational analyses, faster weight gain in infancy was associated with higher later blood pressure.Conclusions - In the present randomized study targeted to investigate the effect of early nutrition on long-term cardiovascular health, we found that a nutrient-enriched diet increased later blood pressure. These findings support an adverse effect of relative "overnutrition" in infancy on long-term cardiovascular disease risk, have implications for the early origins of cardiovascular disease hypothesis, and do not support the promotion of faster weight gain in infants born small for gestational age

Partial Hydrolyzed Protein as a Protein Source for Infant Feeding: Do or Don't?

Exclusive breastfeeding until the age of six months is the recommended feeding method for all infants. However, this is not possible for every infant. Therefore, a second choice of feeding, as close as possible to the gold standard, is needed. For historical reasons, this has been cow's-milk-based feeding. This paper discusses if this second-choice feeding method should contain intact protein or partially hydrolyzed proteins. The limited data available indicates that mother's milk is relatively rich in bioactive peptides. Whether partially hydrolyzed protein might be a protein source closer to human milk protein content than intact cow's milk needs further research. However, more research on protein and bioactive peptides in mother's milk should be a priority for future scientific development in this field. Results of such research will also provide an answer to the question of which option would be the best second choice for infant feeding if sufficient breast milk is not available

Catch-up Growth in Infants and Young Children with Faltering Growth: Expert Opinion to Guide General Clinicians

Faltering growth (FG) is a problem regularly seen by clinicians in infants and young children (<2 years of age). It can occur due to non-disease related and disease-related causes and is associated with a wide range of adverse outcomes, including shorter-term effects such as impaired immune responses and increased length of hospital stay, and longer-term consequences, including an impact on schooling and cognitive achievements, short stature, and socioeconomic outcomes. It is essential to detect FG, address underlying causes and support catch-up growth where this is indicated. However, anecdotal reports suggest misplaced fear of promoting accelerated (too rapid) growth may deter some clinicians from adequately addressing faltering growth. An invited international group of experts in paediatric nutrition and growth reviewed the available evidence and guidelines on FG resulting from disease-related and non-disease-related effects on nutritional status in healthy term and small for gestational age (SGA) infants and children up to the age of two years in low-, middle- and high-income countries. Using a modified Delphi process, we developed practical consensus recommendations to provide clarity and practical recommendations for general clinicians on how faltering growth should be defined in different young child populations at risk, how faltering growth should be assessed and managed and the role of catch-up growth after a period of faltering growth. We also suggested areas where further research is needed to answer remaining questions on this important issue

Catch-Up Growth in Infants and Young Children With Faltering Growth:Expert Opinion to Guide General Clinicians

Faltering growth (FG) is a problem regularly seen by clinicians in infants and young children (&lt;2 years of age). It can occur due to non-disease-related and disease-related causes and is associated with a wide range of adverse outcomes, including shorter-term effects such as impaired immune responses and increased length of hospital stay, and longer-term consequences, including an impact on schooling and cognitive achievements, short stature, and socioeconomic outcomes. It is essential to detect FG, address underlying causes and support catch-up growth where this is indicated. However, anecdotal reports suggest misplaced fear of promoting accelerated (too rapid) growth may deter some clinicians from adequately addressing FG. An invited international group of experts in pediatric nutrition and growth reviewed the available evidence and guidelines on FG resulting from disease-related and non-disease-related effects on nutritional status in healthy term and small for gestational age infants and children up to the age of 2 years in low-, middle-, and high-income countries. Using a modified Delphi process, we developed practical consensus recommendations to provide clarity and practical recommendations for general clinicians on how FG should be defined in different young child populations at risk, how FG should be assessed and managed, and the role of catch-up growth after a period of FG. We also suggested areas where further research is needed to answer remaining questions on this important issue.</p