Micronutrient Status in Children with Cerebral Palsy

Micronutrients play a principal role in intermediary metabolism as cofactors in numerous enzymatic reactions or in non-enzymatic physiological functions such as in haematopoiesis. They also operate as antioxidants or immune system modulators, as well as being essential in cell proliferation and differentiation. Many micronutrients are essential for human nutrition, while deficiencies may arise if the need is high, intake or absorption is impaired or if excretion rates are increased. Adequate micronutrient levels may lead to improvements in immune function, inflammation and wound healing, catch up growth in children and lean body weight gain in adults, along with an improved psychological profile. The ability to be able to accurately detect and correct marginal depletions in both hospital patients and in more general populations may have significant public health implications. Their role in maintaining cellular homeostasis highlights a need for monitoring micronutrient adequacy, while their proper administration may have a substantial and measurable impact on nutritional adequacy, hospital costs and patient outcome. As limited data exists on micronutrient status in children with Cerebral Palsy (CP), the aims of this thesis were to evaluate micronutrient intake and functional biochemical parameters indicative of whole body nutritional status. Micronutrient status in children with marked forms of CP was explored and also whether percutaneous endoscopic gastronomy (PEG) tube supplemental feeding is adequate to maintain optimal physiological balance in these children. Micronutrient and antioxidant status, as well as other biochemical parameters were assessed in children with severe CP, whether orally or enterally fed, compared to typically developing children. All subjects were prepubescent boys and girls aged 4-12 years. Dietary intake duplicate samples were also analysed, including any supplemental feeds were applicable, for direct content of minerals, trace elements, energy and protein. Preliminary data led to further investigations involving methylation cycle capacity and protein adequacy, both of which revealed some interesting results. Overall these investigations highlighted the intricate workings of body biochemistry and the need for this to be adequately balanced, which calls for focus in these children to be expanded beyond the commonly held theories of nutrition relating mainly to energy intake and expenditure. This thesis will detail the findings of various investigations which have been reported in manuscripts, either under review, in press or published. It will conclude with a general discussion to integrate the most significant findings and also address the limitations of the studies detailed herein

Enabling Valuation of Nutrition Integration into MBBS Program

Good nutrition is the foundation for good health. While basic nutritional assessment is part of many medical consultations, it remains underutilized despite becoming increasingly recognized as important for chronic disease prevention and management. Many studies identify shortfalls in physicians’ knowledge and attitudes toward nutrition as a result of inadequate emphasis in medical school. Additional teaching about nutrition and nutritional assessment procedures was integrated within a first year module of a MBBS program. Blended learning techniques were employed to facilitate student engagement and sessions were evaluated via student response system technology (clickers) or minute paper feedback. The initial survey to all medical students (n=1037) documented that less than half (45%) felt they could discuss nutrition with patients. The majority (n=606) regularly consulted the internet for nutrition information, while only 163 utilised peer-reviewed journals. With the first year cohort (n=297) “clickers” revealed that 91% felt nutrition important to health care and 82% felt it important in general practice. 71% found using clickers an interesting enhancement, whilst 70% noted the nutrition content informative. Early nutrition teaching was well received by students. Long-term increases in nutritional information dissemination, particularly by influential health care workers, might benefit not only economies but also the health of society as a whole

Analysis of lead and cadmium in cereal products and duplicate diets of a small group of selected Brisbane children for estimation of daily metal exposure

Exposure to toxic metals such as lead (Pb) and cadmium (Cd) from foods is a concern for young children. The aims of the study were to analyse the levels of Pb and Cd in breakfast cereals, rice products and diets of selected children, and to estimate the daily intakes of Pb and Cd in these children. The samples (n = 82) of ready-to-eat breakfast cereals and rice products (n = 36) were collected and obtained from various markets in Brisbane, Australia. The samples for a duplicate diet study were collected for 3 consecutive days from normal healthy children (n = 15). The analysis was performed using ICP-MS after microwave digestion. The levels of Pb and Cd found in breakfast cereals and rice products ranged fro

Micronutrient interrelationships: synergism and antagonism

Appropriate physiological functioning requires optimal nutrition, which needs to be in balance to prevent potential detrimental interactions, especially when administered at pharmacological dosages. Many nutrients function in harmony to complement digestive function and assimilation. Some may hinder these processes and compete for uptake, while others may also be required in tandem to assist in metabolism which may ultimately affect a number biochemical cycles.Many similar synergistic and antagonistic functions exist within human physiology and should be considered, particularly in the health and research arenas, where positive outcomes may be more likely if nutrient preparations are formulated with assistant supplementary nutrients, while nutrient related confounders need also to be accounted for. A variety of these are discussed in detail, with emphasis on relationships in health and disease

Micronutrient adequacy and morbidity: paucity of information in children with cerebral palsy

A literature review was conducted to investigate the status of vitamins and minerals in children with cerebral palsy and the implications of various deficiencies on health outcomes. Children with cerebral palsy commonly have feeding difficulties, which significantly impact their growth, general health, and life expectancy. Current nutritional literature focuses on energy expenditure, with little information available on other parameters, such as micronutrient status. Due to the paucity of micronutrient research in these children, the impacts of deficiencies and benefits in other populations have been considered. The role of micronutrients in maintaining cellular homeostasis throughout all body systems highlights a need for future research and monitoring of their levels, particularly in vulnerable populations with well-documented incidence of undernutrition. © 2010 International Life Sciences Institute

Future Doctors' Perceptions about Incorporating Nutrition into Standard Care Practice

Objective: The increasing prevalence of chronic disease has been largely attributed to long-term poor nutrition and lifestyle choices. This study investigates the attitudes of our future physicians toward nutrition and the likelihood of incorporating nutrition principles into current treatment protocols. Methods: Setting: The setting of this study was an Australian university medical school. Subjects: Subjects including year 1–4 students (n D 928) in a 4-year medical bachelor, bachelor of surgery (MBBS) degree program. Students were invited to participate in a questionnaire based on an existing instrument, the Nutrition in Patient Care Attitude (NIPC) Questionnaire, to investigate their attitudes toward nutrition in health care practices. Results: Respondents indicated that “high risk patients should be routinely counseled on nutrition” (87%), “nutrition counseling should be routine practice” (70%), and “routine nutritional assessment and counseling should occur in general practice” (57%). However, despite overall student support of nutritional counseling (70%) and assessment (86%), students were reluctant to perform actual dietary assessments, with only 38% indicating that asking for a food diary or other measure of dietary intake was important. Conclusion: These findings demonstrate that future physicians are aware of the importance of considering nutrition counseling and assessment. However, students are unlikely to adequately integrate relevant nutritional information into their treatment protocols, evidenced by their limited use of a basic nutritional assessment. This is potentially the result of a lack of formal nutrition education within their basic training

Urox containing concentrated extracts of Crataeva nurvala stem bark, Equisetum arvense stem and Lindera aggregata root, in the treatment of symptoms of overactive bladder and urinary incontinence: a phase 2, randomised, double-blind placebo controlled trial

Storage lower urinary tract symptoms (LUTS) including overactive bladder (OAB) and urinary incontinence (UI) affect millions of people worldwide, significantly impacting quality of life. Plant based medicines have been documented both empirically and in emerging scientific research to have varying benefits in reducing bladder symptoms. We assessed the efficacy of Urox®, a proprietary combination of phytomedicine extracts including, Cratevox™ (Crataeva nurvala) stem bark, Equisetem arvense stem and Lindera aggregata root, in reducing symptoms of OAB and UI.Efficacy of the herbal combination on a variety of bladder symptoms compared to an identical placebo, were documented in a randomised, double-blind, placebo controlled trial conducted at two primary care centres. Data were collected at baseline, 2, 4 and 8\ua0weeks, with the primary outcome being self-reported urinary frequency. Statistical analysis included mixed effects ordered logistic regression with post hoc Holm's test to account for repeated measures, and included an intention-to-treat analysis.One hundred and fifty participants (59% female, aged; mean ± SD; 63.5 ± 13.1\ua0years) took part in the study. At week 8, urinary day frequency was significantly lower (OR 0.01; 95%CI 0.01 to 0.02; p