Absence of hypermetabolism after operation in the newborn infant.

This study was designed to assess the effect of operative stress on resting energy expenditure (REE) in the newborn infant. In 13 neonates who had an uncomplicated abdominal, thoracic, or spinal operation, REE was measured both preoperatively and on the third postoperative day. The mean preoperative REE of 43.19 +/- 7.95 kcal/kg per day was not significantly different from the mean postoperative REE of 41.70 +/- 7.94 kcal/kg per day. Sixteen neonates had REE measured on the first, second, and seventh postoperative days. The mean postoperative REE values of 43.12 +/- 6.92, 42.41 +/- 7.58, and 46.33 +/- 6.89 kcal/kg per day at 1, 2, and 7 days, respectively, were not significantly different from the preoperative REE. There was no significant difference in oxygen consumption, carbon dioxide production, and respiratory quotient between the preoperative and postoperative groups. In this study, an uncomplicated operation did not increase REE in the neonate.     

Equation to estimate resting energy expenditure in adolescents with sickle cell anemia

BACKGROUND: Basal energy requirements are higher in adolescents with sickle cell anemia (SCA) than in healthy control subjects. However, no equation is available to accurately predict their energy needs. OBJECTIVE: Our objective was to develop a clinically useful equation to estimate resting energy expenditure (REE) in adolescents with SCA. DESIGN: REE and other components of total energy expenditure were measured in adolescents with SCA (n = 37) and in control subjects (n = 23) for 24 h in a whole-room indirect calorimeter. Multiple linear regression analysis was used to describe the relations of REE with independent variables such as sex, weight, height, fat-free mass, fat mass, age, and hemoglobin concentration in adolescents with SCA. The Bland-Altman comparison technique was used to compare values predicted by existing equations with measured REE values. RESULTS: Mean (+/-SD) measured REEs were 7746 +/- 974 and 6332 +/- 869 kJ/d in the male and female subjects with SCA, respectively, and these values were 16% higher than those in the healthy control subjects. Standard equations underestimated REE by 12% (P 相似文献   

Weight gain in adolescents during pregnancy: rate related to birth-weight outcome.

This study of 459 subjects from prenatal clinics for teenagers at three universities across the United States, addresses questions about gestational weight gain in adolescents raised by the 1990 Institute of Medicine Report. Rate and pattern of gain, independent of pregravid weight, are based on serial measures of mothers with favorable and unfavorable outcomes. Rate of gain (determined by using regression statistics) from weeks 15 to 40 was 0.588, 0.510, and 0.488 kg/wk for mothers of term infants weighing 3000-4000 g, term infants weighing < 3000 g, and preterm infants, respectively. The significantly lower percentage of infants weighing 3000-4000 g vs < 3000 g needing intensive care at birth (6% vs 15%, respectively, P < 0.05) further indicates the superior outcome among mothers with higher rates of gain. Rate of gain of mothers of infants weighing 3000-4000 g (favorable outcome) equaled the highest amount provisionally recommended, suggesting that restricting natural gain of adolescents to recommended rates may result in smaller than optimal infants.     

Energy intake, energy expenditure, and body composition of poor rural Philippine women throughout the first 6 mo of lactation.

Between 6 and 30 wk postpartum, body weight and body-fat mass of 40 healthy, rural, lactating Filipino women decreased by 1.5 (P < 0.05) and 0.7 kg (P < 0.05), respectively. Energy intake decreased slightly (NS) from 8.84 +/- 2.05 MJ/d (2113 +/- 489 kcal/d; mean +/- SD) at 6 wk to 8.67 +/- 2.37 MJ/d (2073 +/- 566 kcal/d) at 30 wk. Basal metabolic rate (BMR) remained unchanged throughout lactation, and physical-activity level increased significantly (P < 0.05) from 1.61 +/- 0.17 x BMR at 6 wk to 1.97 +/- 0.18 x BMR at 30 wk. Energy intakes at 6 and 30 wk of lactation were 1.02 and 0.77 MJ/d (244 and 185 kcal/d) higher (P < 0.05), respectively, than in early pregnancy. At ages 1-6 mo, mean weights and lengths of mainly breast-fed infants had Z scores between 0 and -1. By using the growth patterns of the breast-fed infants as proxy indicators for adequacy of lactational performance, this study suggests that present recommended energy intakes for lactation are too high for healthy Filipino women who show adequate lactational performance.     

Energy stress during pregnancy and lactation: consequences for maternal nutrition in rural Bangladesh

OBJECTIVE: To assess the relationship of energy stress during pregnancy and lactation to maternal body stores in marginally nourished rural Bangladeshi women. SUBJECTS AND METHODS: Two-hundred and fifty-two women were followed from 5-7 months of pregnancy until 6 months postpartum. Energy intake was estimated during pregnancy and at 1, 3 and 6 month(s) postpartum using 24 h dietary recall. Body weight was measured on enrollment, another once or twice during pregnancy, and at 1, 3 and 6 month(s) postpartum. The weekly rates of pregnancy weight gain and postpartum weight changes were determined. Weight and length of the infants were measured at birth and at approximately 1, 3 and 6 month(s). RESULTS: Maternal energy intake at 5-7 months of gestation was 1464+/-416 kcal/day (mean+/-s.d.). Women gained a mean of 200 g/week or a total of 4 kg during the second half of pregnancy. An analysis of maternal weight showed no indication of accrual of fat stores during pregnancy. Dietary energy during lactation exceeded the intake during pregnancy by 248-354 kcal/day. Mothers lost an estimated average of 1 kg of weight during the first 6 months of lactation. The mean (+/-s.d.) birth weight was 2.55+/-0.38 kg, and the prevalence of low birth weight (<2500 g) was 48%. Infants exhibited some catch-up growth only during the first 3 months but overall growth during the first 6 months did not change from their relative status at birth when compared with NCHS reference. CONCLUSIONS: These rural Bangladeshi women failed to gain sufficient weight during the last half of pregnancy to maintain body weight during lactation when the energy demand is high. Poor growth of their primarily breastfed infants raises concern about the adequacy of lactation in this community.     

分娩巨大儿孕妇体重的危险因素分析

目的 探讨孕妇孕期增重及各孕期体重增加速度与分娩巨大儿的相关性,减少巨大儿的发生率.方法 采用病例对照研究方法,将106例巨大儿和109例正常体重出生儿(对照组)母亲的孕前体重及孕期体重变化等资料作一回顾性分析. 结果 经过单因素和多因素非条件logistic回归分析表明,孕前体重(OR=2.204,95%CI:1.377～3.529)、孕12～20周体重增加速度(kg/周,OR=1.961,95% CI:1.204～3.194)、孕20～30周体重增加速度(kg/周,OR=1.811,95%CI:1.078～3.041)、孕30周至产前体重增加速度(kg/周,OR=1.858,95%CI:1.095～3.153)、男性婴儿(OR=2.630,95%CI:1.420～4.850),是发生巨大儿的危险因素.值得注意的是孕30周后每周体重增加在0.5～1.0 kg的孕妇比每周体重增加在0.5 kg以下的孕妇发生巨大儿的风险增加1.13倍(OR=2.13,95%CI:1.07～4.22). 结论 巨大儿的发生与孕妇孕前体重、孕期增重、胎儿性别等因素相关.     

Maternal and cord blood metal concentrations and low birth weight--a case-control study

There has been speculation on the possible role of trace metals in contributing to the occurrence of low birth weight, but few data are available for most metals. Twenty-five women giving birth to infants weighing between 1500 and 2500 g (cases) and 50 women giving birth to infants weighing more than 2500 g (controls) were studied. The cases and controls were matched for age +/- 4 years), race, and socioeconomic status. Cord blood and maternal blood collected at delivery were analyzed by atomic absorption spectrophotometry for calcium, magnesium, copper, lead, and iron. Significant differences between the mean blood metal concentrations of the low birth weight and control groups were found for calcium (P less than 0.001) and iron (P less than 0.05) in the maternal blood samples and for calcium (P less than 0.001) and iron (P less than 0.01) in the cord blood samples. All concentrations were lower in the low-birth weight group except for the maternal iron level. No significant differences between the low birth weight and control groups were found for copper, lead, and magnesium in either maternal or cord blood.     

The effect of feeding route (i.v. or oral) on the protein metabolism of the neonate

We have examined the effect of the route of feeding (intravenous versus enteral) on the protein metabolism of postsurgical human neonates. Twelve infants, birth weight 2.5 +/- 0.2 kg, gestational age 38 +/- 1 wk, were studied. The IV study was carried out 1-4 days after surgery at a postnatal age of 14 days and a weight of 2.6 +/- 0.2 kg. The repeat (oral) study was carried out 16 days later. Protein intakes were similar during both studies (2.7 g/kg/d). Energy intakes were within the requirement range for age and feeding route and were: IV, 85 +/- 4 kcal/kg/d; oral, 111 +/- 7 kcal/kg/d. Whole body protein metabolism was studied using a continuous infusion of 15N-glycine. Amino nitrogen flux, protein synthesis, and breakdown were 40% higher during the enteral than the IV studies (p less than 0.001). Skeletal muscle degradation was investigated by measuring urinary excretion of creatinine and N-T-methylhistidine. No differences were detected due to feeding route. We suggest that the differences seen in whole body protein turnover rates reflect the rapid growth and development of the gut in the enterally (rather than the IV) fed infant.     

Maternal zinc supplementation does not affect size at birth or pregnancy duration in Peru.

To estimate the effect of maternal zinc deficiency on pregnancy outcomes, we conducted a zinc supplementation trial in an urban shantytown in Lima, Peru, a population with habitual low zinc intakes. Beginning at 10-24 wk gestation, 1295 mothers were randomly assigned to receive prenatal supplements containing 60 mg iron and 250 (g folate, with or without 15 mg zinc. Women were followed up monthly during pregnancy. At birth, newborn weight was recorded, and crownheel length, head circumference and other circumferences and skinfold thicknesses were assessed on d 1. At delivery, 1016 remained in the study; duration of pregnancy was known for all women, and birth weight information was available for 957 newborns. No differences were noted in duration of pregnancy (39.4 +/- 2.2 vs. 39. 5 +/- 2.0 wk) or birth weight (3267 +/- 461 vs. 3300 +/- 498 g) by prenatal supplement type (iron + folate + zinc vs. iron + folate; P > 0.05), and there were no differences in the rates of preterm (<37 wk) or post-term (>42 wk) delivery, low birth weight (<2500 g) or high birth weight (>4000 g). Finally, there were no differences by prenatal supplement type in newborn head circumference, crownheel length, chest circumference, mid-upper arm circumference, calf circumference or skinfold thickness at any of three sites. Adjustment for covariates and confounding factors did not alter these results. Adding zinc to prenatal iron and folate tablets did not affect duration of pregnancy or size at birth in this population.     

Leucine metabolism in preterm infants receiving parenteral nutrition with medium-chain compared with long-chain triacylglycerol emulsions

BACKGROUND: Although medium-chain triacylglycerols (MCTs) may be utilized more efficiently than long-chain triacylglycerols (LCTs), their effect on protein metabolism remains controversial. OBJECTIVE: The aim of the study was to compare the effects of mixed MCT-LCT and pure LCT emulsions on leucine metabolism in preterm infants. DESIGN: Fourteen preterm [gestational age: 30+/-1 wk; birth weight: 1409+/-78 g (x +/- SE)] neonates were randomly assigned to receive, from the first day of life, either a 50:50 MCT-LCT (mixed MCT group; n = 7) or an LCT (LCT group; n = 7) lipid emulsion as part of an isonitrogenous, isoenergetic total parenteral nutrition program. On the fourth day, infants received intravenous feeding providing 3 g lipid, 15 g glucose, and 3 g amino acids kg(-1) x d(-1) and underwent 1) indirect calorimetry and 2) a primed, 2-h infusion of H13CO3Na to assess the recovery of 13C in breath, immediately followed by 3) a 3-h infusion of L-[1-13C]leucine. RESULTS: The respiratory quotient tended to be slightly but not significantly higher in the mixed MCT than in the LCT group (0.96+/-0.06 compared with 0.93+/-0.03). We did not detect a significant difference between the mixed MCT and LCT groups with regard to release of leucine from protein breakdown (B; 309+/-40 compared with 257+/-46 micromol x kg(-1) x h(-1)) and nonoxidative leucine disposal (NOLD; 296+/-36 compared with 285+/-49 micromol x kg(-1) x h(-1)). In contrast, leucine oxidation was greater in the mixed MCT than in the LCT group (113+/-10 compared with 67+/-10 micromol x kg(-1) x h(-1); P = 0.007). Net leucine balance (NOLD - B) was less positive in the mixed MCT than in the LCT group (-14+/-9 compared with 28+/-10 micromol x kg(-1) x h(-1); P = 0.011). CONCLUSION: Mixed MCTs may not be as effective as LCT-containing emulsions in promoting protein accretion in parenterally fed preterm neonates.     

Birth weights in two rural hospitals in the United Republic of Tanzania

Low birth weight (less than 2500 gm) is considered a health indicator by the World Health Organization. Birth weight data are scarce in Africa; therefore, this study was made of 2319 births in Lugarawa hospital from 1976-79 and 4372 births at Mbozi hospital from 1980-83. Infants weighing less than 1000 gm were considered abortions and were not included. Of the 2319 live births at Lugarawa, 402 weighed less than 2500 gm, and of the 4372 live births at Mbozi 678 did. The mean weight of singleton births at Mbozi was 2946 gm. The infants of primiparas weighed less than did those of multiparas, and male infants weighed more than female infants, but the difference deceased with increasing parity. 13% of women taller than 150 cm, 26% of women shorter than 146 cm, and 18% of women between 146 and 150 cm had low-eight babies. Perinatal mortality of low birth weight infants in Mbozi was compared with that of a mixed-race population in Amsterdam. The risk of perinatal mortality was greater in Mbozi for all birth weights, but the highest relative risk was among infants in Mbozi who weighed more than 1500 gm. Mortality of infants weighing between 1500 and 1999 gm was almost the same in Mbozi as in Amsterdam, where there were facilities for prenatal care, which were nonexistent in Mbozi. The cause of the greater mortality of the heavier infants in Mbozi was cephalopelvic disproportion. Obstructed labor was the most frequent cause of perinatal mortality in Mbozi (26%), and 85% of these infants weighed more than 2500 gm. Thus, although providing dietary supplements to pregnant women who are nutritionally at risk will reduce perinatal mortality due to low birth weight, it may increase the risk of deaths due to prolonged and obstructed labor.     

Continuous insulin infusion in hyperglycaemic very-low-birth-weight infants receiving parenteral nutrition

Continuous infusion of insulin was used to improve glucose tolerance in 30 premature (26.4+/-1.4 weeks) very-low-birth-weight (750+/-211.3 g) hyperglycaemic infants receiving parenteral nutrition. Infusion of insulin was started at 159.1+/-67 h of life; while glycaemia was 12.1+/-3.3 mmol/l. Normoglycaemia was restored within 31.4h (range 2-134 h). A maximum insulin dose of 0.4 (range 0.07-4.2)IU/kg/h was required to control the blood glucose, the mean cumulative doses of insulin required was 3.27 IU/kg (range 0.09-18.1). The mean glucose infusion rate during insulin treatment was 20.3+/-1.7 g/kg/day; lipid was 4.6+/-1.1 g/kg/day and non-protein caloric intake 121.7+/-16.5 kcal/kg/day. Infants reach 85 kcal/kg/day of non-protein energy intake at 179.5+/-71.2 h after birth. During continuous insulin infusion, enteral feeding was started in all infants at 124.9+/-75.8 h of life. Insulin was continued for 317.7+/-196.6 h. Only two infants lost weight during the first week of treatment, the remaining infant gained weight steadily. In conclusion, continuous insulin infusion can rapidly and safely improve intravenous glucose tolerance, allowing higher caloric intake and growth in very-low-birth-weight infants who develop hyperglycaemia during total parenteral nutrition.     

Body composition of neonates from fan beam dual energy X-ray absorptiometry measurement

BACKGROUND: Fan beam dual energy x-ray absorptiometry (FB DXA) has recently been validated for the measurement of body composition in small subjects. This study represents the first report of body composition (bone mineral content, fat mass, and lean mass) in human neonates measured by FB DXA. METHODS: FB DXA measurements were performed in 73 healthy singleton neonates with mean +/- SD birth weights 3354 +/- 316 g (range, 2720 to 3982 g) and gestational ages 39.5 +/- 1.2 weeks (range, 37 to 42 weeks). There were 26 white (11 male infants, 15 female infants), 42 African American (17 male infants, 25 female infants), and 5 Hispanic (4 male infants, 1 female infant) infants. The predictive ability of physiologic parameters to predict body composition measurements was determined with regression analysis. RESULTS: The mean +/- SD for bone mineral content was 89.3 +/- 14.1 g, fat mass was 485 +/- 14.1 g, and lean mass was 2898 +/- 281.5 g. Weight was significantly correlated with all DXA measurements and was the single best predictor of body composition. Weight alone contributed 32% to 98% of the variance of the DXA measured parameters. Gender, race, and length were additional predictors that could be forced into a predictive equation for selected DXA dependent variables according to statistical significance. An independent gender effect was also demonstrated, with male infants having higher lean mass but lower fat mass. CONCLUSIONS: Our data in human neonates demonstrated the ability of FB DXA to measure body composition. Body weight is the best physiologic predictor of overall body composition. There is also an independent gender effect on soft tissue body composition.     

Evaluation of transthyretin as a monitor of protein-energy intake in preterm and sick neonatal infants

In the past, weight and weight gain have been the two parameters used frequently in neonatal units to monitor nutrition among high-risk infants. Our investigation sought to assess how several anthropometric measures (weight, length, head circumference, arm:head circumference ratio, and tricep skinfold) and serum albumin, transthyretin, and transferrin concentrations reflect protein and energy intake. After monitoring 42 preterm and 40 sick infants over 3 consecutive weeks, we found that transthyretin concentration proved the only serum protein which accurately measured energy and protein intakes in less than 1 week from dietary manipulation. Among preterm infants, as protein and energy intakes rose, transthyretin concentration increased significantly (p less than 0.001). Preterm infants ingested 79 +/- 39 kcal/kg/day and 2.04 +/- 1.02 g protein/kg/day at the first assessment point after birth and rose to 103 +/- 34 kcal/kg/day and 2.64 +/- 0.94 g protein/kg/day. Likewise, transthyretin measured 10.83 +/- 3.91 mg/dl at the initial measurement and rose to 14.80 +/- 4.44 at the second measurement time. Although protein intakes measured slightly lower in the sick group, their intakes correlated to transthyretin concentration (assessment time 1, r = 0.39; time 2, r = 0.33; time 3, r = 0.33). Thus, transthyretin concentration in neonatal infants offers a rapid, accurate, and moderately inexpensive way to monitor protein-energy adequacy.     

The effect of severe undernutrition and subsequent refeeding on whole-body metabolism and protein synthesis in human subjects

BACKGROUND: To determine the consequences of severe undernutrition and refeeding on whole-body metabolism and protein synthesis. METHODS: Respiratory quotient (RQ), resting energy expenditure (REE), and whole-body protein synthesis (WBPS) were assessed in undernourished patients, with anorexia nervosa (n = 8) or with coexistent disease (n = 17). Results were compared with 17 healthy controls. Six anorexic patients and 13 disease patients consented to study after nutrition support. RESULTS: Mean body mass index was 12.46 +/- 0.53 kg/m2 in the anorexia patients and 13.81 +/- 0.40 kg/m2 in the disease patients (controls 23.71 +/- 0.72 kg/m2; p < .001). Compared with controls, RQ was similar in anorexia patients (0.85 +/- 0.05 vs 0.90 +/- 0.05) but lower in the disease patients (0.76 +/- 0.03 vs 0.90 +/- 0.05; p = .02). REE was lower in the patients (anorexia 1058 +/- 134.0 kcal/d, disease 1189 +/- 101.4 kcal/d vs 1828 +/- 89.76 kcal/d; p < .001); however, expressed as kcal/kg/d, it was higher (anorexia 32.17 +/- 4.25, disease 31.30 +/- 2.14 vs 25.07 +/- 1.00; p < .05). WBPS was lower in the patients (anorexia 140.9 +/- 10.54 g/d, disease 119.8 +/- 8.57 g/d vs 305.0 +/- 21.64 g/d; p < .001); however, when expressed as g/kg/d, the anorexia patients were similar to controls, whereas the disease patients were lower (3.11 +/- 0.24 vs 4.27 +/- 0.32; p < .05). Refeeding increased RQ in the disease patients (0.84 +/- 0.03 vs 0.76 +/- 0.03; p < .05), and normalized REE (anorexia 27.65 +/- 3.05 kcal/kg/d, disease 28.90 +/- 1.85 kcal/kg/d). WBPS increased in the disease patients (173.6 +/- 16.38 g/d vs 116.5 +/- 10.15 g/d; p < .01). CONCLUSIONS: Undernutrition is associated with increased REE (kcal/kg/d). Reduction in RQ and protein synthesis (g/kg/d) was evident in those patients with coexistent disease. Refeeding resulted in normalization of RQ, REE (kcal/kg/d), and protein synthesis (g/kg/d).     

Body fat in neonates and young infants: validation of skinfold thickness versus dual-energy X-ray absorptiometry

BACKGROUND: There is an interest in noninvasive measurement of body fat in newborns and infants. Measurement of skinfold thickness (SFT) is a simple clinical method. OBJECTIVE: We correlated fat mass (FM) values of neonates and infants predicted from SFT measurements and compared them with FM values measured by dual-energy X-ray absorptiometry (DXA), a validated in vivo method for determining body fat. DESIGN: The weight, length, body composition (DXA measurement of FM and percentage of body fat), and SFT of 104 healthy term and preterm infants were measured at 0, 2, and 4 mo of age. RESULTS: Mean (+/- SD) FM determined by DXA increased from 440 +/- 220 g at birth to 1310 +/- 450 g at 2 mo of age and to 2170 +/- 605 g at 4 mo of age. The percentage of body fat increased from 13.3% at birth to 24.5% and 31.2% at 2 and 4 mo of age, respectively. An equation was developed to calculate FM (in g) in newborns by using the sum of SFT measurements (in mm) and body length (l; in cm): FM = 68.2 x SigmaSFT((0.0162) x l) - 172.8 (R(2) = 0.948, P < 0.001). CONCLUSIONS: With the use of statistical bootstrap analysis, the results provide an in vivo validation of SFT measurements against DXA for newborns and young infants. Body fat measurements by SFT correlate with FM values determined by DXA (R(2) = 0.936). Estimation of nutritional status is possible with errors (SD) of +/- 75, +/- 170, +/- 300, and +/- 380 g for infants with an FM 2000 g, respectively.     

Relationship of resting energy expenditure with liver function and nutritional status in patients with alcoholic cirrhosis.

Resting energy expenditures (REEs) were measured in 40 alcoholic cirrhotic (AC) patients by indirect calorimetry and corrected for 24-h urinary creatinine and excretion. These REEs were compared according to the stage of severity of the cirrhosis, the nutritional status, and the presence or absence of alcoholic hepatitis (AH). Mean REE was not significantly different between the Child class A, B, and C patients, even when corrected for 24-h urinary creatinine. Mean REE was significantly less in malnourished AC than in well-nourished patients (1308 +/- 285 vs. 1531 +/- 255 kcal, p less than 0.02). However, when measured energy expenditure was corrected for 24-h urinary creatinine, the difference between the two groups of patients disappeared (1800 +/- 540 kcal/g creatinine in malnourished patients vs. 1890 +/- 780 kcal/g creatinine in well-nourished patients). Finally, there was no significant difference between the REE, corrected or not, for the 24-h urinary creatinine in AC with or without AH. Thus, when REE is normalized to lean body mass, represented by 24-h urinary creatinine, the metabolic activity in AC is not dependent on the severity of the cirrhosis, nutritional status, or existence of AH.     

Physical activity and weight loss: does prescribing higher physical activity goals improve outcome?

BACKGROUND: Recommending increased physical activity facilitates long-term weight loss, but the optimal level of physical activity to recommend is unknown. OBJECTIVE: The objective of the study was to evaluate the efficacy for long-term weight loss of recommendations for much higher physical activity than those normally used in behavioral treatments. DESIGN: Overweight men and women (n = 202) were randomly assigned to either a standard behavior therapy (SBT) for obesity, incorporating an energy expenditure (EE) goal of 1000 kcal/wk, or to a high physical activity (HPA) treatment, in which the goal was an EE of 2500 kcal/wk. To help HPA treatment group participants achieve this high exercise goal, their treatment included encouragement to recruit 1-3 exercise partners into the study, personal counseling from an exercise coach, and small monetary incentives. RESULTS: The HPA treatment group reported achieving higher mean (+/- SD) physical activity levels than did the SBT group at 6 mo (EE of 2399 +/- 1571 kcal/wk compared with 1837 +/- 1431 kcal/wk), 12 mo (EE of 2249 +/- 1751 kcal/wk compared with 1565 +/- 1309 kcal/wk), and 18 mo (EE of 2317 +/- 1854 kcal/wk compared with 1629 +/- 1483 kcal/wk) (all P < 0.01). Mean (+/- SEM) cumulative weight losses at 6, 12, and 18 mo in the HPA treatment group were 9.0 +/- 7.1, 8.5 +/- 7.9, and 6.7 +/- 8.1 kg, respectively. In the SBT group, the corresponding weight losses were 8.1 +/- 7.4, 6.1 +/- 8.8, and 4.1 +/- 7.3 kg, respectively. Between-group differences in weight loss were significant at 12 and 18 mo. CONCLUSION: These results suggest that recommendations of higher levels of physical activity (EE of 2500 kcal/wk) promote long-term weight loss better than do conventional recommendations.     

Concurrent administration of albumin with total parenteral nutrition in sick newborn infants.

The effects of concurrent administration of albumin with total parenteral nutrition were studied in 12 premature newborns (birth weight 1.26 +/- 0.1 kg [mean +/- SEM] and gestational age 30 +/- 0.8 weeks [mean +/- SEM]) compared with a control group of 12 premature newborns (birth weight 1.17 +/- 0.2 kg and gestational age 29 +/- 0.1 weeks) who received total parenteral nutrition. All newborns had a plasma albumin level below 3 g/dL and were in cardiorespiratory distress requiring assisted ventilation. Albumin supplementation of total parenteral nutrition resulted in a sustained increase in serum albumin concentration as well as increased mean arterial blood pressures in the study group. Slow albumin infusion had no observed effect on the severity of respiratory distress. Study group infants regained birth weight earlier than control group infants. These data suggest that the concurrent administration of albumin may be clinically beneficial in critically ill newborn infants.     

Energy Expenditure,Protein Oxidation and Body Composition in a Cohort of Very Low Birth Weight Infants

The nutritional management of preterm infants is a critical point of care, especially because of the increased risk of developing extrauterine growth restriction (EUGR), which is associated with worsened health outcomes. Energy requirements in preterm infants are simply estimated, so the measurement of resting energy expenditure (REE) should be a key point in the nutritional evaluation of preterm infants. Although predictive formulae are available, it is well known that they are imprecise. The aim of our study was the evaluation of REE and protein oxidation (Ox) in very low birth weight infants (VLBWI) and the association with the mode of feeding and with body composition at term corrected age. Methods: Indirect calorimetry and body composition were performed at term corrected age in stable very low birth weight infants. Urinary nitrogen was measured in spot urine samples to calculate Ox. Infants were categorized as prevalent human milk (HMF) or prevalent formula diet (PFF). Results: Fifty VLBWI (HMF: 23, PFF: 27) were evaluated at 36.48 ± 0.85 post-conceptional weeks. No significant differences were found in basic characteristics or nutritional intake in the groups at birth and at the assessment. No differences were found in the REE of HMF vs. PFF (59.69 ± 9.8 kcal/kg/day vs. 59.27 ± 13.15 kcal/kg/day, respectively). We found statistical differences in the protein-Ox of HMF vs. PFF (1.7 ± 0.92 g/kg/day vs. 2.8 ± 1.65 g/kg/day, respectively, p < 0.01), and HMF infants had a higher fat-free mass (kg) than PFF infants (2.05 ± 0.26 kg vs. 1.82 ± 0.35 kg, respectively, p < 0.01), measured with air displacement plethysmography. Conclusion: REE is similar in infants with a prevalent human milk diet and in infants fed with formula. The HMF infants showed a lower oxidation rate of proteins for energy purposes and a better quality of growth. A greater amount of protein in HMF is probably used for anabolism and fat-free mass deposition. Further studies are needed to confirm our hypothesis.