Profiling the diet and body composition of subelite adolescent rhythmic gymnasts

The aim of this study was to investigate the body composition and dietary intake of competitive club-level rhythmic gymnasts, who represent the larger cohort of the sport's practitioners. Fifty-five rhythmic gymnasts and 55 nonathlete females (13-19 years of age) were seen individually to collect a dietary recall and to take anthropometric data and bioelectric-impedance analysis. Gymnasts had lower body-mass index and lesser skinfold thickness, although middle arm-muscle circumference was similar in the 2 groups. Gymnasts had lower body-fat measures but normal levels of fat-free mass (FFM) and body-cellular mass. Gymnasts had better dietary habits than the age-matched controls. Low levels of calcium, phosphorous, iron, and zinc and a disparity between reported energy intake and estimated energy requirement were observed in both groups.     

A nutrition study in juvenile elite gymnasts

Twenty-two female teenagers engaged in elite gymnast training and 22 healthy girls of comparable age were studied with regard to nutritional intake. The mean daily intakes of most nutrients in both groups were in accordance with the Swedish Nutritional Recommendations; exceptions were iron and dietary fibre which were too low in both groups. The individual variation was large in both groups and many subjects had an intake below the nutritional recommendations. Both the gymnasts and the reference group had an energy intake significantly below the estimated energy need. The mean daily energy intake was 725 kcal less than the energy need in the gymnast group and 450 kcal less in the reference group. The clinical investigation revealed that several gymnasts had delayed menarche or irregular menstruation as well as less body fat than the reference group. Among the gymnasts, girls with a regular menstrual pattern had more body fat than those who had not started to menstruate. The higher energy expenditure of the gymnasts could partly explain their smaller amounts of body fat, late pubertal development and menstrual patterns.     

Relation between dietary intake and nutritional status in cystic fibrosis

This study evaluated adherence to current dietary recommendations of children with cystic fibrosis and mild lung disease and their siblings by comparing energy intake. Fifty children (25with cystic fibrosis) aged between 7 and 12 years completed the study. Energy intake was assessed by weighed dietary intake, resting energy expenditure was used to calculate recommended daily intakes. The children with cystic fibrosis had significant deficits in Z scores for both height and weight compared with their siblings, but there was no difference in percentage of ideal weight for height. The cystic fibrosis group had a significantly higher energy intake per kilogram body weight per day but there was no difference in the percentage of energy derived from fat, protein or carbohydrate. Energy intake (per kg/day) and fat intake (g/kg) were both significant predictors of weight for height in the cystic fibrosis group. Targets for dietary management in cystic fibrosis should perhaps be related to fat intake per kilogram body weight.

     

Relation between dietary intake and nutritional status in cystic fibrosis

This study evaluated adherence to current dietary recommendations of children with cystic fibrosis and mild lung disease and their siblings by comparing energy intake. Fifty children (25 with cystic fibrosis) aged between 7 and 12 years completed the study. Energy intake was assessed by weighed dietary intake, resting energy expenditure was used to calculate recommended daily intakes. The children with cystic fibrosis had significant deficits in Z scores for both height and weight compared with their siblings, but there was no difference in percentage of ideal weight for height. The cystic fibrosis group had a significantly higher energy intake per kilogram body weight per day but there was no difference in the percentage of energy derived from fat, protein or carbohydrate. Energy intake (per kg/day) and fat intake (g/kg) were both significant predictors of weight for height in the cystic fibrosis group. Targets for dietary management in cystic fibrosis should perhaps be related to fat intake per kilogram body weight.     

Evaluation of total energy balance and food habits of obese children

Total daily energy expenditure (TDEE) and time spent for activities of different intensities (heart rate monitoring method), as well as dietary and food habits (24-hour dietary recall) in two groups of 12-14 year-old boys, including 35 obese (weight 67.0 kg +/- 9.3, height 162 cm +/- 7.6) and 35 control group boys (weight 46.0 kg +/- 6.5, height 160 cm +/- 7.5) were estimated. Obese boys spent more time at rest and less time on physical activities than nonobese (p < 0.001). That resulted in differences of TDEE expressed per unit of body mass (p < 0.001). Time for sleeping and time in school was not statistically different in the two groups. The evaluation of nutritional habits indicated that the obese boys, when compared with controls, had higher energy intake and significantly higher percentage of fat energy in total energy intake, low intake of fruits and vegetables and irregular frequency of meals during the day. Diets of boys were not balanced with respect to calcium and phosphorus.     

Total but not resting energy expenditure is increased in infants with ventricular septal defects

OBJECTIVE: The purpose of this study was to determine the effect of left-to-right shunting on the resting energy expenditure (REE), total energy expenditure (TEE), and energy intake in a group of 3- to 5-month-old infants with moderate to large unrepaired ventricular septal defects (VSDs) compared with age-matched, healthy infants. METHODS: Eight infants with VSDs and 10 healthy controls between 3 to 5 months of age participated in the study. Indirect calorimetry was used to measure REE and the doubly-labeled water method was used to measure TEE and energy intake. An echocardiogram and anthropometric measurements were performed on all study participants. Daily urine samples were collected at home for 7 days. Samples were analyzed by isotope ratio mass spectrometry. Data were compared using analysis of variance. RESULTS: No significant differences were found in REE (VSD, 42.2 +/- 8.7 kcal/kg/d; control, 43.9 +/- 14.1 kcal/kg/d) or energy intake (VSD, 90.8 +/- 19.9 kcal/kg/d; control, 87.1 +/- 11.7 kcal/kg/d) between the groups. The percent total body water was significantly higher in the VSD infants and the percent fat mass was significantly lower. TEE was 40% higher in the VSD group (VSD, 87.6 +/- 10.8 kcal/kg/d; control, 61.9 +/- 10.3 kcal/kg/d). The difference between TEE and REE, reflecting the energy of activity, was 2.5 times greater in the VSD group. CONCLUSIONS: REE and energy intake are virtually identical between the two groups. Despite this, infants with VSDs have substantially higher TEE than age-matched healthy infants. The large difference between TEE and REE in VSD infants suggests a substantially elevated energy cost of physical activity in these infants. These results demonstrate that, although infants with VSDs may match the energy intake of healthy infants, they are unable to meet their increased energy demands, resulting in growth retardation.     

Growth, nutrient retention, and metabolic response in low birth weight infants fed varying intakes of protein and energy

Growth, nutrient retention, and metabolic response were determined in low birth weight (LBW) infants fed daily protein and energy intakes, respectively, of 2.8 gm/kg and 119 kcal/kg (group 1), 3.8 gm/kg and 120 kcal/kg (group 2), and 3.9 gm/kg and 142 kcal/kg (group 3). The mean rates of both weight gain and nitrogen retention in group 1 were somewhat greater than intrauterine rates; plasma concentrations of transthyretin and albumin also were acceptable. Thus the lower protein intake appeared to be adequate. On the other hand, the rates of weight gain and nitrogen retention in groups 2 and 3 were greater than those in group 1, supporting the efficacy of the higher protein intake with respect to growth. However, blood urea nitrogen and plasma amino acid concentrations also were higher in groups 2 and 3; both were higher in group 2 than in group 3, reflecting the positive effect of the higher energy intake on protein utilization. This observation, combined with data from an earlier study, indicates that protein intakes in excess of 3 gm/100 kcal will not be utilized completely. Energy expenditure in group 3 was greater than in group 1 but not group 2, raising the possibility that protein intakes not utilized completely contribute to diet-induced thermogenesis. The higher energy intake in group 3 vs group 2 did not affect rate of weight gain significantly, but energy storage in group 3, and hence fat accretion, was greater than that of other groups. In all groups the ratio of protein accretion to fat accretion reflected dietary proportions of protein and energy.     

Alterations in serum growth hormone (GH)/GH dependent ternary complex components (IGF-I, IGFBP-3, ALS, IGF-I/IGFBP-3 molar ratio) and the influence of these alterations on growth pattern in female rhythmic gymnasts

BACKGROUND AND AIM: Normal growth in children is regulated to a great extent through the actions of the GH/IGF-I axis, a system consisting of GH and its mediators (ternary complex) that modulate growth in many tissues. The ternary complex (IGF-I/IGFBP-3/ALS) provides an acute regulatory mechanism in which IGF-I may be mobilized from the circulating reservoir of 150 kDa complexes to the tissues. Acute exercise is known to be a stimulus for GH secretion. The beneficial effects of scheduled exercise on body composition are also well established. However, the impact of strenuous exercise on the pubertal development of child athletes is still not well understood. The first goal of this study was to assess the acute effects of high intensity exercise training on GH-dependent ternary complex components in female rhythmic gymnasts compared to age-matched healthy female controls with normal physical activity. The second goal was to explore the influence of these exercise-induced changes on skeletal and pubertal growth in the same group prospectively over a period of 4 years. SUBJECTS AND METHODS: Seventeen female rhythmic gymnasts, aged 11.4 +/- 0.9 years, who had 10 h per week intense exercise for at least 4 months volunteered to participate in this study. Anthropometric measurement of height (Height SDS for chronological age [HtSDS(CA)], parentally adjusted height, predicted adult height), bone age and weight (BMI) were made using standard techniques in gymnasts and controls (aged 12.5 +/- 3.0 years, n = 12). Gymnasts were followed up to 4 years to observe growth velocity and pubertal progression. In order to determine the acute impact of exercise on levels of GH and GH-dependent ternary complex component (IGF-I, IGFBP-3, ALS, IGF-I/IGFBP-3 molar ratio), blood samples were obtained from gymnasts after a routine 2-h high-intensity training program and then after a 2-day rest period. These results were compared with age-matched controls with no scheduled sports activity. RESULTS: Despite the significant increment in serum GH and GH-dependent components immediately following the exercise, serum GH/IGF-I levels showed a significant decrement (p < 0.01) after a 2-day rest in gymnasts, to a nadir as low as those of the control subjects' baseline levels (p < 0.01). There was no difference in anthropometric characteristics of gymnasts and controls except BMI; gymnasts were leaner than controls. During a 4-year follow up, there were no differences between the gymnasts and controls in regard to skeletal growth and reaching their predicted height. However, in gymnasts there was a delay in pubertal tempo but not in growth. CONCLUSION: Intense exercise induces an acute rise in GH levels, but this acute elevation rapidly normalizes after a 2-day rest in female rhythmic gymnasts. These fluctuations in serum GH and GH-dependent ternary complex components had no reflection on the skeletal growth patterns in gymnasts over the 4-year follow up but there was a delay in their pubertal progression.     

Changes in body composition and energy expenditure after six weeks' growth hormone treatment.

Changes in body composition and energy expenditure were assessed in 15 children after six weeks of human growth hormone (hGH) treatment. Body composition measurements were made by stable isotope labelled water (H2(18)O) dilution, bioelectrical impedance, and skinfold thickness techniques. Energy expenditure was assessed both by indirect ventilated hood calorimetry (resting energy expenditure) and the stable isotope doubly labelled water (2H2(18)O) technique (free living daily total energy expenditure). Mean increases in weight of 0.96 kg and fat free mass of 1.37 kg and a mean decrease in fat mass of 0.41 kg were observed. Significant increases both in resting energy expenditure and free living daily energy expenditure were detected. Absolute changes in fat mass and resting energy expenditure were correlated. The data suggest (i) that the increase in the fat free mass is the most significant early clinical measure of hGH response and (ii) that hGH increases the metabolic activity of the fat free mass. Monitoring such changes may be predictive of the efficacy of hGH in promoting growth.     

Reported consumption of low-nutrient-density foods by American children and adolescents: nutritional and health correlates,NHANES III, 1988 to 1994

OBJECTIVE: To examine the contribution of foods of modest nutritional value to the diets of American children and adolescents. METHODS: The data were from the third National Health and Nutrition Examination Survey, 1988 to 1994, and included 4852 children and adolescents, aged 8 to 18 years. Foods reported in the 24-hour dietary recall were grouped into the following low-nutrient-density (LND) food categories: visible fat; table sweeteners, candy, and sweetened beverages; baked and dairy desserts; salty snacks; and miscellaneous. The independent association of the number of LND foods mentioned in the recall with intake of food groups, macronutrients, micronutrients, and body mass index was examined by means of regression procedures to adjust for multiple covariates. RESULTS: The LND foods contributed more than 30% of daily energy, with sweeteners and desserts jointly accounting for nearly 25%. Intakes of total energy and percentage of energy from carbohydrate and fat related positively, but percentage of energy from protein and dietary fiber (in grams) related inversely to the reported number of LND foods (P<.05). The reported number of LND foods was a negative predictor (P<.001) of the amount of nutrient-dense foods reported. The mean amount of reported intake of several micronutrients-vitamins A, B6, and folate, and the minerals calcium, magnesium, iron, and zinc-declined (P<.05) with increasing tertiles of reported number of LND foods. The LND food reporting was not a significant predictor of body mass index. CONCLUSION: High LND food reporting was related to higher energy intake but lower amounts of the 5 major food groups and most micronutrients.     

Nutritional support and growth in thalassaemia major

Twelve thalassaemic children under 3 years of age received intensive nutritional support for one month and were discharged on a prescribed diet of locally available foods. Anthropometry, bioelectrical impedance analysis and dietary intake were longitudinally assessed. Mean energy intake was 20% greater than the recommended daily allowance during nutritional supplementation as compared with below the recommended daily allowance before and after the period of nutritional support. Weight, but not height, significantly increased during the support period and was due to increases in both fat free mass and fat mass. Body weight, fat free mass and fat mass declined in line with the reduced intake upon return home; however, height velocity accelerated and exceeded normal through the fourth month before resuming a below normal rate. It can be concluded that (1) nutritional stunting as the result of reduced nutrient intake is an important cause of growth failure in young children with thalassaemia and is responsive to nutritional support, (2) the deficit in height velocity was due to retarded truncal height growth, and (3) the bioelectrical impedance analysis method is suitable for body composition analysis of thalassaemic children.     

Body composition and energy expenditure in adolescents with cerebral palsy or myelodysplasia

We measured body composition, resting metabolic rate (RMR), and total energy expenditure (TEE) in a group of adolescents with cerebral palsy (CP) and myelodysplasia (M) aged 13- to 20-y-old using indirect calorimetry and the doubly labeled water method. Fat-free mass (FFM), RMR, and TEE were significantly lower in both the CP and M groups than comparable measurements in a control group of normal adolescent males and females. The ratio of TEE to RMR did not differ between controls and ambulatory M and CP subjects. However, TEE/RMR was significantly lower in the nonambulatory M and CP subjects than in controls (p less than 0.01). Our data indicate that energy requirements are reduced in both populations because both FFM and activity are decreased. Although energy requirements were decreased in both groups, the relationships between FFM and body weight differed. FFM and body weight were significantly correlated with RMR only in the M group. These data suggest that the type of paralysis in a handicapped population may affect resting energy expenditure.     

Effects of 16 weeks of training prior to a major competition on hormonal and biochemical parameters in young elite gymnasts

The aim of this study was to investigate the response to 16 weeks of training on selected hormonal and biological parameters in seven international competition level female artistic gymnasts (14.5 +/- 1.2 years). Data were collected at the beginning of the first training week (W1) and in the 16th week (W16). Assessments also included anthropometric measurements, dietary intake for 7 days and Tanner staging. No gymnast had reached menarche and the puberty stages corresponded to Tanner's pubertal stage 2. The gymnasts were smaller than average for their age group, with a height:weight ratio above the 50th percentile. Energy intake was about 31% lower than recommendations. Significant decreases in IGF-I, IGFBP3, IGF-I:C ratio and triglyceride values and increases in uric acid and creatinine levels were noted. Cortisol values were high regardless of the period. This training provided evidence for alterations in resting somatotropic and adrenocorticotropic parameters.     

Prolonged bottle feeding in a cohort of children: does it affect caloric intake and dietary composition?

Little is known about the consequences to children of bottle feeding prolonged beyond age 1 year on caloric intake and overall dietary composition. To obtain these data, 165 children, followed up from infancy, were assessed in these respects for a 24-hour period at age 3 1/2 years. Bottle-fed children (n = 14) consumed more milk than their weaned counterparts (p < 0.001), had a higher mean daily calcium intake (p < 0.05), received fewer calories from carbohydrates (p = 0.034), and received a greater percentage of calories from protein (p = 0.033). There were no significant differences between the groups in total caloric intake, total iron intake, total volume ofjuice, or calories from fat. Pediatricians questioned about the effects of continuing to offer children nutritive liquids from bottles as well as cups (versus offering cups alone) may inform parents that this feeding practice is associated with significantly greater milk consumption and daily calcium intake. However, this study could not find evidence that prolonged bottle feeding at age 3 1/2 years is associated with a significantly decreased total daily iron intake or an increased risk for factors associated with adiposity such as a greater daily calorie intake, a higher body mass index, or greater percentage of total calories derived from fat.     

Growth and nutrition of Hong Kong children aged 0-7 years

OBJECTIVE: To study the early dietary practices in relation to growth of Hong Kong children from birth to 7 years. METHODOLOGY: One hundred and seventy-three full-term Hong Kong Chinese babies were recruited at birth and were followed up for anthropometric measurements using standardized methods and dietary assessment using a combination of dietary history, 24 h recall and food frequency. At 7 years, 125 children remained in the study. RESULTS: Mean (SD) birthweight was 3.3 (0.38) kg for boys and 3.1 (0.38) kg for girls. Mean (SD) weight at 7 years was 22.4 (4.2) kg for boys and 21.1 (3.7) kg for girls, and mean (SD) height was 120.3 (4.8) cm for boys and 119.8 (5.1) cm for girls. Hong Kong children were lighter and shorter than Australian children and the National Centre for Health Statistics (NCHS) references, but the magnitude is less than one standard deviation score. Mean weight and height of Hong Kong children were lower compared to Caucasian and Beijing children, with more obvious differences between 1 and 5 years. At 1 year, mean (SD) daily energy intake was 98 (24) kcal/kg/day for boys and 100 (26) kcal/kg/day for girls. By 7 years, it decreased to 82 (18) kcal/kg/day for boys and 73 (22) kcal/kg/day for girls. Between 2 to 4 years of age the energy intake of studied children were slightly lower than the Australian and Finnish children, but the protein intake was higher. Percentage of fat contributing to total daily energy intake was lower throughout at a level of 30%. Such differences in diet reflect a lower consumption of milk fat, higher consumption of meat and lower level of physical activity in Hong Kong children. Intakes of calcium, iron and vitamin C all reached 60% or above of US recommended daily allowance. CONCLUSIONS: The smaller body build of Chinese compared to Caucasians cannot be explained by dietary differences. The diet of Hong Kong children is changing to one which is more Westernized with a higher consumption of animal products.     

Energy intake, metabolic balance and growth in preterm infants fed formulas with different nonprotein energy supplements

OBJECTIVE: To study metabolic and energy balances, growth and composition of increased body mass in healthy preterm infants fed control formula or control formula with three different nonprotein energy supplements. PATIENTS AND METHODS: Growing preterm infants (birth weight < 1,500 g and gestational age < 31 weeks) were fed standard preterm formula (control group) or the same formula enriched with three different nonprotein energy supplements. An energy supplement of 23 kcal/kg/day was achieved by adding medium-chain triglyceride and dextrinomaltose in three different caloric ratios: 33:66 in group A, 66:33 in group B, and 85:15 in group C. Energy balance was determined by open-circuit continuous (5-6 hours) measurements of energy expenditure, with simultaneous measurement of 24-hour urinary nitrogen excretion. Metabolic balance was determined by measurements of energy intake, energy oxidation, and energy output in urine and stool. The composition of body mass accretion was determined as the accretion of fat and protein in the total weight gain. RESULTS: The fat accretion (4.9, 5.9, 6.2, and 3.8 g/kg/day in groups A, B, C and D, respectively) correlated directly with fat intake. Infants receiving standard energy intake had a fat percentage of weight gain significantly lower (28%) than that of the high-energy intake groups (31%, 40%, and 38% in groups A, B, and C, respectively). This difference corresponded to the results obtained from skinfold thickness measurements. CONCLUSIONS: Excess nonprotein energy is stored as fat regardless of its source (fat or carbohydrate). High caloric and medium-chain triglyceride intake in otherwise healthy growing preterm infants does not promote nitrogen retention.     

De darm: een egoïstisch orgaan

The portal-drained viscera (stomach, intestine, pancreas and spleen) have a much higher rate of both energy expenditure and protein synthesis than can be estimated on the basis of their weight. A high utilization rate of dietary nutrients by the portal-drained viscera could result in a low systemic availability, which determines whole-body growth. In this paper we discuss the energy expenditure by the portal-drained viscera; which substrates are used as a source of energy; the amino acid utilization by the portal-drained viscera under normal feeding conditions; the impact of protein restriction on the portal availability of dietary amino acids; recycling of amino acids by the intestine. We conclude: that the energy expenditure by the portal-drained viscera is three times higher than could be expected on the basis of their weight; that dietary amino acids are the major fuel source, while glucose is oxidized as well; that 65% of the dietary amino acid intake is utilized by the portal-drained viscera; that protein restriction increases the amino acid utilization by the portal-drained viscera to 81% of the dietary intake, while amino acids are not longer the main oxidative substrate and that recycling of endogenous synthesized intestinal proteins contributes significantly to overall systemic amino acid availability, resulting in an overall amino acid availability of 48% of the daily protein intake.     

Swedish pre-school children eat too much junk food and sucrose

Aim: To analyze dietary intake in healthy 4‐year‐old children. Methods: Families from three Paediatric Health Care Centres in different socio‐economic areas in Göteborg completed 7‐day food records and questionnaires about socio‐economy. Results: One hundred thirty two/153 completed the study, 49% of parents were university educated. Eighteen percent of children were overweight/obese. Energy intake was high; 67% had sucrose intake exceeding Nordic Nutrition Recommendations (NNR) but 36% had n‐3 fatty acid intake <0.5 energy percent. Significant negative correlations were found between sucrose and fat and between BMI and fat intake. Junk food supplied 24% of energy. Ninety‐two percent had low vitamin D intake, 70% low iron and 21% low calcium intake. Gruel, which was consumed by 28%, had a positive impact on micronutrient intake. Child care and mother's origin seemed to influence dietary intake. Conclusion: In 4‐year olds from well‐educated urban families, 18% was overweight/obese. Total energy intake was above present NNR but lower than 20 years ago, when overweight was rare. Fat energy intake was negatively associated with BMI, and low n‐3 fatty acid intake was associated with higher body weight. In several aspects dietary intake was not optimal in the children.     

Tracking of serum lipids and dietary energy, fat and calcium intake from 1 to 15 years

We describe the results of tracking serum lipids, and dietary intake of energy, fat and calcium in a cohort of 106 children in the Adelaide Nutrition Study who were followed to 15 years of age together with an additional 123 children recruited from 11 years of age. Measures of energy, fat and calcium intakes were obtained from analyses of 4-day weighed records. The pattern and level of tracking were similar for males and females. The tracking coefficient for total cholesterol was 0.28-0.49 between 1 and 15 years of age, 0.3-0.64 between 2-8 and 15 years of age, 0.48-0.64 between 8-11 and 15 years of age, 0.71-0.78 between 11-13 and 15 years of age and 0.71-0.78 between 13 and 15 years of age. The pattern was similar for low density lipoprotein cholesterol, but lower for high density lipoprotein cholesterol. For mean daily energy, fat and calcium intake, tracking coefficients were low below 4 years of age, but from then on were 0.46-0.64 for energy intake, 0.38-0.51 for fat (g) and 0.51-0.62 for calcium (mg). Adolescence, child, cholesterol, nutrition, tracking     

Energy expenditure, energy balance, and composition of weight gain in low birth weight infants fed diets of different protein and energy content

The effect of energy and protein intakes on energy expenditure, energy balance, and amount and relative rate of both protein and fat deposition in new tissue was investigated in 19 low birth weight infants whose mean protein and energy intakes, respectively, were 2.24 g/kg/d and 113 kcal/kg/d (formula A, n = 8), 3.6 g/kg/d and 115 kcal/kg/d (formula B, n = 5), and 3.5 g/kg/d and 149 kcal/kg/d (formula C, n = 6). The higher energy intake (formula C) but not the higher protein intake (formula B) resulted in greater energy expenditure. Both the higher protein (formula B vs formula A) and higher energy intakes (formula C vs formula B) resulted in greater weight gain secondary, in group B, to a greater absolute rate of protein deposition and, in group C, to a greater absolute rate of fat deposition. The relative composition of the new tissue deposited reflected the proportional intakes of protein and energy. The numerical value of the protein/fat ratio (g/g) of the new tissue deposited by infants fed formulas A and C, the protein contents of which were low relative to energy contents, were similar and significantly lower than the numerical value of the protein/fat ratio of the new tissue deposited by infants fed formula B, which had a higher protein content relative to energy content. These findings suggest that the composition of weight gain is related to both the absolute amounts and the proportions of dietary protein and energy; thus, both must be considered in formulation of nutritional regimens for LBW infants.