Quantification of L-type fatty acid binding protein in the urine of preterm neonates

We measured urinary excretion of L-type fatty acid binding protein (L-FABP) in preterm neonates on days 1, 5-10, and 25-30 of life. Urinary L-FABP levels (expressed as the ratio to creatinine) in preterm neonates were considerably higher than those of healthy adults. They did not change significantly during the study period. Urinary L-FABP levels showed significant positive correlation with those of urinary N-acetyl-beta-D-glucosaminidase activity on day 1, and with those of 8-hydroxy-2'-deoxyguanosine on days 25-30. These results suggest that L-FABP is expressed in the neonatal kidney. Our results may also point to potential effects of proximal tubular damage and oxidative stress on urinary excretion of L-FABP.     

肠脂肪酸结合蛋白在肺炎合并胃肠功能损伤患儿血清中的变化及意义

目的探讨肠脂肪酸结合蛋白 （IFABP）在社区获得性肺炎患儿血清中的变化及与胃肠功能损伤的相关性。方法选择2015年1月至10月的社区获得性肺炎患儿82例 （轻症34例,重症48例）,根据小儿危重病例评分 （PCIS）将重症肺炎患儿分为非危重组 （25例）和危重组 （23例）;另选取体检的健康儿童30例作为对照组。采用酶联免疫吸附法检测血清IFABP浓度,并对重症肺炎患儿进行急性胃肠损伤 （AGI）分级。比较各组间血清IFABP浓度的差异,并对IFABP与AGI分级和PCIS进行相关性分析。结果重症肺炎血清IFABP浓度均高于对照组和轻症肺炎组 （均P <0.01）,轻度肺炎组血清IFABP浓度亦明显高于对照组 （P <0.01）。危重组血清IFABP浓度高于非危重组 （P <0.01）。AGI1~4级组血清IFABP均高于对照组 （P <0.01）,而且随着AGI级别的增高,血清IFABP浓度也逐渐增高,差异有统计学意义 （P <0.01）。IFABP与AGI分级呈正相关 （P <0.01）;与PCIS呈负相关 （P <0.01）。结论肺炎患儿血清IFABP均有所增高,血清IFABP可以作为肺炎患儿合并胃肠损伤早期诊断和病情评估的敏感指标。     

Serum intestinal fatty acid binding protein level for early diagnosis and prediction of severity of necrotizing enterocolitis

Background/Aim

Intestinal fatty acid binding protein (I-FABP) is found within cells at the tip of the intestinal villi, an area commonly injured in necrotizing enterocolitis (NEC). In this study, we aimed to investigate the value of serum I-FABP in early diagnosis and predicting severity of NEC.

Methods

This prospective study was conducted between April 2009 and November 2009. The preterm infants with suspected NEC were included in the study. These infants were divided into two groups according to their final diagnoses; Group 1: Stage 1 NEC and Group 2: Stages 2–3 NEC (Group 2a: Stage 2 NEC, Group 2b: Stage 3 NEC). Healthy preterms were assigned to control group (Group 3). Serial blood samples were obtained from the patients at symptom onset, 24 h and 72 h later. One blood sample was taken from the controls. Serum I-FABP levels were compared among the groups.

Results

Initial serum I-FABP concentrations were 324.0 ± 165.8 pg/ml, 764.7 ± 465.1 pg/ml, and 360.2 ± 439.5 pg/ml in Group 1, Group 2a, and Group 2b, respectively, and all were significantly higher than those of the control group (76.9 ± 115.9 pg/ml) (p < 0.001). The serum I-FABP levels gradually decreased from the onset of the disease to 72nd hour in Group 1 and Group 2a (p = 0.001). In Group 2b I-FABP concentrations slightly decreased at 24th hour of the disease and increased thereafter, but the difference was not significant (p = 0.06).

Conclusion

Serial measurements of I-FABP levels may be a useful marker for early diagnosis and prediction of disease severity in NEC.     

Randomized, double-blind trial of long-chain polyunsaturated fatty acid supplementation with fish oil and borage oil in preterm infants

OBJECTIVE: To test the efficacy and safety of long-chain polyunsaturated fatty acid (LCPUFA) supplementation with gamma-linolenic acid, a precursor of arachidonic acid, and docosahexaenoic acid in preterm infants. STUDY DESIGN: Preterm (<35 weeks, < or =2000 g birth weight) infants (n=238) randomly assigned to unsupplemented or LCPUFA-supplemented formula to 9 months after term. The main outcome measure was the Bayley Mental and Psychomotor Indexes (MDI, PDI) at 18 months after term. Safety outcome measures were anthropometry (9 and 18 months), feed tolerance, infection, and clinical complications. RESULTS: There were no significant differences in neurodevelopment between groups overall. In preplanned subgroup analyses, LCPUFA-supplemented boys had significantly higher Bayley MDI than did control boys (difference, 5.7 points; 95% CI, 0.3 to 11.1; P=.04). LCPUFA-supplemented infants showed significantly greater weight gain (difference, 310 g; 95% CI, 30 to 590 g; P=.03) and length gain (difference, 1.0 cm; 95% CI, 0.02 to 1.9; P=.05) between birth and 9 months, with greater effect in boys (weight difference at 9 months, 510 g; 95% CI, 80 to 930 g; P=.02; length difference at 18 months, 1.8 cm; 95% CI, 0.1 to 1.8; P=.03). CONCLUSIONS: This trial, using the strategy of providing gamma-linolenic acid as a source of arachidonic acid, showed efficacy for growth and for neurodevelopment in boys, with no adverse effects. These data have important implications for LCPUFA-supplementation strategy in preterm infants.     

Ghrelin levels in obesity and anorexia nervosa: effect of weight reduction or recuperation

OBJECTIVE: To study the influence of dietary intervention on plasma ghrelin levels in obese children and adolescents with anorexia nervosa (AN).Study design Prepubertal obese children (n=16) and 16 anorexic adolescents were studied at three different points: clinical diagnosis and after a reduction or recuperation of 25% and 50% of the initial BMI SD score. Controls included 21 Tanner growth stage 1 and 36 Tanner growth stage 5 subjects. We analyzed plasma ghrelin levels and their correlation with plasma levels of leptin, insulin, insulin-like growth factor I (IGF-I), insulin-like growth factor binding protein 1 (IGFBP-1), insulin-like growth factor binding protein 2 (IGFBP-2), insulin-like growth factor binding protein 3 (IGFBP-3), and integrated concentration of growth hormone (ICGH) before and after dietary intervention. RESULTS: At diagnosis, ghrelin levels were significantly decreased in obese children (52% of control levels) and significantly increased in adolescents with AN (164% of control levels). After dietary intervention, ghrelin increased in obese patients but without reaching control levels even after a 50% reduction in body mass index (BMI). In adolescents with AN, ghrelin levels normalized after a 25% increase in BMI. Ghrelin correlated negatively with the BMI and positively with IGFBP-1 levels in controls but not in obese patients or in patients with AN at diagnosis. The positive correlation between ghrelin and IGFBP-1 was recovered after dietary intervention. CONCLUSIONS: Plasma ghrelin levels present opposite changes in obesity and AN after dietary intervention, suggesting that ghrelin is a good marker of nutritional status.     

Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease

OBJECTIVE: To describe the clinical characteristics of nonalcoholic fatty liver disease (NAFLD) in children, including insulin resistance, and to test for correlation with liver pathology. STUDY DESIGN: A retrospective review of children with biopsy-proven NAFLD at Children's Hospital San Diego from 1999 to 2002. Liver biopsy specimens were independently reviewed by two pathologists. RESULTS: Children with NAFLD (n=43) were mostly male (70%), Hispanic American (53%) and obese (88%). The criteria for insulin resistance were met by 95% of subjects. Steatosis was predicted by the combination of quantitative insulin sensitivity check index, age, and ethnicity (P<.0001). Portal inflammation was predicted by the combination of ALT and fasting insulin (P=.0009). Perisinusoidal fibrosis was predicted by the combination of AST, fasting insulin, and BMI Z score (P<.0001). Portal fibrosis was predicted by the combination of right upper quadrant pain and homeostasis model assessment of insulin resistance (P=.0028). CONCLUSIONS: We identified significant predictors of liver pathology in children with NAFLD. Children being evaluated for NAFLD should be screened for insulin resistance, which is nearly universal and correlates with liver histology.     

Feeding and growth of normal birth weight infants during the first year of life in Shanghai

Aim

This study aimed to explore the relationship between infant feeding practices and growth outcomes in the first 12 months of life.

Design

Investigators completed 262 questionnaires, which included infant feeding patterns, feeding environment, feeding beliefs/attitudes and caregivers' feeding behaviors through on-site face-to-face interviews with the main caregivers of infants at 12 months of age. The infant's weight and length at ages 6 and 12 months were measured.

Setting

The study was conducted in urban Shanghai, China.

Subjects

This study included 262 healthy normal birth weight full-term singleton 6-month-old infants and their main caregivers.

Results

Among 262 infants, 86 (32.82%) infants were overweight [BMI-for-age z scores (BAZ) > + 1] at 12 months. Compared with normal weight infants, the overweight infants had higher birth weights (P = 0.009). Furthermore, the overweight infants gained significantly more weight (P < 0.001) in the first year of life. In normal weight infants, caregivers worried more about infants being “underweight” and “eating less” (P < 0.001) whereas caregivers with overweight infants worried more about infants being “overweight” (P < 0.001). Consequently, the total score of caregivers' over-feeding behaviors was significantly higher in normal weight infants (P = 0.029). However, in overweight infants, the scores of “fed quickly within 10 min” (r = 0.223, P = 0.039) and “feeding was the best way to stop the infant's fussiness” (r = 0.285, P = 0.008) were positively correlated with BAZ.

Conclusions

Overweight in early life is associated with carelessness about excessive appetite and some particular infant feeding behaviors of caregivers in Shanghai.