Parenteral Nutrition in paediatrics

The provision of nutrients intravenously or Parenteral Nutrition (PN), has been one of the biggest therapeutic progress over the last 50 years. PN has increased survival rates in children with gastro-intestinal and extra-intestinal diseases not tolerating oral or enteral nutrition. Moreover PN decreases malnutrition and therefore increases survival. PN related complications have been minimized thanks to advances in equipment, training and expertise, however, this treatment still has substantial risks. PN in paediatrics should be delivered by expert multidisciplinary nutrition team to ensure appropriate use, delivery, monitoring and weaning.In this review we will take the reader through the ESPGHAN/ESPEN guidelines, at present the main reference for paediatric PN.     

Nutrition and sickle cell disease

The role of protein and calorie deficiency in sickle cell disease remains poorly defined. While such features as growth retardation, impaired immune function, and delayed menarche do suggest a relationship between sickle cell disease and undernutrition, measurement of more direct nutritional parameters in these patients have yielded mixed results. Anthropometric measurements such as skinfold thickness are subnormal in many but not all reports. Serum protein levels are normal, but low values for serum lipids have been reported. Finally, one small study shows an improvement in both growth parameters and clinical course following caloric supplementation. A variety of micronutrient deficiencies have been suggested in sickle cell disease. Numerous case reports describing an exacerbation of the chronic anemia that was reversed by folic acid therapy led to routine folate supplementation. More recent studies have shown, however, that clinically significant folic acid deficiency occurs only in a small minority of sickle cell patients. Clearly, more work is necessary to define the cost/benefit ratio of routine folic acid supplementation. Pharmacological amounts of vitamin B6 and certain of its derivatives possess in vitro antisickling activities. Nevertheless, a small clinical trial failed to demonstrate any consistent hematologic effects of B6 supplementation. Several reports indicate that vitamin E levels are low in sickle erythrocytes. Since these abnormal red cells both generate excessive oxidation products and are more sensitive to oxidant stress, and because oxidants appear to play a role in ISC formation, vitamin E deficiency could well be linked to ISC formation and hemolysis. Small clinical trials, however, have again failed to produce a clear hematological response in sickle cell anemia. The role of zinc in sickle cell disease has received considerable attention. Though studies are generally small, most do support a relationship between sickle cell disease and zinc deficiency. Etiologic associations between zinc deficiency and such complications of sickle cell disease as poor ulcer healing, growth retardation, delays in sexual development, immune deficiencies, and high ISC counts have all been suggested. Most of these studies need further corroboration. Iron deficiency is now known to be a relatively common occurrence in sickle cell anemia, especially in children and pregnant women. The theoretical benefits of concomitant iron deficiency and sickle cell anemia remain to be proven in a controlled clinical trial.(ABSTRACT TRUNCATED AT 400 WORDS)     

Use of nutritional supplements in Parkinson's disease patients.

The use of nutritional supplements has almost doubled in the elderly population in the United States (US) in the past decade. We evaluated the use of nutritional supplements in Parkinson's disease (PD) patients to determine the prevalence of their use and whether patients were aware of possible side effects and drug interactions in the supplements they were taking. Consecutively selected PD patients from an academic movement disorders center completed a 33-item questionnaire regarding their use of nutritional supplements. A total of 120 PD patients completed the questionnaire and were included in the data analysis (mean age +/- SD = 68.2 +/- 11.65 years, 67 [55.8%] men and 53 women). Seventy-six patients (63%) took nutritional supplements at the time of data collection. Vitamins were the most common nutritional supplements used, and vitamin E was the most commonly used vitamin. Thirty-six patients (47%) who took nutritional supplements consulted with their doctor before taking them, and only 4% of patients who took nutritional supplements were aware of possible side effects from their use. Twenty patients (16.7%) reported that they were currently taking nutritional supplements because of symptoms related to their Parkinson's disease. The vast majority of PD patients surveyed were not aware that nutritional supplements could cause adverse side effects. Less than half of the patients who took nutritional supplements consulted their physician before starting them. Greater awareness of nutritional supplement use in PD patients is warranted to avoid potentially harmful effects and drug interactions.     

复合氨基酸和维生素治疗肝硬化低蛋白血症病人的疗效

目的：观察复合氨基酸和维生素胶囊治疗肝硬化低蛋白血症的疗效。方法：肝硬化低蛋白血症１０１例，随机分为２组。治疗组５８例（男性３９例，女性１９例；年龄５３±ｓ９ａ），在使用一般护肝药物同时加复合氨基酸和维生素胶囊２粒（３５０ｍｇ／粒），ｐｏ，ｔｉｄ。对照组４３例（男性３１例，女性１２例；年龄５２±１１ａ）用一般护肝药物，２组疗程皆是６ｗｋ。结果：复合氨基酸和维生素胶囊对改善乏力、纳差、消退腹水，提高清蛋白有非常显著的效果（Ｐ＜０．０１）。无不良反应发生。结论：复方氨基酸和维生素胶囊治疗肝硬变低蛋白血症有显著的疗效。     

A study of a single high potency multivitamin preparation in the management of cystic fibrosis

Background: ADEKs® is a new multivitamin preparation formulated specifically for cystic fibrosis (CF) patients, containing all four fat-soluble vitamins. There is no data currently available on its use in CF. Method: We carried out a retrospective study to evaluate ADEKs® in 54 CF patients attending the specialist CF Unit at Nottingham City Hospital. Plasma vitamin A and E levels were collected from annual review reports when taking ADEKs® and a year previously when using other vitamin preparations. Dietary assessment data was available for 24 of these patients (11 children, 13 adults). Results: ADEKs® was taken for a median of 9.5 months by 19 children (mean age 11.3 years; range 7–15 years) and for 4 months by 35 adults (mean age 24 years; range 17–36 years). Median plasma vitamin A levels were significantly higher ( P <0.05) for all age groups (27% increase for 7–10 year olds, 48% increase for 11–15 year olds, 100% increase for 16+ year olds) following the change from other vitamin supplements to ADEKs®. Median plasma vitamin E levels were also significantly higher (59% increase for 7–10 year olds; 16% increase for 11–15 year olds; 26% increase for 16+ year olds). Fifteen (28%) and 9 (17%) patients went from below to within the normal plasma reference range for vitamins A and E, respectively, when changed onto ADEKs®. Four (7%) and 11 (20%) patients had values above the normal plasma range for vitamins A and E, respectively, whilst on ADEKs®. Conclusion: This study suggests that ADEKs® tablets are useful for CF patients aged over 10 years as plasma vitamin A and E levels were improved. The use of a single vitamin preparation such as ADEKs® is likely to improve compliance. We have reservations over its use amongst the 7–10 year olds because of high plasma vitamin A (3/9) and E (7/9) levels, although further research may ultimately endorse its future use within this group.     

高效液相色谱-库仑电化学检测法对多种脂溶性维生素及营养物质的分析

[目的]建立快速分析多种脂溶性维生素及营养物质的检测方法，准确分析多种脂溶性维生素及营养物质的水平。[方法]采用美国ESA公司的高效液相色谱—库仑电化学检测器(HPLC—CoulArray Detector)及天津医科大学和天津大学共同研制的血清脂溶性维生素提取试剂盒。[结果]对多种脂溶性维生素A(视黄醇)、维生素D2(麦角钙化醇)、维生素D3(胆钙化醇)、维生素E(α—生育酚和γ—生育酚)、维生素K1(叶绿醌)、类胡萝卜素(α—胡萝卜素和β—胡萝卜素)、类维生素A(维生素A棕榈酸盐)、生育酚乙酸酯和营养物质辅酶Q10(泛醌)进行同时检测。[结论]多通道EC—HPLC检测脂溶性维生素，因其操作简便，灵敏度高，准确性强，可作为临床对脂溶性维生素分析的可靠方法。     

维生素与糖尿病

维生素作为机体物质代谢的辅酶和/或抗氧化剂，其缺乏及失衡在糖尿病及其并发症的发生发展中有重要作用。给糖尿病患补充维生素可改善病情并有益于预防血管，神经及肾脏等并发症的发生。     

Polymorphic trophonosis: The pseudo-omnivorous diet-related disease — A hypothesis

Consideration of a wide range of seemingly disparate, non-infectious diseases reveals that most of them are only the varying forms or symptoms of a single, diet-related disease postulated to be Polymorphic Trophonosis. It is pointed out that they are all associated with pseudo-omnivorous dietary practices — negating the biological limitations of Homoomnivorus. In these practices, neither the out-of-all-proportion consumption of certain essential nutrients nor the liberal eating of new types of food seems to be suitable to the structure and mode of functioning of the digestive and/or metabolic systems.     

Vitamin content of some normal human brain segments

Nicotinates, pantothenates, riboflavin, vitamins B₆ and B_12′ free (acetyl) and total (free and bound) choline, biopterin, thiamin, biotin, methylated and nonmethylated folates in frontal, temporal, precentral, postcentral, and occipital cortex, thalamus, cerebellum, pons, basal ganglia, and substantia nigra were estimated. Nicotinates are significantly more concentrated in basal ganglia and thalamus than pons. Nonmethylated folate content is not significantly varied in brain segments; the pons contains more methylated folate. Riboflavin content is higher in the basal ganglia and temporal cortex than frontal cortex. Biotin is concentrated in pons and basal ganglia. Thiamin concentration is less in the postcentral cortex than the thalamus and substantia nigra. Biopterin is significantly higher in substantia nigra and basal ganglia than the other brain segments. Total choline content is high in substantia nigra, pons, and thalamus; free (acetyl) choline is significantly elevated in basal ganglia. B₁₂ content is less concentrated in the cortex segments. B₆ is highly concentrated in the basal ganglia. Pantothenate content is elevated in pons when compared to the various cortex segments and cerebellum.