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Malnutrition is a common problem in children with end-stage liver disease (ESLD), and accurate assessment of nutritional status is essential in managing these children. In a retrospective study, we compared nutritional assessment by anthropometry with that by body composition. We analyzed all consecutive measurements of total body potassium (TBK, n = 186) of children less than 3 years old with ESLD awaiting transplantation found in our database. The TBK values obtained by whole body counting of 40K were compared with reference TBK values of healthy children. The prevalence of malnutrition, as assessed by weight (weight Z score < -2) was 28%, which was significantly lower (chi-square test, p < 0.0001) than the prevalence of malnutrition (76%) assessed by TBK (< 90% of expected TBK for age). These results demonstrated that body weight underestimated the nutritional deficit and stressed the importance of measuring body composition as part of assessing nutritional status of children with ESLD.

The Codex Alimentarius Commission of the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) develops food standards, guidelines and related texts for protecting consumer health and ensuring fair trade practices globally. The major part of the world's population lives in more than 160 countries that are members of the Codex Alimentarius. The Codex Standard on Infant Formula was adopted in 1981 based on scientific knowledge available in the 1970s and is currently being revised. As part of this process, the Codex Committee on Nutrition and Foods for Special Dietary Uses asked the ESPGHAN Committee on Nutrition to initiate a consultation process with the international scientific community to provide a proposal on nutrient levels in infant formulae, based on scientific analysis and taking into account existing scientific reports on the subject. ESPGHAN accepted the request and, in collaboration with its sister societies in the Federation of International Societies on Pediatric Gastroenterology, Hepatology and Nutrition, invited highly qualified experts in the area of infant nutrition to form an International Expert Group (IEG) to review the issues raised. The group arrived at recommendations on the compositional requirements for a global infant formula standard which are reported here.

Background: Alterations in energy expenditure during activity post head injury has not been investigated due primarily to the difficulty of measurement. Objective: The aim of this study was to compare energy expenditure during activity and body composition of children following acquired brain injury (ABI) with data from a group of normal. controls. Design: Energy expenditure was measured using the Cosmed K4b(2) in a group of 15 children with ABI and a group of 67 normal children during rest and when walking and running. Mean number of steps taken per 3 min run was also recorded and body composition was measured. Results: The energy expended during walking was not significantly different between both groups. A significant difference was found between the two groups in the energy expended during running and also for the number of steps taken as children with ABI took significantly less steps than the normal controls during a 3 min run. Conclusions: Children with ABI exert more energy per activity than healthy controls when controlled for velocity or distance. However, they expend less energy to walk and run when they are free to choose their own desirable, comfortable pace than normal controls. (C) 2003 Elsevier Ltd. All rights reserved.

Objective: To investigate measures aimed at defining the nutritional status of cystic fibrosis (CF) populations, this study compared standard anthropometric measurements and total body potassium (TBK) as indicators of malnutrition. Methods: Height, weight, and TBK measurements of 226 children with CF from Royal Children’s Hospital, Brisbane, Australia, were analyzed. Z scores for height for age, weight for age, and weight for height were analyzed by means of the National Centre for Health Statistics reference. TBK was measured by means of whole body counting and compared with predicted TBK for age. Two criteria were evaluated with respect to malnutrition: (1) a z score < –2.0 and (2) a TBK for age

Introduction: Growth recovery is important in quality of life for long term patients after organ transplantation. Patients transplanted in infancy may not complete growth until 20yrs post transplant. Limited information is available about growth beyond 10yrs post transplant. Our aim was to assess height and weight recovery up to 15yrs after liver transplant in childhood. Summary/Conclusions: Long term survivors after childhood liver transplant can expect to have ongoing height recovery for at least 10 years. Weight recovery is most marked within the first year. Since weight recovers more than height, these children maybe at risk of developing obesity in future.

LEARNING OUTCOME: To describe how home nocturnal tube feeding can be used to supplement food intake in young patients with anorexia nervosa. Rising inpatient costs lead clinicians to find effective nutritional management practices that can be continued at home. Due to the nature of the disease, anorexia nervosa and some other eating disorder conditions, it was not a general practice to try home tube feeding. However, long hospitalization itself can have detrimental effects to the patient, such as alienation and isolation from the family. A home nocturnal tube feeding pilot program was successfully offered to selected inpatients (n=5, 10-16 years old) as an alternative to inpatient care. A visiting nurse was available to assist the patient to set up overnight feeding and support. The overnight feeds were usually set up by 8.30 PM and run until 6.30 AM. A 1.5 kcal/ml commercially available product was generally used. Telephone contact with the psychiatric case manager, dietitian and physician was also encouraged. Careful selection criteria for patients trying this method is necessary. The patients'family situations varied from very supportive, to detached, to ward of the state. Patients themselves generally wanted to be out of hospital but some were not highly motivated to improve health status. None of the patients were known bulimic. One of the aims of this program was to avoid contact with patients with similar conditions, as this often had a negative impact. Frequent outpatient appointments were put in place, i.e. initially once a week and then fortnightly to a multidisciplinary Eating Disorders Clinic which includes a physician, a psychiatrist and a dietitian. The major aim of keeping the client medically safe and thus able to stay outside the hospital was achieved, and nutritional rehabilitation was achieved and maintained.

Introduction: Growth normalization after liver transplant is a desirable long term outcome in children with chronic liver disease. Weight recovery is usually rapid and often normalizes within a year although height recovery can be prolonged. It is unknown whether this recovery occurs as a result of increased body cell mass. Aims: To assess whether there was improvement in the body cell mass of long term survivors after liver transplant in childhood. Methods: Total body potassium (TBK) measurements to estimate metabolically active body cell mass were performed with a shadow shield whole body counter over a scanning bed. Body cell mass (BCM) was calculated from TBK measurements [BCM (kg) = (TBK*9.18)/39.1], andadjusted for height and gender (males=BCM/Ht3; females=BCM/Ht2.5). Measurements were performed before and after liver transplant. Paired t-tests were used to analyse the data.Results: Pre and post transplant measurements were available in 20 patients. There was no difference in the age of transplant or timing of TBK measurement after transplant between the genders. Body cell mass for height was significantly reduced after transplant in long term survivors (t= 3.83, p=0.00). When analysed according to gender, this was significant for boys (t=6.04, p=0.00)but not girls. Summary/Conclusions: Body cell mass was significantly reduced in long term survivors after liver transplant, especially boys. This implies that fat accumulation is the main reason for weight recovery, which may subsequently predisposethese children to obesity.

DIOS, a common cause of abdominal pain in CF patients, is due to impaction of muco-feculent material in distal ileum and cecum. Conventional therapy with mucolytics, laxatives and retention enemas is often unsatisfactory and may require hospitalization. We have extensive experience with the use of intestinal lavage with Colytely®. 22 CF patients (mean 21.8 yrs, range 13-34 yrs, 15 male) presented with abdominal pain and a mass in the right iliac fossa; 3 vomited and 13 had acute weight loss. In the first lavage 5.6±1.9 L (M±SD) of Golytely® were given p.o. (n=14) or via n-g tube (n=8) over a period of 5.6±2.4 hrs. Body weight and serum electrolytes did not change significantly. No serious side effects occurred. Minor symptoms included bloating (n=12), nausea (n=8), vomiting (n=1), increased urine output (n=7) and chills (n=3). All but one patient reported impressive relief of symptoms, and remained pain-free for an average of 3 months (range 1-19 months). We developed a score to assess DIOS with regard to pain (absent - acute obstruction; range 0-30) and radiological signs of impaction (absent - severe; range 0-30). Lavage led to a significant reduction of pain (20.5±4.9 vs. 1.4±4.7; p