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Biomedical subjects

K H Brown

Publications and source records attributed to K H Brown.

At least 19 recordsLinked to original sources
PubMed1992

Potential for misclassification of infants' growth increments by using existing reference data.

The observed variances in monthly weight and length gains of 96 Peruvian infants were compared with predicted variances obtained by applying the reference curve-fitting methods to the same Peruvian data. Predicted variance estimates were significantly less (P less than 0.0001) than the observed variances from 2 to 12 mo of age. The extent of underestimation in total variance that occurred when 1-mo growth-increment reference data were generated by curve-fitting and interpolation was approximated. This underestimation, caused by not taking into account infants' random deviations from their own growth trajectories, ranged from 59% to 94% and resulted in misclassification of approximately 24-67% of infants as abnormal gainers (below the 5th percentile or above the 95th percentile with respect to existing reference data) in the intervals evaluated.

Analysis of Variance↗
PubMed1992

Growth patterns of breast-fed infants in affluent (United States) and poor (Peru) communities: implications for timing of complementary feeding.

We compared growth, dietary intake, and morbidity of infants breast-fed for > or = 12 mo from two populations: Davis, CA (n = 46) and Huascar, Peru (n = 52). When compared against WHO reference data (based primarily on formula-fed infants), Huascar infants appeared to falter as early as 3-4 mo, but when compared with Davis breast-fed infants, the curves for weight and length were very similar in girls until 10-12 mo and in boys until 6-9 mo. Thereafter, Huascar infants grew less rapidly than did Davis infants. Breast milk intake was very similar between groups, but in Huascar the amount and nutrient density of complementary foods consumed after 6 mo were lower and morbidity rates were much higher than in Davis. These results indicate that growth faltering of Huascar infants, when judged against breast-fed infants in the United States, occurs primarily after the first 6 mo of life and is not due to poor lactation performance.

Animals↗
PubMed1992

Effect of milk-containing diets on the severity and duration of childhood diarrhea.

Individual components of milk from humans and other mammalian species may influence the severity, duration, and nutritional outcome of childhood diarrhea in different ways. Nonetheless, empirical data from clinical trials can be used to assess children's responses to specific milk-containing diets. Factors modifying the response to milk include its source, amount, frequency of feeding, type of processing, and accompanying foods, as well as the type and severity of enteric infection and specific characteristics of the host. Whereas breast-fed infants have less severe diarrhea when breast milk is continued rather than interrupted, infants and children fed with non-human milks tend to have more severe illness than those receiving milk-free or lactose-limited formulas or milk-cereal mixtures. Fermentation of milk may reduce the severity of lactose malabsorption, but additional information regarding the efficacy of yogurt in acute, childhood diarrhea is still needed.

Animals↗
PubMed1992

Feeding during acute diarrhea as a risk factor for persistent diarrhea.

Dietary intake during diarrhea in children less than three years of age was estimated from information recorded on illustrated dietary forms used by children's caretakers during the first week of illness in a prospective community-based study of diarrheal diseases in Lima, Peru. The frequency of consumption and the amount consumed of food groups and selected commonly consumed foods were analyzed by the final duration of the diarrheal episode. Cereals were less frequently consumed during the acute phase of diarrheal episodes that ultimately became persistent (> 14 days' duration), apparently shortening the duration of the episode by one day (median duration of four days in children not consuming vs three days in children consuming cereals during diarrhea, p < 0.02 Kaplan-Meier log-rank test). Only roots and tubers (mainly potatoes) were consumed in greater quantity during episodes that became persistent. There was no evidence that consumption of breast milk or non-maternal milk was associated with an alteration in diarrheal duration. This study provides further evidence of the beneficial effects of continuing feeding during diarrhea using foods available at the home level, especially cereals, which are commonly used in the diet of young children.

Acute Disease↗
PubMed1992

Determinants of dietary intake during childhood diarrhea and implications for appropriate nutritional therapy.

Diarrheal diseases have a well recognized negative effect on children's growth, probably due in part to reduced dietary intake during illness. Previous studies have shown that the effects of diarrhea on dietary intake are greater among hospitalized children than among those observed in their homes. Breast milk intake does not change during diarrhea, however, so breast-fed children are less likely to reduce their total energy and nutrient intakes. Recent analyses of clinical studies found that acidosis and dehydration were most closely associated with reduced dietary intake of hospitalized patients. The implications of these and other studies for the dietary management of patients during and after diarrhea are discussed.

Anorexia↗
PubMed1992

Lactose feeding during persistent diarrhoea.

Lactose intolerance is a recognized complication of some episodes of diarrhoea. Whereas it is of clinical importance in relatively few children with acute diarrhoea it seems to be a more common problem in children presenting with persistent diarrhoea, especially in malnourished children with severe diarrhoea. We describe a recent study which also demonstrated adverse clinical and nutritional consequences in the majority of children with mild but persistent diarrhoea consuming 6 g lactose/kg body weight/d. It is desirable to identify these children who need to reduce their lactose intake in order to limit unnecessary dietary changes which are expensive to implement and/or nutritionally disadvantageous. Admission clinical characteristics were analyzed for their ability to predict clinical outcome in a group of 33 children with persistent diarrhoea taking a lactose-containing diet. The results of tests of stool reducing substances and a lactose breath hydrogen test (LHBT) were analyzed in the same group whose clinical management had been independent of the test results. Eighty-nine percent of children who deteriorated had one of the following characteristics: age < 12 months, weight-for-height less than -2 SD below NCHS norms or fever > 37 degrees C. Children who unequivocally improved while continuing to take lactose could not be selected without the risk of including children who deteriorated. Neither tests of stool reducing substances nor the LBHT improved the predictive value of simple clinical parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Breath Tests↗
PubMed1992

Effect of dietary energy density on total ad-libitum energy consumption by recovering malnourished children.

Clinical trials were conducted to measure the effect of dietary energy on total daily energy intakes by nine hospitalized young children recovering from protein-energy malnutrition. Semi-solid mixed diets containing either 50 or 100 kcal/100 g were offered at fixed intervals five times per day until the children refused further intake. Each diet was offered for seven consecutive days in alternate order. The mean +/- SD amount consumed with the low-density (LD) diet was significantly greater than with the high-density (HD) diet (220 +/- 35 vs 148 +/- 21 g/kg/d, P less than 0.001), but the amount of energy consumed with the HD diet was significantly greater than with the LD diet (148 +/- 21 vs 110 +/- 18 kcal/kg/d, P less than 0.001). There were no differences in total daily intake by day of diet period with the HD diet, but the intakes increased during the first 2-4 days with the LD diet. The maximum intakes at a single meal averaged between 40 and 66 g/kg/d for individual children receiving the LD diet, and were negatively related to the children's lengths and weight-for-length Z scores. We conclude that dietary energy density limited the amount of energy consumed from LD weaning diets offered at fixed frequencies, presumably because the volume of intake required to satisfy the children's energy needs exceeded their gastric capacity.

Analysis of Variance↗
PubMed1992

Effect of inclusion of beans in a mixed diet for the treatment of Peruvian children with acute watery diarrhea.

A double-masked clinical trial was conducted to assess the effects of inclusion of beans in a mixed diet for young Peruvian children with acute diarrhea. Dietary treatment consisted of either rice, beans, and vegetable oil (group RB, n = 25) or rice, soy-protein isolate, corn syrup solids, and vegetable oil (group RS, n = 21), each given in amounts up to 150 kcal/kg body weight per day immediately following rehydration therapy. The groups were generally similar at the time of admission, and there were no differences in the rates of treatment failure (8% in group RB, 14% in group RS; P = .65). Mean stool outputs were 83 +/- 46 (SD) g/kg body weight in group RB and 71 +/- 43 g/kg body weight in group RS on day 1, and these outputs consistently ranged from 25% to 40% greater in group RB than in group RS (P = .058). By contrast, the median duration of liquid stool excretion was substantially less in group RB than in group RS (60 vs 121 hours, P = .01). The fractional absorption of carbohydrate, fat, and total energy was significantly greater by children in group RS, but there were no differences in net apparent absorption of these nutrients because the children in group RB consumed significantly more of their assigned diet. Children in group RS gained significantly more weight during the whole period of observation (194 g vs 1 g, P = .047), but these differences could be entirely explained by the weight (and presumably fluid) changes on day 1. There were no consistent differences by dietary group in any of the other anthropometric indicators.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

Lack of therapeutic efficacy of vitamin A for non-cholera, watery diarrhoea in Bangladeshi children.

Vitamin A deficiency has been postulated to increase childhood mortality, possibly through increasing the severity and case-fatality of infectious diseases like diarrhoea. A clinical trial was conducted to measure the effect of vitamin A therapy on the severity and duration of acute episodes of non-cholera, watery diarrhoea; 83 children with less than 48 h of illness were randomized to receive vitamin A (200,000 IU of retinyl palmitate) orally or placebo during hospitalization at the International Centre for Diarrhoeal Disease Research in Bangladesh. The patients were similar initially with regard to age, nutritional status and severity of diarrhoea prior to admission. No adverse effects of vitamin A were detected. During hospitalization there were no differences between groups in duration of illness or stool output. Thus, vitamin A can be given safely during diarrhoeal illness to augment hepatic reserves and possibly provide a beneficial effect in regard to subsequent episodes of diarrhoea and other infections, but this supplementation should not be expected to have a therapeutic effect on a current episode.

Bangladesh↗
PubMed1991

Development of a nutritionally adequate and culturally appropriate weaning food in Kwara State, Nigeria: an interdisciplinary approach.

A nutrition education program was undertaken in Kwara State, Nigeria to improve infant feeding practices and nutritional status of weaning-aged children. A series of ethnographic, market survey, epidemiological, dietary, clinical, and communications research studies were implemented to develop a culturally acceptable, yet nutritionally adequate, weaning food. A premise of the project was that the development and introduction of any new weaning food should be based upon ingredients available in the community and to households, at a low cost and with minimum preparation time, and that would be culturally acceptable by mothers for feeding young children. Initially, research was conducted to define the problem in both nutritional and anthropological terms. Data was collected to describe: (1) present patterns of infant feeding and their determinants; and (2) dietary intake and nutritional status of infants in the intervention area. This paper focuses on the process of defining the problem and developing an intervention from an interdisciplinary perspective. The development of the new weaning food, Eko-Ilera, a fortified pap based on the traditional weaning food, is described.

Breast Feeding↗
PubMed1991

Sociodemographic and clinical factors affecting recognition of childhood diarrhea by mothers in Kwara State, Nigeria.

Early diagnosis of infant and child diarrhea by family members is the key to timely treatment. Factors that influence the caregiver's recognition of diarrhea have not been systematically studied, but may include characteristics of the caregiver, the child, or the illness itself. This paper examines the relationships between the caregivers' diagnoses of diarrhea during the previous 24 hr and the reported frequency and consistency of their children's bowel movements during the same period of time, using information from a representative sample of 2655 children less than 3 years of age in Kwara State, Nigeria. Diarrheal point prevalence based on maternal diagnosis (10.0%) was about half that based on the clinical criteria of three or more liquid or semi-liquid stools (18.8%). Only 36% of the mothers recognized a recent episode of diarrhea defined by the clinical criteria. Mothers were more likely to recognize diarrhea when a greater number of stools of watery consistency were excreted or when the stools contained blood or mucus. Mothers were least likely to recognize diarrhea when the child was a girl or less than 2 months of age. These results suggest that cross-cultural comparisons of diarrheal rates should use consistent, objective evidence of illness to compare rates rather than maternal diagnosis alone. Also, diarrheal disease control programs should explore those factors affecting recognition of illness in local contexts to assure that treatment recommendations can be applied in a timely fashion.

Attitude to Health↗
PubMed1991

Dietary management of acute childhood diarrhea: optimal timing of feeding and appropriate use of milks and mixed diets.

Several recent clinical trials have examined the optimal timing of feeding and the appropriate foods for use in the dietary management of acute childhood diarrhea. Important methodologic issues relevant to these trials, such as the composition and masking of study diets, measurement of outcome variables, and assessment of nutritional status, are discussed. Available data suggest that feeding should be continued during diarrhea, although a small subgroup of patients receiving nonhuman milk exclusively may have an excess rate of complications. These children should be closely supervised or provided with alternative diets. By contrast, children receiving human milk, nonmilk formulas, and mixed diets are generally able to tolerate these foods and to benefit nutritionally from continued feeding.

Acute Disease↗
PubMed1991

Nonabsorbable marker and single, random stool samples used for measuring intestinal absorption of macronutrients in infants and children.

To measure intestinal absorption by using a single, random stool sample, polyethylene glycol (PEG), 1 g/d, and a constant diet were given to healthy infants, with a constant PEG-to-macronutrient ratio. After 10 d equilibration, apparent intestinal absorption of macronutrients was estimated from a standard 3-d metabolic balance and compared with that estimated by using the ratio of PEG to macronutrients in a single random sample of feces. Correlation coefficients for this comparison were 0.649, 0.715, and 0.924 for nitrogen, carbohydrate, and fat, respectively. Additionally, apparent intestinal absorptions estimated from two separate consecutive 3-d metabolic-balance studies were compared, showing correlation coefficients of 0.106, 0.653, and 0.463 for nitrogen, carbohydrate, and fat, respectively. The random sample-marker technique appears to be acceptable for measuring apparent absorption of macronutrients and is at least as accurate as a standard 3-d metabolic-balance study.

Child, Preschool↗
PubMed1991

Relative effects of diarrhea, fever, and dietary energy intake on weight gain in rural Bangladeshi children.

Quantitative studies of morbidity, food intake, and somatic growth were done prospectively during 14 mo for 70 children aged 5-18 mo in two Bangladeshi villages. When random-effect regression models were used, monthly changes in weight were inversely related to proportions of days in the month with fever and diarrhea and positively related to energy intake per kilogram body weight. Interestingly, weight changes did not vary with age in this interval. Estimates indicate that increasing energy intakes to the recommended World Health Organization level would have a significantly greater effect on weight gain than would the elimination of diarrhea and fever. With energy at recommended intake and diarrhea and fever prevalence as found in US children, weight gain is predicted to be near that of the international reference population. Therefore, interventions aimed at improving dietary intake may be as important as infection-control programs for improving growth of children in poor developing nations.

Bangladesh↗
PubMed1991

Clinical trial of home available, mixed diets versus a lactose-free, soy-protein formula for the dietary management of acute childhood diarrhea.

A randomized clinical trial was completed to study the severity, duration, and nutritional outcome of acute diarrhea in 85 Peruvian children between 5 and 24 months of age who received a soy-protein-isolate, lactose-free formula (group SF) or one of two mixtures of home-available foods, all in amounts up to 110 kcal/kg of body weight/day. The mixed diets contained either wheat flour, pea flour, carrot flour, sucrose, and vegetable oil (group WP) or potato flour, dried whole milk, carrot flour, sucrose, and oil (group PM). The characteristics of the children in each group were generally similar initially. There were no differences in treatment failure rate by diet group. Fecal outputs were similar in all groups during the first day of treatment, averaging 60 to 65 g/kg/day. However, stool outputs were greater for the PM group than for other groups on days 3 and 4, and were less for the SF group than the other groups on days 5 and 6. The estimated median durations of diarrhea in the WP group (52 h) and PM group (53 h) were significantly less than in the SF group (154 h, p = 0.005). Energy intakes, energy absorption, and nitrogen retention (% of intake) were generally similar in all dietary groups, although there were minor differences in the absorption of specific macronutrients. Children in all groups gained weight during hospitalization, and there were no significant differences by diet group in the change in anthropometric status during treatment. We conclude that these locally available, low-cost staple food mixtures offer a safe and nutritionally adequate alternative to a commercially produced lactose-free formula for the dietary management of young children with acute diarrhea in this setting.

Acute Disease↗
PubMed1991

Clinical trial of modified whole milk, lactose-hydrolyzed whole milk, or cereal-milk mixtures for the dietary management of acute childhood diarrhea.

A randomized, double-masked clinical trial was completed to compare the effects of four dietary regimens for the nutritional management of 116 Peruvian children between 3 and 24 months of age with acute diarrhea. Diets consisted of a modified whole milk formula (group M), a lactose-hydrolyzed milk formula (HM), wheat noodles and whole milk (N-M), or wheat noodles and lactose-hydrolyzed whole milk (N-HM), all offered in amounts up to 55 kcal/kg body weight/day for the first 2 days of treatment and up to 110 kcal/kg/day for 4 days thereafter. The clinical characteristics of the patients in each group were similar initially. Treatment failure rates in the two milk groups combined (M = 14.3%, HM = 20.0%) were greater than in the two noodle-milk groups combined (N-M = 3.4%, N-HM = 3.4%), p = 0.03. The average stool outputs by children in both M groups (range 40-66 g/kg body weight per day on all study days) were consistently greater than those by children in both N-M groups (range 29-50 g/kg/day). The differences by dietary group were statistically significant on days 3 and 4 (p less than 0.04, analysis of variance). The estimated median durations of illness [and 95% confidence limits (CL)] in each milk group (M = 138 h, CL: 88-214; HM = 113 h, CL: 75-170) were significantly greater than in each noodle-milk group (N-M = 52 h, CL: 35-76; N-HM = 67 h, CL: 45-100), p less than 0.001-0.071. In this group of patients, noodle-milk mixtures produced fewer treatment failures, lower fecal outputs, and shorter durations of diarrhea than did milk alone, regardless of the lactose contents of the respective milks or mixed diets. Small differences in intestinal absorption and changes in body weight by dietary group that were identified were of minor clinical importance during the short duration of study. Thus, the noodle-milk diets employed during this study were safer than the milk diets for the dietary management of children with acute diarrhea.

Acute Disease↗
PubMed1991

Appropriate diets for the rehabilitation of malnourished children in the community setting.

The treatment of severe PEM includes--as appropriate in individual patients--fluid and electrolyte therapy, antimicrobial drugs, dietary management, and social and behavioral counseling. Except in the case of severe anorexia or life-threatening infections or dehydration, nutritional rehabilitation can be completed in the community setting, using centrally-processed or locally-prepared food mixtures and, when necessary, supplemental vitamins, minerals, and trace elements. Energy intakes should be maximized to promote rapid recovery, and protein: energy ratios must be increased according to the expected rate of weight gain. Nutrient: energy densities should meet or exceed the RDAs. Cultural and economic factors must be considered in the formulation of mixed diets, and organoleptic characteristics of the enhanced recipe(s) must be appropriate for young children. Selected issues concerning implementation of a community-based rehabilitation program are discussed.

Child↗