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Biomedical subjects

M A Holliday

Publications and source records attributed to M A Holliday.

At least 37 records · Page 2Linked to original sources
PubMed1988

Growth rate in infants with impaired renal function.

We report changes in renal function and growth rate in children with reduced renal function who were kept on a low normal phosphorus formula until 18 months of age. The relationship between serum creatinine values and derived creatinine clearance and residual renal function is reviewed regarding the risk of progressive loss of function. Expressing growth as growth velocity standard deviation scores over 6-month intervals gave a more accurate description of growth performance than did change in height standard deviation scores. A relationship between residual clearance and growth velocity was inferred. However, the growth of children with a less severe reduction in function was affected intermittently by intercurrent infections and inadequately treated acidosis and salt wasting. Children with a more severe reduction in function, despite maintenance on the low-phosphorus formula, had elevated serum parathormone levels. We conclude that following growth (as serial growth velocity standard deviation scores) in relation to other variables gives more insight into factors affecting growth in these children; the level of residual function affects growth potential but other complicating factors also have an effect.

Body Height↗
PubMed1987

Nutritional management of children with chronic renal failure. Summary of the task force on nutritional management of children with chronic renal failure.

Current information on the adaptations to progressive loss of renal function is presented. The assessment of renal function in infants and children using serum creatinine concentration and its derivatives is considered as are various methods for assessment of growth. Children with creatinine clearances less than 50% of normal, who do not have uremic symptoms (and who are not on dialysis), should be ingesting diets providing close to 100% of the RDA for calories with 8% of the calories as protein. Recommendations for nutritional management of children on chronic peritoneal dialysis are also presented.

Child↗
PubMed1986

Nutrition therapy in renal disease.

Dietary therapy in chronic renal insufficiency has as its principle aim preservation of residual renal function and to a lesser extent addresses metabolic abnormalities--notably relating to calcium, phosphorus, and vitamin D. Assuring an adequate calorie intake and determining a safe low level of protein and phosphorus are therapeutic goals. Dietary therapy in chronic renal failure emphasizes the goal of avoiding the metabolic problems--particularly those relating to excess dietary protein and phosphorus. Lowering protein and phosphorus to levels at or below the recommended level for normal adults has beneficial effects. However the issue of what level of intake is adequate or safe has not been fully addressed. While comparable studies in infants and children are more difficult, the effects of lower intakes upon growth are a rigorous test of adequacy or safety for this therapy.

Adult↗
PubMed1983

Effects of caloric supplementation on growth in children with uremia.

Growth and nutritional status were evaluated in 12 children with chronic renal insufficiency over a 2-year period. During 1 year the children received nutritional counseling but no caloric supplement; during year 2, they received both nutritional counseling and caloric supplementation. With caloric supplementation, food intake as a percent of normal increased from 73 to 103% and the rate of growth increased from 59 to 90% of expected. The deviation from normal for height, as measured by SD scores, did not improve during the period of supplementation, that is, there was no accelerated or compensatory growth. During the unsupplemented period growth rate, as percent normal, correlated with energy intake as percent normal (r = 0.68). Growth rate and energy intake did not correlate during the period of caloric supplementation. Anthropometric measurements and plasma albumin increased during the period of supplementation, but other indices of body protein mass did not change. Plasma lipid levels also rose with caloric supplementation. We interpret these findings as evidence that dietary energy deficiency exists in many children with chronic renal insufficiency and contributes to their poor growth. Caloric supplementation in children improves total energy intake, growth rate, and skinfold thickness, but it does not lead to accelerated or compensatory growth.

Child↗
PubMed1983

Nutritional aspects of renal disease in children and adults.

Renal disease tends to exact a greater nutritional toll in children than in adults because the needs for growth and development and differences in body composition impose a greater excretory load on the child's kidneys. Tubular disorders disturb body composition in specific ways and mandate individualized dietary supplementation or restriction. Management approaches are outlined.

Acid-Base Equilibrium↗
PubMed1983

Somatomedin in children with chronic renal insufficiency - relationship to growth rate and energy intake.

The relationship of energy intake, growth rate and serum concentration of somatomedin-A was evaluated in eighteen children with chronic renal insufficiency. Serum concentrations of somatomedin-A were found to be 0.84 micro/ml in normal children and were elevated to 3.06 micro/ml in children with chronic renal insufficiency prior to dialysis (p less than 0.01). Somatomedin-A concentrations increased during chronic hemodialysis to 5.81 micro/ml and decreased to 1.59 micro/ml following successful renal transplantation (p less than 0.01). Serum concentrations of somatomedin-A correlated with residual glomerular filtration rates (r = -0.5), serum creatinine concentration (r = 0.59), and blood urea nitrogen (r = 0.6). Growth rates correlated with energy intake (r = 0.58) and somatomedin-A concentrations (r = 0.4) in the children with chronic renal insufficiency. Both energy intake and somatomedin-A increased significantly after one year of nutritional supplementation. Our findings are consistent with the hypothesis that somatomedin, like other polypeptide hormones, is elevated in uremia and that increased energy intake may affect the growth of children with chronic renal insufficiency by increasing somatomedin levels.

Adolescent↗
PubMed1981

Thyroid hormones and muscle protein turnover. The effect of thyroid-hormone deficiency and replacement in thryoidectomized and hypophysectomized rats.

We have investigated the effects of thyroidectomy, hypophysectomy and 3,3',5-tri-iodothyronine replacement on protein synthesis and degradation in skeletal muscle in vivo. Thyroidectomy resulted in a decrease in the rate of protein synthesis as a result of a loss of RNA. However, RNA activity, the rate of protein synthesis per unit of RNA, was not decreased. This was the case in both young growing rats and mature nongrowing rats. Tri-iodothyronine treatment of thyroidectomized rats increased protein synthesis by increasing RNA concentration without changes in RNA activity, and this occurred even when food intake was restricted to prevent any increase in growth. The rate of protein degradation was decreased by thyroidectomy and increased by tri-iodo-thyronine replacement in both animals fed ad libitum and food-restricted animals. Hypophysectomy decreased protein synthesis by decreasing both RNA concentration and activity. these changes were reversed by tri-iodothyronine treatment even in the presence of persistent marked hypoinsulinaemia. This indicates that tri-iodothyronine can activate athe translational phase of protein synthesis in muscle in the absence of significant quantities of insulin. However, tri-iodothyronine does not seem to be obligatory for the maintenance of normal RNA activity in muscle, since in the thyroidectomized rat, in which plasma insulin concentrations are normal, RNA activity is maintained. From a consideration of the magnitude of changes in RNA activity observed in these experiments, it would appear that alterations in rates of elongation as well as initiation are involved in the changes in RNA activity.

Animals↗
PubMed1980

Treatment of end-stage renal disease in children: a 15-year experience.

From 1964-1979, 154 children 1 to 16 years of age with end-stage renal disease (ESRD) were treated in a regional pediatric dialysis and transplant program. The incidence of ESRD was 1.6 per million total population per year. The survival rate of children undergoing dialysis for an average of 10 months was 93%. After living donor kidney transplantation (LD), patients survival rates in 60 children were 89% at 5 years, 83% at 10 years, and 74% at 15 years. After cadaver donor kidney transplantation (CD), patient survival rates in 85 children were 70% at 5 and 10 years. LD kidney survival was 71% at 5 years, 55% at 10 years, and 40% at 15 years, whereas CD kidney survival was 43% at 5 years and 31% at 10 years. The survival of first and second transplants was similar. Patient and kidney survival have improved since 1972. The survival rate of 26 children 1 to 5 years of age was 46%, but patients with Wilms' tumor accounted for most of the deaths. We attribute these favorable long-term results in children to an integrated program of dialysis and transplantation with special pediatric facilities.

Adolescent↗
PubMed1980

In vitro suppression of insulin-mediated amino acid uptake in uremic skeletal muscle.

Resistance to insulin-mediated glucose uptake is well documented in uremia. We have previously reported that in vivo resistance to insulin mediated amino acid uptake is present in the skeletal muscle of acutely uremic rats. This report compares the effect of insulin on in vitro 14C alpha-amino isobutyric acid and cycloleucine uptake by skeletal muscle from uremic and control rats. Intracellular accumulation of 14C alpha-amino isobutyric acid were normal in the diaphragm and epitrochlear muscle of acutely uremic rats in the absence of insulin. However, insulin failed to further stimulate amino acid uptake in both tissues. Insulin also failed to stimulate cellular uptake of cycloleucine in skeletal muscle from acutely uremic animals. Resistance to insulin-mediated amino acid uptake was evident in rats with chronic uremia. This resistance to insulin mediated increases in intracellular amino acid concentration may contribute to the abnormal depression in protein synthesis or the exaggerated gluconeogenesis and alanine turnover seen in uremia.

Amino Acids↗
PubMed1979

Nutritional management of chronic renal disease.

The importance of nutritional evaluation and diet therapy in the overall management of the patient with chronic renal disease is unquestioned. Its application often is limited by a lack of knowledge regarding the requirement for certain nutrients in health as well as the way in which these requirements are modified by chronic disease. However, the most important and often the most difficult task is engaging the cooperation of the patient in the nutritional management of his disease. Acceptance of dietary manipulation depends upon the patient's family structure and the importance of food and mealtime within the particular cultural and ethnic background. Dietary recommendations implemented by the parents of pediatric patients may produce untoward changes in the child's behavior, attitudes toward food, or relationships with other family members. Dietary recommendations must be carefully planned and their effect reevaluated. They should be individualized to the age, intellectural skills, and developmental stage of the patient.

Adolescent↗
PubMed1979

Tissue resistance to insulin stimulation of amino acid uptake in acutely uremic rats.

Peripheral tissue resistance to insulin-mediated glucose uptake occurs in uremia. A similar resistance also may exist to insulin-mediated amino acid uptake. The present study examined the effect of insulin on the uptake or distribution ratios (DR) of alpha-aminoisobutyric acid (AIBA) attained in the tissues of rats made acutely uremic by bilateral nephrectomy. Both uremic and control rats concentrated equally AIBA in the gastrocnemius muscle in the absence of insulin (DR = 2.82 +/- 0.39 in controls, 2.52 +/- 0.40 in uremics). Compared to control rats, the diaphragm and liver of uremic rats, in the absence of insulin, had higher concentrations of AIBA. Insulin had the expected effect of increasing the uptake in the gastrocnemius, diaphragm, and liver of control rats but had no effect on uptake in the gastrocnemius muscle of uremic rats (DR = 5.82 +/- 0.78 in controls, 3.07 +/- 0.60 in uremics). The effect of insulin on the distribution ratio of AIBA in diaphragm and liver or uremic rats was less than it was in control rats. Uremia is associated with inhibition of insulin-mediated amino acid uptake as well as peripheral resistance to glucose utilization.

Amino Acids↗
PubMed1979

A comparison of essential and general amino acid infusions in protein-depleted patients receiving parenteral alimentation.

Six malnourished patients were studied during intravenous nutrition therapy to compare the efficiency of essential and general amino acids when given as the sole nitrogen source during intravenous nitrogen therapy. A cross-over design was used so that each patient received both essential amino acids plus arginine and histidine and a general amino acid solution in random order. Glucose provided the remainder of the energy and both infusions contained 2 g of amino acid per 100 kcal. Each patient's daily urea nitrogen production was greater during infusion of the general amino acid solution. Consequently, nitrogen intake minus urea nitrogen production was significantly greater when the essential amino acid solution was infused. Plasma amino acid levels were determined on each patient during both essential and general amino acid infusion. Abnormalities tend to reflect the composition of the amino acid solutions as well as their administration directly into the systemic circulation bypassing the portal circulation.

Adult↗