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Biomedical subjects

Mary S Fewtrell

Publications and source records attributed to Mary S Fewtrell.

11 recordsLinked to original sources
PubMed2006

Evaluation of arm anthropometry for assessing pediatric body composition: evidence from healthy and sick children.

Arm anthropometry is used as a proxy of body composition in clinical and field research but its validity has not been established in children. To address this issue, mid-upper arm circumference (MUAC) and triceps skinfold thickness (TS) were measured in 110 healthy children aged 4.4-13.9 y (55 boys) and 49 cystic fibrosis (CF) patients aged 8.1-13.4 y (22 boys). Reference values were arm and whole-body fat mass (FM) and fat-free mass (FFM) measured by dual x-ray absorptiometry and four-component model, respectively. Arm fat area (AFA), MUAC, and TS correlated well with arm FM (r = 0.84-0.92) and total FM (r = 0.78-0.92). Arm muscle area (AMA) and MUAC correlated well with arm FFM (r = 0.68-0.82) and total FFM (r = 0.60-0.86). After adjusting for age, sex, and height, arm anthropometry correlated strongly with FM but weakly with FFM. AFA, MUAC, and TS explained 67, 63, and 61% of variability in total FM in healthy children and 70, 72, and 63% in CF. AMA and MUAC explained only 24 and 16% of variability in total FFM in healthy children and 33 and 28% in CF. Arm anthropometry is useful for predicting FM and ranking healthy children and patients for fatness. It has poorer success in predicting regional or total FFM.

Absorptiometry, Photon↗
PubMed2006

Body composition in children in remission from acute lymphoblastic leukemia.

BACKGROUND: Changes in body composition are commonly reported in pediatric survivors of acute lymphoblastic leukemia (ALL). However, the effect of ALL and of its treatment on body composition in children in remission from ALL has not been fully examined with the use of a reference method. OBJECTIVES: We aimed to determine the body composition and composition of fat-free mass (FFM) in children in remission from ALL. We also aimed to compare the effects that prednisolone and dexamethasone had on the body composition of an ALL survivor population. DESIGN: This cross-sectional study measured height, weight, body volume, total body water, and bone mineral content in 24 children in remission from ALL and 24 age-matched, healthy control subjects. Body composition and FFM composition were evaluated by using the 4-component model. RESULTS: The mean body mass index and fat mass index were significantly (P = 0.05 for both) higher in the ALL survivors than in age-matched control subjects. The composition of the FFM in the 2 treatment groups was not observed to differ significantly. Examination of the composition of FFM made it evident that children in remission from ALL had both significantly greater hydration (P = 0.001) and lower density (P = 0.0001) of FFM than did the control children. CONCLUSIONS: Children in remission from ALL may develop excess body fat. To measure body composition accurately in an ALL population, the high hydration and low density of FFM in this population should be taken into consideration.

Absorptiometry, Photon↗
PubMed2006

Evaluation of Lunar Prodigy dual-energy X-ray absorptiometry for assessing body composition in healthy persons and patients by comparison with the criterion 4-component model.

BACKGROUND: Dual-energy X-ray absorptiometry (DXA) is widely used to assess body composition in research and clinical practice. Several studies have evaluated its accuracy in healthy persons; however, little attention has been directed to the same issue in patients. OBJECTIVE: The objective was to compare the accuracy of the Lunar Prodigy DXA for body-composition analysis with that of the reference 4-component (4C) model in healthy subjects and in patients with 1 of 3 disease states. DESIGN: A total of 215 subjects aged 5.0-21.3 y (n = 122 healthy nonobese subjects, n = 55 obese patients, n = 26 cystic fibrosis patients, and n = 12 patients with glycogen storage disease). Fat mass (FM), fat-free mass (FFM), and weight were measured by DXA and the 4C model. RESULTS: The accuracy of DXA-measured body-composition outcomes differed significantly between groups. Factors independently predicting bias in weight, FM, FFM, and percentage body fat in multivariate models included age, sex, size, and disease state. Biases in FFM were not mirrored by equivalent opposite biases in FM because of confounding biases in weight. CONCLUSIONS: The bias of DXA varies according to the sex, size, fatness, and disease state of the subjects, which indicates that DXA is unreliable for patient case-control studies and for longitudinal studies of persons who undergo significant changes in nutritional status between measurements. A single correction factor cannot adjust for inconsistent biases.

Absorptiometry, Photon↗
PubMed2004

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.

Body Height↗
PubMed2004

Prematurity and reduced body fatness at 8-12 y of age.

BACKGROUND: Increasing evidence suggests that body composition, an important factor influencing morbidity and mortality in adult life, might be programmed by early growth and nutrition. Children born preterm remain shorter and lighter than their term-born peers during childhood, but it is unclear whether the size difference is associated with altered body composition. OBJECTIVE: We tested the hypothesis that both fat mass (FM) and fat-free mass (FFM) are proportionately lower in children born preterm than in children born at term. DESIGN: A total of 497 children born preterm and 95 children born at term were studied at 8-12 y of age. Body composition was determined with the use of skinfold thicknesses and dual-energy X-ray absorptiometry (in 200 preterm and 95 term children). FM and FFM were normalized for height to give fat mass index (FMI) and fat-free mass index (FFMI), respectively. RESULTS: Children born preterm were significantly lighter than those born at term and had lower FM and FFM. However, FMI was significantly lower in preterm children, whereas FFMI was not. FMI was also significantly lower in boys than in girls and in children with higher activity levels. Additional data available for the preterm group showed no association between birth weight, gestational age, or neonatal diet and later FMI or FFMI. CONCLUSIONS: The smaller size of children born preterm than of children born at term is associated with lower FM but not FFM when normalized for height. We hypothesize that this could result in a reduction in the risk of obesity and related diseases during adult life.

Absorptiometry, Photon↗
PubMed2004

Neurodevelopment in children born small for gestational age: a randomized trial of nutrient-enriched versus standard formula and comparison with a reference breastfed group.

OBJECTIVE: Many studies have shown that children born small for gestational age (SGA) are at a neurodevelopmental disadvantage. We have shown that nutrient enrichment of formula fed to term SGA infants improves their growth and hypothesized that it also would improve their neurodevelopmental outcome. DESIGN: A randomized, controlled trial of standard term-infant (n = 147) or nutrient-enriched (n = 152) formula for the first 9 months. A reference group of 175 breastfed SGA infants was also recruited. SETTING: Subjects were recruited in 5 maternity hospitals in Cambridge, Nottingham, and Leicester, all in the United Kingdom. PARTICIPANTS: Healthy, term infants (gestation: > or =37 weeks) with birth weight <10th centile. OUTCOME MEASURES: Bayley mental and psychomotor scores at 18 months (primary) and developmental scores from Knobloch, Pasamanick, and Sherrard's developmental screening inventory at 9 months (secondary). RESULTS: There was no significant intergroup difference in Bayley Mental Development Index (MDI) or Psychomotor Development Index (PDI) scores at 18 months. However, at 9 months, children fed the enriched formula had a significantly lower developmental quotient (99.5 vs 102.0; 95% confidence interval [CI] for difference: -4.6, -0.4). A significant disadvantage was seen in girls (-5.1; 95% CI: -7.8, -2.4) but not in boys (0.9; 95% CI: -2.4, 4.2). Breastfed infants had significantly higher MDI and PDI scores at 18 months than formula-fed infants. Confounding factors accounted for approximately 34% of the observed association between breastfeeding and MDI score and none of the association between breastfeeding and PDI score. CONCLUSIONS: The previously reported enhanced linear growth in SGA children fed enriched formula was not matched by a neurodevelopmental advantage. At 9 months, girls fed the enriched formula had a significant developmental disadvantage, although this was not seen at 18 months. Later follow-up will determine any long-term effects on health or development. Meanwhile, use of enriched formula for term SGA children should not be promoted. It seems that breastfeeding may be especially beneficial for neurodevelopment in children born SGA.

Breast Feeding↗
PubMed2003

Growth and nutrition after discharge.

Preterm infants are frequently discharged from hospital growth retarded and show reduced growth during childhood. However, nutrition during the post-discharge period has been neglected. Randomized trials show growth benefits, particularly in boys, when nutrient-enriched diets (preterm formula or post-discharge formula) rather than term formula are fed after discharge, with effects persisting beyond the intervention period. These findings suggest that post-discharge period may be a critical time for influencing the growth trajectory, but further research is required to investigate longer-term effects on growth, health and development. Preterm infants who are breast-fed after discharge show slower weight and length gain and lower bone mass than formula-fed infants. Further studies should establish whether differences persist or have long-term consequences, and clarify whether such infants would benefit from post-discharge nutritional supplementation. The introduction of solids may have a significant effect on growth and nutritional status, but insufficient data are currently available for evidence-based guidelines.

Child Development↗
PubMed2002

Double-blind, randomized trial of long-chain polyunsaturated fatty acid supplementation in formula fed to preterm infants.

OBJECTIVE: We tested the hypothesis that balanced addition of long-chain polyunsaturated fatty acid (LCPUFA) to preterm formula during the first weeks of life would confer long-term neurodevelopmental advantage in a double-blind, randomized, controlled trial of preterm formula with and without preformed LCPUFA. METHODS: The participants were 195 formula-fed preterm infants (birth weight <1750 g, gestation <37 weeks) from 2 UK neonatal units and 88 breast milk-fed infants. Main outcome measures were Bayley Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) at 18 months and Knobloch, Passamanick and Sherrard's Developmental Screening Inventory at 9 months' corrected age. Safety outcome measures were anthropometry at 9 and 18 months, tolerance, infection, necrotizing enterocolitis, and death. RESULTS: There were no significant differences in developmental scores between randomized groups, although infants who were fed LCPUFA-supplemented formula showed a nonsignificant 2.6-point (0.25 standard deviation) advantage in MDI and PDI at 18 months, with a greater (nonsignificant) advantage (MDI: 4.5 points; PDI: 5.8 points) in infants below 30 weeks' gestation. LCPUFA-supplemented infants were shorter than control infants at 18 months (difference in length standard deviation score: 0.44; 95% confidence interval: 0.08-0.8). No other significant short- or long-term differences in safety outcomes were observed. Breastfed infants had significantly higher developmental scores at 9 and 18 months than both formula groups and were significantly heavier and longer at 18 months than LCPUFA-supplemented but not control infants. CONCLUSIONS: With the dose, duration, and preparation of LCPUFA used, efficacy was not demonstrated, although an advantage in later neurodevelopment cannot be excluded by global tests of development up to 18 months, particularly in infants below 30 weeks' gestation. The surprising effect of LCPUFA-supplemented formula on growth 18 months beyond the intervention period needs to be confirmed in other studies using similar supplementation strategies. Additional follow-up of this cohort is critical at an age when more specific tests of cognitive function are possible.

Age Factors↗
PubMed2002

Energy requirements and body composition in stable pediatric intensive care patients receiving ventilatory support.

Energy requirements of pediatric intensive-care patients are unknown due to the difficulty of measuring total energy expenditure in free-living conditions. We investigated energy expenditure and body composition in stable pediatric intensive-care patients receiving long-term ventilatory support. Total energy expenditure and total body water were measured in 10 such patients using the doubly-labeled water method. The patients had significantly lower energy expenditure than healthy children of the same age. Relative to length, fat-free mass deposition was significantly lower, and fat deposition was significantly greater, than in healthy subjects. In general, total energy requirements of these patients are significantly reduced as compared to healthy children, which can be attributed to their lower activity levels and their reduced muscle mass. Although they gain weight similar to healthy children, their weight gain is disproportionately higher in fat. However, one patient with myofibromatosis contradicted this general pattern.

Adipose Tissue↗