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Biomedical subjects

S A Abrams

Publications and source records attributed to S A Abrams.

At least 19 recordsLinked to original sources
PubMed2004

Bioavailability of elemental iron powder in white wheat bread.

OBJECTIVE: Iron fortification of wheat flour is widely used. In most cases, elemental iron powders are utilized as fortificants due to their lower cost and few, if any, sensory problems. However, their bioavailability is unknown. We aimed to measure the bioavailability of H(2)-reduced elemental iron powder in white wheat bread made from 72% extraction flour. DESIGN: A stable isotope of H(2)-reduced iron powder (mean particle size 15 microm) was used as fortificant in bread prepared from unfortified wheat flour. In all, 12 5- to 7-y-old children were fed bread with 4 mg of H(2)-reduced (58)Fe /100 g of flour. The next day (57)Fe ascorbate was given as reference dose. After 14 days, erythrocytes were analyzed for isotopic enrichment using mass spectrometry. RESULTS: When normalized to 40% absorption of the reference dose, the geometric mean (+/-range of 1 s.d.) bioavailability of reduced (58)Fe in wheat bread rolls was 6.5% (3.7-11.8). CONCLUSIONS: When compared to previous radioiron studies of ferrous sulfate showing 10% absorption from an identical meal in adult women, the relative bioavailability can be estimated at about 65%. However, the bioavailability of this smaller particle size (58)Fe (15 microm) is likely to be higher than that of commercial iron powder (45 microm) although the precise difference cannot be ascertained with current methods. Thus, the bioavailability of commercial elemental iron powders currently used in fortification programs is likely to be substantially lower than that of ferrous sulfate. SPONSORSHIP: This work was funded in part by Grant No 910313 by Micronutrient Initiative, IDRC, Ottawa, Canada.

Biological Availability↗
PubMed2004

Calcium and bone mineral metabolism in children with chronic illnesses.

Increased longevity and improved medical management of children with chronic illnesses has led to a focus on the short- and long-term consequences of these conditions on bone health. Bone loss is influenced by diet, malabsorption, and disease-related imbalances in bone turnover. It may be exacerbated by common medications, especially corticosteroids. Assessment of bone mass and quality, calcium absorption, kinetically derived rates of bone turnover, and biochemical markers of bone turnover have increased our knowledge of the pathophysiology of bone loss in these children as well as provided insights into possible therapeutic interventions. Increased intake of calcium and vitamin D, while useful, is unlikely to prevent or resolve bone loss in many chronically ill children. Emphasis on combination of nutritional interventions with exercise and newer bone-sparing therapies may be necessary.

Adrenal Cortex Hormones↗
PubMed2004

Current issues in nutritional management of very low birth weight infants.

Infants less than 1,500 g birth weight (very low birth weight, VLBW) are at risk for significant nutritional deficiencies. Enhancing nutritional care of these infants during their first months of life may have important short and long-term benefits. In this article we will consider several areas of recent research in the nutritional management of VLBW infants. In particular we will focus on issues related to the introduction and use of enteral nutrition. These issues include avoiding mineral deficiencies, early (minimal) enteral nutrition, human milk fortification, and postdischarge nutrition. Transitioning VLBW infants successfully to enteral nutrition is a key to their achieving adequate growth and development without the long-term risks related to parenteral nutrition. Human milk is a key component of any strategy for enteral nutrition of all infants. Its introduction in the first days of life leads to improved growth and better health outcomes for infants. However, although some nutrients are initially increased in the milk of mothers delivering prematurely, there are inadequate amounts of calcium, phosphorus, zinc and other nutrients to meet the needs of the VLBW infant during growth. Therefore, safe and effective means of fortifying human milk are essential to the care of VLBW infants. The optimal approaches for this fortification and the potential risks related to human milk fortification remain controversial. Limited data are available for the optimal content, initiation and methods for mixing fortifier with human milk.

Enteral Nutrition↗
PubMed2003

Bone mineral mass in overweight and obese children: diminished or enhanced?

Childhood obesity has become a worldwide health problem. Recent studies have suggested that obese and overweight children have lower bone mass. We used dual-energy X-ray absorptiometry to examine the relation between bone mineral content (BMC) and body fatness (%Fat) in healthy children. Obese children (%Fat>30%) had higher BMC compared with age-, gender-, and ethnic-matched children with normal adiposity (%Fat<25%). When adjusted for height, these differences were less significant. We conclude obese children do not have lower whole-body BMC when compared with leaner children, even when adjusted for height, age, gender, and ethnicity.

Adipose Tissue↗
PubMed2003

Zinc absorption by infants.

UNLABELLED: Zinc is a vital mineral in human nutrition and rare cases of overt zinc deficiency are well described in term and preterm infants. A variety of methods have been developed to assess zinc absorption, retention and balance in humans, either using mass (metabolic) balance or stable isotope-based METHODS: The different methods have different benefits and disadvantageous. Many studies have used such methods to examine zinc absorption in term and preterm infants. In preterm infants the main interest has been establishing whether different diets lead to positive zinc balance and approached in utero accretion rates. The earliest studies were concerning as they suggested that preterm infants may be in negative zinc balances for prolonged periods after birth. Subsequent studies have been more contradictory and it remains unclear from the literature how much zinc preterm infants absorb early in life. Nor is it clear whether poor zinc absorption during this period has any long-term consequences. Studies in term infants have suggested no such prolonged period of negative zinc balance. Generally the absorption values are in line with those used by the Institute of Medicine in the most recent edition of the Dietary Reference Intakes. Other studies have been designed to assess the effect of changes in formula composition on zinc intake (e.g. the presence or absence of lactose, high vs low zinc contents, etc.). Ho-wever, despite almost 20 studies of zinc absorption in infants many physiologically important questions remain unanswered, especially in preterm infants.

Breast Feeding↗
PubMed2003

Using stable isotopes to assess the bioavailability of minerals in food-fortification programs.

Food fortification with minerals is often undertaken without consideration of the bioavailability or nutrient-nutrient interactions related to its use. Stable isotopes provide a safe and accessible approach to providing direct evidence regarding these issues. Studies can be applied in all areas of the world and in all population groups. Mineral stable isotopes are safe and meet stringent ethical standards for use in children. Clinical studies in children allowing scientists, policy makers and the food industry to obtain data needed to understand how best to fortify foods to enhance the nutritional health of children of all ages. It is not necessary to have analytical mass spectrometry equipment available in each country where studies are performed. Rather, international collaborations can be developed to allow clinical studies to be performed in the field setting with analysis elsewhere if needed. The combination of isotope studies with field intervention trials may be beneficial.

Biological Availability↗
PubMed2002

Non-digestible oligosaccharides and calcium absorption in girls with adequate calcium intakes.

Non-digestible oligosaccharides such as inulin and oligofructose have been shown to consistently increase calcium absorption in experimental animals, but data in humans are less clear-cut. The objective of this study was to assess the effect of 8 g/d of oligofructose or a mixture of inulin and oligofructose on calcium absorption in girls at or near menarche. A total of fifty-nine subjects were studied using a balanced, randomized, cross-over design. They received, in random order, 8 g/d placebo (sucrose), oligofructose or the mixture inulin+oligofructose for 3 weeks, separated by a 2-week washout period. Throughout the study, subjects consumed a total of approximately 1500 mg/d dietary calcium, by adding two glasses of calcium-fortified orange juice to their diet. Four grams of placebo, oligofructose or the mixture inulin+oligofructose was added to each glass of orange juice immediately before it was consumed. At the end of each 3-week adaptation period, calcium absorption was measured, using a dual stable isotope technique, from the cumulative fractional excretion of an oral and an intravenous tracer over 48 hours. Calcium absorption was significantly higher in the group receiving the inulin+oligofructose mixture than in the placebo group v. P=0.01), but no significant difference was seen between the oligofructose group and the placebo group v. P=NS). We conclude that modest intakes of an inulin+oligofructose mixture increases calcium absorption in girls at or near menarche.

Adolescent↗
PubMed2002

Using stable isotopes to assess the bioavailability of minerals in food fortification programs.

The fortification of various types of food with minerals is often undertaken without consideration of either their bioavailability or the potential nutrient-nutrient interactions resulting from their use. Stable isotopes provide a safe and accessible method of resolving these issues by providing the proper evidence in each case. They must be conducted according to strict safety and ethical guidelines and may be readily conducted in a field setting. Clinical studies in children enable researchers, policymakers, and food manufacturers to obtain the data necessary to determine the best way to fortify specific foods and beverages, in order to optimally enhance the nutritional health of growing children. We have shown the utility of this approach in studies in both developing countries and in the United States.

Biological Availability↗
PubMed2001

Iron and breastfeeding.

Given the importance of iron nutrition during the first year of life, there are surprisingly few true, randomized, controlled studies addressing this issue; however, it seems that iron deficiency is unlikely in full-term, breastfed infants during the first 6 months of life because these infants' body iron stores are sufficient to meet requirements. After this time, many infants exhaust their iron stores and become dependent on a secondary dietary iron supply. Although iron deficiency is a significant nutritional problem worldwide, most of the adverse effects of iron deficiency in this age group are hypothetical and rely on extrapolation from animal studies or studies at different ages. This, however, also is true of most of the adverse effects of iron excess in this age group. Given this uncertainty, it seems prudent to use the lowest dose of iron that prevents iron-deficiency anemia. Currently, the best evidence is that this is achieved by prolonged breastfeeding, avoidance of unfortified formulas and cow's milk, and the introduction of iron-fortified and vitamin C-fortified weaning foods at approximately 6 months of age. Despite much research, there are many areas of uncertainty regarding iron supplementation of infants, including that: 1. The optimal age for introducing iron-fortified supplemental foods is poorly defined and should be further evaluated. 2. The natural history of iron deficiency and iron-deficiency anemia during the first year of life is unclear, as are the possible long-term effects of this, especially on developmental outcome. 3. The biologic variability among infants and among their mothers that allows many infants who do not receive iron-fortified foods to prevent iron deficiency while receiving only human milk throughout the first year of life is intriguing and warrants additional study. 4. The iron requirements of small-for-gestational-age, term infants are unknown. Their iron requirements are likely to be higher than those of average term infants, but whether iron supplements are required is unclear. 5. The optimum amount of dietary iron in the weaning diet needs to be further defined. Similarly, the optimal source and amount of iron in infant formulas given to infants who receive a mixture of human milk and formula is unclear.

Age Factors↗
PubMed2001

Calcium fortification of breakfast cereal enhances calcium absorption in children without affecting iron absorption.

OBJECTIVES: Provision of calcium-fortified foods may represent an important component of improving the calcium intake of children. We sought to determine whether the addition of calcium to cereal would have a net positive effect on calcium absorption without decreasing iron absorption. METHODS: Twenty-seven children, 6 to 9 years of age, were provided two servings per day (30 g of cereal per serving) of either a low (39 mg/serving) or fortified (156 mg/serving) calcium-containing cereal product for 14 days. Calcium absorption was measured by using stable isotopes added to milk (extrinsically labeled) and to the calcium-fortified cereal (intrinsically labeled). RESULTS: Fractional calcium absorption from the fortified cereal was virtually identical to that from milk. Fractional absorption of calcium from milk did not differ significantly when given with enriched or low-calcium-containing cereal. Total calcium absorption increased from 215 +/- 45 mg/d to 269 +/- 45 mg/d with the addition of the calcium-fortified cereal (P <.001). Iron absorption was similar when children received the calcium-fortified cereal or unfortified cereal. CONCLUSIONS: The addition of a moderate amount of calcium to a cereal product was beneficial to calcium absorption and did not interfere with iron absorption. Use of calcium-fortified food products may be considered a practical approach to increasing the calcium intake of children.

Absorption↗
PubMed2001

Calcium turnover and nutrition through the life cycle.

Ca nutritional requirements and bone Ca turnover can be assessed using numerous techniques. Among these techniques are bone mass measurements, tracer kinetic studies, bone histomorphometry and biochemical studies. Stable-isotope-based kinetic studies offer unique advantages in their ability to assess both Ca absorption and turnover. This approach is safe and readily applicable to subjects of all ages. Ca is essential for growth and maintenance of bone mineral throughout life. During pregnancy, increased intestinal absorption of Ca by the mother provides much of the Ca supplied to the fetus. During infancy, Ca supplied in human milk is primarily derived from maternal bone stores, which are quickly replenished during and after weaning. Early childhood is a time of relatively slow bone growth, with a rapid increase occurring during puberty. Recent kinetic studies demonstrate an increase in both Ca absorption and bone Ca deposition associated with early puberty. Bone Ca deposition reaches a maximum in females shortly before menarche. At that time the bone Ca deposition rate is approximately five times that of adulthood. The decline in bone Ca deposition rate is gradual after menarche. Ca absorption from the diet shows a gradual decline in adulthood as well. Ca supplementation, in the presence of adequate vitamin D, is effective in enhancing bone mineral content in childhood and in helping to maintain bone mineral content in adults. Maintaining adequate Ca nutriture throughout life may be necessary to minimize the risk of bone-loss disorders.

Adolescent↗
PubMed2001

Effect of acute zinc depletion on zinc homeostasis and plasma zinc kinetics in men.

BACKGROUND: Zinc homeostasis and normal plasma zinc concentrations are maintained over a wide range of intakes. OBJECTIVE: The objective was to identify the homeostatic response to severe zinc depletion by using compartmental analysis. DESIGN: Stable zinc isotope tracers were administered intravenously to 5 men at baseline (12.2 mg dietary Zn/d) and after 5 wk of acute zinc depletion (0.23 mg/d). Compartmental modeling of zinc metabolism was performed by using tracer and mass data in plasma, urine, and feces collected over 6-14 d. RESULTS: The plasma zinc concentration fell 65% on average after 5 wk of zinc depletion. The model predicted that fractional zinc absorption increased from 26% to essentially 100%. The rate constants for zinc excretion in the urine and gastrointestinal tract decreased 96% and 74%, respectively. The rate constants describing the distribution kinetics of plasma zinc did not change significantly. When zinc depletion was simulated by using an average mass model of zinc metabolism at baseline, the only change that accounted for the observed fall in plasma zinc concentration was a 60% reduction in the rate constant for zinc release from the most slowly turning over zinc pool. The large changes in zinc intake, excretion, and absorption-even when considered together-only explained modest reductions in plasma zinc mass. CONCLUSION: The kinetic analysis with a compartmental model suggests that the profound decrease in plasma zinc concentrations after 5 wk of severe zinc depletion was mainly due to a decrease in the rate of zinc release from the most slowly turning over body zinc pool.

Adult↗
PubMed2001

Chronic pulmonary insufficiency in children and its effects on growth and development.

Conditions leading to chronic pulmonary insufficiency can affect infants and children. These can lead to growth failure and delayed development. Among the most common and severe of these are bronchopulmonary dysplasia (BPD) and cystic fibrosis. In addition to the respiratory consequences of these diseases, there is ample evidence that they lead to decreased growth as a result of decreased energy intake and increased energy expenditure. Furthermore, there is evidence that infants with BPD may also have delayed development, independent of the effects of their prematurity. Enhancing the long-term outlook for these conditions may therefore require consideration of both improved pulmonary management and aggressive nutritional management to limit growth failure and potentially enhance developmental outcome. Specific micronutrient supplementation, such as antioxidant therapy, may also enhance pulmonary and nutritional status.

Asthma↗
PubMed2001

Z score prediction model for assessment of bone mineral content in pediatric diseases.

The objective of this study was to develop an anthropometry-based prediction model for the assessment of bone mineral content (BMC) in children. Dual-energy X-ray absorptiometry (DXA) was used to measure whole-body BMC in a heterogeneous cohort of 982 healthy children, aged 5-18 years, from three ethnic groups (407 European- American [EA], 285 black, and 290 Mexican-American [MA]). The best model was based on log transformations of BMC and height, adjusted for age, gender, and ethnicity. The mean +/- SD for the measured/predicted in ratio was 1.000 +/- 0.017 for the calibration population. The model was verified in a second independent group of 588 healthy children (measured/predicted In ratio = 1.000 +/- 0.018). For clinical use, the ratio values were converted to a standardized Z score scale. The whole-body BMC status of 106 children with various diseases (42 cystic fibrosis [CF], 29 juvenile dermatomyositis [JDM], 15 liver disease [LD], 6 Rett syndrome [RS], and 14 human immunodeficiency virus [HIV]) was evaluated. Thirty-nine patients had Z scores less than -1.5, which suggest low bone mineral mass. Furthermore, 22 of these patients had severe abnormalities as indicated by Z scores less than -2.5. These preliminary findings indicate that the prediction model should prove useful in determining potential bone mineral deficits in individual pediatric patients.

Absorptiometry, Photon↗
PubMed2000

Body weight-specific zinc compartmental masses in girls significantly exceed those reported in adults: a stable isotope study using a kinetic model.

Maintaining optimal zinc status is important for normal growth and development in children, but minimal data are available regarding zinc metabolism in this age group. Our objectives were to utilize stable isotope-based compartmental modeling techniques to investigate zinc metabolism in healthy children; to expand a current stable isotope-based model to include red blood cell data; and to compare kinetic parameters in children with those previously reported in adults. Seven healthy girls, age 9.94 +/- 0.79 y, received 1.1 mg of a (67)zinc-enriched tracer orally and 0.5 mg of a (70)zinc-enriched tracer intravenously. Blood, urine and fecal samples were collected for 6 d. Stable isotope enrichments were measured by thermal ionization magnetic sector mass spectrometry. A six-compartment model based on a model previously reported in adults was used; the model excluded red blood cell data. Body weight-corrected masses of the body zinc compartments derived using this model were significantly greater in children than those reported in adults. Modification of the model to include a red blood cell compartment increased the total identifiable zinc mass of the nongastrointestinal compartments by approximately 2.5%. We conclude that compartmental modeling can be used to describe zinc kinetics in children, and that the body weight-corrected zinc pool masses are significantly greater in children than in adults.

Adult↗
PubMed2000

Prenatal iron supplements impair zinc absorption in pregnant Peruvian women.

Prenatal iron supplements may adversely influence zinc absorption during pregnancy. To examine the impact of prenatal iron supplements on supplemental zinc absorption, fractional zinc absorption was measured in 47 pregnant Peruvian women during the third trimester of pregnancy (33 +/- 1 wk gestation). Of these 47 women, 30 received daily prenatal supplements from wk 10-24 of pregnancy until delivery. Supplements contained 60 mg of Fe and 250 microg of folate without [iron group (Fe), n = 16] or with [iron and zinc supplemented group (Fe + Zn), n = 14] 15 mg of Zn. The remaining 17 women [unsupplemented control group (C)] received no prenatal supplementation. Zinc concentrations were measured in plasma, urine and cord blood and percentage zinc absorption was determined following dosing with oral ((67)Zn) and intravenous ((70)Zn) stable zinc isotopes. Percentage zinc absorption was significantly lower than controls in fasting women receiving iron- containing prenatal supplements (20.5 +/- 6.4 vs. 20.2 +/- 4.6 vs. 47.0 +/- 12.6%, Fe, Fe + Zn and C groups, respectively, P: < 0.0001, n = 40). Plasma zinc concentrations were also significantly lower in the Fe group compared to the C group (8.2 +/- 2.2 vs. 9.2 +/- 2.2 vs. 10.9 +/- 1. 8 micromol/L, Fe, Fe + Zn and C groups, respectively, P: = 0.002), and cord zinc concentrations were significantly related to maternal plasma Zn levels (y = 6.383 + 0.555x, r = 0.486, P: = 0.002). The inclusion of zinc in prenatal supplements may reduce the potential for iron supplements to adversely influence zinc status in populations at risk for deficiency of both these nutrients.

Adult↗