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A rice-based oral rehydration solution (ORS) known as Amylyte may rehydrate children with acute diarrhea more effectively than the World Health Organization's (WHO) glucose-ORS. A total of 127 male children with diarrhea, ages four months to three years, in five medical centers in Asia, were randomly assigned to treatment with either WHO-ORS or Amylyte-ORS. The Amylyte-ORS contains rice proteins, short glucose polymers, fat, and five times as many calories as the WHO-ORS. The duration of diarrhea was reduced by 15% in children treated with Amylyte-ORS. Children in the Amylyte-ORS group also required significantly less ORS, and gained significantly more weight. Five children receiving WHO-ORS and three receiving Amylyte-ORS were considered treatment failures. The rice-ORS may be especially beneficial for patients with cholera in reducing stool output and duration of diarrhea. A smaller benefit from rice-ORS may be seen for acute, non-cholera diarrhea., Objective. To compare the efficacy of an oral rehydration solution (ORS) containing short polymers of glucose derived from rice (Amylyte-ORS) and five times the caloric density of current ORS to the standard glucose-ORS (World Health Organization [WHO]= ORS) in the treatment of acute diarrhea in children. Methods. The rice ORS (Amylyte-ORS) was obtained by adding thermophilic amylase (252 500 MW units) and salts (1.5 g NaCl, 600 mg KCI, and 150 mg [CaCl.sub.2]) to 100 g rice and boiling for 10 minutes in 500 mL water. This yields 250 mL Amylyte-ORS, which contains 92% to 96% short-chain glucose polymers, three to nine molecules in length, and provides 425 kcal/L, compared to 80 kcal/L for the WHO-ORS. One hundred forty-four male children, 4 months to 3 years of age, presenting with acute diarrhea and mild, moderate, or severe dehydration, were assigned by random allocation to receive either WHO-ORS or Amylyte-ORS. Data from 127 children were analyzed (57 received the WHO-ORS and 70 the Amylyte-ORS). Two children given Amylyte-ORS and 15 given the WHO-ORS were not included in the analysis because of improperly collected data or lost urine or fecal specimens. None were given antibiotics during the study. Free water and feeding were allowed after the children were rehydrated. Results. The clinical characteristics of the children in the two treatment groups were comparable. Five children who received the WHO-ORS and three children given Amylyte-ORS were treatment failures. Amylyte-ORS reduced diarrhea duration by 15% (41.4 [+ or -] 2.5 vs 34.7 [+ or -] 1.8 hours; P < .03) compared to the WHO-ORS, regardless of the severity of dehydration. In the Amylyte-treated group, ORS requirements were significantly less (234 [+ or -] 15.2 vs 295 [+ or -] 17.6 mL/kg; P < .01) and weight gain was significantly more (367.7 [+ or -] 45.1 vs 199.2 [+ or -] 38.2 g; P < .01) than in those given the WHO-ORS. The net intestinal fluid balance and total body fluid balance were similar in the two groups. Conclusions. Amylyte-ORS efffectively rehydrates children with acute diarrhea, reduces diarrhea duration, decreases ORS requirements, and improves weight gain compared to the WHO-ORS. Pediatrics 1995;95:198-202; rice, oral rehydration solutions, diarrhea, glucose polymers, thermophilic amylase., ABBREVIATIONS. ORS, oral rehydration solution(s); WHO, World Health Organization. The glucose-electrolyte oral rehydration solutions recommended by the World Health Organization (WHO-ORS) effectively correct the dehydration and electrolyte imbalance due to [...]

Prolonged diarrhea is a major cause of infant mortality throughout the world, with US mortality at 45 percent of affected children. The cause of the disorder is unknown, but it is associated with intestinal malabsorption of nutrients and consequent malnutrition. Protracted diarrhea has been treated by total intravenous feeding, but this is not feasible in developing countries. The alternative of a semielemental diet, a formula containing basic food nutrients (amino acids, fatty acids and sugars) rather than whole foods, is more easily implemented in such areas. It has been thought that fat malabsorption may be one feature of protracted diarrhea; consequently, the fat content of semielemental formulas has usually been restricted. However, for infants at risk for malnutrition and poor growth, fats may provide an important source of calories. The effect of a high-fat semielemental diet was compared with that of a regular semielemental diet in 20 children with protracted diarrhea of infancy from Buffalo, New York and 30 similarly affected children from Bangkok, Thailand. Children in Buffalo given the experimental diet gained an average of 28 grams per day, while those on the standard diet gained only 20 grams per day. Two children from the experimental group and one from the regular group were rehospitalized for recurrent diarrhea and dehydration. Children in Bangkok on either diet improved, as indicated by growth in weight, height, and head circumference. However, the total weight gain of children who received the high-fat diet was significantly greater. These children also showed significant improvement in mid-arm muscle mass. These findings suggest that infants with protracted diarrhea benefit from a high-fat elemental diet. Further research is needed to determine the optimal fat sources and fat content for infants with persistent diarrhea. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective: To determine whether chicken-based formula can replace soy-based formula in infants with cow milk allergy. Subjects and Methods: Thirty-eight infants with cow's milk allergy, aged between 2-24 months of age were randomized to receive either chicken-based formula or soy-based formula for 14 days. Results: In the group of soy-based formula, 12 out of 18 infants had evidence of intolerance and could not continue with the formula. However, only 4 out of 20 infants in the chicken-based formula group had evidence of clinical intolerance. All other 16 infants were fed the chicken-based formula with success. The number of infants who were intolerant to chicken formula was significantly lower than the number of those fed soy-based formula (p = 0.009). Conclusion: Chicken-based formula can be used more effectively than soy-based formula in infants with cow milk allergy. [ABSTRACT FROM AUTHOR]

Fructose malabsorption has not been well-defined in Thai populations but there has been increasing consumption of fructose-fortified drinks Objectives: To assess the incidence of fructose malabsorption and intolerance in Thai normal subjects as well as the facilitating effect of glucose on fructose absorption. Methods: Twenty-five gram of fructose was ingested by 77 subjects (37 men, 40 women; mean age 26 and 31 y, range 20-50 y and 21-50 y for men and women, respectively). Measurement of breath-H2 levels after fructose ingestion in each subject up to 2 h was performed. Those who showed fructose malabsorption were later given 25 g of each glucose and fructose and second tests of breath-H2 tests were done. Results: Fructose malabsorption was found in eleven females with a significant rise in average breath-H2 level at 30, 60, 90, and 120 min (p < 0.001), whereas none of the males had an abnormal breath-H2 test. Only 1 of the 11 females with increased breath H2 had gastrointestinal symptoms. In all the fructose malabsorbers, excess breath- H2 reverted to normal when the fructose solution was mixed and administered with 25 g glucose (p < 0.001). Conclusion: The incidence rate of fructose malabsorption was 11 of 77 subjects but these were female. One of the 11 had gastrointestinal symptoms. It was found that an equal amount of glucose would abolish fructose malabsorption. [ABSTRACT FROM AUTHOR]

Chylothorax and chylopericardium are rare conditions occurring in infants and children. Both may be traumatic or nontraumatic in origin. We reviewed our experiences with the management of sixteen pediatric cases (10 males, 6 females; 11-days to 14-years old) of chylothorax and chylopericardium from 1997 to 2003. There were fifteen cases of chylothorax (9 left, 2 right, 4 bilateral) and two cases of chylopericardium (1 isolated and I associated with chylothorax), and their incidences of occurrence after cardiothoracic surgery were 0.89% and 0.12%, respectively. Of the fifteen cases occurring after cardiothoracic surgery, thirteen patients had corrective or palliative surgery for complex congenital heart disease, and two patients had removal of thymolipoma and neuroblastoma, respectively. Included also in this review was an 11-day old preterm infant with hydrops fetalis and congenital heart disease who developed chylothorax. Characteristics of chylous effusion included a presence of whitish opaque fluid in the pleural cavity and the pericardial cavity, having a triglyceride content ranging from 59 to 1689 mg/dl which was higher than a plasma triglyceride, a protein content of 2.4 to 7.4 g/dl, and a presence of lymphocyte predominance. The average latent period for diagnosis of chylothorax or chylopericardiuin was 13 days (range 3-30). All patients were treated primarily with nutritional modification using medium-chain triglycerides (MCT) instead of long-chain triglycerides in their diet; and only a few cases needed bowel rest with total parenteral nutrition (TPN). Twelve patients completely responded to a MCT-rich diet; two cases resolved after switching to TPN and another case needed surgery for ligation of lymphatic vessels around the thymus gland. The mean duration of lymph drainage was 12.1 days (range 3-29) and the average length of time of continued conservative treatment (MCT-rich diet and TPN) was 29.8 days (range 1 8- 47). Fourteen patients (87.25%) had good outcome, i.e. resolution from chylothorax or chylopericardium and return to normal diet. Two of the fourteen patients developed severe infections; one was diagnosed with suspected bacterial endocarditis and the other had candidemia. However, both responded well to antibacterial and antifungal drugs, respectively. One case succeeded after surgery. A case that had low compliance with dietary recommendations and required repeated placement of drainage devices died due to infection with enterococcal septicemia. Early and good compliance with MCT-rich diet is essential for achieving a favorable outcome in the management of chylothorax and chylopericardium in children. [ABSTRACT FROM AUTHOR]

Background: Infants with cow's milk protein allergy (CMPA) are at risk for nutrient inadequacy and impaired growth., Objective: To evaluate the effect of a new amino acid-based formula (nAAF) compared with commercial amino acid-based formula (cAAF) on growth and protein status of cow's milk protein (CMP)-allergic infants and to compare their growth with those of healthy infants., Methods: Infants less than 6 months of age with CMPA were enrolled in the nAAF or cAAF groups. Healthy infants fed breast milk (BM) or infant formula (IF) were controls. They remained on their formula/milk until day 28 of the study. Anthropometric evaluation was performed at birth, day 0 and day 28 of the study and calculated to z-scores of weight-for-age (WAZ), length-for-age (LAZ) and head circumference-for-age (HAZ). Plasma amino acids, albumin, urea nitrogen, and creatinine were assessed for infants with CMPA on day 0 and day 28., Results: The nAAF and cAAF groups did not differ in increases in WAZ [regression coefficient (95%CI): 0.088 (-0.619, 0.796), p = 0.791], LAZ [0.045 (-0.789, 0.880, p = 0.909], and HAZ [-0.645 (-2.082, 0.793), p = 0.337] between day 0 and day 28. The increases in WAZ and LAZ during 28 days in the nAAF group did not differ from the controls. The changes in the blood chemistry values, except albumin, were not different between CMPA groups., Conclusions: The nAAF, similar to the cAAF, supports growth and protein status for infants with CMPA, and it might be used as a substitute for the cAAF.

Objective: To study the association between analfissures and cow's milk allergy (CMA) in infants. METHODS AND METHOD: In a prospective study, 72 confirmed cases of CMA in infants were examined for anal fissure by pediatricians with five years' experience. A positive finding was defined as when an anal fissure was detected by at least two out of three examiners., Results: Of infants with CMA with and without gastrointestinal GI symptoms, 79% and 83% had anal fissures, respectively The prevalence of anal fissure in these infants is significantly higher than in normal infants., Conclusion: Anal fissure may be a pathognomonic sign of cow's milk allergy in infants.

Objective: To study the prevalence of atopic dermatitis in exclusively breast-fed infants of allergic mothers who were placed either on liberal diets or on dairy-product-restricted diets., Material and Method: Infants aged 0 to 4 months old, who were exclusively breast-fed and whose mothers had a history of allergic disease, were the subjects of the present study. The mothers were randomized into two groups; mothers in a control group were on liberal diets, while mothers in an intervened group were on dairy product-restricted diets. Infants of both groups were examined for atopic dermatitis at seven days, one month, and four months of age., Results: There were 32 and 30 infants in the control and intervened groups, respectively. Eight infants in the control group and two infants in the intervened group developed atopic dermatitis by the age of four months. The prevalence of atopic dermatitis in the intervened group was significantly lower than that in the control group (6.67% vs. 25%, p < 0.05)., Conclusion: Dairy product restriction in allergic mothers results in decreasing prevalence of atopic dermatitis in 4-month-old infants who were exclusively breast-fed.

Background: The recommended formulas for treatments of cow's milk allergy (CMA) in infants are hydrolyzed protein-based and amino acid-based formulas. However they are not always affordable. Furthermore, some patients are still allergic to these formulas. Therefore, chicken-based formula has been innovated and used as an alternative formula to treat CMA in these infants., Objective: To assess the growth of infants with CMA who consumed chicken-based formula compared to normal infants., Material and Method: A prospective study was performed in 34 infants aged 3 to 24 months diagnosed as CMA at Siriraj Hospital. All subjects consumed the chicken-based formula for at least three months. The growth parameters were recorded., Results: Manifestations occurred in dermatological (78.60%), respiratory (67.9%), and gastrointestinal (53.6%) systems. Mean (+/-SD) chicken-based formula intake was 77 (+/-39.6) kcal/kg/d Weight gains are higher (35.7%), equal (10.8%), and lower (53.5%) than those of normal infants. In addition, length gains were higher (38%), equal (5%), and lower (57%) than those of normal infants. However, the difference of weight and length in chicken-basedfed, cow s milk-allergic infants, and normal infants were not statistically significant (p = 0.141, p = 0.192). None of these infants had severe complications., Conclusion: Growth parameters of infants fed with chicken-based formula are not diferent from those of normal infants.

Background: Malnutrition and malabsorption are common consequences in pediatric human immunodeficiency virus (HIV) infection. The gastrointestinal tract is a major site affected by HIV Rapid gastrointestinal transit time may contribute to malabsorption., Objective: To determine whether the whole gastrointestinal transit time (WGTT) correlates with disease stages or degrees of malnutrition in HIV-infected children., Material and Method: Forty HIV-seropositive children, at various stages of disease, and thirty seronegative age-matched controls, aged between 1 mo and 3 yr, were enrolled in the present study. The body weight, length, or height and the WGTT were assessed Then the WGTT of children in different stages of HIV disease and in different degrees of malnutrition were compared with those of the control group., Results: The mean ages were 15.5 and 14.3 mo in HIV-infected and control groups respectively. A greater degree of malnutrition was found in HIV-infected children with more advances HIV clinical symptoms. Compared to controls, WGTT was most rapid in severely symptomatic acquired immunodeficiency syndrome (AIDS) patients (Category C) (14.32 +/- 3.88 versus 7.22 +/- 3.17 h; p < 0.01) but not in asymptomatic, mildly and moderately symptomatic children. Accelerated WGTT in HIV-infected children was also significantly associated with a higher degree of malnutrition., Conclusion: Malnutrition is clearly related to the progression ofHIV disease. Accelerated WGTT is associated with HIV seropositivity, severe clinical symptoms, and higher degrees of malnutrition.

Background: DHA contents in breast milk varied upon maternal dietary intakes., Objective: To study DHA contents in breast milk in Thai lactating women from four diferent regions of Thailand., Material and Method: 20 mL of hind milk from 40 lactating women from Bangkok, Chantaburi, Tak, and Surin were collected and analyzed for fatty acids contents by gas chromatography Dietary intake of lactating women after delivery until the present study was assessed by a food frequency questionnaire. Then, the average DHA intake was estimated from the diets by using the reference data., Results: DHA contents in breast milk of mothers from Surin were higher than those from other areas. There were no correlations between history of DHA intake and DHA contents in breast milk., Conclusion: DHA contents in breast milk vary from region to region of the country. Local dietary intake and genetics might explain this contrast.

The authors carried out a retrospectively study of bodyweights of primary-school children from Grade I to Grade VI in 4 schools from Bangkok, one school from Saraburi and data of school children from a district in Sakolnakorn with a six year follow-up period. In the cohort there were 437 children from Bangkok, 225 children from Saraburi and 633 children from Sakolnakorn. Initial data show that prevalence of obesity at grade I in schools from Bangkok, Saraburi and Sakolnakorn were 16%, 23% and 4%, respectively. However, when these children were in grade VI, the prevalence of obesity increased to 31%, 30% and 9%, respectively. Relative risks of becoming obese at grade VI in children who were overweight and obese at grade I are 3 and 5 fold in Bangkok, 2 and 3 fold in Saraburi, 6 and 12 fold in Sakolnakorn, respectively. The present study shows that prevalence of obesity increased at quite dramatic rates during the primary school period in these study groups.

The authors carried out a longitudinal study of bodyweights of secondary-school children from Grade VII to Grade XII. Initial data of weight for height at Grade VII showed that the prevalences of overweight boys and girls were 13.6% and 9.9% and of obesity of boys and girls 26.8% and 13.5%, respectively. However, when these children were at Grade XII the prevalences of overweight of boys and girls were 14.0% and 10.5% and of obesity of boys and girls were 15.0% and 10.8%, respectively. The relative risks of becoming overweight of boys and girls at Grade XII who were already overweight at Grade VII were 1.5 and 4.0 respectively, and the relative risks of obesity in boys and girls at Grade XII who were already obese at Grade VII were 1.4 and 4.6, respectively. The present study showed that without any nutritional intervention those children, especially girls who were overweight and obese were more likely to maintain their bodyweights throughout the 6-year period in secondary school.

Lactose intolerance is common in Thai adults who ingest cow's milk but its incidence has not been clearly defined The authors evaluated 45 volunteers (15 males, 35 females), aged 21-31 yrs old, who drank one 240-ml box of milk daily. A Lactose tolerance test was performed using a breath-hydrogen test (BHT) after oral intake of 25 g of lactose dissolved in 250 ml of water The presence of gastrointestinal symptoms of lactose intolerance, flatulence, abdominal pain and diarrhea, were recorded Twenty-one subjects (47%) were categorized as lactose malabsorbers and intolerant, two subjects (4%) were malabsorbers but tolerant, and 22 of 45 (49%) were absorbers and tolerant. The incidence of lactose malabsorption was, thus, 51%; symptoms of intolerance were found in 21 of the 23 malabsorbers, making the incidence of lactose intolerance 47%. In the lactose malabsorbant and intolerant group, the more breath-hydrogen (H) the more symptoms observed All subjects who had a negative breath-H2 test had no symptoms. The breath-H2 test should be used as a standard method to evaluate lactose absorption and lactose tolerance. The incidence of lactose intolerance has decreased from the past and the symptoms are not so severe that the people limit the consumption of milk since it is a major source of food containing good quality of protein and calcium.

Background: The authors proposed that ketogenic diets will produce an increase in the ratio of branched chain amino acids (BCAAs) and aromatic amino acids (BCAAs) in plasma of children who are on the diets., Subjects and Method: A sample of plasma amino acids sample before initiation of fasting and on day 10 of the dietary treatment was obtained in patients with refractory epilepsy who were newly admitted for initiation of ketogenic diet. Plasma amino acids were determined by high performance liquid chromatography equipment., Results: There are 20 patients with refractory epilepsy participating in this study. Outcomes of ketogenic diet therapy were satisfactory. Nineteen cases out of 20 cases had a significantly higher ratio of plasma BCAAs:ARAAs during ketogenic diets than before the diet (P < 0.001)., Conclusion: The ketogenic diets produced an increased ratio of plasma BCAAs:ARAAs. Whether the increased ratio of plasma BCAAs:ARAAs plays an important role in controlling epilepsy is yet to be elucidated.

Objective: To compare the types and quantities of carbohydrate, electrolytes, pH and osmolarity of fresh fruit juices and commercial fruit juices., Material and Method: Forty kinds of fresh fruits available in Thai markets were analyzed for types and quantities of carbohydrate, electrolyte, pH and osmolarity and compared with previously obtained data for commercial fruit juices., Results: Most fresh fruit juices did not contain sucrose, whereas, commercial fruit juices mostly have sucrose in the range of 3-112 g/L. Although both fruit juices were acidic (pH varied from 3.6-6.7 and 3.2-5.8 of fresh juice and commercial juice), fresh fruit juices had a more neutral pH than commercial fruit juices. Apple, guava, orange, pear, and pineapple juices from commercial fruit juices had a high osmolarity compared with fresh fruit juices. All types of fresh fruit juices contained less sodium than commercial ones, whereas, most fresh fruit juices contained more potassium, phosphorus, and magnesium than commercial fluids., Conclusion: The nutrient content of fresh fruit juices and commercial fruit juices from the same kinds of fruits are not the same, possibly due to the manufacturing process. Therefore, physicians should know the composition of fruit juices in order to advise patients properly.

Probiotics administration has been claimed to prevent antibiotic-associated diarrhea. The investigators thus conducted a double blind, placebo controlled study of providing probiotics to infants and children with severe bacterial infections and receiving broad spechum antibiotics. The results of the study showed that the group receiving probiotics had fewer diarrheal episodes (37.5%) than the control group (80%), although the numbers were too small for statistical analysis. In conclusion, probiotics administration to patients receiving high doses of broad spectrum antibiotics may prevent the occurrence of antibiotic-associated diarrhea. A further study with a larger number is required.