Aerobic endurance and serum leptin response in obese prepubertal children

PEDIATRICS

s73

of this handheld device, is simple, quick and provides accurate measures of REE.

Table PAA

270-P. MONITORING CLINICAL AND ECONOMIC IN PEDIATRIC NUTRITION SUPPORT: AN 8 YEAR PROSPECTIVE STUDY

OUTCOMES

J.E. Bines t , M. Pete&in’, H. Shalley’, L. Rogers3, P. Parkin4, R. Heine’ ’Gastroenterology and Clinical Nutrition, Royal Children’s Hospial, Murdoch Children’s Research Institute, University of Melbourne, ‘Gastroenterology and Clinical Nutrition, 3Nutrition and Food Services, 4Pharmacy, Royal Children’s Hospital, Melbourne, Australia Rationale: Evidence to assessthe shalt- and long-telm impact of a Nutrition Support Service (NSS) on the clinical and economic outcomes associated with parentera nutrition (PN) provision in infants and children is limited. Method: A prospective audit of PN prescribing practices, compliance to monitoring recommendations, and clinical and economic outcomes was performed during a one month period, before (1993) and, for each year after (1994-2001), the introduction of an NSS. Results: A 46% reduction in patients prescribed PN was observed from 1993 to 2001 (46 pts/mo to 25 pts/mo) associated with a 70% reduction in costs associated with PN (solutions, manufacture, nursing time, IV equipment, blood tests, NSS) from US $32,3OO/mo to US $9,9OO/mo. Rationalisation of PN delivery occurred despite a significant increase in hospital activity reflected by an increase in admissions (22%) and operations (32%). In 2001 PN patients had more complex illness with 38% increase in patient illness severity score and more patients receiving > 5 other IV infusions (2001:60% vs. 1996:23%). Improved clinical outcome was associated with ieduced hospital length of stay (57d vs 37d) and ventilation time (516hrs vs 367hrs). Compliance to blood monitoring recommendations was significantly improved (42% to 100%). While many outcome measures showed a marked improved in the first 3 years of the NSS, there was a further progressive improvement in most outcomes over the next 5 years. Conclusions: Marked improvement in clinical and economic outcomes in pediatric PN was observed in association with a NSS.This included a 46% leduction in PN prescribing and a 70% reduction in costs despite an increase in hospital activity and patient illness severity.

271-P. PLASMA AMINO ACID LEVELS IN CHILDREN W ITH SICKLE CELL DISEASE RECEIVING AN ORAL GLUTAMINE SUPPLEMENT M.C. Storm’, R.A. Helms’, R. Williams’, S. Olivi’, C. Li3, W .C. Wang4 ‘Department of Pharmacy, University of TennesseeHealth Science Center, ‘Clinical Nutrition, 3Biostatistics, 4Hematology-Oncology, St. Jude Children’s Research Hospital, Memphis, United States Rationale: Children with sickle cell disease (SCD) have weight, height, and fasting plasma amino acid (PAA) levels that are lower than age-matched controls. Low amino acid (AA) availability may limit protein synthesis in SCD. W e evaluated PAA levels in SCD patients at baseline and after 3 and 6 months of daily oral glutamine (Gln) supplementation. Method: Fasting blood was drawn at baseline and after 3 and 6 months of daily oral Gln (600 mg/kg/d). Plasma was sepxated and deproteinized immediately. PAA were analyzed on a Beckman 6300 AA analyzer using System Gold software (Beckman Coulter, Inc.). Data was analyzed using SAS version 8.2 software (SAS, CXY, NC). PAA xe reported in nmoles/mL (mean f SD) and compz&ons were made by the Wilcoxon matched-pairs signed-rank test. A p value less than 0.05 was considered significant. Results: Twenty-seven (13 male, 14 female) subjects completed the study. Significant differences were found in plasma Gln, isoleucine (Ile), proline (Pro), and tryptophan (Trp) at six months compared to baseline. Conclusions: W e have previously reported an increase in resting energy requirement of approximately 20% in chil&en with SCD. The decreased weight and height of children with SCD (compxed to age-matched healthy controls) may be due to an increased calorie and protein requirement. Low fasting PAA levels may impede tissue protein synthesis in growing chil&en. Daily supplementation with Gln at 600 mg/kg/d for six months results in

1 (nmole/mL)

Six Months

B&dine

Gh

616 * 97.0

653 zk 116*

Ile Trp

50.5 *

13.4

55.0 *

15.9x’

51.6 zk 9.33

54.x *

x.xX*

1X6 zk 54.3

199 * 53.F

PKl * p less than 0.03,

Six Month

vemu

Baseline

improved fasting PAA levels for two essential (Ile and Trp) and two semiessential (Gln and Pro) amino acids.

272-P. AEROBIC ENDURANCE AND SERUM LEPTlN RESPONSE IN OBESE PREPUBERTAL CHILDREN M. Souza, A. Cardoso, P. Yazbek Jr Obesity Group, Children’s Institute, Hospital ohs Clinicas, S o Paula, Brazil Rationale: Exercise is p& of the lifestyle changes suggested for obesity, but tolerance and energy cost in sedentary chil&en is not well known.With the objective of analysing aerobic endurance, energy expenditure and serum leptin variation, a group of untrained obese childen and adolescents was studied. Method: Prepubertal male and female childlen aged 6-l 1 (n=40) displaying obesity (Group I) were submitted to a stepwise maximal aerobic endurance test (Bruce protocol) on a treadmill. Controls (Group II) were represented by similarly aged non-obese childlen (n= 16). Vzuiables included anthropometry, serum leptin and physiological measurements. Results: Maximal V02 consumption was 29.9 -/+6.7 in Group I versus 47.2~/+5.3 ml/kg/min in Group II (piO.05). Number of exercise steps was also smaller in Group I (3.7~/+0.7 vs 5.3~/+0.4, piO.OS), similzuly to time to exhaustion (9.3~/+1.9 vs 15.1~/+1.9 min, piO.05). However, energy expenditure was similar (57.7~/+17.8 vs 65.2~/+17.6 kcal). Initial leptin was much increased in Group I (24.~/+13.1 vs 1.6-/+1.7 rig/ml, piO.OOl), but exercise did not modify these findings. Conclusions: 1) Obese children were seriously unfit, endured little exercise, and payed a high energy price for the treadmill test; 2) Initial leptin was very high, practically in the adult range, but no change was observed at the end of the test, probably because of the short duration of the activity; 3) It seems important that exercise be introduced for obese sedentary children, but always slowly and progressively;

273-P. OUTCOME IN CHILDREN ON LONG TERM-(HOME)-PARENTERAL NUTRITION: A 20 YEAR-EXPERIENCE V. Colomb t , C. Talbotec ‘, 0. Goulet ‘, 0. Corriol’, M. Lamor’ ’Pediatn’c gastroenterology and Nutrition, ‘Pharmacy, Necker-Enfants malades hospital, Paris, France Rationale: The current study aimed to assesssurvival and prognosis factors in chil&en on long telm- HPN in one single French HPN center. Method: From januxy 1980 to january 2000, the pediatric HPN center I-ecruited 300 patients (boys 57%). The mean age at HPN onset was 4.4f0.6 ys (median 1.5 ys) with 57% childlen younger than 1 year. Primay digestive diseases (PDD) accounted for 76% of HPN indications: short bowel syndrome (SBS, 47%), chronic intestinal pseudo obstruction (CIPOS,lO%), inflammatory bowel diseases (IBD, 11%) and intractable diarrhea of infancy (IDI, 8%). Other indications were primxy non digestive diseases (PNDD): immune deficiency (IDEF, 14%) and miscellaneous (10%). Results: The mean HPN duration was 2.6 ys. HPN ended up at simple weaning in 54% cases, HPN ongoing (26%), death (16%) or small bowel transplantation (SBT, 4%). Outcomes for the main indications are summarized in the table (%). Functional prognosis in SBS patients was associated with the length of remaining small bowel and the presence of the ileo-caecal valve (Pi 0.05). As compared to other PDD, the probability of PN weaning was lower for ID1 patients (Pi 0.01). Death occurred in 9% PDD vs 38% of PNDD patients. The main causes of deaths were underlying disease (62%),