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Resting metabolic rate of adults with cerebral palsy is higher than age-matched controls
THURSDAY, OCTOBER 28 POSTER SESSION: CLINICAL NUTRITION
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MINERAL STATUS AND BLOOD PRESSURE LEVELS IN AFRICAN AMERICAN PREGNANT AND NON-PREGNANT WOCEN. E. Isles, PhD, RD, C. Welch, MS, E.M. Knight, PhD, A.A. Johnson, PhD, Z. Shah, BS, and L. Westney, MD, Dept. of Nutritional Sciences, College of Allied Health Sciences, and the Department of Obstetrics and Gynecology, College of
Medicine, Howard University, Washington, D.C. The study was designed to determine the relationships of calcium, phosphorus and magnesium status to the blood pressure levels of 22 African AmPerican pregnant and 26 African American non-pregnant waren between the ages of 16 and 35 years. Serun samples were analyzed spectrophotrometrically for the mineral levels. A 24-hour food recall was analyzed by ccanputer for selected nutrients. When expressed as percentages of the RDA, there was no significant difference in the intake of calcium but the intake of phosphorus (121.5% and 95.5%) was significantly higher amnng the pregnant than among the non-pregnant women (p z 0.05). Conversely, the intake of agnesium, expressed as a percentage of the RDA, was significantly lower (72.6% and 44.6%) among the pregnant wanen (p < 0.05). There was no significant difference in serun calcium in both groups. However, serum magnesium was significantly higher (2.28 vs 1.96 mrg/dl) among the non-pregnant subjects (p 0.05). Serum phosphorus was significantly higher (p 0.05) arrong the pregnant women (3.98 + 0.2 vs 3.64 + 0.1 mg/dl). The pregnant women had a significantly lower diastolic blood pressure level (67.3 vs 75.8 mmnHg) than their non-pregnant counterparts (p 5 0.05). There was a positive correlation between diastolic blood pressure levels and serum magnesium but a negative correlation between diastolic blood pressure and serum phosphorus (p 0.05) in both groups. In a subset of the subjects, 8 non-pregnant and 17 pregnant woaren, alkaline phosphatase was significantly higher in the pregnant women (47.8 4.5 U/L) when cared to the levels in the non-pregnant women (30.9 + 4.5 U/L). The data show that in this group of pregnant women, the calcium nutritional status of the pregnant women parallels that of those who are not pregnant.
THE DEVELDOPENT OF A VITAMIN C-DEFICIENT DIET USING A SELECTIVE MINU DESIGN. J. King, MS, RD, R.W. Welch, PhD, Y. Wang, MD, P.W. Washko, PhD, DMHD,K.R.
Dhariwal, PhD, A. Lazerov, MS, C. Conry-Cantelina, MD, . Levine, MD, National Institutes of Health, Warren G. Magnuson Clinical Center, Nutrition Department, Bethesda, MD. The amount of vitamin C found in human plasma as a direct function of dietary ingestion is unknown. This relationship, which must be understood to predict
the
ideal
vitamin C requirement, can be
identified by assaying serum from hospitalized normal volunteers who are placed on a controlled, vitamin C-deficient diet. With the development of a unique assay for serum ascorbic acid analysis, an 18 week study was designed, requiring the creation of a vitamin C-deficient diet. A 14-day cycle, selective menu design was used to develop a diet restricted to <5 milligrams (mg) vitamin C daily. This approach depleted both plasma and dietary vitamin C, while controlling for other nutrients. The three volunteers who have completed this study to date depleted plasma vitamin C from >50 micromolar (umol/L) to 7.0 + 1.0 umol/L (scorbutic range) within 1-3 weeks. The diet was maintained and daily intake was monitored throughout the repletion phase of the study, during which time controlled oral and intravenous vitamin C doses were administered. Plasma ascorbic acid increased from 7.0 + 1.0 umol/L to 76 + 18 umol/L with subsequently increased doses of vitamin C. Nutritional parameters remained within normal ranges. Mean dietary compliance, calculated by number of days with <5.0 mg vitamin C/total days on study, was 84.5 ± 8.7% over the 18 weeks. This rate is indicative of the high degree of diet acceptance achieved with a selective menu design. This successfully developed diet was essential to the study of ascorbic acid pharmacokinetics over a 4-5 month period.
li J
RESTING METABOLIC RATE OF ADULTS WITH CEREBRAL PALSY IS HIGHER THAN AGE-MATCHED CONTROLS R.K. Johnson, PhD, MPH, RD; M.S. Ferrara, PhD, ATC; E.T. PoehIman, PhD Departments of Nutritional Sciences and Medicine, University of Vermont, Burlington, VT Adults with cerebral palsy (CP) exhibit problems of energy balance, resulting in extremes of leanness and fatness. To examine whether resting energy needs are different between adults with CP and age-matched controls without CP, we compared resting metabolic rate and body composition between these groups. Eleven adults with CP were compared with 50 normal, healthy controls within the same age range (18-40). Resting metabolic rate (RMR) using indirect calorimetry, body composition, anthropometrics, and usual physical activity patterns were determined. There were no significant differences in height, weight, fat-free mass, percent body fat, or calories expended in physical activity between the two groups. The CP subjects had a measured RMR that was 19 percent higher (p .05) than the controls (1945 versus 1576 kcal/24 hours). After statistically adjusting for individual differences in fat-free mass, a 22 percent higher RMR remained (p< .05) in the CP subjects (2011 versus 1560 kcal/24 hours). This adjustment was needed because energy needs are a function of the metabolically active cell mass, and therefore a person's RMR must be evaluated relative to their fat-free body mass; not just relative to total body weight. Thus, the higher RMR of these CP subjects was independent of any differences in fat-free mass. These results suggest that resting energy needs of adults with CP are higher for their metabolic size than normal controls. Thus, energy requirements of CP adults cannot be estimated with any degree of accuracy from the traditional methods which are based on the resting energy needs of healthy adults without disabilities.
A CALL FOR DIETITIANS IN EARLY INTERVENTION. M.E. Kirby, MS,RD, and J.E. Peddick, PhD,RD, Mount Mary College, Milwaukee, WI. Wisconsin has joined a national effort to improve services to families of developmentally disabled young children, and is actively involved in designing a multidisciplinary coordinated system for early intervention. This research is part of a statewide effort to ensure that nutrition services became an integral part of that system. A study was conducted in the fall of 1991 at the University Affiliated Program (UAP) of the Waisman Center in Madison, Wisconsin to identify the frequency with which develomentally disabled children with identifiable nutrition risk conditions had documented referral to a dietitian (RD) for nutrition intervention. The investigation was a retrospective chart review of 184 clients ages 0 to 3 years seen during the 1990 calendar year in five of the clinics of the UAP. A research instrument was developed to identify demographic information, incidence of specific nutrition risk conditions, and frequency of documented RD referral or consultation. The investigation identified a high incidence of nutrition risk conditions, yet a low frequency of documented RD consultation: 149 (81%) of the total population had at least one identifiable nutrition risk condition and 117 (62%) had multiple nutrition risk conditions. However, only 56 (38%) had documentation of RD consultation or referral. Furthermore, while neither severity nor frequency of a nutrition risk condition corresponded with an increased rate of RD consultation, on site availability did parallel increased utilization of RD consultation. These figures highlight a significant gap in nutrition services, and support the need for dietitians to take an active role in assuring nutrition screening, referral, and intervention become integral components of the newly emerging system of family-centered, conmunity-based, multi-disciplinary care for this high risk pediatric population.
JOURNAI, OF T I AM ERICAN DIETETIC ASSOCIATION / A-99
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MINERAL STATUS AND BLOOD PRESSURE LEVELS IN AFRICAN AMERICAN PREGNANT AND NON-PREGNANT WOCEN. E. Isles, PhD, RD, C. Welch, MS, E.M. Knight, PhD, A.A. Johnson, PhD, Z. Shah, BS, and L. Westney, MD, Dept. of Nutritional Sciences, College of Allied Health Sciences, and the Department of Obstetrics and Gynecology, College of
Medicine, Howard University, Washington, D.C. The study was designed to determine the relationships of calcium, phosphorus and magnesium status to the blood pressure levels of 22 African AmPerican pregnant and 26 African American non-pregnant waren between the ages of 16 and 35 years. Serun samples were analyzed spectrophotrometrically for the mineral levels. A 24-hour food recall was analyzed by ccanputer for selected nutrients. When expressed as percentages of the RDA, there was no significant difference in the intake of calcium but the intake of phosphorus (121.5% and 95.5%) was significantly higher amnng the pregnant than among the non-pregnant women (p z 0.05). Conversely, the intake of agnesium, expressed as a percentage of the RDA, was significantly lower (72.6% and 44.6%) among the pregnant wanen (p < 0.05). There was no significant difference in serun calcium in both groups. However, serum magnesium was significantly higher (2.28 vs 1.96 mrg/dl) among the non-pregnant subjects (p 0.05). Serum phosphorus was significantly higher (p 0.05) arrong the pregnant women (3.98 + 0.2 vs 3.64 + 0.1 mg/dl). The pregnant women had a significantly lower diastolic blood pressure level (67.3 vs 75.8 mmnHg) than their non-pregnant counterparts (p 5 0.05). There was a positive correlation between diastolic blood pressure levels and serum magnesium but a negative correlation between diastolic blood pressure and serum phosphorus (p 0.05) in both groups. In a subset of the subjects, 8 non-pregnant and 17 pregnant woaren, alkaline phosphatase was significantly higher in the pregnant women (47.8 4.5 U/L) when cared to the levels in the non-pregnant women (30.9 + 4.5 U/L). The data show that in this group of pregnant women, the calcium nutritional status of the pregnant women parallels that of those who are not pregnant.
THE DEVELDOPENT OF A VITAMIN C-DEFICIENT DIET USING A SELECTIVE MINU DESIGN. J. King, MS, RD, R.W. Welch, PhD, Y. Wang, MD, P.W. Washko, PhD, DMHD,K.R.
Dhariwal, PhD, A. Lazerov, MS, C. Conry-Cantelina, MD, . Levine, MD, National Institutes of Health, Warren G. Magnuson Clinical Center, Nutrition Department, Bethesda, MD. The amount of vitamin C found in human plasma as a direct function of dietary ingestion is unknown. This relationship, which must be understood to predict
the
ideal
vitamin C requirement, can be
identified by assaying serum from hospitalized normal volunteers who are placed on a controlled, vitamin C-deficient diet. With the development of a unique assay for serum ascorbic acid analysis, an 18 week study was designed, requiring the creation of a vitamin C-deficient diet. A 14-day cycle, selective menu design was used to develop a diet restricted to <5 milligrams (mg) vitamin C daily. This approach depleted both plasma and dietary vitamin C, while controlling for other nutrients. The three volunteers who have completed this study to date depleted plasma vitamin C from >50 micromolar (umol/L) to 7.0 + 1.0 umol/L (scorbutic range) within 1-3 weeks. The diet was maintained and daily intake was monitored throughout the repletion phase of the study, during which time controlled oral and intravenous vitamin C doses were administered. Plasma ascorbic acid increased from 7.0 + 1.0 umol/L to 76 + 18 umol/L with subsequently increased doses of vitamin C. Nutritional parameters remained within normal ranges. Mean dietary compliance, calculated by number of days with <5.0 mg vitamin C/total days on study, was 84.5 ± 8.7% over the 18 weeks. This rate is indicative of the high degree of diet acceptance achieved with a selective menu design. This successfully developed diet was essential to the study of ascorbic acid pharmacokinetics over a 4-5 month period.
li J
RESTING METABOLIC RATE OF ADULTS WITH CEREBRAL PALSY IS HIGHER THAN AGE-MATCHED CONTROLS R.K. Johnson, PhD, MPH, RD; M.S. Ferrara, PhD, ATC; E.T. PoehIman, PhD Departments of Nutritional Sciences and Medicine, University of Vermont, Burlington, VT Adults with cerebral palsy (CP) exhibit problems of energy balance, resulting in extremes of leanness and fatness. To examine whether resting energy needs are different between adults with CP and age-matched controls without CP, we compared resting metabolic rate and body composition between these groups. Eleven adults with CP were compared with 50 normal, healthy controls within the same age range (18-40). Resting metabolic rate (RMR) using indirect calorimetry, body composition, anthropometrics, and usual physical activity patterns were determined. There were no significant differences in height, weight, fat-free mass, percent body fat, or calories expended in physical activity between the two groups. The CP subjects had a measured RMR that was 19 percent higher (p .05) than the controls (1945 versus 1576 kcal/24 hours). After statistically adjusting for individual differences in fat-free mass, a 22 percent higher RMR remained (p< .05) in the CP subjects (2011 versus 1560 kcal/24 hours). This adjustment was needed because energy needs are a function of the metabolically active cell mass, and therefore a person's RMR must be evaluated relative to their fat-free body mass; not just relative to total body weight. Thus, the higher RMR of these CP subjects was independent of any differences in fat-free mass. These results suggest that resting energy needs of adults with CP are higher for their metabolic size than normal controls. Thus, energy requirements of CP adults cannot be estimated with any degree of accuracy from the traditional methods which are based on the resting energy needs of healthy adults without disabilities.
A CALL FOR DIETITIANS IN EARLY INTERVENTION. M.E. Kirby, MS,RD, and J.E. Peddick, PhD,RD, Mount Mary College, Milwaukee, WI. Wisconsin has joined a national effort to improve services to families of developmentally disabled young children, and is actively involved in designing a multidisciplinary coordinated system for early intervention. This research is part of a statewide effort to ensure that nutrition services became an integral part of that system. A study was conducted in the fall of 1991 at the University Affiliated Program (UAP) of the Waisman Center in Madison, Wisconsin to identify the frequency with which develomentally disabled children with identifiable nutrition risk conditions had documented referral to a dietitian (RD) for nutrition intervention. The investigation was a retrospective chart review of 184 clients ages 0 to 3 years seen during the 1990 calendar year in five of the clinics of the UAP. A research instrument was developed to identify demographic information, incidence of specific nutrition risk conditions, and frequency of documented RD referral or consultation. The investigation identified a high incidence of nutrition risk conditions, yet a low frequency of documented RD consultation: 149 (81%) of the total population had at least one identifiable nutrition risk condition and 117 (62%) had multiple nutrition risk conditions. However, only 56 (38%) had documentation of RD consultation or referral. Furthermore, while neither severity nor frequency of a nutrition risk condition corresponded with an increased rate of RD consultation, on site availability did parallel increased utilization of RD consultation. These figures highlight a significant gap in nutrition services, and support the need for dietitians to take an active role in assuring nutrition screening, referral, and intervention become integral components of the newly emerging system of family-centered, conmunity-based, multi-disciplinary care for this high risk pediatric population.
JOURNAI, OF T I AM ERICAN DIETETIC ASSOCIATION / A-99