BACKGROUND:Childhood obesity has been associated with elevated serum levels of total cholesterol, triglycerides, and low-density lipoproteins (LDLs). We observed the lipid profiles of obese female subjects versus obese male subjects before and after significant weight loss.METHODS:We studied 29 girls and 21 boys enrolled in a multidisciplinary weight reduction program.RESULTS:Measures were taken at enrollment and at 10 weeks. Significant improvements were observed for changes in percentage of ideal body weight and total cholesterol and triglyceride levels. In addition, LDL decreased significantly in girls but not in boys.CONCLUSIONS:A combination of diet, behavior modification, and exercise, is an effective instrument for lowering total cholesterol and triglyceride levels in obese children. In addition, girls tend to be more susceptible to a decrease in LDL level, which might result in an increased cardiovascular protective effect.

Epidermal growth factor (EGF) inhibits carbachol (CCh)-induced chloride secretion in colonic epithelial cells (T 84) but the signaling mechanisms are not fully understood. EGF was shown to inhibit calcium-dependent chloride secretion at the level of a basolateral potassium conductance via phosphatidylinositol 3-kinase (PI 3-K). Additional signaling events might link PI 3-K activity to potassium channel inhibition. The present study examined if the inhibitory effect of EGF is due to protein kinase (PK) C activation, if so. which isoforms, and whether PI 3-K is involved in PKC activation. Studies were performed using T 84 cells on permeable supports and chloride secretion measured as changes in short-circuit current (Isc). The PKC inhibitorsRo318220 (10 p.M)and Gii6983 (10 p.M),which were respectively known to differentially inhibit E and~isoforms, were used.Western analysis revealed thatPKCa, "y (conventional), E, 7), P. (novel), and AiL, ~(atypical) isoforms were expressed in T 84 cells.As expected, EGF (100 ng/ml) inhibited the Isc response to CCh (100p.M): 46.0:±:10.3VS. 16.8:±:3.4p.Ncm 2 (n==5, p<0.05).The inhibitory effect of EGF on

Background: Safe and effective exercise programs are needed to prevent and treat chronic diseases in childhood. In particular, preadolescent obese children should participate in activities that are specific to their special needs. Resistance or strength training has been prescribed for adult obese persons. Research is limited concerning the use of resistance training in programs that treat obese preadolescents. Methods: Nineteen treatment subjects (7-12 years of age) were enrolled in a 10-week weight management program which included diet, behavior modification, and aerobic and flexibility exercises. Forty-eight control subjects (7-12 years of age) participated in the diet, behavior modification program, and a thrice-a-week walking program. The efficacy of the overall weight management program was examined by anthropometry at 10 weeks and 1 year. Results: Fifteen treatment subjects completed the 10-week program (retention rate, 78.9%). Thereafter compliance decreased by approximately 33% for the long-term study. Seventeen control subjects completed the program (retention rate, 35%). Weight percent of ideal body weight, and body mass index were reduced significantly at 10 weeks (P<0.0001) and did not increase significantly at 1-year follow-up in both treatment and control groups. Height increased significantly at 1 year in bath treatment and control In the treatment subjects, percent fat decreased significantly (P<0.001), whereas fat-free mass did not change significantly (P>0.05). Conclusions: A resistance-training program may be included safely in a multidisciplinary weight management program for obese preadolescent: male and female children. The addition of specific exercise regimes such as resistance training may improve program retention especially in severely obese youth.

1. Uwe Blecker* 2. Devendra I. Mehta* 3. Rebecca Davis† 4. Melinda S. Sothern† 5. Robert M. Suskind† 1. 2. *Department of Pediatrics, Alfred I. duPont Hospital for Children, Wilmington, DE. 3. 4. †Department of Pediatrics, Louisiana State University Medical Center, New Orleans, LA After completing this article, readers should be able to: 1. Describe the nutritional problems of children who have malignacies. 2. Delineate the role of gastroesophageal reflux in a neurologically impaired child. 3. Describe the nutritional problems of children who have cystic fibrosis. 4. List the nutritional deficiencies that may occur with chronic renal disease and renal failure. 5. Explain the effects of a restricted diet for multiple food allergies. 6. Describe what nutritional deficiency may develop in children who have malabsorption. Nutritional problems in chronic disease are a significant cause of increased morbidity, mortality, and psychosocial consequences of growth failure. Several mechanisms may coexist that could lead to nutritional problems. Mere increased inflammatory burden can increase the caloric need and, thereby, the risk of protein-calorie malnutrition. The organs involved, such as the liver and small bowel, may be important in the digestive and absorptive processes, and their Winvolvement may lead to selective nutrient deficiencies. Anorexia of chronic disease may coexist and compound the situation. Although this discussion focuses on general principles in specific areas, attention to detail in individual cases is needed. Nutrition support can be achieved at several levels. Dietary counseling leading to better choices in caloric density can be augmented by using specific high-calorie commercial preparations to boost caloric intake. Occasionally, a multidisciplinary approach with a feeding team can help with issues relating to gastroesophageal reflux and delayed gastric emptying as well as oral skills and behavioral aversion, which can optimize intake. Nasogastric tube feeding and, for long-term use, gastrostomy tube feedings are the next step. These devices allow delivery of appropriately chosen milk-based formulas either in convenient bolus regimens or continuously, as needed. Continuous nocturnal feeding regimens are particularly popular because they allow oral intake when awake, yet increase the caloric intake. These generally are safe techniques that can be taught easily to …

The prevalence of obesity in American youth is increasing and treatment of the condition is difficult. We have developed a multi-disciplinary weight reduction program that extends over 1 y and includes a very low-calorie diet (VLCD) followed by a hypocaloric diet, exercise, and behavior modification. Based on data collected at baseline, at the end of the acute intervention phase (10–20 wk), and at 1-y evaluation, we assessed the efficacy of this outpatient weight reduction program in treating obese children and adolescents in a follow-up of a series of cases. Furthermore, we examined the impact of the approach on growth velocity and maintenance of weight loss at 1 y. Fifty-six overweight children (aged 7–17 y) were recruited during a period of 18 mo to participate in the weight management program; 52 (93%) completed the acute phase of treatment and 35 (62.5%) successfully completed the I-y program. There was a significant decrease in body weight and body fat, as assessed by weight determinations and skinfold measurements 0, < 0.0001; results not corrected for age). The body mass index for the 35 individuals who completed the 1-y program decreased significantly from 32.7 on entry to 28.72 at 1 y (p < 0.0001; results not corrected for age). Conclusion: We conclude that a multidisciplinary weight reduction program that combines a VLCD, followed by a balanced hypocaloric diet, with a moderate-intensity progressive exercise program and behavior modification is an effective means for weight reduction in obese children and adolescents.

BACKGROUNDThe prevalence of pediatric obesity has increased over the past few decades in all ethnic, gender, and age groups. The treatment of obesity, especially in children with moderate to severe conditions, is difficult. In this study, we examined the impact of significant weight loss as a result of participation in a multi-disciplinary weight management program on maximal oxygen uptake (VO2max) in obese children and adolescents.METHODSEleven obese children and adolescents (7 to 14 years of age; mean age, 12.3 +/- 1.9 years) were enrolled in a weight management program at the Children's Hospital of New Orleans. The treatment program included a high-protein, very low-calorie diet (VLCD; protein intake, 1.5 to 2.0 g/kg of ideal body weight per day; and 800 kcal/d). Diets were supplemented with extra fluid, minerals, and vitamins. All subjects attended weekly 2-hour clinic sessions. During these sessions, they received nutrition instruction, participated in a moderate-intensity, progressive exercise program, and learned behavior-modification techniques. Weight, height, body mass index ([BMI]; wt/ht2), and VO2max by indirect calorimetry were obtained at enrollment and at the end of 10 weeks of treatment.RESULTSThere was a significant decrease in body weight after 10 weeks. The BMI decreased significantly from 34.1 +/- 4.8 on entry to 29.4 +/- 3.5 (mean +/- SD; P < 0.0001). Despite the significant weight loss, VO2max increased significantly (P < 0.001) from entry (19.2 +/- 3.0 mL/kg/min) to completion of 10 weeks (22.4 +/- 5.8 mL/kg/min). However, absolute VO2max L/min was unchanged.CONCLUSIONSWe conclude that relative VO2max mL/kg/min is significantly improved in obese youth after significant weight loss with a VLCD and moderate-intensity, progressive exercise. However, because absolute VO2max L/min was unchanged, this improvement seems to result from the reduction in total body weight as opposed to the effect of the moderate-intensity exercise intervention.

BACKGROUND:Obesity is a rapidly increasing health problem among US youth. Hyperinsulinemia is associated with obesity and has been found to be a contributory factor for the development of cardiovascular disease in the obese. It has been suggested that hyperinsulinemia of obesity is a result of increased insulin secretion caused by insulin resistance. However, it has been shown in adults that decreased hepatic insulin clearance (HIC) is the primary cause of hyperinsulinemia in this population.METHODS:We studied 15 obese children and adolescents (11 F, 4 M; 8.6 to 18.1 years) before and 10 weeks after their enrollment in a multidisciplinary weight reduction program, which included a protein-sparing modified fast, a moderate intensity progressive exercise program, and a behavior-modification intervention.RESULTS:All patients lost weight (P < 0.05). Measurements of immunoreactive insulin (IRI) and C-peptide reactivity (CPR) were performed before the program and at 10 weeks. IRI levels dropped significantly, whereas CPR levels did not change. CPR/IRI molar ratios, considered an indirect estimation of HIC, rose significantly after weight loss.CONCLUSIONS:Our data suggest that hyperinsulinemia seen in obese children and adolescents is caused by decreased HIC. The cause for this decrease remains unknown, but it is reversible upon weight loss.

Iron deficiency is defined as a deficit that is severe enough to limit the production of hemoglobin. Seventy-five percent of the iron found in the body is used as a constituent of hemoglobin. A deficiency in iron is extremely common among infants and can lead to anemia, but it also is prevented easily through dietary intervention.Iron deficiency anemia is most common among children between 6 months and 3 years of age. Infants of 9 to 15 months of age usually are screened routinely. Iron deficiency and infection are the most common causes of anemia. In the United States, the prevalence of iron deficiency anemia has declined significantly during the past two decades.In a term infant, iron deficiency anemia is uncommon before 4 to 6 months of age because of the abundance of iron stores at birth. After these iron stores are depleted by growth, dietary iron must be provided. Preterm infants and twins have low iron stores at birth, and because their rate of growth is more rapid, their iron stores may be depleted by 2 to 3 months of age.The iron content of human milk is much less than that of iron-fortified cow milk-based formulas,but the bioavailability of human milk iron is much higher. Compared with a regular diet, which contains about 6 mg of iron per 1,000 kcal,milk contains only approximately 1.5 mg of iron per 1,000 kcal. The time period when iron deficiency is most common (ie, 6 months to 3 years of age) is when milk is a major source of calories.Recommendations for preventing iron deficiency differ for term versus preterm infants and for formula-fed versus breastfed infants. Term breastfed infants usually do not experience a depletion of iron stores before 6 months of age. The relatively high iron stores of healthy term infants and the high bioavailability of human milk iron probably protect against iron deficiency. Because supplementary foods may interfere with the bioavailability of human milk iron, exclusively breastfed infants should receive supplementation with iron-fortified foods. No differences have been observed through 4 to 6 months of age in the iron status of exclusively breastfed infants and infants fed iron-fortified cow milk-based formulas.Iron supplementation should start when term infants are 4 to 6 months of age. Common sources of iron are iron-fortified infant formulas and cereals. The latter also is a good source of iron for breastfed infants. Supplementation should begin no later than age 2 months in preterm infants. It can be administered in the form of a single liquid ferrous sulfate preparation beginning at 1 month of age. Iron deficiency is uncommon prior to this time in preterm breastfed infants because of a decrease in hemoglobin concentration and a subsequent release of excess iron, which is more than could be reused for production of red blood cells. Iron is absorbed best when administered between or before feedings. Formula-fed preterm infants should begin to receive fortified formula no later than 1 to 2 months of age.An adequate supply of iron consists of approximately 1 mg/kg per day of elemental iron for term infants. Guidelines from the Committee on Nutrition of the American Academy of Pediatrics (AAP)recommend 2 to 3 mg/kg per day of elemental iron to a maximum of 15 mg/day for breastfed low-birthweight infants. Infants who have birthweights of more than 1,500 g can be satisfied by an iron-fortified formula containing 12 mg/L of iron, which supplies approximately 2 mg/kg of iron.Iron-fortified formulas can prevent iron deficiency in formula-fed term infants. “Unfortified” cow-milk formulas supply only 1.5 mg of iron per reconstituted liter compared with 12 mg of iron as ferrous sulfate per reconstituted liter in iron-fortified formulas. It has been argued that infants consuming “unfortified”formula should change to fortified formulas before 3 months of age because they are at risk for depleting iron stores at approximately 6 months of age. The Committee on Nutrition of the AAP has recommended that the change from human milk or formula to cow milk not occur before the age of 1 year.Potential adverse effects of high iron concentrations on the bacterial flora of the gastrointestinal tract remain in question. The low iron concentrations of human milk and its high bioavailability combine to produce very low levels of iron in the gastrointestinal lumen, which are considered to have a limiting effect on the growth of potential bacterial pathogens.

Vitamins A, D, E, and K are fat-soluble. As a class, fat-soluble vitamins are responsible for regulating protein synthesis. These vitamins require carrier proteins for transport. Vitamins A and D are carried by specific plasma proteins, and vitamins E and K are carried by plasma lipoproteins, mostly low-density lipoproteins. All of the fat-soluble vitamins are converted to active forms.Deficiencies in these vitamins during infancy and childhood often result in numerous complications. However, the medical manifestations of fat-soluble vitamin deficiency are preventable if recognized early and treated appropriately.Vitamin A is present in food. It is hydrolyzed in the small intestine by a pancreatic esterase and an intestinal hydrolase. Bile salts are required for activation of these enzymes. Human vitamin A requirements range from 10 to 30 mcg retinol per kilogram of body weight,although infants have higher requirements.Vitamin A deficiency in infants causes night blindness, Bitot spots(keratinization of the cornea),xerophthalmia (dry eyes),keratomalacia, corneal opacities, growth failure, hyperkeratosis, reduced resistance to infection, and death. Laboratory tests may show a mild leukopenia. Clouding of the cornea in a child who has vitamin A deficiency is considered a medical emergency and requires parenteral administration of high doses of the vitamin.Vitamin D is required to prevent rickets in children and osteoporosis and osteomalacia in adults. Rickets once was considered the most common disease of early childhood. With adequate light exposure, there is no need to supplement with vitamin D. Indeed, vitamin D is a facultative vitamin that is required only when vitamin D3, made from the action of sunlight on 7-dehydro-cholesterol, is in insufficient supply. Consequently, one of the factors that places a child at risk is limited sun exposure. In countries where sunlight is less available due to a poor angle of radiation of clouds(northern and western countries), dietary vitamin D is essential. Other risk factors for deficiency include prematurity, poor socioeconomic background, prolonged breastfeeding,and being of Asian or African origin and having dark skin. In addition,vitamin D requirements are increased in preterm infants,especially if they are growing rapidly and have a low intake of either calcium or phosphorus.Clinical manifestations of rickets include failure to grow,hypocalcemia, hypophosphatemia, tetany and muscle weakness, and skeletal deformations with bone pain. In addition,when rickets causes a failure to mineralize bone tissue at the epiphyseal-diaphyseal junction, a variety of deformities may result. These include craniotabes, enlargement of the joints or "rachitic rosary" at the costochondral junctions, "bow legs,"and "knock knees." Diagnosis of rickets requires radiographic examination of the long bones, which reveals rarefied shafts and uneven,blurred ends. Long bone ends will brighten with vitamin D treatment. Laboratory data reveal hypocalemia,hypophosphatemia, elevated alkaline phosphatase, and decreased 25-(OH)D3 levels.Absorption of fat-soluble vitamins commonly is impaired more than is the absorption of dietary fat. This is particularly true in the case of vitamin E (also named tocopherol from the Greek tokos, childbirth,and pherin, to bring forth); it may be malabsorbed completely. One of the primary functions of vitamin E is to serve as a physiologic membrane-bound antioxidant. It promotes good health by inhibiting the biologic process that damages cellular and intercellular structures (free radical-catalyzed lipid peroxidation)and by terminating radical chain reactions (by reacting with peroxy radicals). Therefore, it is necessary to replace vitamin E through dietary means. Vitamin E is used gradually during antioxidation.Vitamin E deficiency is associated with neuroaxonal degeneration,a potentially reversible degenerative neurologic syndrome, especially in children who have chronic liver disease. Treatment for this condition includes administration of intramuscular vitamin E or an oral vitamin E preparation, d-alpha-tocopheral polythylene glycol-1000 succinate. In early childhood, the genetic absence of apoliprotein B may result in abetalipoproteinemia. This condition causes serious fat malabsorption and steatorrhea with progressive neuropathy and retinopathy. Symptoms of fat malabsorption in young patients have been improved with high-dose vitamin E supplementation. Among infants, the degree of deficiency can be linked to size at birth, with smaller infants exhibiting greater deficiency. Factors leading to the vitamin E-deficient state of a preterm infant, especially during the first few weeks of life, include: low tissue levels of the vitamin at birth,limited placental transfer of vitamin E, intestinal malabsorption, and rapid growth. However, as the infant's digestive system matures,tocopheral absorption improves, and serum vitamin E levels rise. Another manifestation of vitamin E deficiency may be hemolytic anemia in the preterm infant. Anemia exists when hemoglobin levels range from 1.09 to 1.40 mmol/L (7 to 9 g/dL). Hemolytic anemia also may be accompanied by low plasma vitamin E levels, reticulocytosis, and hyperbilirubinemia. Parenteral vitamin E improves the anemia, corrects hemolysis, and prevents destruction of red blood cells when combined with iron supplementation.Term infants require vitamin E dosages of 0.7 IU/100 kcal. Preterm infants have much higher needs because they have poor tissue stores,absorb the vitamin poorly, grow rapidly, and often need iron. Thus, an additional 5 to 25 IU/d of vitamin E should be administered. Absorption from human milk, even though the amount of vitamin E is less than in infant formulas, compensates for immaturity and rapid growth in both term and preterm infants. Requirements increase in chronic illnesses that involve fat malabsorption,particularly cystic fibrosis. The doses used with success in preventing deficiencies in cystic fibrosis are 25 to 50 IU/d in infants, 50 to 100 IU/d for 1- to 10-year-olds, and 100 to 200 IU/d for 10-year-olds to adults. These are reasonable doses for other chronic disorders that involve fat malabsorption.Vitamin K is vital to maintaining normal plasma levels of prothrombin and Factors VII, IX, and X. It also functions as a cofactor for carboxylation of the first 10 glutamic acids from the prothrombin precursor,thereby forming prothrombin. Although the primary source of vitamin K is dietary (dark leafy vegetables, cauliflower, and soybeans),bacterial synthesis in the gastrointestinal tract provides a secondary source. Clinical deficiency may be prevented in children by ensuring an intake of 27 mcg/d. In infants,1 mcg/d will prevent vitamin K deficiency.This deficiency is rare once the intestinal flora have been established, except in malabsorption states such as cystic fibrosis, celiac sprue, ulcerative colitis, intestinal resection, and regional enteritis. Consequently, vitamin K deficiency usually is seen in newborns and infants who have not yet developed significant bacterial gastrointestinal flora and who have not received vitamin K prophylaxis (0.5 to 1 mg intramuscularly or 1 to 2 mg orally).Poor placental transmission,immature hepatic prothrombin synthesis, and low levels in human milk are additional factors that lead to hemorrhagic disease of the newborn. Hemorrhaging of the skin, central nervous system, gastrointestinal tract, genitourinary system, gingiva,and lungs may occur in the infant or child who has vitamin K deficiency. This condition is more prevalent after minor surgical procedures, such as circumcisions in the newborn period. In addition, infants who are solely breastfed should receive 1 mg vitamin K intramuscularly every 5 to 7 days as long as diarrhea persists.Antibiotic therapy also increases the likelihood of vitamin K deficiency among infants and children. Use of broad-spectrum antibiotics,such as cephalosporins, and enteral aminoglycosides such as neomycin that can sterilize the bowel can lead to deficiency. Moxalactam and cefamandole also antagonize the action of vitamin K and can cause bleeding. However, dietary sources of vitamin K are abundant in older childhood and, therefore, deficiency following judicious use of antibiotics is unlikely. Frequent use of broad-spectrum antibiotics, though,should raise some concern.

Childhood obesity is a chronic disease that is associated with significant co-morbidity. Successful treatment and prevention of childhood obesity requires a multidisciplinary approach, including diet, nutrition education, behavior modification, and exercise. We studied 87 children (39 males, 48 females; aged 7-17 years) enrolled in a one-year multidisciplinary weight reduction program. Subjects were placed on a very low calorie/high protein diet, a moderate-intensity progressive exercise program, and behavior modification sessions for 10 weeks. Measures were taken at baseline 10 weeks, and 1 year. Significant anthropometric changes in weight, percent of ideal body weight, and percent body-fat were observed in all patients. We conclude that a multidisciplinary weight reduction program including diet, behavior modification, and exercise is an effective instrument to achieve weight loss in obese children and adolescents.

Clinical, epidemiological and basic research evidence clearly supports the inclusion of regular physical activity as a tool for the prevention of chronic disease and the enhancement of overall health. In children, activities of a moderate intensity may enhance overall health, and assist in preventing chronic disease in at-risk youth. The numerous health benefits of regular exercise are dependent on the type, intensity and volume of activity pursued by the individual. These benefits include reduction of low density lipoproteins while increasing high density lipoprotein; improvement of glucose metabolism in patients with type II diabetes; improved strength, self esteem and body image; and reduction in the occurrence of back injuries. In addition, a progressive, moderate-intensity exercise program will not adversely effect the immune system and may have a beneficial effect on the interleukin-2/natural killer cell system. Furthermore, by decreasing sedentary behaviors and, thus, increasing daily physical activity, individuals may experience many stress-reducing benefits, which may enhance the immune system.Conclusion Moderate intensity exercise:of a non-structured nature seems to facilitate most of the disease prevention goals and health promoting benefits. With new guidelines promoting a less intense and more time-efficient approach to regular physical activity, it is hoped that an upward trend in the physical activity patterns, and specifically children at risk for chronic disease, will develop in the near future.

OBJECTIVE:Helicobacter pylori plays a major role in abdominal symptoms and gastroduodenal pathology, including gastric cancer. Pregnancy has been associated with changes in both humoral and cell-mediated immunity. These changes include alterations in the various classes of antibodies during different gestational periods. It has been previously suggested that these alterations may expose pregnant women to an increased risk of infection with this microorganism.METHODS:To further investigate this hypothesis, we assayed sera from 229 asymptomatic pregnant women for the presence of H.-pylori-specific immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies by means of a commercially available serum ELISA test (Malakit, Biolab, Belgium). Both tests were previously validated in large series of H.-pylori-positive and -negative subjects. While the presence of H.-pylori-specific IgG antibodies is only a marker for a "chronic" infection with this bacterium and therefore no indicator of the time of acquisition of the infection, specific IgM antibodies are a more specific marker for a recently acquired infection with H. pylori. Results were compared with those previously obtained in asymptomatic, healthy, nonpregnant individuals.RESULTS:One hundred twenty of 229 women (52.4%) and 55/118 nonpregnant subjects (46.6%) were seropositive for H.-pylori-specific IgG antibodies (P > 0.3). Out of these 120 IgG-antibody-positive women, 36 (30%) were positive for H.-pylori-specific IgM antibodies, as were 25/109 (22.9%) in the IgG-antibody-negative group (P > 0.3). Overall, 61/229 (26.6%) of the pregnant women had recently been infected with H. pylori, compared with 11% of the healthy, nonpregnant population (P > 0.01).CONCLUSIONS:Our observations confirm the possibility of an increased susceptibility to H. pylori infection in pregnancy. Additional studies are necessary to further understand the immune response to H. pylori in pregnancy.

116 Dumping syndrome is a frequent complication of gastric surgery that leads to disabling symptoms. In children, particularly if neurologically handicapped, the array of symptoms can be difficult to attribute to dumping, as opposed to other complications of gastric surgery, or indeed unrelated factors. AIM: Determine clinical correlates of specific symptoms and the presence of dumping syndrome as diagnosed by radionucleotide scanning using standard criteria. METHOD: We reviewed the records of 59 consecutive neurologically challenged children ages 1.5 to 21 years, who had gastric scans performed after gastric surgery for retching, gagging, nausea, chronic or recurrent diarrhea, post-prandial diaphoresis, poor 6 month weight gain (z score < -1 SD for age), or abdominal pain. The procedures were fundoplication with or without gastrostomy (33), additional pyloroplasty (10), and gastrostomy tube alone (16). RESULTS: Diaphoresis was noted to be the most specific, with 15/44 (34%) with dumping, and 0/15 without (p<0.005 Fishers). Indeed 9/15 with diaphoresis had documented hypoglycemia either postprandially (4) or after oral glucose tolerance test (5). Retching was common in dumping, but not useful to discriminate, with 27/44 with dumping and 5/15 without (p>0.05). Malabsorption was suggested in 31/44 (69%) dumpers who had poor weight gain despite adequate intakes (p<0.05). The numbers of episodes of diarrhea were not different between the groups. CONCLUSION: Difficulty in gaining weight despite adequate caloric intake and post-prandial diaphoresis after gastric surgery are significantly associated with dumping syndrome. Retching and diarrhea are non-specific.

Journal of Pediatric Gastroenterology and NutritionVolume 29, Issue 4 p. 501-501 Abstracts: Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Denver, October 21-24, 1999 MEASURING LIQUID GASTRIC EMPTYING TIME USING 13C-GLUTAMINE T Nadal BS, T Nadal BS Department of Pediatrics and Imaging, Alfred I duPont Hospital for Children, Wilmington, DESearch for more papers by this authorG Mandell, G Mandell Department of Pediatrics and Imaging, Alfred I duPont Hospital for Children, Wilmington, DESearch for more papers by this authorS Shaffer, S Shaffer Department of Pediatrics and Imaging, Alfred I duPont Hospital for Children, Wilmington, DESearch for more papers by this authorE Reed, E Reed Department of Pediatrics and Imaging, Alfred I duPont Hospital for Children, Wilmington, DESearch for more papers by this authorU Blecker, U Blecker Department of Pediatrics and Imaging, Alfred I duPont Hospital for Children, Wilmington, DESearch for more papers by this authorD I Mehta, D I Mehta Department of Pediatrics and Imaging, Alfred I duPont Hospital for Children, Wilmington, DESearch for more papers by this author T Nadal BS, T Nadal BS Department of Pediatrics and Imaging, Alfred I duPont Hospital for Children, Wilmington, DESearch for more papers by this authorG Mandell, G Mandell Department of Pediatrics and Imaging, Alfred I duPont Hospital for Children, Wilmington, DESearch for more papers by this authorS Shaffer, S Shaffer Department of Pediatrics and Imaging, Alfred I duPont Hospital for Children, Wilmington, DESearch for more papers by this authorE Reed, E Reed Department of Pediatrics and Imaging, Alfred I duPont Hospital for Children, Wilmington, DESearch for more papers by this authorU Blecker, U Blecker Department of Pediatrics and Imaging, Alfred I duPont Hospital for Children, Wilmington, DESearch for more papers by this authorD I Mehta, D I Mehta Department of Pediatrics and Imaging, Alfred I duPont Hospital for Children, Wilmington, DESearch for more papers by this author First published: 01 October 1999 https://doi.org/10.1002/j.1536-4801.1999.tb02536.xRead the full textAbout ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume29, Issue4October 1999Pages 501-501 RelatedInformation

BACKGROUND:The prevalence of obesity in American youth is increasing and treating the condition is difficult. METHODS:We have developed a multidisciplinary weight-reduction program that includes a very low calorie diet followed by a hypocaloric diet, exercise, and behavior modification. Based on data collected at baseline and at the end of the acute intervention phase (10 weeks), we assessed the impact of the weight loss that resulted from participation in this weight reduction program on the resting energy expenditure and body composition of obese children and adolescents. RESULTS:There was a significant decrease in body weight and body fat as assessed by weight determinations and skin-fold measurements after 10 weeks. The body mass index decreased significantly from 33.8 on entry to 29.6 (P < 0.0001). Despite the significant weight loss, resting energy expenditure and lean body mass remained constant from entry until the completion of the acute phase. CONCLUSION:We conclude that a multidisciplinary weight-reduction program that combines a very low calorie diet followed by a balanced hypocaloric diet, with a moderate-intensity progressive exercise program and behavior modification is an effective means for weight-reduction in obese children and adolescents. Furthermore, fat mass is significantly reduced while lean body mass and resting energy expenditure are unaltered.

BACKGROUND:Safe and effective exercise programs are needed to prevent and treat chronic diseases in childhood. In particular, preadolescent obese children should participate in activities that are specific to their special needs.METHODS:We included a moderate intensity, progressive resistance training program in a multidisciplinary weight management program for obese preadolescent children. The program included diet, behavior modification, and aerobic and flexibility exercises.RESULTS:The subjects reported no accidents or injuries and 100% compliance with the minimum required exercise prescription. Weight, percent ideal body weight, body mass index, and percent fat were reduced significantly at 10 weeks and did not increase significantly at 1 year follow-up. Height and lean body mass increased significantly at 1 year.CONCLUSION:A resistance training program may be safely included in a multidisciplinary weight management program for obese preadolescent children.

Inflammation of the gastric and duodenal mucosa is the end result of an imbalance between mucosal defensive and aggressive factors. The degree of inflammation and imbalance between defensive and aggressive factors can then result in varying degrees of gastritis and/or frank mucosal ulceration. Gastritis and ulcers of the duodenum or stomach can be classified either as primary or secondary. The majority of children with chronic active or chronic gastritis and ulcers in the stomach or duodenum have secondary inflammation or mucosal ulceration. These ulcers generally occur due to a systemic condition like head trauma or overwhelming sepsis, or, as sequelae to drug ingestion (i.e., non-steroidal anti-inflammatory agents), but secondary gastroduodenal ulcers can also occur in specific disease conditions such as Zollinger-Ellison syndrome or Crohn's disease. The different causes of gastritis and peptic ulcer disease will be discussed in this paper.Conclusion In almost all children presenting to their treating pediatric gastroenterologist with duodenal or gastric ulcers of these patients, mucosal inflammation and less frequently, ulceration is caused by a spiral shaped, Gram-negative, microaerobic rod, properly named Helicobacter pylori. Recent epidemiological evidence has linked chronic H. pylori infection with the development of gastric carcinomas.

BACKGROUNDThe prevalence of childhood obesity is rapidly increasing. Successful prevention and treatment of childhood obesity depends on increasing the physical activity patterns of obese youth. However, motivating the obese child to participate in physical activity is difficult.METHODSWe designed a four-phase physical activity intervention, consisting of a structured progressive exercise program of moderate intensity, along with motivational methods to increase physical activity and improve body movement awareness.RESULTSSeventy-three overweight children participated in the weight management program. They had a significant weight loss and reduction in body fat, which was maintained at 1-year follow-up. Subjects also maintained lean body mass and showed improved physical activity patterns.CONCLUSIONSProgressive exercise, used in conjunction with nutrition and behavior modification, provides successful motivational strategies. These strategies encourage increased physical activity patterns, the adoption of regular structured exercise training, and the loss of excess body fat.

207 Research indicates that prevention of adult obesity may be accomplished through the treatment of pediatric obesity. However, it is unclear whether treatment should begin during the early or later childhood years. We examined the one-year program retention and weight maintenance of obese children(N=139; M=63, F=76; Age=12.11±2.6 yrs.; 7.1-17.6 yrs.) enrolled in a pediatric weight management program. The one-year program consisted of a protein-sparing modified fast diet, followed by a balanced hypocaloric diet, nutrition education, behavior modification, and a moderate-intensity (45-55% VO2max), progressive exercise program. Measures of height, weight, percent of ideal body weight (%IBW), and body mass index (BMI) were obtained at baseline, ten weeks and one year. Subjects were blocked by age as follows: 7-8 yrs., 9-10 yrs., 11-12 yrs., and 13+ yrs. for statistical analysis. A repeated measures one way analysis of variance indicated the following (%IBW, mean ± S.D).TableAll age groups experienced a significant reduction in%IBW and BMI at 10 weeks which was maintained at one year. However, the 7-8 yrs. and 9-10 yrs. age groups exhibited a higher one-year program retention rate (77.8% and 65.6%, respectively) than the 11-12 yrs. and 13+ yrs. age groups (57.6% and 60.7%, respectively). Therefore, even though all age groups lost and maintained significant weight, the younger subjects demonstrated increased retention at one year. This may provide support for the early treatment of childhood obesity. However, further investigation is needed to determine the factors that contributed to the increased program retention observed in the younger subjects.