RESUMO
OBJECTIVE: To test the hypothesis that healthy preterm infants randomly assigned to a semi-demand feeding protocol would require fewer days to attain oral feeding and have a satisfactory weight gain compared with control infants receiving standard care. STUDY DESIGN: In 2 neonatal intensive care nurseries, 81 infants 32 to < or = 34 weeks' postconceptional age were randomly assigned to the control (n = 41) or experimental (n = 40) protocol for transition from gavage to oral feedings. The control protocol followed the standard practice of gradually increasing scheduled oral feedings, whereas the experimental protocol used a semi-demand feeding method contingent on infant behavior. Analysis of variance techniques were used to compare the study groups for number of days to attain oral feeding and weight gain. RESULTS: The semi-demand method shortened the time for infants to achieve oral feeding by 5 days (P < .001). There were no differences in weight gain between the study groups, and both groups had satisfactory weight gain. CONCLUSION: The semi-demand method for the transition from gavage to oral feeding in healthy, preterm infants 32 to < or = 34 weeks postconceptional age promotes faster attainment of oral feeding and does not compromise their weight gain.
Assuntos
Nutrição Enteral , Alimentos Infantis , Recém-Nascido Prematuro , Leite Humano , Administração Oral , Análise de Variância , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Aumento de PesoRESUMO
As part of a multicenter V.A. Cooperative Study, 437 male veterans with varying stages of alcoholic liver injury were followed over a 4.5 year period. Their ethnic distribution consisted of 256 Caucasians, 109 black Afro-Americans, 63 Puerto Rican Hispanics, and 9 Native American Indians. Survival analyses revealed significant differences between groups (P = 0.0002): 66% of Afro-Americans were still living at 42 months; Caucasians were intermediate with 40% survival; and only 28% of Hispanics were alive. The number of Native American Indians enrolled was too small to draw conclusions but none of those enrolled survived beyond 24 months. Survival regression analysis of 30 clinical, laboratory, histologic and nutritional parameters, revealed the following significant risk factors: clinical severity (P less than 0.0001), histologic severity (P less than 0.0001), race (P = 0.001), age (P = 0.002), BUN (P = 0.01) and ALT (P = 0.02). These analyses indicated that ethnicity, independent of other variables, is significantly associated with outcome from the disease.
Assuntos
Alcoolismo/complicações , Etnicidade , Hepatopatias Alcoólicas/mortalidade , Longevidade , Adulto , Idoso , População Negra , Seguimentos , Hispânico ou Latino , Humanos , Indígenas Norte-Americanos , Hepatopatias Alcoólicas/etnologia , Hepatopatias Alcoólicas/patologia , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Cooperação do Paciente , Porto Rico/etnologia , Análise de Regressão , Fatores de Risco , Estados Unidos , United States Department of Veterans Affairs , População BrancaRESUMO
Plasma lipids, lipoproteins, and anthropometric measurements were assessed in 996 Venezuelan school children (ages 13--18 years) (441 in private, 555 in public schools, Merida, Venezuela) with cross-cultural comparisons to 419 13--18-year-old American school children from suburban Cincinnati, Ohio. Although there were no systematic differences in plasma cholesterol and triglyceride between public and private Venezuelan school children, low density lipoprotein cholesterol (LDL-C) levels were higher and high density lipoprotein cholesterol (HDL-C) levels lower in public than private school children. Within Venezuelan schools, and between sex, female children had consistently higher total plasma cholesterol, marginally higher HDL-C, and appreciably higher LDL-C than males. There were no consistent cross-sectional changes in lipids and lipoproteins in Venezuelan school children with age. Within sex, cross-cultural comparisons with Cincinnati school children revealed 2 major, consistent differences; Venezuelan children had higher fasting plasma triglyceride and lower HDL-C levels, not attributable to systematic differences in Quetelet index, laboratory methodology, subject selection, or sampling technique. Total plasma cholesterol and HDL-C were similar for Venezuelan and Cincinnati school children. Maintenance of comparable LDL-C but lower HDL-C levels by Venezuelan children into adulthood might, speculatively, be associated with augmented risk for coronary heart disease.
Assuntos
Comparação Transcultural , Lipídeos/sangue , Lipoproteínas/sangue , Adolescente , Antropometria , Colesterol/sangue , Demografia , Feminino , Humanos , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Masculino , Ohio , Triglicerídeos/sangue , VenezuelaAssuntos
Sangue Fetal/análise , Recém-Nascido , Lipídeos/sangue , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Feminino , Humanos , Masculino , Ohio , VenezuelaRESUMO
This study was designed to focus upon within-culture differences in plasma lipids and lipoproteins in Venezuelan schoolchildren having different socioeconomic and nutritional backgrounds and also to provide cross-cultural comparisons of lipids, lipoproteins, and anthropometric measurements between Venezuelan and American schoolchildren. The study was carried out in 1298 schoolchildren, ages 7 to 12 years, 428 in private and 870 in public schools in Merida, Venezuela, with comparison to 472 public schoolchildren in the (Cincinnati, OH) Princeton School District. Within Venezuelan schools, private shcoolchildren were heavier, taller, had marginally higher Quetelet indices, and had considerably higher fasting plasma cholesterol, plasma high-density lipoprotein (C-HDL), and plasma low-density lipoprotein (C-LDL) levels. These lipid-lipoprotein differences were highly significant after adjusting (by covariance analysis) for Quetelet index, sex, and age. Children from private Venezuelan schools ingested more total calories, more protein, more fat, and more carbohydrate. When the diet compositions were calculated as percentage of total calories, the private schoolchildren ingested nearly twice as many calories as fat and a somewhat lower proportion of calories as carbohydrate, with a comparable proportion as protein, when compared to the public Venezuelan schoolchildren. Male-female comparisons within Venezuelan schools revealed patterns of sex-related lipoprotein differences which were qualitatively similar to those in Princeton schoolchildren. Thus, 7- to 12-year-old females had higher total plasma cholesterol and triglyceride, lower C-HDL, and higher C-LDL. Within sex, cross-cultural comparisons of lipids, lipoproteins, and Quetelet indices revealed two major differences. Venezuelan children had significantly higher fasting plasma triglyceride and lower C-HDL levels, differences not attributable to systematic differences in measures of ponderosity, because Quetelet indices in Venezuelan and Cincinnati schoolchildren did not differ appreciably. In regard to total and low-density lipoprotein cholesterol, Venezuelan and Princeton public schoolchildren were remarkably comparable, although Venezuelan private schoolchildren had somewhat higher plasma cholesterol and C-LDL levels than did Princeton public schoolchildren. We speculate that increasing "westernization" and "urbanization" of Venezuelan society is associated with convergence of Venezuelan and American pediatric plasma lipid and lipoprotein levels. Maintenance of comparable total plasma cholesterol and C-LDL levels with lower C-HDL into adulthood in Venezuela would, in fact, suggest augmented risks for coronary heart disease for Venezuela within this lipid-lipoprotein frame of reference.