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Background: There are no internationally agreed recommendations on compositional requirements of follow-up formula for young children (FUF-YC) aged 1-3 years. Aim: The aim of the study is to propose international compositional recommendations for FUF-YC. Methods: Compositional recommendations for FUF-YC were devised by expert consensus based on a detailed literature review of nutrient intakes and unmet needs in children aged 12-36 months. Results and Conclusions: Problematic nutrients with often inadequate intakes are the vitamins A, D, B12, C and folate, calcium, iron, iodine and zinc. If used, FUF-YC should be fed along with an age-appropriate mixed diet, usually contributing 1-2 cups (200-400 ml) of FUF-YC daily (approximately 15% of total energy intake). Protein from cow's milk-based formula should provide 1.6-2.7 g/100 kcal. Fat content should be 4.4-6.0 g/100 kcal. Carbohydrate should contribute 9-14 g/100 kcal with >50% from lactose. If other sugars are added, they should not exceed 10% of total carbohydrates. Calcium should provide 200 mg/100 kcal. Other micronutrient contents/100 kcal should reach 15% of the World Health Organization/Food and Agriculture Organization recommended nutrient intake values. A guidance upper level that was 3-5 times of the minimum level was established. Countries may adapt compositional requirements, considering recommended nutrient intakes, habitual diets, nutritional status and existence of micronutrient programs to ensure adequacy while preventing excessive intakes.

Six-hundred-and-forty-two previously healthy children aged 1 month to 5 years with fever of acute onset, without localizing signs of infection, were prospectively recruited over 1 year. Sixty-three per cent had malaria, 4 per cent bacteraemia, and 7 per cent malaria and bacteraemia. Neither infection was identified in 27 per cent. Malaria was the predominant infection irrespective of season, temperature on presentation, or age (except under 6 months). Although Gram-negative bacteraemia was overall commoner than Gram-positive bacteraemia, Staphylococcus aureus was the commonest single organism (43 per cent) in bacteraemic patients. The prevalence of malaria increased with age while that of bacteraemia decreased with age (P < 0.0005). The prevalence of an identifiable infection increased with the temperature on presentation (P < 0.025). It is concluded that although malaria is the predominant infection in previously healthy under-5 children with acute fever without specific localizing signs of infection, bacteraemia (alone or associated with malaria) occur with an importantly high frequency. It is recommended that while presumptive treatment for malaria is justified in such children, evaluation for bacteraemia should be given consideration.

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The fatty acid (FA) composition of the main plasma lipids was analysed in eight well-nourished, generally healthy Nigerian children aged 14.1 +/- 7.2 months and in 17 malnourished children (8 marasmus, 9 kwashiorkor) aged 14.6 +/- 3.8 months within the first 2 days of admission at the Dept. of Child Health, University of Benin. In comparison to the control group, the malnourished children showed a marked decrease of polyunsaturated FA with low linoleic acid, mainly in sterol esters (STE), and severely reduced linoleic acid metabolites, including arachidonic acid, in all lipid fractions. omega-3-FA were not altered except for a reduction of docosapentaenoic and docosahexaenoic acids in phospholipids. Clearly increased values were found for saturated FA in STE and for the non-essential monoenoic FA in all lipid classes. This pattern indicates the presence of essential fatty acid deficiency in the malnourished children. There was no significant difference between marasmus and kwashiorkor. Eight malnourished children were followed up in the early phase of recovery during hospital treatment 14.0 +/- 3.1 days after obtaining the first sample. Linoleic acid had increased again in STE, but its metabolites were as low or even lower than before. An impaired activity of delta-6-desaturase, the rate limiting enzyme of linoleic acid metabolism, in suggested by elevated substrate-product-ratios of this enzyme in untreated children with protein energy malnutrition and in the early phase of recovery, which may be due to low insulin levels, protein and zinc deficiency. The trientetraen ratio (20:3 omega 9/20:4 omega 6) thus is not a reliable indicator of essential FA status in protein-energy malnutrition.

The fatty acid composition of mature human milk from 10 rural Nigerian women was analyzed by high-resolution capillary gas-liquid chromatography and compared to previously determined results on mature human milk from 15 German mothers. Human milk of the Nigerian group contains significantly higher proportions of saturated fatty acids (median 54.07 vs. 42.76% wt/wt). The difference is primarily caused by high values for lauric (C12:0, 8.34%) and myristic acids (C14:0, 9.57%), but not of medium chain fatty acids (C8:0, C10:0), presumably due to increased de novo fatty acid synthesis in the African women consuming a high carbohydrate and low-fat diet. Markedly lower values of oleic and total cis-monounsaturated (22.82 vs. 37.98%) as well as trans-isomeric fatty acids (1.20 vs. 4.40%) in Nigerian milk appear to result from low dietary intakes of animal and partially hydrogenated fats, respectively. Although percentage contribution of linoleic acid (18:2n-6) is similar, arachidonic acid (C20:4n-6) and total n-6 long-chain polyunsaturates with 20 and 22 carbons (n-6 LCP) are higher in the African samples. N-6 LCP secretion with human milk lipids is not correlated to the precursor linoleic acid and seems not to depend on maternal dietary intake of preformed dietary LCP with animal fats. N-3 LCP are very high in milk of the Nigerian women who obtain a large portion of dietary lipids from sea fish, but even then docosaehexanoic (C22:6n-3) and not eicosapentaenoic (C20: 5n-3) is the predominant n-3 LCP in milk.(ABSTRACT TRUNCATED AT 250 WORDS)

Background: In Nigeria, and perhaps other African countries, thyroid disorders in childhood and adolescence have not been sufficiently studied. Where studies are available, they were either conducted decades ago or they involved only adults. Objective: To describe the pattern of thyroid disorders among children and adolescents seen in a Nigerian teaching hospital and highlight the management challenges encountered. Methods: In this retrospective study, the case notes of all the children and adolescents with thyroid disorders seen in the Paediatric Endocrine-Metabolic Clinic and of those admitted into the wards of the University of Benin Teaching Hospital (UBTH) were audited. Information extracted included age, gender, duration of symptoms before presentation, clinical features, laboratory test results, management challenges and admission outcome. The total number of new cases seen at the paediatric clinics of the Department of Child Health, UBTH was derived from the clinic attendance register of the department. Results: Of the 8,350 new cases seen during the 7-year period, 9(0.12%) had thyroid disorders, representing one per 1000 new cases. Of the 9 patients with thyroid disorders, 6 (66.7%) had hyperthyroidism, 2(22.2%) had nongoitrous hypothyroidism and 1(11.1%) had euthyroid goiter. The overall mean age at presentation for thyroid disorders was 11.2+4.3 years (95% Confidence Interval, CI = 8.4-14.0)and female-to-male ratio was 4:1. For the patients with hyperthyroidism, the mean age of presentation was 12.8+3.1 years (95% CI= 10.3-15.3) and female-to-male ratio was 5:1. The mean age at presentation of the two children (a boy and a girl) with hypothyroidism was 4.75 years (range 3.5 and 6 years). The mean duration of symptoms before presentation was as follows: thyroid disorders 1.72+1.2 years (95% CI=0.94-2.50), hyperthyroidism 8.5+1.5 months (95% CI=7.3-9.7). The only case of euthyroid goiter (female) presented at the age of 14 years. The management challenges encountered included suboptimal diagnostic facilities and high clinic default rate. Conclusion: Hyperthyroidism was the most common form of thyroid disorder observed and patients with thyroid disorders tended to present late. Suboptimal diagnostic facility and high clinic default rate were the principal management challenges encountered.

Five-hundred-and-twenty-two infants and children aged 1 month to 6 years presenting at the Children's Emergency Room of the University of Benin Teaching Hospital with convulsions associated with fever (CAF) of acute onset were prospectively evaluated to determine the pattern of infections. Twenty-six per cent had localized infections of which 38 per cent were intracranial (meningitis = 16 per cent, cerebral malaria = 19 per cent, and encephalitis = 3 per cent) and 62 per cent were extracranial with respiratory tract infections contributing 51 per cent. Although, the prevalence of meningitis was significantly higher in 1-6 months old infants when compared with older children (47 per cent v. 12 per cent; P < 0.005), it was, none-the-less, present in all the other age groups (with a prevalence of 8-17 per cent). Seventy-four per cent of the children had no localizing signs of infection. Of these 68 per cent had malaria, 4 per cent bacteraemia, and 7 per cent malaria with bacteraemia, while no infections were identified in 21 per cent. Among children with bacteraemia Staphylococcus aureus was the commonest single isolate (33 per cent) although, overall, enterobacteriaceae were the commonest. We conclude, first, that meningitis should be excluded in all children aged under 6 years who present with CAF of acute onset and, secondly, that although anticipatory treatment for malaria is justified in children with CAF of acute onset without localizing signs of infection, consideration should also be given to the problem of bacteraemia.