Previous studies have suggested that children with phenylketonuria (PKU) have a reduction in bone mineralization compared with control subjects. To investigate this, bone mineral density (BMD) of the total body (TBMD) was measured in 32 prepubertal children with PKU and in 95 age-matched control subjects. Spine bone mineral density (SBMD) was also recorded in a subset, 24 with PKU and 55 control subjects. The effect of dietary intake on bone mass was assessed in 30 of the children with PKU and in 12 control subjects. In the children with PKU, TBMD and SBMD were significantly lower than in the control subjects after adjustment for height and weight (P = 0.03 and P = 0.003, respectively). The children with PKU had a higher intake of calcium (P < 0.0001), phosphorus (P = -0.0002), and magnesium (P < 0.0001), suggesting that their lower BMD occurred despite an adequate diet based on current recommendations. Further study is needed to establish the cause of this deficit in bone mass and the benefit of additional nutritional support to reverse this problem.

There is a high prevalence of over-nutrition in paediatric patients, and increased length of stay for older over-nourished inpatients. These issues need to be addressed in terms of opportunities for intervention and impact on hospital resources.

Barriers to nutritional assessment can lead to failure to diagnose and treat both over- and under-nutrition, thereby affecting quality of patient care, and may have financial implications for hospitals. Suggestions for service improvement include provision of accurate equipment, adequate training of staff undertaking nutritional assessments and clear definitions of staff responsibilities in all aspects of the process.

The use of areal bone mineral density (aBMD) in paediatric populations has aroused some concern, as it fails to take the age‐related increase in bone thickness into account. We have developed a measure of true bone density, volumetric bone mineral density (vBMD), which is independent of age and height. In order to examine the relationship between growth parameters, aBMD and vBMD, we studied patients with phenylketonuria (PKU, n = 40), chronic renal failure (CRF, n = 27) and chronic asthma (n = 19). aBMD of the femoral neck and the mid‐femoral shaft was measured using dual energy X‐ray absorptiometry (DXA), vBMD was calculated on the basis of values of bone mineral content and bone dimension provided by DXA, with the assumption that both sites are cylinders. aBMD and vBMD were then compared with the normal reference, expressed as a standard deviation score (SDS). aBMD and vBMD were normal in the femoral neck region of the PKU group, but aBMD, either standardized for age or for height, was low in the femoral shaft region (p < 0.01). In the CRF group, profound growth retardation was seen (mean height SDS, −3.2) and aBMD and vBMD were both low in the femoral shaft region but not in the femoral neck. In the asthma group, aBMD for age was low at both sites, but vBMD did not differ from that seen in normal individuals. We conclude that the true vBMD provides a different interpretation of bone density compared with aBMD and requires further evaluation in paediatrics because of its age and height independence.

Reported cases of acquired immunodeficiency syndrome (AIDS) in San Francisco as of March 31, 1986, include 92 individuals who had donated blood subsequent to 1978. Their donated blood components had been transfused into 406 different recipients. The current status of 336 of these recipients was ascertained as of April 1, 1986. Of these, 223 had died at the time of our first contact, almost all as a result of the condition for which they were transfused. Seven had developed AIDS; five of these died, two before entry into the study and three subsequently. Forty-six additional living recipients were interviewed and evaluated. Seven had the AIDS-related complex, 18 had antibody to the human immunodeficiency virus (HIV) but were otherwise healthy, and 19 had no detectable anti-HIV. Two had risk factors other than transfusion. The frequency of infection of the recipient decreased as the time interval between transfusion and the diagnosis of AIDS in the donor increased. This information should be useful when counseling patients who have been transfused with blood components from donors later found to be infected with HIV.

Prevalence of iron deficiency at 18 months was high despite appropriate infant feeding practices during the first year. Modification of the diet in the second year of life may decrease the risk of iron deficiency in Vietnamese children.

Objective: To investigate in children with cystic fibrosis (CF) and children without CF: (1) the test -retest reproducibility of a 20 min resting energy expenditure (REE) measurement; and (2) the long-term reproducibility of REE measurements in children with CF using longitudinal data. Design: Cross-sectional study and longitudinal cohort. Setting: A tertiary referral paediatric hospital. Subjects: A total of 31 (11 male, 20 female) children (aged 12.8 AE 3.6 y) with CF and 32 (14 male, 18 female) healthy children without CF (aged 12.2AE 2.3 y) were enrolled in the short-term reproducibility study. Long-term REE measurement reproducibility was assessed in another 14 children (5 male, 9 female) with CF, comparing their initial REE measurement with a subsequent measurement 1 -2 y later. Methods: All children had measurements of height, weight, skinfold thickness and indirect calorimetry. Results: There was no statistically significant difference in REE between repeated measurements in children with CF (mean AE s.d., 6240AE 1280 and 6220 AE 1315 kJ=24 h) and in the children without CF (6040 AE 956 and 6015 AE 943 kJ=24 h). For the children with CF, the intraclass correlation coefficient was 0.99 and for children without CF the intraclass correlation coefficient was 0.97. The measurement errors were 119 and 177 kJ, respectively. Approximately 80% of the variation in REE in the CF group and 70% in the group without CF was explained by fat-free mass (FFM). Analysis of the longitudinal CF data show there was no difference in REE between a child's first measurement (5140 AE 1140 kJ) and their subsequent measurement (5460 AE 1190 kJ), after adjustment for changes in body size between the measurements. Conclusion: This study has demonstrated that a short-term 20 min REE measurement is reproducible and therefore valid in children with CF and children without CF. These results also indicate that in children with CF, long-term REE measurements are reproducible.

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