No abstract

Abnormal growth is a common feature of thalassaemia major in children. In an attempt to determine whether it has a nutritional cause, 12 children aged 1 to 3 years with thalassaemia major were studied under metabolic ward conditions. Nutritional status was assessed by anthropometry and biochemistry before and after an intensive nutrition regimen. Five children had wasting or stunting on admission. As a result of the nutrition intervention, mean weight for height improved significantly. The mean height increase of0 4 cm after one month was not significant. Plasma zinc, depressed in half the children on admission, improved, as did (x tocopherol, while copper decreased. Plasma insulin-like growth factor-I also increased commensurate with improved growth. Fat absorption was normal in all children. Undernutrition is an important cause of associated growth disturbances in children with thalassaemia major. Malnutrition was primarily caused by inadequate nutrient intake, as indicated by the capacity to gain weight appropriately when provided with nutrition support, and by the absence of intestinal malabsorption. While long term studies are required to determine if nutritional support will prevent stunting, these results underscore its central role in preventing nutritional deficiencies and in promoting normal growth in thalassaemic children.

Recurrent aphthous ulceration (RAU) is the most common lesion of the oral mucosa. Although many factors have been postulated as etiological factors for RAU, the role of Helicobacter pylori as a causative agent of RAU remains controversial. We therefore investigated the association of H. pylori and RAU by a highly sensitive technique, nested polymerase chain reaction (PCR), in 22 patients with RAU with ages ranging from 12-36 years. Samples were brushed from the lesions and the dorsum of the tongue of each patient. In addition, samples from the dorsum of the tongue of 15 normal individuals with ages ranging from 13-40 years were used as controls. The results showed that only one sample from a lesion (4.5 %) and one sample from the tongue (4.5 %) of two different patients with RAU were positive for H. pylori. In the control group, 3 samples (20 %) were positive for H. pylori. These findings suggest that H. pylon does not play a role in the pathogenesis of RAU and the dorsum of the tongue may be a reservoir of H. pylori in some individuals. (J.

For populations such as ours most anaemia is not due to iron deficiency and a single Hb determination is therefore not acceptable for a presumptive diagnosis of IDA.

Twelve thalassaemic children under 3 years of age received intensive nutritional support for one month and were discharged on a prescribed diet of locally available foods. Anthropometry, bioelectrical impedance analysis and dietary intake were longitudinally assessed. Mean energy intake was 20% greater than the recommended daily allowance during nutritional supplementation as compared with below the recommended daily allowance before and after the period of nutritional support. Weight, but not height, significantly increased during the support period and was due to increases in both fat free mass and fat mass. Body weight, fat free mass and fat mass declined in line with the reduced intake upon return home; however, height velocity accelerated and exceeded normal through the fourth month before resuming a below normal rate. It can be concluded that (1) nutritional stunting as the result of reduced nutrient intake is an important cause of growth failure in young children with thalassaemia and is responsive to nutritional support, (2) the deficit in height velocity was due to retarded truncal height growth, and (3) the bioelectrical impedance analysis method is suitable for body composition analysis of thalassaemic children. (Arch Dis Child 1997;76:509-512)