4 Winick M Malnutrition and Brain Development J
当時、私がしばしば引用した 4つの論文 Winick M: Malnutrition and Brain Development. J Pediatrics, 1969 Sinclair et al: Supportive management of the sick neonate. Parenteral Calories, Water, and Electrolytes. Pediatric clinics of North America, vol. 17, 1970 Davidson M: Formula feeding of normal term and low birth weight infants. Pediatric clinics of North America, vol. 17, 1970 Raiha et al. : Milk protein quantity and quality in low-birth weight infants: Metabolic responses and effects on growth. Pediatrics 1976 11
Malnutrition and Brain Development by Myron Winick: J Pediatr, 1969 Reduction in cell number in 9 children who died of malnutrition in Santiago, Chile. (by Brown RE, 1965) Lines indicate US norms. ●= brain of normal Chileans; ▲= brains of Chilean children who died of marasmus. 12
Malnutrition and Brain Development by Myron Winick: J Pediatr, 1969 DNA content, % of normal DNA content of rat specific brain regions after increasing periods of malnutrition from birth 13
Supportive management of the sick neonate Parenteral Calories, Water, and Electrolytes Sinclair et al: Pediatric clinics of North America, vol. 17, 1970 16
Supportive management of the sick neonate Parenteral Calories, Water, and Electrolytes Sinclair et al: Pediatric clinics of North America, vol. 17, 1970 17
Wedding Party at Kobe Plaza Hotel, July 7, 2002 24
Protein requirement for premature infants • Gordon et al. (1947) 6 g/kg/dなら母乳より体重増加がよい • Omans et al. (1961) 3~8 g/kg/dで体重増加は同じ • Davidson et al. (1967) 最少蛋白摂取量として 4 g/kg/dなら体重増加がよい • 平田美穂ら (1969) 牛乳蛋白濃度が2%(2/3希釈牛乳)を越えると、腸管を そのまま通り抜け、尿中にペプタイドとし排泄される。 • Raiha et al. (1976) Milk protein quantity and quality in low-birthweight infants: I. Metabolic responses and effects on growth. In Pediatrics 25
Milk protein quantity and quality in low-birthweight infants: Metabolic responses and effects on growth. by Raiha et al. : Pediatrics 1976 (Whey/Casein) Weight gain, crownrump length, HC, femoral length BUN, Osm, TP, Alb F 1: 1. 5% (60: 40) F 2: 3. 0% (60: 40) F 3: 1. 5% (18: 82) F 4: 3. 0% (18: 82) Human Milk = = = ↑ ↑↑ → → ↑↑ ↑↑ ↑↑ → Metabolic acidosis Bw<2100 g, T 1=28 to 30 wks , T 2=31 to 33 wks , T 3=34 to 36 wks Isocaloric: 117 kcal/150 m. L/kg/d, HMのみ : 170 m. L 26
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Early Lipid and High Dose Amino Acid Supplementation Stimulates Anabolism in Preterm Infants by Vlaardingerbroek H et al. at PAS 2010, Vancouver OBJECTIVE: To investigate the safety and efficacy of intravenous lipid and high dose amino acid (AA) supplementation from birth onwards to VLBW infants. 28
Early Lipid and High Dose Amino Acid Supplementation Stimulates Anabolism in Preterm Infants by Vlaardingerbroek H et al. at PAS 2010, Vancouver Plasma urea conc: control Intervention A Intervention B Triglyceride remained < 3 mmol/L in all groups. 10. 1 ± 5. 4 mmol/L 7. 9 ± 2. 2 mmol/L 11. 1 ± 3. 7 mmol/L CONCLUSIONS: Introduction of lipids at 2 g/(kg. d) and amino acids at 3. 6 g/(kg. d) from birth onwards seems safe and results in a high rate of anabolism in VLBW infants. 29
FIN Brigitte Bardot 30
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Malnutrition and Brain Development by Myron Winick: J Pediatr, 1969 Physical and chemical measurement Animal Human ↓ ↓ ↓ of neurons and glia - ↓ in total brain. earliest effect on cerebellum ↓ in total brain. Delayed in hippocampus - ↓ - Norepinephrine and serotonin conc. RNA/DNA Transient ↓ - RNA content / cell Transient ↓ - - ↓ Weight Histology Cell number Cell migration Myelin synthesis Head circumference 33
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