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To examine the contribution of 100 % fruit juice (FJ) consumption to dietary adequacy of shortfall nutrients by children and adolescents.
Secondary analysis of data from the 2003–2006 National Health and Nutrition Examination Survey (NHANES).
Children and adolescents aged 2–18 years (n 7250). Usual intake, determined from two 24 h dietary recalls, was calculated using the National Cancer Institute method. The population was dichotomized into consumers or non-consumers of 100 % FJ. The age/gender-specific percentage of the two consumption groups with intakes less than the Estimated Average Requirement or that exceeded the Adequate Intake for selected nutrients was determined. A Z-statistic for differences in population proportions was used to determine significance (P < 0·05).
Children aged 2–5 years had the highest percentage of 100 % FJ consumers (71·1 %), followed by children aged 6–12 years (57·0 %) and adolescents aged 13–18 years (44·5 %). Compared with 100 % FJ consumers, a significantly higher percentage of non-consumers had intakes below the Estimated Average Requirement for vitamin A (24·4 (se 2·5) % v. 42·2 (se 2·5) %), vitamin C (0·1 (se 0·2) % v. 38·9 (se 4·1) %), folate (8·8 (se 1·5) % v. 22·1 (se 2·4) %), P (11·6 (se 2·1) % v. 21·3 (se 2·6) %) and Mg (25·8 (se 1·7) % v. 46·1 (se 2·0) %). A greater percentage of 100 % FJ consumers exceeded the Adequate Intake for K (2·4 (se 0·5) v. 0·5 (se 0·2) %) compared with non-consumers.
Consumption of 100 % FJ is associated with improved nutrient adequacy and can contribute to a healthy diet.
To examine the association of consumption of whole grains (WG) with diet quality and nutrient intake in children and adolescents.
Secondary analysis of cross-sectional data.
The 1999–2004 National Health and Nutrition Examination Survey.
Children aged 2–5 years (n 2278) and 6–12 years (n 3868) and adolescents aged 13–18 years (n 4931). The participants were divided into four WG consumption groups: ≥0 to <0·6, ≥0·6 to <1·5, ≥1·5 to <3·0 and ≥3·0 servings/d. Nutrient intake and diet quality, using the Healthy Eating Index (HEI)-2005, were determined for each group from a single 24 h dietary recall.
The mean number of servings of WG consumed was 0·45, 0·59 and 0·63 for children/adolescents at the age of 2–5, 6–12 and 13–18 years, respectively. In all groups, HEI and intakes of energy, fibre, vitamin B6, folate, magnesium, phosphorus and iron were significantly higher in those consuming ≥3·0 servings of WG/d; intakes of protein, total fat, SFA and MUFA and cholesterol levels were lower. Intakes of PUFA (6–12 years), vitamins B1 (2–5 and 13–18 years), B2 (13–18 years), A (2–5 and 13–18 years) and E (13–18 years) were higher in those groups consuming ≥3·0 servings of WG/d; intakes of added sugars (2–5 years), vitamin C (2–5 and 6–12 years), potassium and sodium (6–12 years) were lower.
Overall consumption of WG was low. Children and adolescents who consumed the most servings of WG had better diet quality and nutrient intake.
PATHOPHYSIOLOGY OF PEDIATRIC LIVER DISEASE
Stephen Hardy, Instructor, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Attending Physician, Department of Pediatric Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts,
Ronald E. Kleinman, Professor, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Acting Physician-in-Chief, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
Cirrhosis is a form of chronic liver injury that represents an end stage of virtually any progressive liver disease. In fact, the process of cirrhosis may be superimposed on the primary liver disease and obscure the nature of the original insult. There is considerable overlap between the clinical features of the various forms of cirrhosis. In 1977, the World Health Organization defined cirrhosis as a diffuse liver process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules . Cirrhosis represents a dynamic state reflecting the competing processes of cell injury (necrosis), response to injury (fibrosis), and regeneration (nodule formation). Isolated hepatic fibrosis or nodule formation alone does not represent cirrhosis. As cirrhosis advances, it results in distortion of liver architecture and compression of hepatic vascular and biliary structures. These critical architectural changes lead to irregular delivery of nutrients, oxygen, and metabolites to various areas of the liver and may perpetuate the cirrhotic process even after the original insult has been brought under control or has ceased (Table 6.1).
Many schemes for categorizing cirrhosis have been proposed, including classification based on gross morphology, microscopic histology, etiology, and clinical presentation. Because cirrhosis is, in its later stages, a self-perpetuating process, the gross and microscopic appearances of the liver only occasionally reveal the nature of the original pathogenic process. The morphologic classification divides cirrhosis into micronodular, macronodular, and mixed types of cirrhosis.
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