AE, Billingham RE, Head J: The immunologic significance of the mammary gland. / Invest Dermatol 63: 65, 1974 2. Gerrard JW: Breast feeding: second thoughts. Pediatrics 54: 757, 1974 1. Beer
Obesity
in childhood
diagnosis nor a disease, but simply phenomenon that may result from a variety of causes some physiologic, some genetically de¬ termined and others acquired. Obesity in childhood cannot be regarded in the same diagnostic or therapeutic terms as obesity in adults, even though many obese children will retain their obesity throughout life. It is also misleading to think of most obese children as reflect¬ ing a state of "overnutrition", as is commonly done. The following points are important: 1. Obesity in some children occurs as a result of an increase in the number of fat cells (hyperplastic obesity), in others because of an increase in size of fat cells (hypertrophic obesity) and Obesity is
neither
fewer calories than are their though there are a few notable exceptions. 6. Although there is an association between obesity and hypertension, false recordings of hypertension in obese children and adults are common, due simply to the fact that the bladder of the blood pressure cuff is too narrow for an oversized arm. Readings should always be checked with the cuff on the forearm. 7. The concept of obesity as a dis¬ ease of affluence is misleading. In fact, a striking inverse relation between so¬ cioeconomic status and the prevalence of obesity has been well documented in Western society. This strengthens the concept that physical inactivity is a major determinant of the phenomenon. 8. Emotional disturbances are more often the result of than the cause of obese states. There are strong social pressures against the obese in our so¬ ciety, and medical treatment that focuses only on the obesity is not only likely to fail but also may aggravate the associated depression and diminished self-system of the obese youngster. 9. The physician's role in preventing obesity should probably be directed to¬ number
Background reading
a a
.
in some because of a combination of the two processes. This distinction has important implications for treatment: thus, in the hyperplastic type other tissues (e.g. muscle and bone) also are hyperplastic, obesity begins early in life, the children mature early and are taller than average, and the obesity is resistant to therapy. 2. Several specific and rare genetic disorders are associated with marked obesity. These include the LaurenceMoon-Biedl syndrome, the PraderWilli syndrome and pseudohypopara-
thyroidism. 3. Obesity due to endocrine disturb¬ ance is exceedingly rare, and the meta¬ bolic abnormalities associated with obesity (impaired glucose tolerance and insulin resistance) appear to be results of obesity rather than causes. 4. Genetic factors and reduced ca¬ loric expenditure (inactivity) are the major operative factors in most cases of childhood obesity. Although exces¬ sive calorie intake can occur, this is the main problem in a minority of in¬ stances. The insulating effect of a layer of adipose tissue and the lack of insulation in its absence probably tend to keep fat people fat and thin people thin, despite a wide variation in calorie intakes. 5. The recent suggestion that overfeeding in infancy is an important cause of obesity has not been substantiated in careful studies. Weight gain in the 1st year of life has been found to be of virtually no value as a predictor of obesity at age 7 years. In older chil¬ dren careful measurement of calorie intake shows that most obese indivi¬ duals are consuming either the same
or
nonobese peers,
encouraging daily physical ac¬ tivity in the schools, with less emphasis on team performance. A better under¬ standing of the mechanisms of obesity should help the physician to take a more sympathetic and realistic ap¬ proach to his obese patients of all ages.
wards
Richard B. Goldbloom, md Physician in chief The Izaak Walton Killam Hospital for Children Halifax, NS
Additives in infant foods A food additive is any substance added
to a food during production, processing, packaging or storing. Intentional addi¬ tives are included to provide specific functions and have either nutritional or non-nutritional properties. Nutritional compounds consist primarily of vita¬
mins and minerals and, to a minor ex¬ tent, certain amino acids. Non-nutritive additives may function as stabilizers or thickeners, flavouring agents, emulsi-
For the Optimum Management of Iron Deficiency
Slow-fe Formula: Each SLOW-FE tablet contains 160 mg. of dried ferrous sulfate U.S.P. (equivalent to 50 mg. of ferrous iron), in a specialty formulated slow release base. The iron content is released evenly over an aver¬ age period of 1 /2 hours, the optimum time for maximum effective absorption. The tablets are film-coated. Indications: The management of iron deficiency states. SLOW-FE is formulated to be better tolerated than ordinary ferrous sulfate tablets and it is therefore especially suitable for prolonged administration. The minimization of nausea and gastrointestinal irritation is advantageous in pregnancy, gastroin¬ testinal disorders, e.g. peptic ulcer, convalescence and in old age, all of which may be associated with simple iron deficiency anemias. and Administration: Because it is Dosage slowly released an adequate dose is possible by giving SLOW-FE only once daily. As the'ferrous sulfate content is evenly distributed through the special slow release base only a very small quantity is released in the stomach. There is therefore no need to advise that SLOW-FE tablets be taken with or after food as with other ferrous sulfate tablets. Prophylaxis; A single tablet daily is sufficient to maintain iron intake both during pregnancy and in patients with simple iron deficiency. Iron Deficiency; Depending on the severity, one or two tablets of SLOW-FE daily, usually in one dose. In mild anemias, e.g. hemoglobin above 75%, one tablet daily will usually suffice. For moderate or severe anemias two tablets daily should be given, until the hemoglobin levels return to normal. This physiological process may require up to approximately eight weeks. In most patients the dose can then be reduced to one tablet daily for maintenance, to build up iron reserves over a further 12 to 16 weeks. For Children: One tablet of SLOW-FE daily is a suitable dose for children able to swallow a small tablet. Side Effects: Gastrointestinal side effects such as nausea and gastrointestinal irritation usually occurring with other iron-containing tablets, are unlikely to arise with SLOW-FE. Treatment of Overdosage: Care has been taken to minimize the risk of accidental consumption of Slow-Fe by children by making the tablets a relatively unattractive off-white colour with an almost tasteless film coat rather than the customary sweet-tasting sugar coat. Moreover the push-through type of foil packaging makes the extraction of many tablets difficult and tedious for children. However, in the event of overdosage the usual treatment for iron poisoning should be instituted. Because the iron is only slowly released the risk of toxic levels of ionic iron being absorbed is less and there is a wider time margin in which to carry out stomach wash outs; also the use of an iron-chelating agent such as Desferal® (deferoxamine CIBA) is likely to be more effective. The treatment of iron poisoning is described in detail in the CIBA literature
Desferal®. fiers, acidulants, preservatives (antimi¬ on Contraindications: Iron therapy is contraindicated crobial and antioxidant), sweeteners or in the presence of hemochromatosis, hemosiderosis colouring agents. The general food and hemolytic anemia.
market of the future will be influenced primarily by the continued demand for convenience foods, the need for a longer shelf-life and increased empha¬ sis on nutritional value all of which make additives necessary. Therefore, use of additives will continue to in¬ .
crease.
In infant foods most of the additives nutritive. The types and amounts of additives and the foods to which are
Precautions: SLOW-FE like all oral iron prepara¬
tions, may aggravate existing peptic ulcer, regional
enteritis and ulcerative colitis. in Supplied: SLOW-FE tablets are30packaged push-through packs containing tablets per sheet and are available in units of 30,120 and 4,800 tablets. Reference: 1. Nutrition Canada National Survey. A report by Nutrition Canada to The Department of National Health and Welfare, Ottawa, Information Canada, 1973.
CIBA
DORVAL, QUEBEC
H9S1B1
C-5024
CMA JOURNAL/JULY 26, 1975/VOL. 113 139
Obesity
in childhood
diagnosis nor a disease, but simply phenomenon that may result from a variety of causes some physiologic, some genetically de¬ termined and others acquired. Obesity in childhood cannot be regarded in the same diagnostic or therapeutic terms as obesity in adults, even though many obese children will retain their obesity throughout life. It is also misleading to think of most obese children as reflect¬ ing a state of "overnutrition", as is commonly done. The following points are important: 1. Obesity in some children occurs as a result of an increase in the number of fat cells (hyperplastic obesity), in others because of an increase in size of fat cells (hypertrophic obesity) and Obesity is
neither
fewer calories than are their though there are a few notable exceptions. 6. Although there is an association between obesity and hypertension, false recordings of hypertension in obese children and adults are common, due simply to the fact that the bladder of the blood pressure cuff is too narrow for an oversized arm. Readings should always be checked with the cuff on the forearm. 7. The concept of obesity as a dis¬ ease of affluence is misleading. In fact, a striking inverse relation between so¬ cioeconomic status and the prevalence of obesity has been well documented in Western society. This strengthens the concept that physical inactivity is a major determinant of the phenomenon. 8. Emotional disturbances are more often the result of than the cause of obese states. There are strong social pressures against the obese in our so¬ ciety, and medical treatment that focuses only on the obesity is not only likely to fail but also may aggravate the associated depression and diminished self-system of the obese youngster. 9. The physician's role in preventing obesity should probably be directed to¬ number
Background reading
a a
.
in some because of a combination of the two processes. This distinction has important implications for treatment: thus, in the hyperplastic type other tissues (e.g. muscle and bone) also are hyperplastic, obesity begins early in life, the children mature early and are taller than average, and the obesity is resistant to therapy. 2. Several specific and rare genetic disorders are associated with marked obesity. These include the LaurenceMoon-Biedl syndrome, the PraderWilli syndrome and pseudohypopara-
thyroidism. 3. Obesity due to endocrine disturb¬ ance is exceedingly rare, and the meta¬ bolic abnormalities associated with obesity (impaired glucose tolerance and insulin resistance) appear to be results of obesity rather than causes. 4. Genetic factors and reduced ca¬ loric expenditure (inactivity) are the major operative factors in most cases of childhood obesity. Although exces¬ sive calorie intake can occur, this is the main problem in a minority of in¬ stances. The insulating effect of a layer of adipose tissue and the lack of insulation in its absence probably tend to keep fat people fat and thin people thin, despite a wide variation in calorie intakes. 5. The recent suggestion that overfeeding in infancy is an important cause of obesity has not been substantiated in careful studies. Weight gain in the 1st year of life has been found to be of virtually no value as a predictor of obesity at age 7 years. In older chil¬ dren careful measurement of calorie intake shows that most obese indivi¬ duals are consuming either the same
or
nonobese peers,
encouraging daily physical ac¬ tivity in the schools, with less emphasis on team performance. A better under¬ standing of the mechanisms of obesity should help the physician to take a more sympathetic and realistic ap¬ proach to his obese patients of all ages.
wards
Richard B. Goldbloom, md Physician in chief The Izaak Walton Killam Hospital for Children Halifax, NS
Additives in infant foods A food additive is any substance added
to a food during production, processing, packaging or storing. Intentional addi¬ tives are included to provide specific functions and have either nutritional or non-nutritional properties. Nutritional compounds consist primarily of vita¬
mins and minerals and, to a minor ex¬ tent, certain amino acids. Non-nutritive additives may function as stabilizers or thickeners, flavouring agents, emulsi-
For the Optimum Management of Iron Deficiency
Slow-fe Formula: Each SLOW-FE tablet contains 160 mg. of dried ferrous sulfate U.S.P. (equivalent to 50 mg. of ferrous iron), in a specialty formulated slow release base. The iron content is released evenly over an aver¬ age period of 1 /2 hours, the optimum time for maximum effective absorption. The tablets are film-coated. Indications: The management of iron deficiency states. SLOW-FE is formulated to be better tolerated than ordinary ferrous sulfate tablets and it is therefore especially suitable for prolonged administration. The minimization of nausea and gastrointestinal irritation is advantageous in pregnancy, gastroin¬ testinal disorders, e.g. peptic ulcer, convalescence and in old age, all of which may be associated with simple iron deficiency anemias. and Administration: Because it is Dosage slowly released an adequate dose is possible by giving SLOW-FE only once daily. As the'ferrous sulfate content is evenly distributed through the special slow release base only a very small quantity is released in the stomach. There is therefore no need to advise that SLOW-FE tablets be taken with or after food as with other ferrous sulfate tablets. Prophylaxis; A single tablet daily is sufficient to maintain iron intake both during pregnancy and in patients with simple iron deficiency. Iron Deficiency; Depending on the severity, one or two tablets of SLOW-FE daily, usually in one dose. In mild anemias, e.g. hemoglobin above 75%, one tablet daily will usually suffice. For moderate or severe anemias two tablets daily should be given, until the hemoglobin levels return to normal. This physiological process may require up to approximately eight weeks. In most patients the dose can then be reduced to one tablet daily for maintenance, to build up iron reserves over a further 12 to 16 weeks. For Children: One tablet of SLOW-FE daily is a suitable dose for children able to swallow a small tablet. Side Effects: Gastrointestinal side effects such as nausea and gastrointestinal irritation usually occurring with other iron-containing tablets, are unlikely to arise with SLOW-FE. Treatment of Overdosage: Care has been taken to minimize the risk of accidental consumption of Slow-Fe by children by making the tablets a relatively unattractive off-white colour with an almost tasteless film coat rather than the customary sweet-tasting sugar coat. Moreover the push-through type of foil packaging makes the extraction of many tablets difficult and tedious for children. However, in the event of overdosage the usual treatment for iron poisoning should be instituted. Because the iron is only slowly released the risk of toxic levels of ionic iron being absorbed is less and there is a wider time margin in which to carry out stomach wash outs; also the use of an iron-chelating agent such as Desferal® (deferoxamine CIBA) is likely to be more effective. The treatment of iron poisoning is described in detail in the CIBA literature
Desferal®. fiers, acidulants, preservatives (antimi¬ on Contraindications: Iron therapy is contraindicated crobial and antioxidant), sweeteners or in the presence of hemochromatosis, hemosiderosis colouring agents. The general food and hemolytic anemia.
market of the future will be influenced primarily by the continued demand for convenience foods, the need for a longer shelf-life and increased empha¬ sis on nutritional value all of which make additives necessary. Therefore, use of additives will continue to in¬ .
crease.
In infant foods most of the additives nutritive. The types and amounts of additives and the foods to which are
Precautions: SLOW-FE like all oral iron prepara¬
tions, may aggravate existing peptic ulcer, regional
enteritis and ulcerative colitis. in Supplied: SLOW-FE tablets are30packaged push-through packs containing tablets per sheet and are available in units of 30,120 and 4,800 tablets. Reference: 1. Nutrition Canada National Survey. A report by Nutrition Canada to The Department of National Health and Welfare, Ottawa, Information Canada, 1973.
CIBA
DORVAL, QUEBEC
H9S1B1
C-5024
CMA JOURNAL/JULY 26, 1975/VOL. 113 139
