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Neonatal Nutrition and Metabolism

Neonatal nutrition has a pivotal role in normal child devel-opment and is of even greater importance in the sick orpremature neonate. This substantially revised and updatednew edition includes a comprehensive account of the basicscience, metabolism, and nutritional requirements of theneonate, and a greatly expanded number of chapters deal-ing in depth with clinical issues ranging from intrauterinegrowth restriction, intravenous feeding, nutritional thera-pies for inborn errors of metabolism, and care of the neo-natal surgical patient. Evolving from these scientific andclinical aspects, the volume highlights the important long-term effects of fetal and neonatal growth on health in laterlife. In addition, there are very practical chapters on meth-ods and techniques for assessing nutritional status, bodycomposition, and evaluating metabolic function. Writtenby an authoritative, international team of contributors,this will be an essential source of scientific knowledge andclinical reference.

Dr. Patti J. Thureen and Dr. William W. Hay Jr. are at theDepartment of Pediatrics, University of Colorado HealthSciences Center, Denver, Colorado.

© Cambridge University Press www.cambridge.org

Cambridge University Press0521824559 - Neonatal Nutrition and Metabolism, Second EditionEdited by Patti J. Thureen and William W. HayFrontmatterMore information

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Neonatal Nutrition and Metabolism

Second Edition

Edited by

Patti J. Thureen

William W. Hay Jr.






c a m b r i d g e u n i v e r s i t y p r e s sCambridge, New York, Melbourne, Madrid, Cape Town, Singapore, Sao Paulo

Cambridge University PressThe Edinburgh Building, Cambridge CB2 2RU, UK

Published in the United States of America by Cambridge University Press, New York

www.cambridge.orgInformation on this title: www.cambridge.org/9780521824559

First edition C© Mosby Year Book 1999Second edition C© Cambridge University Press 2006This publication is in copyright. Subject to statutory exceptionand to the provision of relevant collective licensing agreements,no reproduction of any part may take place withoutthe written permission from Cambridge University Press.First published 1999 by Mosby Year BookSecond edition published 2006 by Cambridge University PressPrinted in the United Kingdom at the University Press, CambridgeA catalog record for this publication is available from the British Library

ISBN-13 978-0-521-82455-2 hardbackISBN-10 0-521-82455-9 hardback

Every effort has been made in preparing this publication to provide accurate andup-to-date information which is in accord with accepted standards and practice atthe time of publication. Although case histories are drawn from actual cases, everyeffort has been made to disguise the identities of the individuals involved.Nevertheless, the authors, editors and publishers can make no warranties that theinformation contained herein is totally free from error, not least because clinicalstandards are constantly changing through research and regulation. The authors,editors and publisher therefore disclaim all liability for direct or consequentialdamages resulting from the use of material contained in this book. Readers arestrongly advised to pay careful attention to information provided by themanufacturer of any drugs or equipment that they plan to use.

Cambridge University Press has no responsibility for the persistence or accuracy ofURLs for external or third-party Internet websites referred to in this publication,and does not guarantee that any content on such websites is, or will remain,accurate or approriate.






Patti Thureen: To my very caring and

supportive family – Ken, Alex and Christina.

Bill Hay: To Judy, Emily and Bill, and Andy,

who make everything I do worthwhile.






Contents

List of contributors page xiPreface xviiAcknowledgments xixList of abbreviations xx

1 Fetal nutrition 1F. H. Bloomfield and J. E. Harding

2 Determinants of intrauterine growth 23J. W. Sparks and I. Cetin

3 Aspects of fetoplacental nutrition inintrauterine growth restriction andmacrosomia 32T. R. H. Regnault, S. W. Limesand, and W. W. Hay

4 Postnatal growth in preterm infants 47R. J. Cooke

5 Thermal regulation and effects on nutrientsubstrate metabolism 58J. M. Hawdon

6 Development and physiology of thegastrointestinal tract 67C. L. Berseth

7 Metabolic programming as a consequence ofthe nutritional environment during fetal andthe immediate postnatal periods 76M. S. Patel and M. Srinivasan

8 Nutrient regulation in brain development:glucose and alternate fuels 91C. Fung and S. U. Devaskar

9 Water and electrolyte balance in newborninfants 104S. Sridhar and S. Baumgart

vii






viii Contents

10 Amino acid metabolism and protein accretion 115J. B. van Goudoever

11 Carbohydrate metabolism and glycogenaccretion 122R. A. Simmons

12 Energy requirements and protein-energymetabolism and balance in preterm and terminfants 134S. Kashyap and K. F. Schulze

13 The role of essential fatty acids indevelopment 147W. C. Heird

14 Vitamins 161F. R. Greer

15 Normal bone and mineral physiology andmetabolism 185O. Itani and R. Tsang

16 Disorders of mineral, vitamin D and bonehomeostasis 229O. Itani and R. Tsang

17 Trace minerals 273K. M. Hambidge

18 Iron 291M. K. Georgieff

19 Conditionally essential nutrients: choline,inositol, taurine, arginine, glutamine andnucleotides 299J. Carver

20 Intravenous feeding 312W. C. Heird

21 Enteral amino acid and protein digestion,absorption, and metabolism 332D. K. Rassin and K. E. Shattuck

22 Enteral carbohydrate assimilation 340C. L. Kien

23 Enteral lipid digestion and absorption 350M. Hamosh

24 Minimal enteral nutrition 369J. Neu

25 Milk secretion and composition 377M. C. Neville and J. L. McManaman

26 Rationale for breastfeeding 390R. J. Schanler

27 Fortified human milk for premature infants 401R. J. Schanler

28 Formulas for preterm and term infants 409D. L. O’Connor and J. Brennan

29 Differences between metabolism and feedingof preterm and term infants 437S. C. Denne

30 Gastrointestinal reflux 445S. R. Jadcherla

31 Hypo- and hyperglycemia and othercarbohydrate metabolism disorders 454J. E. McGowan

32 The infant of the diabetic mother 466R. M. Cowett

33 Neonatal necrotizing enterocolitis: clinicalobservations and pathophysiology 482M. S. Caplan and T. Jilling

34 Neonatal short bowel syndrome 492J. Sondheimer

35 Acute respiratory failure 508J. E. E. van Aerde and M. Narvey

36 Nutrition for premature infants withbronchopulmonary dysplasia 522S. A. Atkinson

37 Nutrition in infants with congenital heartdisease 533J. S. Barry and P. J. Thureen

38 Nutrition therapies for inborn errors ofmetabolism 544J. Thomas, A. Tsai, and L. Bernstein

39 Nutrition in the neonatal surgical patient 569A. Pierro and S. Eaton

40 Nutritional assessment of the neonate 586R. E. Ridout and M. K. Georgieff

41 Methods of measuring body composition 602K. J. Ellis

42 Methods of measuring energy balance:calorimetry and doubly labelledwater 609P. J. J. Sauer

43 Methods of measuring nutrient substrateutilization using stable isotopes 617A. Sunehag and M. Haymond






Contents ix

44 Postnatal nutritional influences onsubsequent health 631J. Neu, A. Mackey, and Y. Huang

45 Growth outcomes of preterm and very lowbirth weight infants 640M. Hack

46 Post-hospital nutrition of the preterm infant 654D. M. Anderson and R. J. Schanler

Index 663






Contributors

John E. E. van AerdeStollery Children’s Hospital8440-114 StreetEdmontonAlbertaCanada, T6G 2B7

Diane M. AndersonSection of NeonatologyDepartment of PediatricsBaylor College of Medicine6621 Fannin StreetMC WT 6–104Houston, TX 77030, USA

Stephanie A. AtkinsonDepartment of PediatricsHSC 3V42McMaster University1200 Main St. WestHamilton, ONCanada L8N 3Z5

James S. BarryUniversity of Colorado Health Sciences CenterThe Children’s Hospital1056 East 9th AveBox B070Denver, CO 80218, USA

Stephen BaumgartDivision of NeonatologyDepartment of PediatricsState University of New York at Stony BrookHealth Sciences Center T11–060Stony BrookNY 1794-8111, USA

xi






xii List of contributors

Hilton BernsteinDepartment of PediatricsUniversity of Florida1600 SW Archer RoadRoom HD-513PO Box 100296Gainesville, FL 32610, USA

Laurie BernsteinDepartment of PediatricsThe Children’s Hospital1056 East 9th AveB300Denver, CO 80218, USA

Carol Lynn BersethMead Johnson Nutritionals2400 Lloyd ExpresswayEvansvilleIN 47721, USA

Frank H. BloomfieldLiggins InstituteUniversity of AucklandPrivate Bag 92019AucklandNew Zealand

J. BrennanThe Hospital for Sick Children555 University AvenueTorontoOntarioCanada

Michael S. CaplanDepartment of Pediatrics2650 Ridge AveEvanstonIL 60201, USA

Jane CarverDepartment of PediatricsUniversity of South Florida College of Medicine17 Davis Blvd.Suite 200TampaFL 33606, USA

Irene CetinDepartment of Obstetrics and GynaecologyUniversity of MilanMilan, Italy

Richard J. CookeDepartment of PediatricsUniversity of Tennessee Newborn Center853 Jefferson AvenueRoom 201MemphisTennessee 38163, USA

Richard M. CowettCIGNA InsurancePittsburgh, USA

Scott C. DenneDepartment of PediatricsRR208Indiana School of Medicine702 Barnhill Dr.Indianapolis IN 46202-5210, USA

Sherin U. DevaskarDivision of Neonatology and Developmental BiologyDepartment of PediatricsDavid Geffen School of Medicine at UCLA10833 Le Conte AvenueRoom B-2-377Los AngelesCA 90095-1752, USA

Simon EatonSenior Lecturer in Biochemistry

Kenneth J. EllisUSDA/ARS Children’s Nutrition Research Center1100 Bates St.HoustonTX 77030, USA

Camille FungDivision of Neonatology and Developmental BiologyDepartment of PediatricsDavid Geffen School of Medicine at UCLA10833 Le Conte AvenueRoom B-2-377Los AngelesCA 90095-1752, USA






List of contributors xiii

Michael K. GeorgieffDepartment of PediatricsUniversity of Minnesota School of MedicineBox 39 UMHC420 Delaware Street SEMinneapolisMN 55455, USA

Johannes B. van GoudoeverErasmus MC/Sophia Children’s HospitalDivision of NeonatologyDepartment of PediatricsDr. Molewaterplein 603015 GJ RotterdamThe Netherlands

Frank R. GreerDepartment of Pediatrics and Nutritional SciencesUniversity of WisconsinMadisonand Perinatal CenterMeriter Hospital202 S. Park St.MadisonWI 53715, USA

Maureen HackRainbow Babies and Children’s HospitalUniversity Hospitals of Cleveland11,100 Euclid AveClevelandOH 44106, USA

K. Michael HambidgeUniversity of Colorado Health Sciences CenterC225, 4200 East 9th AveDenver, CO 80262, USA

Margit Hamosh9410 Balfour CourtBethesdaMD 20814, USA

Jane E. HardingLiggins InstituteUniversity of AucklandPrivate Bag 92019AucklandNew Zealand

Jane M. HawdonNeonatal UnitUniversity College London HospitalsHuntley StreetLondon WC1E 6AU, UK

William W. Hay Jr.University of Colorado Health Sciences CenterDepartment of PediatricsDivision of Perinatal MedicinePerinatal Research CenterPO Box 6508F441, AuroraColorado 80045, USA

Morey Haymond5-1000 CNRC 7072Children’s Nutrition Research CenterBaylor School of Medicine

William C. HeirdDepartment of PediatricsChildren’s Nutrition Research CenterRoom 8066Baylor College of Medicine1100 Bates St.HoustonTX 77030-2600, USA

Ying HuangUniversity of FloridaDepartment of PediatricsDivision of NeonatologyChildren’s Hospital of Fudan UniversityShanghaiChina

Oussama ItaniMichigan State University and Kalamazoo Center ofMedical Studiesand Borgess Medical Center1521 Gull RoadKalamazooMI 49048, USA

Sudarshan Rao JadcherlaColumbus Children’s Hospital700 Children’s DriveColumbusOH 43205, USA






xiv List of contributors

Tamas JillingDepartment of Pediatrics2650 Ridge AveEvanstonIL 60201, USA

Sudha KashyapDepartment of PediatricsCollege of Physicians and SurgeonsColumbia University630 West 168th St.New YorkNY 10032, USA

C. Lawrence KienGastroenterology and Nutrition DivisionDepartment of PediatricsChildren’s HospitalRoom 3.240301 University Blvd.GalvestonTX 77555-0352, USA

Sean W. LimesandUniversity of Colorado Health Sciences CenterDepartment of PediatricsDivision of Perinatal MedicinePerinatal Research CenterPO Box 6508F441, AuroraColorado 80045, USA

Amy MackeyDepartment of PediatricsUniversity of Florida1600 SW Archer RoadRoom HD-513PO Box 100296GainesvilleFL 32610, USA

Jane E. McGowanDivision of NeonatologyThe Johns Hopkins Hospital600 N Wolfe St.CMSC 210BaltimoreMD 21287, USA

James L. McManamanDepartment of Obstetrics and GynecologyUniversity of Colorado School of MedicineUniversity of Colorado Health Sciences CenterBox C240Room 38024200 E. Ninth AvenueDenverCO 80262, USA

Michael NarveyStollery Children’s Hospital8440-114 StreetEdmontonAlbertaCanada, T6G 2B7

Josef NeuDepartment of PediatricsUniversity of Florida1600 SW Archer RoadRoom HD-513PO Box 100296GainesvilleFL 32610, USA

Margaret C. NevilleDepartments of Physiology and Biophysicsand Department of Obstetrics and GynecologyUniversity of Colorado School of MedicineUniversity of Colorado Health Sciences CenterBox C240Room 38024200 E. Ninth AvenueDenver, CO 80262, USA

Deborah L. O’ConnorThe Hospital for Sick Children555 University AvenueTorontoOntarioCanada

Mulchand S. PatelDepartment of BiochemistrySchool of MedicineState University of New York at BuffaloBuffaloNY 14214, USA






List of contributors xv

Agostino PierroGreat Ormond Street Hospital for Children NHS Trust30 Guilford StreetLondon WC1N 1EH, UK

Brenda B. PoindexterDepartment of PediatricsRR208Indiana School of Medicine702 Barnhill Dr.Indianapolis IN 46202-5210, USA

David K. RassinDepartment of Pediatrics301 University BoulevardThe University of Texas Medical BranchGalvestonTX 77555-0344, USA

Timothy R. H. RegnaultUniversity of Colorado Health Sciences CenterDepartment of PediatricsDivision of Perinatal MedicinePerinatal Research CenterPO Box 6508F441, AuroraColorado 80045, USA

Robert Erick RidoutUniversity of Colorado Health Sciences CenterThe Children’s Hospital1056 East 9th AveBox B070DenverCO 80218, USA

Pieter J.J. SauerDepartment of PediatricsUniversity Hospital GroningenPO Box 30.0019700 RB Groningenthe Netherlands

Richard J. SchanlerNeonatal-Perinatal MedicineSchneider Children’s Hospital at North ShoreNorth Shore University Hospital300 Community DriveManhassetNew York 11030, USA

Karl F. SchulzeDepartment of PediatricsCollege of Physicians and SurgeonsColumbia University630 West 168th St.New YorkNY10032, USA

Karen E. ShattuckDepartment of Pediatrics301 University BoulevardThe University of Texas Medical BranchGalvestonTX 77555-0344, USA

Rebecca A. SimmonsDepartment of PediatricsUniversity of PennsylvaniaBRB II/IIICRRWH#6142421 Curie BlvdPhiladelphia PA 19104, USA

Judith SondheimerDivision of GastroenterologyThe Children’s Hospital1056 East 19th AveB290, DenverCO 80218, USA

John W. SparksDepartment of PediatricsSection on Perinatal PediatricsUniversity of Texas Medical School6431 Fannin St.Room 3242Houston TX 77030, USA

Shanthy SridharDivision of NeonatologyDepartment of PediatricsState University of New York at Stony BrookHealth Sciences Center T11-060Stony BrookNY 1794-8111, USA

Malathi SrinivasanDepartment of BiochemistrySchool of MedicineState University of New York at BuffaloBuffalo, NY 14214, USA






xvi List of contributors

Agneta Sunehag5-1000 CNRC 7072Children’s Nutrition Research CenterBaylor College of Medicine6621 Fannin StreetMC WT 6-104Houston, TX 77030, USA

Janet A. ThomasDepartment of PediatricsThe Children’s Hospital1056 East 9th AveB300, DenverCO 80218, USA

Patti J. ThureenUniversity of Colorado Health Sciences Center4200 E. 9th AveBox B195Denver, CO 80262

Anne TsaiDepartment of PediatricsThe Children’s Hospital1056 East 9th AveB300, DenverCO 80218, USA

Reginald C. TsangDepartment of PediatricsChildren’s Hospital Medical CenterUniversity of Cincinnati Medical CenterPO Box 670541CincinnatiOH 45267-0541, USA






Preface to the second edition

Preterm infants between 500 and 1000 g birth weight aresurviving at increased rates. Most of their body growth andthe associated development of functional capacity, there-fore, take place outside of the uterus. Nutrition to supportthis growth and development must be provided by intra-venous and enteral routes rather than by the placenta.

Many advances in intravenous and enteral nutrition ofpreterm infants have been developed over the past sev-eral years since the first edition of Neonatal Nutritionand Metabolism, but the increased survival at lower birthweights, advanced degree of immaturity, and increaseddependence on extrauterine nutrition of these uniqueinfants are providing renewed interest in the absoluteimportance of postnatal nutrition. Furthermore, the dimin-ishing frequency and severity of other disorders in theseinfants means that their many adverse long-term outcomescannot be blamed solely, or even primarily, on the conse-quences of other morbidities. Growth and development ofsensitive organs, particularly the brain, clearly are depen-dent on unique, though variable, mixes of specific nutri-ents, provided at optimal rates and by safe and effica-cious routes. There also is abundant evidence from ani-mal experiments and human observational studies thatprolonged undernutrition during critical periods of devel-opment (between 22–40 weeks postconceptional age forhumans) adversely affects long-term growth and neuro-developmental and neurocognitive outcomes. Despite theadvances in nutrition of these infants, therefore, we now areat a new threshold of determining which specific nutrientsshould be provided to these infants, at what rates, in whatmixtures, and by what means, to optimize their growth anddevelopment.

This Second Edition is expanded to include the manyrecent advances in fetal and neonatal nutrition andmetabolism. There also is increased focus on selected fun-damental aspects of nutrition of very preterm infants.

xvii






xviii Preface to the second edition

A second purpose is to recognize that much still is notknown about optimal nutrition of the very preterm infantand that many controversies exist in this field. Newresearch, therefore, must be developed to further optimizenutrition, growth, and developmental outcomes of this vul-nerable population of newborn infants. We hope this bookwill provide, therefore, both up to date information for theclinicians and scientists in this field and the stimulation topursue new research to resolve the problems that still exist.

New Co-Editor: Lastly, but far from least, the field ofNeonatal Nutrition and Metabolism has grown larger and

more complicated and rightfully, therefore, a book of thismagnitude has needed considerably more help. To meetthis need, Dr. Patti Thureen has joined as Co-Editor. Dr.Thureen is an established and well-recognized expert inneonatal nutrition and metabolism. She has brought to thebook a large fund of knowledge, unique insights into designand content of individual chapters and topics, and a per-sonal commitment that involved long hours of hard work.Her commitment and efforts have made this Second Edi-tion possible.






Acknowledgments

A lot of people helped produce this book, but we shouldlike to specifically thank Alison Gilman and Tiffany Brownwho provided secretarial and editorial assistance.

Our mentors, Frederick C. Battaglia and Giacomo Meschia,are retired but still at work as Professors Emeritus, con-tinuing to provide advice, insight, guidance, and above all,inspiration.

Peter Silver’s encouragement, support, and patience keptus going – he and all the leadership and staff at CambridgeUniversity Press are really what made this book possible.

Beyond that, our authors deserve all the credit.

Dr. Hay is supported by NIH Grant MO1 RR00069, GeneralClinical Research Centers Program, National Centers forResearch Resources.

Dr. Thureen is supported by NIH grant K24 RR018358 andNIH Grant MO1 RR00069, General Clinical Research Cen-ters Program, National Centers for Research Resources.

xix






Abbreviations

1,25(OH)2D 1,25 dihydroxyvitamin D25-OHD 25-hydroxyvitamin D3-MH 3-methylhistidineAEDF absent end-diastolic flowATP adenosine triphosphateADP adenosine-5-diphosphateAAPCON American Academy of Pediatric

Committee on NutritionACE angiotensin converting enzymeAEC apical endocytic complexAGA appropriate-for-gestational-ageAA arachidonic acidARC arcuateAVP arginine vasopressinANP atrial natriuretic peptideADHD attention deficit-hyperactivity disorderBM basal membraneb-FGF basic-fibroblast growth factorBSDL bile salt dependent lipaseBIA bioelectrical impedance analysisBIS bioelectrical impedance spectroscopyBUN blood urea nitrogenBMC bone mineral massBSAP bone-specific alkaline phosphataseBAER brainstem auditory evoked responseBCAA branched-chain amino acidsBMUS British Medical Ultrasound SocietyBPD broncho-pulmonary dysplasiaBBM brush border membraneCT calcitoninVCO2 carbon dioxide productionCEL carboxyl ester lipaseCBF cerebral blood flowCV coefficients of variationCDL colipase-dependent lipase

xx






List of abbreviations xxi

CF complementary foodsCHD congenital heart diseaseCNMD congenital neuromuscular diseasesCPAP continuous positive airway pressureCbfaI core binding factor alpha-IICTP C-propeptide of type I collagenCHL crown-heel lengthPICP C-terminal propeptide type ICREB cyclic AMP binding proteincytC cytochrome CCLD cytoplasmic lipid dropletsDSPC desaturated phosphatidylcholineDIT diet-induced thermogenesis

docosahexaenoic acidDLW doubly labeled

down-regulatesDEXA dual-energy x-ray absorptiometryDGR duodeno-gastric refluxDGER duodeno-gastroesophageal refluxEDF end-diastolic flowEI energy intakeEGF epidermal growth factorEFSUMB European Federation of Societies for

Ultrasound in Medicine and BiologyECW extracellular waterFHH familial hypocalciuric hypercalcemiaFIHP familial isolated hyperparathyroidismFM fat massFABP fatty-acid binding proteinFFA free fatty acidsGIP gastric inhibitor peptideGER gastroesophageal refluxGIR gastrointestinal refluxGDM gestational diabetes mellitusGFR glomerular filtration rateGNG gluconeogenesisGLUT glucose transportersG6P glucose-6-phosphataseGSHPx glutathione peroxidaseGP glycogen phosphorylaseGS glycogen synthaseGH growth hormoneGALT gut-associated lymphoid tissueHPT-JT hyperparathyroidism-jaw tumor

syndromeHPS hyperprostaglandin E syndromeIIβ-HSD2 IIβ-hydroxysteroid dehydrogenase 2

in uteroIDM infants of diabetic mothersIGFBP insulin-like growth factor binding

protein

IGF-I, II insulin-like growth factorsICAM-I intracellular adhesion molecule-IICW intracellular waterIUGR intrauterine growth restrictionIVN intravenous nutritionIVA isovaleric acidKHL knee-heel lengthLDH lactate dehydrogenaseLGG lactobacillus GGLMP last monthly periodLM lean massLA linoleic acidLES lower esophageal sphincterMSUD maple syrup urine diseaseMVM maternal microvillous membraneMCFA medium-chain fatty acidsMBDP metabolic bone disease in premature

infantsMeAIB methylaminoisobutyric acidMFG milk fat globulesmOsm milliosmolesMCTs monocarboxylase transportersMSY-I mouse Y box protein IMAdCAM-1 mucosal addressin adhesion

molecule-1MEN1 multiple endocrine neoplasia type 1NAC N-acetylcysteineNEC necrotizing enterocolitisNBS neonatal Bartter syndromeNGF nerve growth factorNPY neuropeptide YNEFA nonesterified fatty acidsVO2 oxygen consumptionPO2 oxygen partial pressurePP pancreatic polypeptidePTH parathyroid hormonePTHrP parathyroid hormone related peptidePDA patent ductus arteriosusPVL periventricular leukomalaciaPIVH periventricular-intraventricular

hemorrhagePNDM permanent neonatal diabetesPPHN persistent pulmonary hypertensionPP Peyer’s patchesPC phosphatidylcholinePG phosphatidylglycerolPEPCK phosphoenolpyruvate carboxykinaseCaBP placental calcium binding proteinPLGF placental growth factorPAF platelet-activating factorPARP poly (ADP)-ribosylating protein






xxii List of abbreviations

PMN polymorphonuclear neutrophilsPUFA polyunsaturated fatty acidsPS population spikePMA postmenstrual agePGR postnatal growth retardationPOMC pro-opiomelanocortinPGE2 prostaglandin E2PDHC pyruvate dehydrogenase complexQUS quantitative ultrasoundRANK receptor to activated NFKappaBRANKL receptor to activated NFKappaB ligandRDI recommended dietary intakesrCGU regional cerebral glucose utilizationRDR relative dose responseRQ respiratory quotientRBP retinol binding proteinslgA secretory immunoglobulin ASBS short bowel syndromeSCFA short chain fatty acidsSGA small-for-gestational-ageSER smooth endoplasmic reticulumEDTA sodium ethylene diamine tetra acetic

acidSDA specific dynamic actionSOD superoxide dismutase

TCIRG1 T cell immune regulator gene 1TOBEC total body electric conductivityTBW total body weightTEE total energy expenditureTIBC total iron-binding capacity (plasma)TPN total parental nutritionTGF-beta transforming growth factor-betaTLESR transient lower esophageal sphincter

relaxationTCA tricarboxylic acidTGs triglyceridesTNF tumor necrosis factorIDDM Type I insulin dependent diabetes

mellitusUPD uniparental disomiesUES upper esophageal sphincterLL/M urinary lactulose:mannitolVEGF vascular endothelial growth factorVIP vasoactive intestinal peptideVLDL very low-density lipoproteinsVLBWI very-low birth weight infantWFUMB World Federation of Ultrasound in

Medicine and BiologyALA α-linolenic acidOHB β-hydroxybutyrate






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