Differences of plasma osmolarity

1
DIFFERENCES OF PLASMA OSMOLARITY
IN HEALTHY BREASTFED AND NON BREASTFED
INFANTS
DR. MUHAMMAD MUSTANSAR
M.B.B.S (Pb), M. Sc (Nutrition)

2
SUPERVISOR
M.B.B.S, M.PHIL, PhD
M.B.B.S (Pb),
M . S c ( N u t r )
POSTGRADUATE MEDICAL INSTITUTE LAHROE

3
CONTENTS
DESCRIPTION PAGE
List of Tables 4
List of Figures 5
List of Abbreviations 6
1. INTRODUCTION 8
Importance of Study 14
Aims and Objective 15
2. REVIEW OF LITERATURE 16
2.1 Historical Background 16
2.2 Chemical Composition of Milks 19
2.3 Solute Load 25
2.4 Consequences of Bottle Feeding 28
2.5 Basic Concept 31
3. MATERIALS AND METHODS 33
3.1 Estimation of Serum Na+
& K+
37
3.2 Estimation of BUN & Urea Level 39
3.3 Estimation of Glucose Level 42
3.4 Estimation of Serum Total Protein 44
3.5 Estimation of Serum Albumin Level 47
3.6 Estimation of Plasma Osmolarity 50
3.7 Statistical Methods 53
4. RESULTS AND OBSERVATIONS 61
5. DISCUSSION 91
5.1 Conclusions 95
5.2 Limitations of Study 96
6. SUMMARY 97
7. Bibliography 101
8. Appendix 106

4
List of Tables
TABLE NO. DESCRIPTION PAGE
Table 1.1 Composition of Human, Cow and Buffalo Milk 13
Table 2.1 Bio-Chemical Values of Breastfed Infants 23
Table 4.1
Age Distribution of Breastfed and Non
Breastfed Infants
62
Table 4.2
Weight Distribution of Breastfed and Non
Breastfed Infants
64
Table 4.3
Blood Glucose Level in Breastfed and Non
Breastfed Infants
66
Table 4.4
BUN and Blood Urea Level in Breastfed and
Non Breastfed Infants
68
Table 4.5
Serum Proteins in Breastfed and Non Breastfed
Infants
70
Table 4.6
Serum Sodium and Potassium in Breastfed and
71
Table 4.7 (a)
Calculated and estimated plasma osmolarity in
Breastfed and Non Breastfed Infants
73
Table 4.7 (b)
Comparison of calculated and estimated
plasma osmolarity in Breastfed and Non
Breastfed Infants
73
Table 4.8
Comparison of Weight in Breastfed and Non
Breastfed Infants
75
Table 4.9
Comparison of Blood Glucose Level in
77
Table 4.10
Comparison of BUN and Urea Level in
80
Table 4.11
Comparison of Serum Proteins in Breastfed
and Non Breastfed Infants
83
Table 4.12
Comparison of Serum Sodium and Potassium
Level in Breastfed and Non Breastfed Infants
84
Table 4.13
Comparison of Calculated and estimated
plasma osmolarity Breastfed and Non
Breastfed Infants
89

5
List of Figures
DESCRIPTION PAGE
Comparison of the Mean Urea Level in Breastfed and Non
Breastfed Infants
80
Comparison of Mean BUN in Breastfed and Non Breastfed
Infants
81
Comparison of the Mean Serum Sodium in Breastfed and Non
Breastfed Infants
83
Comparison of the Mean Serum Potassium Level in Breastfed
and Non Breastfed Infants
84
Comparison of the Mean Calculated Plasma Osmolarity in
86
Comparison of Estimated Plasma Osmolarity in Breastfed and
87

6
List of Abbreviations
Percent Insulin Growth Factor
Less than Potassium
More than Kilo calories
Approximately Kilo gram
Micro Kings unit
Absorbance Liter
Albumin Globulin ratio Milli mole per liter
Analysis of variance Milli osm per liter
Bromocresol green Milli equalent per liter
Blood urea nitrogen Milli gram per deci liter
Centigrade Milli meter of mercury
Confidence interval Number
Centimeter Sodium
Degree of freedom Nano gram
Deoxyribonucleic acid Out patient department
Ethylene diamine tetra acetic acid Probability
Variance ratio Post graduate medical institute
Flame Photo meter Standard deviation
Gram Statistical program for scientific studies

7
Gram per deci liter Total sum of squares
Gastro intestinal tract With in group sum of square

8
1
DIFFERENCES OFPLASMAOSMOLARITY
IN HEALTHY BREASTFED AND NON BREASTFED INFANTS
INTRODUCTION

13
Table: 1.1
Composition of Human, Cow and Buffalo milk (100ml)
NUTRIENT HUMAN COW BUFFALO

16
2
REVIEW OF LITERATURE
2.1: Historical Background

19
2.2: Chemical Composition of Milks

23
Table: 2.1
BIOCHEMICAL VALUESOFBREASRFEDINFANTS
Concentration / 100 ml of Serum Mean SD

28
2.4: Consequences of Bottle Feeding

33
3
MATERIALS & METHODS
STUDY DESIGN
SAMPLE SIZE

34
PLACEOFSTUDY
DURATION OF STUDY
SELECITON OF INFANTS
Researcher
SELECTION CRITERIA

35
EXCLUSION CRITERIA
SAMPLECHARACTERISTICS

36
COLLECITONOFBLOODSAMPLE
LABOARTORYANALYSIS
Calculation of Osmolarity

37
3.1: ESTIMATION OF SERUM Na+
& K+
(Users Manual Fp20 2005)
PRINCIPLE OF FLAMEPHOTOMETRY
BLANK SOLUTIONFORTHESERUM

38
STANDARDSOLUTION FOR SERUM
CALLIBRATION
“EXECUTED”

39
3.2: Estimation of BUN and Urea Level
(Berthelot M 1859, Fawcett 1960, Tobacco A 1979).
METHOD
Reagent 1
Reagent 2

40
Assay
Pipette Into Cuvettes Reagent Blank Sample on STD

41
Calculation of BUN and Urea Concentration

42
3.3: ESTIMATION OFGLUCOSE LEVEL(Trinder P 1969)
PRINCIPLE
REACTION PRINCIPLE
Contents Concentration of Solution
Peroxidase
Glucose Oxidase Gluconic Acid + H2 O2
Quinoneimine + 4H2 O

43
ASSAY
SEMI MICRO METHOD
Standard / Sample Reagent Blank
CALCULATION

44
3.4: ESTIMATION OF SERUMTOTALPROTEIN
(Biuret Method Reinhold J 1953)
PRINCIPLE
REAGENTS

45
ASSAY
PIPEETE INTO CUVETTE
Reagent Blank Standard Sample

47
3.5: ESTIMATION OF SERUM ALBUMIN LEVEL (Doumas B et al 1971)
PRINCIPLE
REAGENTS
BCG Concentrate
Standard

48
ASSAY
PIPEETE INTO TEST TUBES
Reagent
Blank
Standard Sample

50
3.6: ESTIMATION OF PLASMAOSMOLARITY (Wescor 2004)
PROCEDURE
REQUIREMENTS

51
Osmolarity Standard Bovine Serum
INSTRUMENT SPECIFICAITON
PRINCIPLE

53
3.7: STATISTICAL METHODS (Danial WW 2005)
DESCREPTIVE STATISTICS
ANALYTIC STATISTIC
POST HOC TEST (INFERENTIAL)

54
1. Number (n)
2. Arithmetic Mean (X)
3. Standard Deviation (SD)

57
Sum of Square df
Mean
Square
F Significance
Variance Ratio (VR) (F)

59
POSTHOCTESTS
STUDENT’S ‘t’ TEST

60
PROBABILITY VALUE (p value)

62
TABLE 4.1: AGE DISTRIBUTION OF BRESTFEDANDNON
BREASTFED INFANTS
Mode of
Feeding
No. of Cases (n)
Mean Age in
Months
Standard
Deviation
(SD)

64
TABLE 4.2: WEIGHT DISTRIBUTION OFBREASTFEDAND
NON BREAST FED INFANTS
Mode of
Feeding
No. of Cases
(n)
Mean Weight
in Kg
Standard
Deviation
(SD)

66
TABLE 4.3: BLOODGLUCOSELEVEL IN BREASTFED AND
NON-BREASTFED INFANTS
Mode of
Feeding
No. of Cases (n)
Mean Glucose
Level in
mg/dl
Standard
Deviation
(SD)

68
TABLE 4.4: BUN AND BLOOD UREA LEVEL IN BREASTFED AND
NONBREASTFED INFANTS
Mode
of
Feeding
No. of
Cases (n)
Urea mg/dl BUN mg/dl

70
TABLE 4.5: SERUMPROTEINS IN BREASTFED AND
NON-BREASTFED INFANTS
Mode
of
Feeding
No. of
Cases
(n)
Total
Proteins
gm/dl
Serum
Albumin
gm/dl
Serum
Globulin
gm/dl
A/G Ratio
Mean SD Mean SD Mean SD Mean SD

71
TABLE 4.6: SERUM SODIUM AND POTASIUM IN
BREASTFED AND NON-BREAST FED INFANTS
Mode of
Feeding
No. of
Cases (n)
Na+
m mol/L K+
m mol/L
Mean SD Mean SD

73
TABLE 4.7:-A CALCULATEDANDESTIMATED PLASMA
OSMOLARITY IN BREASTFEDANDNONBREASTFED INFANTS
Mode of
Feeding
No. of
Cases (n)
Calculated
Osmolarity m
osm/L
Estimated
Osmolarity m osm/L
Mean SD Mean SD
TABLE 4.7-B: COMPARISION OF CALCULATED AND
ESTIMATED PLASMA OSMOLARITY IN BREASTFED AND NON
BREAST FED INFANTS
T TEST DISTRIBUTION
Mode of
Feeding
T d.f
Sig
(2Tailed)
Mean
Difference
95 % CI of the
differences

74
TABLE 4.8: COMPARISION OF WEIGHT IN BREASTFED AND
NONBREASTFEDINFANTS
Variables Difference
Sum of
Squares
d.f
Mean
Squares
VR
P
Value

75
TABLE 4.8: COMPARISION OF WEIGHT IN BREASTFED AND
NONBREASTFEDINFANTS
POSTHOCTEST
Variable
Group
Code
Group
Code
*Mean
Difference
P
Value
95 %
Confidence
Interval
Lower
Bound
Upp
er
Bou
nd

77
TABLE 4.9: COMPARISION OF BLOOD GLUCOSE LEVEL IN
BREASTFEDANDNONBREASTFEDINFANTS
Variables Difference Sum of
Squares
d.f Mean
Squares
VR P
Val
ue

78
POSTHOCTEST
Variable
Group
Code
Group
Code
*Mean
Difference
P
Value
95 % Confidence
Interval
Lower
Bound
Upper
Bound
1
2 - 4.8333* 0.002 - 7.9385
-
1.7282
3 - 4.9667* 0.002 - 8.0718
-
1.8615
2
1 4.8333* 0.002 1.7282 7.9385
3 - 0.1333 0.933 - 3.2385 2.9718
3
1 4.9667* 0.002 1.8615 8.0718
2 0.1333 0.933 - 2.9718 3.2385

80
TABLE 10: COMPARISION OF BUN AND UREA LEVEL IN
Squares
d.f Mean
Squares
VR P
Value

81
TABLE 10: COMPARISION OF BUN AND UREA LEVEL IN
POSTHOCTEST
Variable
Group
Code
Group
Code
*Mean
Difference
P
Value
95 %
Confidence
Interval
Lower
Bound
Upper
Bound

83
TABLE 4.11: COMPARISION OF SERUM PROTEINS IN
Squares
d.f Mean
Squares
VR P
Value
TABLE 4.11: COMPARISION OF SERUM PROTEINS IN

84
POSTHOCTEST
Variable
Group
Code
Group
Code
*Mean
Difference
P
Value
95 %
Confidence
Interval
Lower
Bound
Upper
Bound

86
TABLE4.12: COMPARISION OF SERUM SODIUM AND
POTASIUM LEVEL IN BREASTFEDAND NON BREASTFED
INFANTS
Squares
d.f Mean
Squares
VR P
Value

87
TABLE4.12: COMPARISION OF SERUM SODIUM AND
POTASIUM LEVEL IN BREASTFEDAND NON BREASTFED
INFANTS
POSTHOCTEST
Variable
Group
Code
Group
Code
*Mean
Difference
P
Value
95 % Confidence
Interval
Lower
Bound
Upper
Bound

89
TABLE 13: COMPARISION OF CALCULATED AND ESTIMATED
PLASMAOSMOLARITY IN BREASTFED AND NON BREASTFED
INFANTS
Squares
d.f Mean
Squares
VR P
Value

90
TABLE 13: COMPARISION OF CALCULATED AND ESTIMATED
PLASMAOSMOLARITY IN BREASTFED AND NON BREASTFED
INFANTS
POSTHOCTEST
Variable
Group
Code
Group
Code
Mean
Difference*
P
Value
95 % Confidence
Interval
Lower
Bound
Upper
Bound

96
5.2
LIMITATIONS OF THE STUDY

97
6
SUMMARY
Objectives:
Design:
Place & Duration of Study:

101
7
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