Efficacy of tolvaptan in an infant with syndrome of inappropriate antidiuretic hormone secretion associated with holoprosencephaly:A case report

BACKGROUND Holoprosencephaly(HPE)is a congenital malformation with various degrees of incomplete separation of the cerebral hemispheres due to differentiation disorders of the forebrain.Although HPE with diabetes insipidus due to associated pituitary dysfunction has been reported,HPE with the syndrome of inappropriate antidiuretic hormone secretion(SIADH)is very rare.Tolvaptan,a vasopressin V2 receptor antagonist,is effective in adults with SIADH.However,there is no report of its efficacy in infants with SIADH.The purpose of this report is to demonstrate that tolvaptan is effective for SIADH in infants and that administration of tolvaptan eliminates the need for restriction of water intake and sodium administration.CASE SUMMARY A 2414-g female infant was born at 38 wk by normal vaginal delivery.Facial anomalies and head magnetic resonance imaging indicated semilobar HPE.After birth,she had hyponatremia due to SIADH and was treated using water and sodium restriction.However,she developed an exaggerated response to the fluid restrictions,resulting in large fluctuations in serum sodium levels.Subsequent administration of tolvaptan improved the fluctuations in serum sodium levels without the need for adjustment of water or sodium administration.Serum sodium was maintained within the normal range after discontinuation of tolvaptan at 80 d of life.There were no side effects,such as hypernatremia or liver dysfunction,during the administration of tolvaptan.CONCLUSION This is the first report on the safety and efficacy of tolvaptan in an infant with SIADH associated with HPE.

Daily Intake of a Commercially Available Vegetable Juice Has Beneficial Effects on Metabolic Syndrome-Related Biomarkers in Young, Healthy Japanese Adults

Adequate vegetable intake is important in reducing the risk of lifestyle-related diseases;however, intake amongst young Japanese adults is poor. This study aimed to assess the effect of daily intake of a commercially available vegetable juice on nutritional status and metabolic syndrome-related markers in healthy young adults. Fifty-one healthy adults (14 men, 37 women), age 20 - 22 years were recruited, and their food and nutritional intake was surveyed using an FFQ based on Food Groups. Subjects were divided into either a control group, who were not administered vegetable juice, or an intervention group, who consumed 200 mL vegetable juice daily for 2 months. Anthropometric data, serum carotenoid concentrations, blood and urinary parameters were measured at baseline and at 2 months. The average intake of vegetables in all subjects at baseline was approximately 140 g/day, less than half the dose recommended by the Japanese government. Total serum carotenoid concentration in the intervention group doubled from baseline after 2 months. In particular, serum concentrations of α-carotene, β-carotene, and lycopene were increased. In the intervention group, 24-hour urinary potassium excretion increased significantly, and 24-hour urinary sodium to potassium ratio decreased significantly. Waist circumference and systolic blood pressure also decreased significantly. Daily intake of a commercial vegetable juice for 2 months improved nutritional status in young adults with inadequate vegetable intake, shown by improved serum carotenoid and urine potassium levels. In addition, intake of vegetable juice may be beneficial in reducing the risk of metabolic syndrome.

Nutritional Biomarker Analyses for Hypertension-Related Risk Assessment and Control

A simple method to collect 24-hour urine (24U) by sampling 2.5% of the voided urine each time was developed for analyzing the biomarkers of the intakes of salt (NaCl), vegetables and grains (K, Mg), soys (isoflavones), sea-foods (taurine), protein (urea nitrogen) etc. This method was applied to WHO-coordinated CARDIAC (Cardiovascular Diseases and Alimentary Comparison) study covering 61 populations in 25 countries, and revealed significant positive associations of Na or Na/K with blood pressure (BP) and stroke mortality and significant inverse associations of isoflavones or taurine with coronary heart disease (CHD) mortality, indicating the adverse effect of salt intake on BP and stroke and beneficial effect of soy or sea food intakes on CHD. Furthermore, higher urinary taurine and/or Mg excretions were associated with significantly lower risks of metabolic syndromes such as obesity, hypertension and hypercholestelomia. 24U collections were useful to prove nutritional improvement by intervention studies for observing soy intake effect on BP and atherogenic index in Japanese immigrants living in Brazil, and in Australian Aboriginals, for observing taurine effect on BP in Tibetans and for confirming soy and fish effects on the risks of metabolic syndromes in Japanese businessmen. 24U collection was utilized for population strategy to reduce salt and to increase soy intake in 5.6 million people of Hyogo Prefecture. A simple method for 24U collection has enabled us to utilize nutritional biomarkers for hypertension-related disease risk analyses, and to apply objective nutritional intake estimation to intervention studies as well as to population strategy for nutritional improvement, and therefore, the methodology will contribute to hypertension-related disease prevention and global health promotion.