[show abstract][hide abstract] ABSTRACT: Previous studies reported a wide range of estimated malnutrition prevalence (6-30%) in paediatric inpatients based on various anthropometric criteria. We performed anthropometry in hospitalised children and assessed the relationship between malnutrition and length of hospital stay (LOS) and complication rates.
In a prospective multi-centre European study, 2567 patients aged 1 month to 18 years were assessed in 14 centres in 12 countries by standardised anthropometry within the first 24 h after admission. Body mass index (BMI) and height/length <-2 standard deviation scores (SDS, WHO reference) were related to LOS (primary outcome), frequency of gastrointestinal (diarrhoea and vomiting) and infectious complications (antibiotic use), weight change during stay (secondary outcomes) and quality of life.
A BMI <-2 SDS was present in 7.0% of the patients at hospital admission (range 4.0-9.3% across countries) with a higher prevalence in infants (10.8%) and toddlers aged 1-2 years (8.3%). A BMI <-2 to ≥-3 SDS (moderate malnutrition) and a BMI <-3 SDS (severe malnutrition) was associated with a 1.3 (CI95: 1.01, 1.55) and 1.6 (CI95: 1.27, 2.10) days longer LOS, respectively (p = 0.04 and p < 0.001). Reduced BMI <-2 SDS was also associated to lower quality of life, and more frequent occurrence of diarrhoea (22% vs 12%, p < 0.001) and vomiting (26% vs 14%, p < 0.001).
Disease associated malnutrition in hospitalised children in Europe is common and is associated with significantly prolonged LOS and increased complications, with possible major cost implications, and reduced quality of life. This study was registered at clinicaltrials.gov as NCT01132742.
[show abstract][hide abstract] ABSTRACT: To describe the cardiovascular disease (CVD) risk factors in a population of children with celiac disease (CD) on a gluten-free diet (GFD).
This cross-sectional multicenter study was performed at Schneider Children's Medical Center of Israel (Petach Tiqva, Israel), and San Paolo Hospital (Milan, Italy). We enrolled 114 CD children in serologic remission, who were on a GFD for at least one year. At enrollment, anthropometric measurements, blood lipids and glucose were assessed, and compared to values at diagnosis. The homeostasis model assessment-estimated insulin resistance was calculated as a measure of insulin resistance.
Three or more concomitant CVD risk factors [body mass index, waist circumference, low density lipoprotein (LDL) cholesterol, triglycerides, blood pressure and insulin resistance] were identified in 14% of CD subjects on a GFD. The most common CVD risk factors were high fasting triglycerides (34.8%), elevated blood pressure (29.4%), and high concentrations of calculated LDL cholesterol (24.1%). On a GFD, four children (3.5%) had insulin resistance. Fasting insulin and HOMA-IR were significantly higher in the Italian cohort compared to the Israeli cohort (P < 0.001). Children on a GFD had an increased prevalence of borderline LDL cholesterol (24%) when compared to values (10%) at diagnosis (P = 0.090). Trends towards increases in overweight (from 8.8% to 11.5%) and obesity (from 5.3% to 8.8%) were seen on a GFD.
This report of insulin resistance and CVD risk factors in celiac children highlights the importance of CVD screening, and the need for dietary counseling targeting CVD prevention.
World Journal of Gastroenterology 09/2013; 19(34):5658-64. · 2.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: The majority of coeliac disease (CD) patients are not being properly diagnosed and therefore remain untreated, leading to a greater risk of developing CD-associated complications. The major genetic risk heterodimer, HLA-DQ2 and DQ8, is already used clinically to help exclude disease. However, approximately 40% of the population carry these alleles and the majority never develop CD. OBJECTIVE: We explored whether CD risk prediction can be improved by adding non-HLA-susceptible variants to common HLA testing. DESIGN: We developed an average weighted genetic risk score with 10, 26 and 57 single nucleotide polymorphisms (SNP) in 2675 cases and 2815 controls and assessed the improvement in risk prediction provided by the non-HLA SNP. Moreover, we assessed the transferability of the genetic risk model with 26 non-HLA variants to a nested case-control population (n=1709) and a prospective cohort (n=1245) and then tested how well this model predicted CD outcome for 985 independent individuals. RESULTS: Adding 57 non-HLA variants to HLA testing showed a statistically significant improvement compared to scores from models based on HLA only, HLA plus 10 SNP and HLA plus 26 SNP. With 57 non-HLA variants, the area under the receiver operator characteristic curve reached 0.854 compared to 0.823 for HLA only, and 11.1% of individuals were reclassified to a more accurate risk group. We show that the risk model with HLA plus 26 SNP is useful in independent populations. CONCLUSIONS: Predicting risk with 57 additional non-HLA variants improved the identification of potential CD patients. This demonstrates a possible role for combined HLA and non-HLA genetic testing in diagnostic work for CD.
[show abstract][hide abstract] ABSTRACT: PREVENTCD, Prevent Coeliac Disease, is an international project investigating the hypothesis of possible induction of tolerance to gluten in genetically predisposed children through introducing small quantities of gluten during the period of breastfeeding.
To summarise current knowledge on the possible relationship between early feeding practices and the risk of coeliac disease (CD).
The Cochrane Library, MEDLINE, and EMBASE databases were searched in May 2011, and the search was updated in January 2012, and again in July 2012.
Breastfeeding (BF) and CD: some studies show a protective effect of BF, while others show no effect. No studies have shown a long-term preventive effect. BF at the time of gluten introduction and CD: Results from a meta-analysis of five observational case-control studies suggest that BF at gluten introduction is associated with a lower risk of CD compared with formula feeding. It is unclear whether BF provides a permanent protection or only delays the onset of CD. Timing of gluten introduction: The data suggest that both early (≤4 months) and late (≥7 months) introduction of gluten may increase the risk of CD. Amount of gluten at weaning (and later) and CD: One incident case-referent study documented that the introduction of gluten in large amounts compared with small or medium amounts increased the risk of CD.
In the absence of clear evidence, in order to decrease the risk of later coeliac disease, it is reasonable to avoid both early (<4 months) and late (≥7 months) introduction of gluten, and to introduce gluten while the infant is still being breastfed. Future studies may clarify the remaining uncertainties.
[show abstract][hide abstract] ABSTRACT: Malnutrition is highly prevalent in hospitalized children and has been associated with relevant clinical outcomes. The scope of this review is to describe the five screening tools and the recent European Society for Parenteral and Enteral Nutrition (ESPEN) research project aimed at establishing agreed, evidence-based criteria for malnutrition and screening tools for its diagnosis in hospitalized children.
Five nutrition screening tools have recently been developed to identify the risk of malnutrition in hospitalized children. These tools have been tested to a limited extent by their authors in the original published studies but have not been validated by other independent studies. So far, such screening tools have not been established widely as part of standard pediatric care.
Although nutrition screening and assessment are recommended by European Society for Parenteral and Enteral Nutrition and the European Society for Pediatric Gastroenterology Hepatology and Nutrition and are often accepted to be required by healthcare facilities, there is no standardized approach to nutritional screening for pediatric inpatients. The near future will provide us with comparative data on the existing tools which may contribute to delineating a standard for useful nutrition screening in pediatrics.
Current opinion in clinical nutrition and metabolic care. 05/2012; 15(3):303-9.
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Anti tumor necrosis factor alpha (TNFα) agents have become widely used in pediatric inflammatory bowel disease (IBD). So far, only few studies examined the long-term results of anti-TNFα treatment in children with IBD. METHODS: The long-term outcome of pediatric patients with IBD was assessed retrospectively in a multicenter cohort of children treated with anti-TNFα beyond induction treatment. Short- and long-term response rates, predictors for loss of response, data on growth and laboratory parameters were assessed. RESULTS: 120 patients [101 crohn's disease (CD), 19 ulcerative colitis (UC) or indeterminate colitis (IC)] received either infliximab or adalimumab. The mean age at initiation of anti-TNFα was 13.4±3.9 years and the median duration of anti-TNFα treatment was 15 months (range: 2-90). Overall, 89% of the cohort experienced short-term response following induction. Response was associated with improvement in weight and BMI Z-scores (p<0.001) but not with linear growth. Responders experienced a significant decrease in erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) during treatment (p<0.001). Albumin and hemoglobin both improved but only albumin increased significantly (p<0.001). The cumulative probability of losing response to anti-TNFα treatment was 17%, 38%, and 49% after 1, 3, and 5years, respectively. Responders had a significantly lower weight and BMI Z-scores at initiation of anti-TNFα treatment in compared to non-responders (p=0.04 and 0.02 respectively). CONCLUSIONS: Our long term cohort supports the current evidence on the effectiveness and safety of anti-TNFα treatment in children with IBD. Response to treatment was interestingly associated with lower weight and BMI.
Journal of Crohn s and Colitis 04/2012; · 3.39 Impact Factor
[show abstract][hide abstract] ABSTRACT: The molecular basis for primary hereditary hypertriglyceridemia has been identified in fewer than 5% of cases. Investigation of monogenic dyslipidemias has the potential to expose key metabolic pathways. We describe a hitherto unreported disease in ten individuals manifesting as moderate to severe transient childhood hypertriglyceridemia and fatty liver followed by hepatic fibrosis and the identification of the mutated gene responsible for this condition. We performed SNP array-based homozygosity mapping and found a single large continuous segment of homozygosity on chromosomal region 12q13.12. The candidate region contained 35 genes that are listed in Online Mendelian Inheritance in Man (OMIM) and 27 other genes. We performed candidate gene sequencing and screened both clinically affected individuals (children and adults with hypertriglyceridemia) and also a healthy cohort for mutations in GPD1, which encodes glycerol-3-phosphate dehydrogenase 1. Mutation analysis revealed a homozygous splicing mutation, c.361-1G>C, which resulted in an aberrantly spliced mRNA in the ten affected individuals. This mutation is predicted to result in a truncated protein lacking essential conserved residues, including a functional site responsible for initial substrate recognition. Functional consequences of the mutation were evaluated by measuring intracellular concentrations of cholesterol and triglyceride as well as triglyceride secretion in HepG2 (hepatocellular carcinoma) human cells lines overexpressing normal and mutant GPD1 cDNA. Overexpression of mutant GPD1 in HepG2 cells, in comparison to overexpression of wild-type GPD1, resulted in increased secretion of triglycerides (p = 0.01). This finding supports the pathogenicity of the identified mutation.
The American Journal of Human Genetics 01/2012; 90(1):49-60. · 11.20 Impact Factor
[show abstract][hide abstract] ABSTRACT: The optimum serological test for celiac disease (CD) in young children is not known. The objective of our study was to compare the performance of three serological tests (IgA + IgG DGP, IgA TTG, and IgA + IgG EMA) for children younger than 3 years of age.
We identified all subjects younger than 3 years of age (n = 6,074) that were tested for CD serology and included those with biopsy data. Patients were classified as group 1 (n = 47): patients with confirmed CD or group 2 (n = 12): patients with normal biopsy findings.
There was statistically significant difference between group 1 and group 2 with regard to number of patients with positive IgA TTG (97.87% vs. 50%, P < 0.001), IgA + IgG DGP (100% vs. 77.78%, P = 0.007), and IgA + IgG EMA (95.65% vs. 9.09%, P < 0.001). There was a significantly positive correlation between Marsh-Oberhuber score on the small duodenal biopsies and all tests. Analysis of sensitivity and specificity showed that manufacturer's levels had high sensitivity for all tests (IgA TTG 97%, IgA + IgG DGP 100%, IgA + IgG EMA 96%), however specificity was low for IgA + IgG DGP (44%) and IgA TTG (50%) but not for IgA + IgG EMA (91%).
For children younger than 3 years of age, IgA + IgG EMA is highly sensitive and specific. Use of IgA + IgG DGP or IgA TTG as a single serological marker is insufficient for definite diagnosis of CD in this age group. Based on our results, it might be reasonable to postpone the biopsy for asymptomatic children with negative EMA.
Digestive Diseases and Sciences 08/2011; 57(1):127-32. · 2.26 Impact Factor
[show abstract][hide abstract] ABSTRACT: Celiac disease (CD) is a prevalent condition with a broad spectrum of presentations requiring a lifelong gluten-free diet (GFD). Our aims were to examine the presentation and adherence to a GFD as well as the adequacy of follow-up of children diagnosed with CD at a tertiary referral center.
A retrospective electronic chart review of pediatric patients suspected of CD (n = 581) who were seen at our institute between January 1999 and December 2008 was performed.
387 children were diagnosed with CD (F/M ratio of 1.54, median age: 6.25 years). Presenting symptoms were iron deficiency anemia (n = 82, 34%), short stature (n = 59, 24.5%) and abdominal pain (n = 59, 24.5%). In 63 patients (16.3%) an associated autoimmune disease was recorded. Only 42.7% of the patients (165/387) had regular out-patient gastroenterologist visits; 22% (86/387) were followed by their primary care physician. Over 35% (136/387) were completely lost to follow-up. Negative serology on follow-up was present in 91% of the CD patients(150/165) followed at our center in comparison to 70% (60/86) in those followed up by their primary physician (p = 0.0002).
At least in our referral center, follow-up of children diagnosed with CD is far from satisfactory. Initiatives aimed at improving adherence to regular follow-up are needed as this intervention is associated with a significant increase in patient compliance with a long-term GFD.
[show abstract][hide abstract] ABSTRACT: It is suggested that for celiac disease (CD) diagnosis, biopsies should also be taken from the duodenal bulb. Whether bulb biopsies suggestive of CD can be found on upper gastrointestinal endoscopy (EGD) done for reasons other than CD diagnosis is not clear. The aim of our study was to evaluate the contribution of routine bulb biopsies to the diagnosis of CD, when taken regardless of prior suspicion of CD.
The study included 96 children who underwent EGD for suspected CD and a control group of 69 children who underwent EGD for reasons other than CD. The mucosal changes were evaluated using the Marsh-Oberhuber classification.
Among the 87 children diagnosed with CD, we identified 6 patients (7%) with typical histologic findings only in the bulb (Marsh 3), but also 1 patient (1.1%) with findings only in the distal duodenum (Marsh 2). In 20 patients (23%) the histological changes were more severe in the bulb. One patient had more prominent findings in the second part of the duodenum. None of the control patients had histological changes compatible with CD in the bulb or the second part of the duodenum.
Our findings suggest that when CD is suspected, biopsies should be taken from both locations (bulb and second part) as mucosal changes may emerge only at one site. Nevertheless, the presence of characteristic histology on duodenal bulb biopsies might be sufficient for the diagnosis of CD.
Journal of clinical gastroenterology 01/2011; 45(1):26-9. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: PreventCD (www.preventcd.com) is a European multicentre study, which studies the influence of infant nutrition, and that of genetic, immunologic and environmental factors, on the risk of developing coeliac disease (CD). The hypothesis is that it is possible to induce tolerance to gluten by introducing small quantities of gluten to infants, preferably while they are still being breast-fed, and that this might also reduce the risk for related autoimmune disorders.
To describe the design of this ongoing European CD research project.
PreventCD encompasses two study designs and two study populations: (i) a European multicentre study: a prospective, double-blind, randomized dietary-intervention study among infants from families with high risk of CD, and (ii) a Swedish population-based CD screening study among 12-year-olds from the general population, divided into two birth cohorts that differ with respect to infant feeding practices.
PreventCD is expected to elucidate some of the genetic and immunological mechanisms involved in the process of immune intolerance.
European journal of gastroenterology & hepatology 12/2010; 22(12):1424-30. · 1.66 Impact Factor
[show abstract][hide abstract] ABSTRACT: Enteral nutrition support (ENS) involves both the delivery of nutrients via feeding tubes and the provision of specialised oral nutritional supplements. ENS is indicated in a patient with at least a partially functioning digestive tract when oral intake is inadequate or intake of normal food is inappropriate to meet the patients' needs. The aim of this comment by the Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition is to provide a clinical practice guide to ENS, based on the available evidence and the clinical expertise of the authors. Statements and recommendations are presented, and future research needs highlighted, with a particular emphasis placed on a practical approach to ENS.Among the wide array of enteral formulations, standard polymeric feeds based on cow's-milk protein with fibre and age adapted for energy and nutrient content are suitable for most paediatric patients. Whenever possible, intragastric is preferred to postpyloric delivery of nutrients, and intermittent feeding is preferred to continuous feeding because it is more physiological. An anticipated duration of enteral nutrition (EN) exceeding 4 to 6 weeks is an indication for gastrostomy or enterostomy. Among the various gastrostomy techniques available, percutaneous endoscopic gastrostomy is currently the first option. In general, both patients and caregivers express satisfaction with this procedure, although it is associated with a number of well-recognised complications. We strongly recommend the development and application of procedural protocols that include scrupulous attention to hygiene, as well as regular monitoring by a multidisciplinary nutrition support team to minimise the risk of EN-associated complications.
Journal of pediatric gastroenterology and nutrition 05/2010; 51(1):110-22. · 2.18 Impact Factor
[show abstract][hide abstract] ABSTRACT: Underweight and specific nutrient deficiencies are frequent in adult patients with inflammatory bowel disease (IBD). In addition, a significant number of children with IBD, especially Crohn's disease (CD) have impaired linear growth. Nutrition has an important role in the management of IBD. In adults with CD, enteral nutrition (EN) is effective in inducing clinical remission of IBD, although it is less efficient than corticosteroids. Exclusive EN is an established primary therapy for pediatric CD. Limited data suggests that EN is as efficient as corticosteroids for induction of remission. Additional advantages of nutritional therapy are control of inflammation, mucosal healing, positive benefits to growth and overall nutritional status with minimal adverse effects. The available evidence suggests that supplementary EN may be effective also for maintenance of remission in CD. More studies are needed to confirm these findings. However, EN supplementation could be considered as an alternative or as an adjunct to maintenance drug therapy in CD. EN does not have a primary therapeutic role in ulcerative colitis. Specific compositions of enteral diets-elemental diets or diets containing specific components-were not shown to have any advantage over standard polymeric diets and their place in the treatment of CD or UC need further evaluation. Recent theories suggest that diet may be implicated in the etiology of IBD, however there are no proven dietary approaches to reduce the risk of developing IBD.
World Journal of Gastroenterology 07/2009; 15(21):2570-8. · 2.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: Parenteral nutrition (PN) is an important component of the supportive care of children undergoing bone marrow transplantation (BMT). The study aimed to assess short-term safety and metabolic effects of an olive oil-based (OO) lipid emulsion compared with a MCT/LCT (M/L) emulsion in the clinical setting of pediatric BMT.
Twenty-eight pediatric BMT patients (age 1-18 years) expected to need PN support for at least 2 weeks, were prospectively enrolled and randomly assigned to receive either OO or M/L lipid emulsions within PN. Clinical and routine laboratory parameters, plasma fatty acids profile, vitamin E and peroxidation status were recorded at baseline and after 14 days of PN.
No significant differences were found for hematological parameters, liver enzymes, vitamins, plasma peroxidation status, percentage and time to engraftment. Taking into consideration the baseline fatty acids levels, the OO group showed higher oleic acid (p=0.012), linoleic (p=0.012) and arachidonic acid (p=0.002) enrichment but similar eicosapentanoic and docosahexanoic acids levels compared to the M/L group at day 14. Cholesterol levels decreased significantly in the OO group after 14 days on PN (p=0.017).
OO lipid emulsion was well tolerated, maintained essential fatty acids and peroxidation status, and generated a favorable plasma lipid profile. In this study short-term use of OO intravenous lipid emulsions was safe in children who needed PN support during BMT.
[show abstract][hide abstract] ABSTRACT: Information on safety and efficacy of adalimumab in children with Crohn's disease (CD) is limited. We present a case-series of 14 children with severe CD treated with adalimumab during a 3.5-year period. Fourteen children (nine boys, five girls), aged 13.9 years (range 1.9-19.1) were treated with adalimumab during 12.5 months (range 7-42). All had steroid or immunosuppression-drugs refractory disease. Ten patients (71%) had been previously treated with infliximab, 13/14 were treated with different immunosuppressive drugs and all were steroid-dependent or resistant. Seven children (50%) showed full clinical response and 5/14 (35%) improved partially. Two children (15%) had loss of response after a period of transient improvement. Adalimumab treatment enabled complete steroids withdrawal in 8/14 (57%) of steroid-dependent children. Currently, five children are in complete remission with adalimumab monotherapy for a median 14 months (range 9-24). Adalimumab may induce and maintain remission in children with severe, refractory CD. Prospective safety and efficacy confirmation of this data in children is necessary.
Digestive Diseases and Sciences 04/2009; 55(3):747-53. · 2.26 Impact Factor
[show abstract][hide abstract] ABSTRACT: Screening and assessment for nutritional risk should be a routine part of clinical evaluation. Goals of nutritional assessment are to determine the risk or presence of malnutrition and to provide guidelines for short- and long-term therapy. Nutritional status is assessed through a simple, mainly clinical approach based on medical history, physical examination, anthropometric measurements, dietary intake, body composition and biological parameters. Nutritional status assessment should start by history and physical examination combined with dietary record. When a child is assumed to be at risk of malnutrition, evaluation for inadequate intake, reduced absorption, excessive losses, impaired utilization or increased requirements is needed. Growth is the best indicator of nutritional status. Analysis of growth (weight gain and growth velocity) using growth curves remains the simplest tool for assessing changes in nutritional status. Other anthropometric indices used for the assessment of nutritional status are body mass index, skinfold thickness and mid-arm circumference (MAC). Several classifications are used to define malnutrition, but none has been properly validated for diagnosing malnutrition in children. To date, routine nutritional screening is rarely carried out in pediatric patients due to the lack of a simple and valid nutritional screening tool. An easy-to-use screening tool that has been validated in a variety of pediatric conditions is yet to be developed.
Annales Nestlé (English ed ) 01/2009; 67(2):55-63.
[show abstract][hide abstract] ABSTRACT: RésuméLa recherche et l’évaluation du risque nutritionnel devraient faire partie intégrante de l’évaluation clinique. Les objectifs d’une telle évaluation sont de déterminer le risque ou la présence d’une dénutrition et de proposer des directives pour un traitement à court et long terme. Le statut nutritionnel est évalué par une approche simple et principalement clinique basée sur les antécédents médicaux, l’examen clinique, les mesures anthropométriques, la consommation alimentaire, la composition corporelle et des paramètres biologiques. L’évaluation du statut nutritionnel devrait débuter par une étude des antécédents médicaux et un examen clinique associés à une évaluation de la consommation alimentaire. Des ingesta inadaptés, une diminution de l’absorption, des pertes excessives, une mauvaise utilisation des nutriments ou une augmentation des besoins sont autant de facteurs permettant de supposer qu’un enfant présente un risque nutritionnel. La croissance est le meilleur indicateur du statut nutritionnel. L’analyse de la croissance (gain pondéral et vitesse de croissance) en utilisant les courbes de croissance demeure l’outil le plus simple pour évaluer les changements du statut nutritionnel. Des mesures anthropométriques peuvent aussi être utilisées: indice de masse corporelle, pli cutané et circonférence brachiale. Plusieurs classifications sont utilisées pour définir la dénutrition, mais aucune n’a été correctement validée chez les enfants. De nos jours, il est rare qu’une évaluation nutritionnelle soit systématiquement réalisée chez l’enfant par manque de paramètres simples et validés. De tels outils de dépistage doivent être développés et validés dans différentes situations en pédiatrie.
[show abstract][hide abstract] ABSTRACT: ResumenEl examen colectivo y la evaluación del riesgo nutricional deben constituir una parte sistemática de la evaluación clínica. Los objetivos de la evaluación nutricional consisten en determinar el riesgo o la presencia de malnutrición y proporcionar normas para el tratamiento a corto y a largo plazo. El estado nutricional se evalúa por medio de un abordaje simple, principalmente clínico, basado en la historia clínica, la exploración física, las mediciones antropométricas, la ingestión alimentaria, la composición corporal y los parámetros biológicos. La evaluación del estado nutricional debe comenzar con la historia y la exploración física en combinación con el registro alimentario. Cuando se presume que un niño presenta riesgo de desnutrición es imprescindible la evaluación de la ingestión inadecuada, la reducción de la absorción, las pérdidas excesivas, el deterioro de la utilización o el aumento de las necesidades. El crecimiento es el mejor indicador del estado nutricional. El análisis del crecimiento (ganancia de peso y velocidad del crecimiento) mediante curvas de crecimiento sigue siendo la herramienta más simple para evaluar los cambios en el estado nutricional. Otros índices antropométricos utilizados para evaluar el estado nutricional son el índice de masa corporal, el espesor del pliegue cutáneo y el perímetro del antebrazo (MAC, por sus siglas en inglés). Aunque se utilizan varias clasificaciones para definir la malnutrición, ninguna de ellas ha sido validada correctamente para diagnosticar la malnutrición en los niños. Hasta la fecha, el examen colectivo nutricional sistemático se realiza raramente en pacientes pediátricos debido a la ausencia de una herramienta de detección sistemática nutricional simple y válida. Todavía no se ha elaborado una herramienta de detección sistemática fácil de usar que haya sido validada en diversos procesos pediátricos.
[show abstract][hide abstract] ABSTRACT: A polymeric diet rich in transforming growth factor-beta 2 used as a single nutrient has been shown to induce remission in 79% of children with Crohn's disease.
To summarize the experience of several pediatric gastroenterology units in Israel using a TGFbeta2-enriched polymeric diet (Modulen IBD) supplementation in children and adolescents with Crohn's disease.
In a retrospective study we reviewed the charts of 28 children with Crohn's disease (10 girls, 18 boys) who received, in addition to conventional treatment, Modulen IBD as a supplement to their regular nutrition. These children were compared with 18 children supplemented with standard polymeric formula (Ensure Plus) and 18 children without formula supplementation. We recorded clinical manifestations, growth, and the Pediatric Crohn's Disease Activity Index before and after initiation of the polymeric diet.
The Modulen-treated children showed a significant decrease in PCDAI from 34.3 to 15.7 (P< 0.0001). A significant decrease in PCDAI was recorded also in the Ensure Plus group, from 35 to 22 (P= 0.02) but not in the non-supplemented group. Significant improvements in body mass index (P = 0.01) and erythrocyte sedimentation rate (P= 0.03) were recorded at follow-up (median 3.4 months) only in the Modulen IBD group.
In this cohort of children with Crohn's disease, supplementation of the diet with Modulen IBD as well as supplementation with Ensure Plus was associated with a decrease in PCDAI. The children supplemented with Modulen IBD also showed improvement in BMI, suggesting an additional advantage of nutritional therapy in children with this disease.
The Israel Medical Association journal: IMAJ 08/2008; 10(7):503-7. · 0.98 Impact Factor