Corina Hartman

Tel Aviv University, Tell Afif, Tel Aviv, Israel

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Publications (64)267.8 Total impact

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    ABSTRACT: Objectives: To evaluate the use of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) in a primary health care clinic in the community and to assess the impact of its use on medical staffs' awareness of nutritional status. Methods: STAMPs' scoring system was tested as is and with modifications in the ambulatory setting. Nutritional risk according to STAMP was compared to a detailed nutritional assessment performed by a registered dietitian. Recording of nutrition-related data and anthropometric measurements in medical files were compared prior and post implementation. Results: Sixty children were included (31 girls, 52%), age ranged between 1-6 years, mean age 2.8 ± 1.5 (mean ± SD). STAMP scores yielded a fair agreement between STAMP and the dietitians' nutritional assessment: κ= 0.47 (95% C.I., 0.24 to 0.7), sensitivity of 47.62% (95% C.I., 28.34 to 67.63%). Modified STAMP yielded more a substantial agreement: κ= 0.57 (95% C.I., 0.35 to 0.79), sensitivity of 76.19% (95% C.I., 54.91 to 89.37%), specificity of 82.05% (95% C.I., 67.33% to 91.02%). The use of STAMP resulted in an increase in recording of appetite, dietary intake and anthropometric measurements. Conclusions: Modification of the STAMP improved nutritional risk evaluation in community setting. The use of STAMP in a primary health care clinic raised clinicians' awareness to nutritional status. Further work will identify whether this could be translated into lower malnutrition rates and better child care.
    No preview · Article · Nov 2015 · Journal of Pediatric Gastroenterology and Nutrition
  • Arieh Riskin · Corina Hartman · Raanan Shamir
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    ABSTRACT: Parenteral nutrition (PN) must be initiated as soon as possible after delivery in very low birth weight (VLBW) preterm infants in order to prevent postnatal growth failure and improve neurodevelopmental outcome. When administered early, high levels of parenteral amino acids (AA) are well tolerated and prevent negative nitrogen balance. Although proteins are the driving force for growth, protein synthesis is energy-demanding. Intravenous lipid emulsions (ILE) constitute a good energy source because of their high energy density and provide essential fatty acids (FA) along with their long-chain polyunsaturated fatty acid (LC-PUFA) derivatives necessary for central nervous system and retinal development. Early supply of ILE is not associated with increased morbidity. No significant differences were found between ILE based on soybean oil only and mixed ILE containing soybean oil in combination with other fat sources, except for a reduction in the incidence of sepsis with non-pure soybean ILE, and possibly less PN-associated liver disease with mixed ILE containing some fish oil. In preterm infants glucose homeostasis is still immature in the first days of life and abnormalities of glucose homeostasis are common. VLBW infants may not tolerate high levels of glucose infusion without hyperglycemia. Administering lower levels of glucose infusion as part of full early PN seems more successful than insulin at this stage. Postpartum there is a transition period when the water and electrolyte balance may be severely disturbed and should be closely monitored. Avoiding fluid overload is critical for preventing respiratory and other morbidities.
    No preview · Article · May 2015 · The Israel Medical Association journal: IMAJ

  • No preview · Article · Mar 2015 · The Israel Medical Association journal: IMAJ
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    ABSTRACT: Background New evidence emerged on early feeding practices and the risk of coeliac disease.AimTo systematically update evidence on these practices to find out whether there is a need to revise current recommendations.MethodsMEDLINE, EMBASE and the Cochrane Library were searched from July 2012 (end of last search) to February 2015 for studies of any design that assessed the effect of gluten consumption and breastfeeding on the development of coeliac disease and/or coeliac disease-related autoimmunity.ResultsWe identified 21 publications, including two, new, large, randomised controlled trials performed in high-risk infants. Exclusive or any breastfeeding, as well as breastfeeding at the time of gluten introduction, did not reduce the risk of developing coeliac disease during childhood. For infants at high risk of developing coeliac disease, gluten introduction at 4 months of age in very small amounts, or at 6 or 12 months of age, resulted in similar rates of coeliac disease diagnosis in early childhood. Later gluten introduction was associated with later development of coeliac specific autoimmunity and coeliac disease during childhood, but not total risk reduction. Observational studies indicate that consumption of a higher amount of gluten at weaning may increase the risk for coeliac disease development.Conclusions Infant feeding practices (breastfeeding, time of gluten introduction) have no effect on the risk of developing coeliac disease during childhood (at least at specific timeframes evaluated in the included studies), necessitating an update of current European recommendations.
    Full-text · Article · Mar 2015 · Alimentary Pharmacology & Therapeutics
  • Corina Hartman · Raanan Shamir
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    ABSTRACT: Parenteral nutrition (PN) in term newborns and older infants is often required for nutritional support for temporary or permanent intestinal failure from any reason. Lipid emulsions (LEs) are an essential source of high-density energy, essential fatty acids, and fat-soluble vitamins. Depending on the fatty acid type, LEs may also have significant immunomodulatory effects. All LEs, starting with soybean oil-based LE and subsequently with medium-chain triglycerides-, olive oil- and fish oil-based LEs, have been investigated in newborns and infants. Laboratory data (mainly liver enzymes, plasma lipid profiles and some metabolic markers) have been investigated for some LEs. The outcome of intestinal failure-associated liver disease after switching to new fish oil-based LEs has been sporadically reported. Long-term outcome data have only looked at the relationship between PN and mortality/morbidity, especially liver disease, and a few studies have looked at growth. There are no controlled studies in this age group that investigated the relationship between different types of LEs and long-term outcomes. In spite of their contribution to understanding the use and indications of various LEs as well as their advantages and adverse effects, most studies in newborns and infants have been observational or retrospective, and the investigated population has been heterogeneous, either in terms of the degree of maturation, age or diagnoses. High-quality studies, preferably randomized and controlled, in this particular population are needed, especially with the widespread use of PN and the emergence of new LEs. © 2015 S. Karger AG, Basel.
    No preview · Article · Jan 2015 · World review of nutrition and dietetics
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    ABSTRACT: Background: Follow-up of celiac disease (CD) patients is recommended for gluten-free diet (GFD) adherence monitoring and complication detection. We recently showed that 35% of children with CD were lost to follow-up (LTFU). We aimed to characterize LTFU population, and thus identify compliance barriers to GFD and follow-up. Methods: 50 LTFU patients were investigated using a telephone questionnaire, regarding frequency of follow-up, serology testing, and adherence to GFD (using the validated Biagi score). Fifty two regular follow-up patients served as controls. Results: LTFU patients had poor adherence to GFD (average Biagi score of 2.0 ± 1.4) compared to controls (3.0 ± 1.0, p < 0.001). Only 22% of LTFU performed periodic celiac serology testing compared to 82% of controls (p < 0.001). LTFU had higher prevalence of positive celiac serology tests (50% compared to 25% of controls, p = 0.01). Fewer LTFU were National Celiac Association members (24%) compared with controls (44%, p = 0.05). Regression analysis showed positive relationships between LTFU and poor adherence to GFD (R(2) = 0.26737, p = 0.001), older age at diagnosis (R(2) = 0.30046, p = 0.03), and non-membership in a celiac association (R(2) = 0.18591, p = 0.0001). Conclusion: LTFU is associated with non-adherence to GFD and positive serology. Risk factors for LFTU should be identified and addressed in order to improve patient care.
    No preview · Article · Dec 2014 · Digestion
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    ABSTRACT: Background: A window of opportunity has been suggested for reducing the risk of celiac disease by introducing gluten to infants at 4 to 6 months of age. Methods: We performed a multicenter, randomized, double-blind, placebo-controlled dietary-intervention study involving 944 children who were positive for HLA-DQ2 or HLA-DQ8 and had at least one first-degree relative with celiac disease. From 16 to 24 weeks of age, 475 participants received 100 mg of immunologically active gluten daily, and 469 received placebo. Anti-transglutaminase type 2 and antigliadin antibodies were periodically measured. The primary outcome was the frequency of biopsy-confirmed celiac disease at 3 years of age. Results: Celiac disease was confirmed by means of biopsies in 77 children. To avoid underestimation of the frequency of celiac disease, 3 additional children who received a diagnosis of celiac disease according to the 2012 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria (without having undergone biopsies) were included in the analyses (80 children; median age, 2.8 years; 59% were girls). The cumulative incidence of celiac disease among patients 3 years of age was 5.2% (95% confidence interval [CI], 3.6 to 6.8), with similar rates in the gluten group and the placebo group (5.9% [95% CI, 3.7 to 8.1] and 4.5% [95% CI, 2.5 to 6.5], respectively; hazard ratio in the gluten group, 1.23; 95% CI, 0.79 to 1.91). Rates of elevated levels of anti-transglutaminase type 2 and antigliadin antibodies were also similar in the two study groups (7.0% [95% CI, 4.7 to 9.4] in the gluten group and 5.7% [95% CI, 3.5 to 7.9] in the placebo group; hazard ratio, 1.14; 95% CI, 0.76 to 1.73). Breast-feeding, regardless of whether it was exclusive or whether it was ongoing during gluten introduction, did not significantly influence the development of celiac disease or the effect of the intervention. Conclusions: As compared with placebo, the introduction of small quantities of gluten at 16 to 24 weeks of age did not reduce the risk of celiac disease by 3 years of age in this group of high-risk children. (Funded by the European Commission and others; PreventCD Current Controlled Trials number, ISRCTN74582487.).
    No preview · Article · Oct 2014 · New England Journal of Medicine
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    ABSTRACT: Intestinal failure-associated liver disease (IFALD) is the most prevalent complication affecting children with intestinal failure receiving long-term parenteral nutrition (PN). We review here the definition, diagnostic criteria, pathogenesis and risk factors. We discuss the role of enteral nutrition, PN and its components, especially lipid emulsions. We discuss the surgical treatment, including intestinal transplantation, its indications, technique and results. We emphasize the importance of specialized intestinal failure centres.
    Full-text · Article · Sep 2014 · Journal of Pediatric Gastroenterology and Nutrition
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    ABSTRACT: Non-Organic Feeding Disorders (NOFEDs) are frequently encountered in children younger than 6 years old. NOFED are characterized by feeding aversion, failure to advance to age-appropriate foods, food selectivity and negative mealtime behaviors. Parents of children with feeding disorders often use abnormal feeding behaviors, such as intrusive feeding. Persistent inadequate caloric intake leads to non-organic failure to thrive in up to 40-50% of cases. Managing children with NOFED is a challenge for even the most experienced pediatric specialists. Management by a multidisciplinary team, as outpatient or inpatient should address both nutritional support and feeding behaviour modification. Even in the absence of failure to thrive, children with behavioural feeding problems are at risk of negative health, social and emotional outcomes, including nutrient deficiencies, social and family disruption or conflict. The aims of the current review are to present an update of the definition, classification, etiology, epidemiology of NOFED, as well as clinical presentation, evaluation and management of this condition and non-organic failure to thrive, often associated with NOFED.
    No preview · Article · Sep 2014 · Clinical Nutrition
  • L. Marderfeld · I. Poraz · G. Rub · S. Ashkenazi · C. Hartman · R. Shamir

    No preview · Article · Sep 2014
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    ABSTRACT: Due to the association of coeliac disease and HLA-specificities DQ2 and DQ8, HLA-typing can be used for risk determination of the disease. This study was designed to evaluate the knowledge of parents from coeliac families regarding HLA-typing and the impact of HLA-typing on the perception of the health of their children. A structured questionnaire was sent to the Dutch, Spanish and German parents participating with their child in the European PreventCD study on disease prevention in high-risk families, addressing parents' understanding of and attitude towards HLA-typing, distress related to HLA-typing and perceived health and health-related quality of life of their children. Sixty-eight percent of parents of 515 children returned the questionnaires, with 85% of children being DQ2/DQ8 positive. The majority of all parents answered the questions on knowledge correctly. Forty-eight percent of parents of DQ2/DQ8-negative children thought their child could develop coeliac disease. More distress was reported by parents of DQ2/DQ8-positive children (P<0.001). All parents showed few regrets and would repeat HLA-typing in future children. Perceived health and health-related quality of life were similar. In conclusion, we can say that misinterpretation of DQ2/DQ8-negative results by parents is frequent. DQ2/DQ8-positive results do not affect perceived health and health-related quality of life of children but may cause temporary negative feelings among parents. Parents of coeliac families seem to support HLA-typing.European Journal of Human Genetics advance online publication, 11 June 2014; doi:10.1038/ejhg.2014.113.
    Full-text · Article · Jun 2014 · European journal of human genetics: EJHG

  • No preview · Article · Jan 2014 · World review of nutrition and dietetics
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    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.
    Full-text · Article · Jan 2014 · Clinical nutrition (Edinburgh, Scotland)
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    Corina Hartman · Raanan Shamir
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    ABSTRACT: The first International Conference on Nutrition and Growth brought together physicians, dietitians, nurses and scientists to discuss one of the major challenges of pediatric nutrition, namely growth. The meeting, which lasted for 2 and a half days, was well attended, with more than 1250 participants from 92 countries. This report reviews selected highlights from the conference.
    Full-text · Article · Jan 2014 · Expert Review of Endocrinology & Metabolism
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    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.
    Preview · Article · Sep 2013 · World Journal of Gastroenterology
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    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.
    Full-text · Article · Jan 2013 · Gut
  • Corina Hartman · Raanan Shamir
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    ABSTRACT: Coronary artery disease (CAD) continues to be the single leading cause of mortality in Europe and United States and a major cause of morbidity [1]. The Framingham cohort and subsequent studies have identified male gender, blood cholesterol, blood pressure, diabetes, and smoking status as the major risk factors for CAD [2]. All CVD risk factors, including abnormal lipid levels, often emerge during childhood and adolescence [3]. The prevalence of lipid abnormalities in children is increasing, primarily in association with the concomitant epidemic of obesity and the metabolic syndrome. The National Health and Nutrition Examination Survey (NHANES) for 1999–2006 found that the prevalence of abnormal lipid levels defined as low-density lipoprotein cholesterol (LDL-C) ≥130 mg/dL, low high-density lipoprotein cholesterol (HDL-C)≤ 35 mg/dL, and high triglyceride levels ≥150 mg/dL, among youths aged 12–19 years was 20.3%. This prevalence varied by body mass index (BMI); 14.2% of normal weight but 22.3% of overweight and 42.9% of obese had at least one abnormal lipid level [4]. Furthermore, elevated non-HDL-C concentrations during childhood and adolescence also have been shown to predict high non-HDL-C concentration during adulthood; for example, a non-HDL-C concentration above the 95th percentile during childhood was found to be 86–96% sensitive and 96–98% specific in predicting an elevated LDL-cholesterol concentration during adulthood [5].
    No preview · Chapter · Jan 2013
  • C. Hartman · I. Poraz · M. Kiri · K. Davidson · L. Peleg-Weis · R. Shamir

    No preview · Article · Sep 2012 · Clinical Nutrition Supplements
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    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.
    No preview · Article · Aug 2012 · Alimentary Pharmacology & Therapeutics
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    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.
    No preview · Article · May 2012

Publication Stats

1k Citations
267.80 Total Impact Points

Institutions

  • 2002-2015
    • Tel Aviv University
      • Sackler Faculty of Medicine
      Tell Afif, Tel Aviv, Israel
  • 2009-2014
    • Schneider Children's Medical Center of Israel
      Petah Tikva, Central District, Israel
  • 2013
    • University of Groningen
      • Department of Genetics
      Groningen, Groningen, Netherlands
  • 2012
    • Medical University of Warsaw
      Warszawa, Masovian Voivodeship, Poland
  • 2011
    • Schneiders Children's Medical Center Of Israel
      Petah Tikva, Central District, Israel
  • 2010
    • Leiden University Medical Centre
      Leyden, South Holland, Netherlands
  • 2007
    • Ospedale Pediatrico Meyer Firenze
      Florens, Tuscany, Italy
  • 2005-2007
    • Rambam Medical Center
      • Department of Gastroenterology
      H̱efa, Haifa, Israel
  • 2001-2006
    • Technion - Israel Institute of Technology
      • Ruth and Bruce Rappaport Faculty of Medicine
      H̱efa, Haifa, Israel
  • 2004
    • Sheba Medical Center
      Gan, Tel Aviv, Israel