ICAN: Infant, Child, & Adolescent Nutrition recent issues

Thoughts on the Nutrition Care Process

Wessel, J. — Wed, 07 Oct 2009 09:43:46 PDT

The Use of Probiotics for the Prevention of Necrotizing Enterocolitis in the Premature Infant

Anderson, T., Lord, A., Shotkoski, N., O'Keefe, C. — Wed, 07 Oct 2009 09:43:47 PDT

Studies have suggested the possible benefits of prophylactic administration of probiotics to the premature infant for the prevention of necrotizing enterocolitis (NEC). A survey was designed to determine the knowledge and practices of neonatal intensive care practitioners regarding the use of probiotics for the prevention of NEC in the premature infant. One hundred seventy-one surveys were completed. Most respondents were neonatal nurse practitioners (n = 100, 59%). Most (64%, n = 110) indicated that NEC was a significant problem; however, only 13 (8%) of these respondents used probiotics for the prevention of NEC. Eighty-six respondents (57%) identified the lack of published studies on the use of probiotics for the prevention of NEC as the reason for not administering probiotics. No statistically significant relationship was found between the use of probiotics for the prevention of NEC and duration of practice, location of practice, or willingness to try new treatments. A statistically significant relationship was revealed between the use of probiotics in general and the use of probiotics for the prevention of NEC. More research is needed in the area of probiotics and the prevention of NEC in the premature infant before a practice change can be considered.

Quantification of Energy Wastage From Canola Oil Supplementation in Preterm Infants

Cohen, S., Dollberg, S., Mimouni, F. B., Peled, Y., Mandel, D. — Wed, 07 Oct 2009 09:43:47 PDT

The objective of this study was to quantify energy wasted when canola oil (CO) is added to the diet of preterm infants. Eight preterm infants were studied; gestational age ranged from 27 to 33 weeks, and birth weight ranged from 800 to 1317 g. Each infant was studied at baseline for 3 days of stool collection, at the end of which energy expenditure (EE) was measured 1 hour after meals. Each infant was then supplemented with 3 g CO/kg/d for 3 days, after which the study was repeated. Stools were collected for fat analysis. EE increased from 58 ± 6.8 to 62.4 ± 4.6 kcal/kg/24 hours after introduction of CO (P < .03). Stool fat increased from 1.37 ± 1.2 to 2.18 ± 1.2 g/kg/d. Of the fat added, 27% was lost in stools, and 17% was wasted as spent energy. The increase in EE correlated significantly with the coefficient of fat absorption (R² = 0.56, P = .029). In conclusion, the addition of CO to the diet of preterm infants leads to net energy storage of more than half of the extra energy administered and may be an inexpensive alternative to medium-chain triglyceride oil.

Perspectives in Nasogastric Feeding the Eating Disorder Patient

Woods, B. K., Runyan, B., Lamb, R. P. — Wed, 07 Oct 2009 09:43:47 PDT

Sapropterin Dihydrochloride (6R-BH4) and Maternal Phenylketonuria Two Case Studies

Moseley, K., Skrabal, J., Yano, S., Koch, R. — Wed, 07 Oct 2009 09:43:47 PDT

The dietary treatment of phenylketonuria (PKU) is a success story. However, the Maternal PKU Collaborative Study reported microcephaly, congenital heart defects, facial dysmorphology, and intrauterine and postnatal growth retardation in the offspring of women with blood phenylalanine (phe) concentrations >600 µmol/L. Dietary control of phe during pregnancy is extremely difficult for many women because of hyper-emesis gravidarum, intolerance of the medical food products, and inability/ refusal to follow dietary recommendations. The authors report 2 case studies using 6R-BH4 along with the phere-stricted diet. Two individuals received 6R-BH4 shortly before conception and throughout the pregnancy. A pherestricted diet was followed with blood phe analysis obtained weekly. Interim plasma amino acids, complete metabolic panels, complete blood counts, and analyses for nutritional deficiencies were also obtained during the pregnancy. Both individuals maintained blood phe concentrations within the recommended range (120-360 µmol/L) nearly all through the pregnancy with a small percentage outside of recommendations. One participant showed deficiencies in vitamin D and zinc and received supplementation. Both were able to increase natural protein as the pregnancy progressed. Ingestion of the 6R-BH4 was well tolerated. Both gave birth to healthy normal infants. In these case studies, both babies’ birth measurements were in the normal range, and the 6R-BH4 had no adverse effects.

In Vitro Stability of Sapropterin Dihydrochloride From Crushed Tablets Mixed in Applesauce, Pudding, and Infant Formula

Striepeke, S., Jurecki, E. R., Hornfeldt, C. S., Turbeville, S., Prince, B. — Wed, 07 Oct 2009 09:43:47 PDT

Sapropterin is approved to reduce blood phenylalanine levels in patients with hyperphenylalaninemia due to tetrahydrobiopterin-responsive phenylketonuria. The current Food and Drug Administration—approved labeling states that sapropterin tablets should be dissolved in 4 to 8 oz of water or apple juice; however, numerous requests for information regarding the feasibility of administering crushed sapropterin tablets in infant formula or soft foods such as applesauce and pudding suggest that the current recommendations for administration may not be suitable for many infants and small children. To determine the safety of administering the medication in formula or soft foods, powdered tablets representing 200 mg of sapropterin were thoroughly mixed with applesauce, lemon pudding, and 3 brands of phenylalanine-free infant formula, incubated for up to 60 minutes at room temperature and then analyzed for sapropterin content. The results indicate there was no significant change in the amount of sapropterin present in any mixture after 60 minutes.

Do Dietary Modifications Made Prior to Pubertal Maturation Have the Potential to Decrease Obesity Later in Life? A Developmental Perspective

Casazza, K., Thomas, O. — Wed, 07 Oct 2009 09:43:47 PDT

Dietary intake is an important contributor to the obesity epidemic in children and adults, but the long-term effects of dietary interventions after obesity has occurred are modest at best. Childhood obesity significantly increases the risk of adult obesity. It has been suggested that prior to puberty, the interaction of physiological and dietary intake factors greatly affects overall trajectory of weight gain of the life course. This review article summarizes research on the role of diet on weight and metabolic outcomes, and it suggests how dietary interventions prior to puberty may decrease the prevalence of obesity life span. Specifically, presented literature examines dietary intake in early life and through the pubertal transition, as well as the role of macro- and micronutrients in mechanisms that influence fat accumulation and storage. The evidence suggests that multiple early life periods for dietary interventions could have a cumulative effect on optimizing tissue partitioning and limiting excessive fat accumulation into adulthood. Prior to the pubertal transition, it appears that improving diet quality in the context of energy balance may also be a key strategy for preventing current and future obesity.

Prader-Willi Syndrome A Review for Pediatric Nutrition Professionals

Pereira, R., Schalk, A., Geraghty, M. E. — Wed, 07 Oct 2009 09:43:47 PDT

Prader-Willi syndrome is a complex, multidimensional disease affecting approximately 1 in 8000 to 1 in 50 000 individuals. Although there is an abundance of data available regarding Prader-Willi syndrome, there are few sources of compiled, nutritionally pertinent information. Nutrition intervention is currently the only treatment for Prader-Willi syndrome, and therefore it is critical that nutrition professionals have an understanding of the disease. This review provides background information regarding Prader-Willi syndrome and the causes of obesity and hyperphagia, as well as outlines current nutritional recommendations and strategies for working with individuals with Prader-Willi syndrome. It is recommended that the diet of these children be strictly controlled and structure provided, yet it is important to allow for some flexibility to enhance quality of life. Behavioral issues also need to be considered as they render it a challenge for parents to impose restrictions on their children’s eating patterns.

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Wed, 07 Oct 2009 09:43:47 PDT

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I'm Listening

Heller, L. — Thu, 13 Aug 2009 15:08:48 PDT

Specialty Practice: Using the Nutrition Care Process in the Neonatal Intensive Care Unit

Nevin-Folino, N., Hanson, C. K. — Thu, 13 Aug 2009 15:08:48 PDT

The Nutrition Care Process introduced by the American Dietetic Association in 2003 can be used within the neonatal intensive care unit (NICU) for standardization of taxonomy for nutrition care. Using this process in the NICU will help to quantify the nutrition activities unique to the neonatal nutrition specialist, unify descriptors of nutrition delivery functions for data collection, and support registered dietician services to other health care professionals. A case study is presented, with tables explaining the 4 steps to the process, and a useful summary of nutrition diagnosis within the NICU population provides a needed reference to the neonatal nutritionist and NICU staff.

Cardiovascular Risk in Preschool Children

Yin, L., Wills, H., Clarke, N., Shacks, J., Bottrell, C., Poulsen, M. K. — Thu, 13 Aug 2009 15:08:48 PDT

The objective of this study is to determine the prevalence of cardiovascular risk in a primarily Latino/ Hispanic preschool population of low socioeconomic status. Preschool health screenings were conducted as part of a publicly funded demonstration project designed to provide consultation, education, services, and support to children living in underserved communities. Cross-sectional analysis was restricted to 2- to 5-year-olds with recorded values for age, gender, ethnicity, height, weight, triceps skinfold, resting heart rate, and blood pressure, resulting in 608 subjects. Most of the study population was of Latino/Hispanic descent. The prevalence of overweight and obesity rivaled adult data, with almost 50% of preschoolers aged 2 to 5 years being overweight or obese. Prevalence of overweight/obesity did not vary by age or gender. The Latino/Hispanic population had a significantly greater prevalence of overweight and obesity (P = .003, P = .02), but severe obesity (body mass index ≥99th percentile) did not vary by ethnicity. Obesity and severe obesity were independent risk factors for systolic blood pressure in the hypertensive range (relative risk [RR] = 2.45, 95% confidence interval [CI] = 1.73-3.45, P < .0001; RR = 2.53, 95% CI = 1.46-4.38; P = .001, respectively). The risk of cardiovascular disease is high in the preschool population studied, especially in the severely obese. Adverse risk was identified in obese children as early as 2 years old. Economically disadvantaged children, particularly of Latino/ Hispanic descent, may be at higher risk. This is an important consideration given population projections by 2050. These findings support the need for earlier intervention as the preschool years may be a more feasible and effective period for intervention.

Legislative Brief: H.R. 26, The Eating Disorders Awareness, Prevention, and Education Act of 2009

Yu, S. — Thu, 13 Aug 2009 15:08:48 PDT

Eating disorders are a widespread problem that is often overlooked. Almost 11 million suffer from anorexia or bulimia, and approximately 25 million more suffer from binge-eating disorder. Eating disorders are a complex and devastating condition that have serious consequences to a person's health, productivity, and relationships. If left untreated, an eating disorder can lead to death. The US government has done very little to help individuals suffering from eating disorders. Before 2008, the only federal eating disorder bill that has ever passed into law was a congressional resolution in the Senate in 1989 designating a National Eating Disorders Awareness Week. H.R. 26, The Eating Disorders Awareness, Prevention, and Education Act of 2009, was reintroduced for the sixth time in the 2009-2010 congressional session by Representative Judy Biggert on February 6, 2009. This legislative brief details the history of eating disorders, the purpose and history of the bill, and the potential impact that this bill will have on maternal and child health.

Managing Diabetes With Glycemic Index

Wood, J., Higgins, L. A., Barraza, V. — Thu, 13 Aug 2009 15:08:48 PDT

Cow's Milk Allergy in a Preterm Infant A Case Presentation

Becker, P. J. — Thu, 13 Aug 2009 15:08:48 PDT

For the infant born prematurely, it is the immaturity of organ systems, such as the pulmonary system, the immune system, and gastrointestinal tract, that is most problematic. Apnea of prematurity, respiratory distress syndrome, uncoordinated suck, swallow, breathe sequence, immature protection of the airway during feeding, and an immature gut are the sequelae that must be overcome to support extrauterine growth. In some infants, as is the case in the patient presented here, other issues influenced by familial trait can also occur, making supporting growth even more of a challenge. In this case, an infant born at 31 weeks gestational age, with a history of several first-degree relatives with cow's milk allergy (CMA), is presented. CMA, respiratory distress with oral feeds, and dysphagia diagnosed by modified barium swallow study are discussed here. Eliminating food allergens from the maternal diet, the use of an amino acid—based infant formula for fortification of human milk to support growth goals, and the modification of thin liquid consistency of human milk to prevent aspiration were required in the treatment of the patient.

Parent Perceptions of Children's Weight Status, Nutrition, and Activity Levels

Chiang, E. S., Molin, A. J., Byrd, S. P., Crawford, Y. J. — Thu, 13 Aug 2009 15:08:48 PDT

Although national statistics indicate about a third of children aged 6 to 11 years are overweight or obese, previous studies have revealed that parents often fail to accurately perceive a child's problematic weight status. In this study, data were collected on 407 parent-child dyads to determine the accuracy of parent perceptions of child weight status across the upper elementary school years. Parents also reported on their perceptions of the healthfulness of the child's daily diet and the amount of physical activity engaged in by the child. Findings indicated that parents underestimate the child's weight status while overwhelmingly perceiving that the child is physically active and consuming a healthy diet. Specifically, 76% of parents of overweight children viewed the child as healthy weight rather than overweight, and about 90% of parents of obese children viewed the child as healthy weight or only slightly overweight. Accordingly, it is proposed that parents may need more information on recognizing healthy and unhealthy weight statuses and, when children are identified as overweight or obese, encouraged to promote greater physical activity and a healthier diet in children.

Simple, Effective--and Inexpensive-- Strategies to Reduce Tooth Decay in Children

Holtzman, J. — Thu, 13 Aug 2009 15:08:48 PDT

Access to primary preventive dental care will likely decrease in a poor economy, challenging all health care providers to identify inexpensive ways to help families prevent tooth decay. The incidence of tooth decay in very young children is increasing. Tooth decay can result in death in children if the subsequent infection is untreated. However, easy, inexpensive, and effective strategies exist to improve the dental health of children, and non-dental health care providers can introduce families to very useful nutritional and dental practices.

Hemp Seed and Hemp Milk: The New Super Foods?

Vahanvaty, U. S. — Thu, 13 Aug 2009 15:08:48 PDT

Gluten-Free Friends: An Activity Book for Kids by Nancy Patin Falini, MA, RD, LDN * Centennial, CO: Savory Palate Inc. * 2004 * 57 pages * $18.95 * ISBN: 1889374091

Braun, S., Barr, E. — Thu, 13 Aug 2009 15:08:48 PDT

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My Introduction to NAPNAP

Heller, L. — Fri, 29 May 2009 15:31:46 PDT

Maternal Variables Influencing Duration of Breastfeeding Among Low-Income Mothers

McKechnie, A. C., Tluczek, A., Henriques, J. B. — Fri, 29 May 2009 15:31:46 PDT

This study used a retrospective comparison of 2 naturally occurring groups, first to examine how exclusive versus partial breastfeeding relates to duration of breastfeeding and, second, to determine if factors such as age and body mass index are associated with exclusive versus partial breastfeeding duration. These factors were hypothesized to influence the amount of breastfeeding in a sample of 42 low-income mothers enrolled in the Supplemental Nutrition Program for Women, Infants, and Children of a predominately rural, Midwestern county. This study examined de-identified data from a state database spanning a calendar year. Breastfeeding behavior, age, and body mass index measurements for mothers giving birth within the first 6 months of that year were analyzed. Exclusive breastfeeding mothers breastfed longer, were of older age, and had lower body mass indexes than partial breastfeeding mothers. These findings further describe characteristics of low-income breastfeeding women. Understanding how factors associated with exclusive versus partial breastfeeding affect breastfeeding duration may inform clinicians and researchers of areas for future interventions.

Excessive Cow's Milk Consumption and Iron Deficiency in Toddlers: Two Unusual Presentations and Review

Bondi, S. A., Lieuw, K. — Fri, 29 May 2009 15:31:46 PDT

Elimination of iron deficiency and iron deficiency anemia in children is a crucial public health concern because these conditions have been linked to cognitive and behavioral deficits. In the infant age group, great strides have been made to reduce iron deficiency and iron deficiency anemia significantly. However, similar progress has not yet been made with toddlers. Cow's milk consumption has long been associated with iron deficiency and iron deficiency anemia in children. Because cow's milk is a staple in the diet of most toddlers, they are at particular risk for these conditions. Two unusual presentations of anemia in toddlers caused by excessive cow's milk consumption are described: one in a child with congestive heart failure, the other in a child with profound eosinophilia. The role of cow's milk in iron deficiency and iron deficiency anemia is also examined.

From Hospital to Home

Shannon, R., Peterson, J., Fisher, J. — Fri, 29 May 2009 15:31:46 PDT

Treatment of a 7-Year Old Girl With Long-standing Disordered Eating Behaviors Since Infancy

Tremblay, L., Lariviere, M. — Fri, 29 May 2009 15:31:47 PDT

The authors present the case of a 7-year-old girl with disordered eating secondary to severe symptoms of gastroesophageal reflux (GER) experienced during infancy. Symptoms include deficits in interpreting signs of hunger and refusals to eat, leading to latent physical development. Methods of assessment include parent and child interviews, child eating behaviors and parental feeding strategies questionnaires, a 2-week food record, and mealtime behavioral observations. The objective of treatment was weight gain through decreasing problematic eating behaviors: dawdling eating, excessive talking at mealtime, and frequently leaving the table during meals. Cognitive-behavioral approaches (eg, using reinforcements and consequences, increasing food intake by small portion sizes, and increasing the child's awareness of signs of hunger through direct prompts and parental modeling) were successful, and parents reported physical growth weight gain at 6-month follow-up.

Milk, Dairy Fat, and Body Weight in Pediatrics: Time for Reappraisal

Slyper, A., Huang, W.-M. — Fri, 29 May 2009 15:31:47 PDT

The objective of this study was to review the pediatric literature on the relationship between dairy, milk fat, and body weight to ascertain whether it supports current recommendations to limit dairy fat in children and adolescents. With only a few exceptions, pediatric crosssectional and prospective studies from across the globe have demonstrated significant negative associations between dairy or milk intake and body mass index or body fat. Four studies have looked specifically at the fat content of milk, and none have implicated whole or 2% milk as being more weight inducing than lower fat milk. The pediatric literature on dairy provides no support to the notion that skim milk is more protective against excessive weight gain than whole milk and in fact raises the possibility that the very opposite may be the case. Hypotheses are suggested to explain this.

Predictors of Weight and Adiposity During Early Infancy: A Prospective Study

Anderson, A. K., Bignell, W., Buen, N., Chakraborty, P., Anderson, M. — Fri, 29 May 2009 15:31:47 PDT

The problem of overweight/ obesity among children has led some experts to suggest that the current Institute of Medicine recommendation for pregnancy weight gain may play a role in early childhood overweight. The study examined the predictors of early infancy weight and body composition as a prospective study that followed mothers and their newborns from birth through 12 weeks postpartum. Participants were 40 mother-infant pairs either exclusively breastfeeding or mixed feeding. The main outcomes were weight changes, weight-for-height z score, height-for-age z score, weight-for-age z score, BMI-for-age z score, and percent body fat measured by the PEA POD body composition system and adjusted for infant feeding practice and gestational age. Female infants accumulated higher percent body fat than male infants through the 12 weeks of follow-up. Maternal pregnancy weight gain positively correlated with infant length at the different time points and not infant weight. Maternal prepregnancy body mass index (P = .030) and pregnancy weight gain (P = .040) significantly correlated with infant birth weight and not weights at 2, 4, 8, and 12 weeks postpartum. Maternal pregnancy weight gain had an inverse association with infant percent body fat after adjusting for other covariates. In conclusion, maternal pregnancy weight gain predicted infant birth weight but not infant adiposity and subsequent weight through the first 12 weeks after delivery. Higher pregnancy weight gain predicts slower early postnatal growth.

Evaluation of Fruit Juice Intake and Body Mass Index Within a Sample of Ontario Preschoolers

Rysdale, L. A., Brunelle, P. L., Simpson, J. R., Knee, C. A., Keller, H. H. — Fri, 29 May 2009 15:31:47 PDT

This study describes fruit juice consumption and associated factors for a sample of Ontario preschoolers and determines potential relationships between intake and body mass index (BMI). Secondary data analysis was conducted on growth, dietary, and demographic data collected during the validation of NutriSTEP (Nutrition Screening Tool for Every Preschooler) with 254 preschoolers, aged 3 to 5 years. Dietary data were collected through parent-completed 3-day food intake records. BMI was determined using child weight and height measurements taken by a registered dietitian. Demographic characteristics were gathered using an 8-item standardized questionnaire adapted from Statistics Canada. Bivariate analyses were performed to determine associations with juice intake, BMI category, and child, parental, and family characteristics. Almost one quarter (23.6%) of the preschoolers were at risk of being overweight or were overweight, 73.2% were within the normal range, and 3.1% were underweight. Overall, 88.1% of the children consumed 100% fruit juice during the intake period, with a mean intake of 210 ± 183.1 mL/d. Fifty-seven percent consumed more than 125 mL/d of fruit juice, and 31.1% consumed more than 250 mL/d, whereas US recommendations limit intake to 125 to 175 mL/d. No significant differences were seen in fruit juice intake among the BMI categories or with selected child, parental, or family characteristics. Consuming 100% fruit juice does not appear to be associated with preschoolers' BMI, but further longitudinal research is needed in larger, more diverse groups to confirm this finding. Meanwhile, increased parent education around appropriate beverage intake, including fruit juice, is warranted.

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Economy of Collaborative Nutrition

Heller, L. — Tue, 07 Apr 2009 14:55:17 PDT

Feeding Regimens and Catch-Up Growth in Premature and Full-Term Small for Gestational Age Infants

Funkquist, E.-L., Tuvemo, T., Jonsson, B., Serenius, F., Nyqvist, K. H. — Tue, 07 Apr 2009 14:55:17 PDT

The aim of this study was to evaluate the growth of infants born small for gestational age (SGA) as a result of 2 different feeding regimens during their hospital stay. A retrospective chart review was performed at 2 hospitals to assess the growth of 42 SGA infants (gestational age: median 37 weeks; range, 30-41 weeks) from birth up to 18 months corrected age. At one hospital, infants were fed according to a proactive nutrition regimen stipulating 200 mL milk/kg per day from day 2 to achieve better weight gain. At the other hospital, milk volumes were gradually increased to 170 mL/kg per day by day 9. Infants fed according to the proactive regimen had lower weight loss and regained their birth weight earlier but did not show better catch-up growth subsequently. The premature SGA infants (n = 20) showed catch-up growth before 40 weeks postmenstrual age. The lower the gestational age at birth, the less negative standard deviation score for length up to a corrected age of 18 months. Although infants fed according to a proactive regimen with liberal volumes of milk during the first days had lower weight loss and regained their birth weight earlier, no evidence was found that this would result in a different pattern of growth in later life.

Prevention and Treatment of Tube Dependency in Infancy and Early Childhood

Tue, 07 Apr 2009 14:55:17 PDT

Tube dependency is recognized as an unintended result of long-term tube feeding in infants and young children. The condition involves disturbing side effects such as vomiting, gagging, and active food refusal. It prevents infants from making the transition from tube to oral feeding and from starting to learn to eat in the absence of any medical indication for continuation of enteral feeding. Tube dependency can have a destructive impact on the child's development, even in cases when the nutritional influence might be beneficial. The authors set up recommendations for the prevention of tube dependency and suggest guidelines for weaning tube-dependent children based on the results of the Graz program and satellite programs using a similar model. A sample of 221 tube-dependent patients aged 4 months to 15 years of age provided the clinical study group on which this article is based. Begun in 1987, a comprehensive tube-weaning program was developed on the basis of clinical experience and encounters with more than 430 tube-dependent children in 20 years, resulting in a success rate of 78/81 (96% for 2007) and 79/84 (94% for 2008). Placement must be preceded by clear criteria and a decision as to the indicated nutritional goal and time of use. The placement of a temporary tube must generate a plan covering maintenance issues, including time, method, and team for weaning. Aspects of tube feeding that go beyond purely medical and nutritional issues need to be considered to minimize the frequency and severity of unintended tube dependency in early childhood.

The Use of Thickening Agents in the NICU

VanDahm, K., Kern, S., Rosoff, J. — Tue, 07 Apr 2009 14:55:17 PDT

Synbiotic Therapy Improves Quality of Life and Reduces Symptoms in Pediatric Ulcerative Colitis

Haskey, N., Dahl, W. J. — Tue, 07 Apr 2009 14:55:17 PDT

The management of ulcerative colitis in children often requires aggressive pharmacological therapy or colonic resection. The authors hypothesized that synbiotic therapy would improve symptoms and quality of life in children diagnosed with ulcerative colitis. Pediatric study participants (8-18 years; n = 9) with ulcerative colitis in remission were provided synbiotic therapy (Bifidobacterium longum R0175 20 billion cfu/d, 15 g/d of inulin; n = 4) or placebo (maltodextrin + ascorbic acid capsule; 15 g/d of non-resistant maltodextrin; n = 5) for 10 months in a pilot study (phase I). At 10 months, the study was unblinded and synbiotic therapy was administered to 8 pediatric study participants (phase II). Quality of life was measured using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). The SIBDQ was administered at baseline and every 2 months. Study participants kept a daily record of symptoms. Phase I quality-of-life scores were significantly better for those receiving the synbiotic therapy versus the placebo (P = .014). Severe symptoms occurred in 60% of the control study participants, whereas no study participants receiving synbiotic therapy experienced severe symptoms (P = .032). Phase II quality-of-life scores were significantly better posttreatment with synbiotic therapy (P = .034). No adverse effects were reported. Synbiotic therapy (B longum R0175 + inulin), when provided in addition to conventional treatment, appears to be a safe and effective strategy for managing pediatric ulcerative colitis in remission.

The Case of the Wretched Retcher

Cook, R. C., Blinman, T. A. — Tue, 07 Apr 2009 14:55:17 PDT

Fundoplication is an effective treatment for severe gastroesophageal reflux disease (GERD) because it provides a mechanical solution to what is essentially a mechanical, not a medical, problem. However, manifestations of feeding intolerance postfundoplasty are well known and include dysphagia, gastric dysfunction, retching, gagging, intestinal dysfunction, and gas bloat syndrome. These difficulties are exacerbated by feeding plans that disregard the mechanical constraints imposed by the operation, particularly limited gastric volume, decreased gastric compliance, diminished ability to burp, sensitivity to osmolarity, and formula composition. These complications are preventable and treatable by informed construction of feeding plans that limit boluses (around 15 mL/kg/bolus), promote proper motility, manage intraluminal air, and limit polypharmacy. This case presentation describes a postfundoplasty infant with severe retching and intolerance treated according to these principles.

Nutritional Intervention to Prevent (NIP) Type 1 Diabetes A Pilot Trial

Tue, 07 Apr 2009 14:55:17 PDT

The objective of this study was to describe a pilot trial of using an omega-3 fatty acid (docosahexaenoic acid [DHA]) to prevent islet cell autoimmunity in infants with an increased risk for developing type 1 diabetes (T1D). Infants from pregnant mothers who either have T1D (or the father or a previous child has T1D) and who entered the study in the third trimester or infants younger than age 5 months having a first-degree family member with T1D were eligible for the study. Infants from either group also had to have an increased genetic (HLA) risk for T1D (or multiple first-degree relatives with T1D) to be eligible. The study is a multicenter, 2-arm, randomized, double-masked clinical trial that will last 4 years (1 year of recruitment and 3 years of treatment). Treatment with DHA (or control) began in the last trimester of pregnancy or in the first 5 months after birth. Inflammatory mediators, including cytokines, chemokines, eicosanoids, and C-reactive protein, are being measured along with fatty acids in maternal and infant blood. Ninety-eight infants were enrolled (41 during pregnancy and 57 in the 5 months after birth). HLA results of the 97 eligible infants (1 infant had a protective 0602 allele and was thus ineligible) showed that 90 have DR3 and/or DR4. Seven infants were enrolled without DR3/4 but who instead had multiple first-degree relatives with T1D. Compliance has been excellent, and no families have discontinued participation. Intervention trials in this high-risk group are feasible but require significant effort to identify potential participants.

Is Vitamin D Protective Against Development of Type 1 Diabetes Mellitus?

Zipitis, C. S. — Tue, 07 Apr 2009 14:55:17 PDT

The literature on vitamin D is expanding rapidly, and new associations with diseases are being described all the time. Many of these associations are derived from observational studies. Many question the importance of observations from such studies and call for a demonstration of effectiveness in what would be very long and expensive randomized controlled trials. This article focuses on the association between vitamin D and development of type 1 diabetes mellitus. Although randomized controlled trials are necessary for clarifying some aspects of intervention, this article demonstrates that the Hill criteria on causality are fulfilled and that randomization to no supplementation is in fact unethical.

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