Dietary intakes of junior schoolchildren self-isolating due to COVID-19

Optimal nutrition under the conditions of self-isolation in the existing epidemiological situation of the COVID-19 pandemic should to the full extent answer the nutrient requirements of children and have a preventive character. The objective of the work: to study the diets of junior schoolchildren who are learning from home during the COVID-19 restrictive measures. Patients and methods. The study included 7–10-year-old children (n = 50). Actual dietary intakes were assessed by 24-hour dietary recalls. Comparison of the qualitative and quantitative characteristics of the nutrient composition of the diets was based on the norms of the health regulations now in force. Results. The average energy values of children’s diets exceeded the physiological needs recommended during quarantine. The nutrient composition of the diets was imbalanced. Intake of total fats exceeded the physiological requirement by 21–48%, animal protein values approached the recommended daily allowances. Unbalanced intakes of phosphorus and calcium were noted. We also found insufficient intake by children of fish and seafood, eggs, milk and dairy products, vegetables, fruits, and juices. While sausage products, bread and pastry, pasta, noodles, sweets and sugar were present in diets in excess. Conclusion. The study has shown that the problems with organisation of schoolchildren’s nutrition have a persistent character, and they remain during a child’d self-isolation at home during the pandemic. Key words: rational nutrition, school children, self-isolation, COVID-19

Enteropathic acrodermatitis in children

Enteropathic acrodermatitis is a rare hereditary form of zinc deficiency, characterized by periorial and acral dermatitis, alopecia and diarrhea. Refers to congenital disorders of zinc metabolism, inherited as an autosomal recessive disease resulting from mutations in the gene for the zinc transporter SLC39A4. The prevalence ranges from 1 to 9:1,000,000, with an overall incidence of 1:500,000 newborns. The disease usually manifests itself in infancy, within a few weeks of stopping breastfeeding and switching the baby to a cow's milk-based formula, or in the first days of life if artificially fed from birth. The classical clinical manifestations of acrodermatitis enteropathic are characterized by the triad: acral and periofital dermatitis, alopecia and diarrhea, but all three signs together occur only in 20% of cases. Diarrhea may develop concurrently with skin symptoms, may precede or occur later. Characteristic signs of skin lesions include sharply demarcated, dry, scaly erythematous plaques or edematous foci with vesicles and pustules on the skin of the elbow and knee joints, distal extremities, genitals, in the inguinal folds, which are usually symmetrically distributed, have sharp boundaries and irregular outlines. The course of the skin syndrome is long, as it progresses, non-healing erosive and ulcerative areas appear. Plasma zinc deficiency is the gold standard for diagnosis. Most infants with AE have low plasma zinc concentrations (<500 mcg/L or <50 mcg/dl), but a level of less than 70 mcg/L on an empty stomach or less than 65 mcg/dl in older non-dieting children is considered diagnostically significant. Treatment for this disease usually includes enteral or parenteral zinc administration, at a dose of 1-3 mg/kg/day. for elemental zinc. A clinical response is observed within 5–10 days. Supportive zinc therapy is necessary throughout the patient's life, although periods of remission have been reported. Topical therapy is also used: Dexpanthenol in the form of a cream, applied 3 times a day in the area of dermatitis, can enhance re-epithelialization. There is no significant evidence of improvement with topical zinc application. No activity restrictions are required for patients with acrodermatitis enteropathic. Key words: zinc deficiency, enteropathic acrodermatitis, children

Dietary specificity in women engaged in intellectual work with low physical activity

Objective. Unbalanced nutrition of women of different age is one of the risk factors for developing chronic non-infectious diseases at early working age. The aim of the work was to study the nutrition of working-age women living in a large industrial centre, whose work patterns are characterized by a low level of physical activity. Patients and methods. A retrospective cross-sectional study included 282 women with low physical activity: group 1 – 18–39-year-olds (n = 176), group 2 – 40 years and older (n = 108). The computer program «Analysis of the state of human nutrition» (version 1.2, Institute of Nutrition RAMS 2003–2005) assessed the actual nutrition. Inter-group comparison of parameters was performed using the Mann–Whitney (U) test with the Benjamini–Hochberg correction. Results. The calorific value of the diets exceeded the norms (in group 1 by 1.1 times, in group 2 by 1.6 times) due to consumption of proteins and fats. Cholesterol intake was reduced in both groups (by 0.6–0.9 times, respectively). The proportions of dietary mono- and disaccharides exceeded the norm by 2 and more times in both groups, deficiency of dietary fiber was found in group 1 – 26.5%, in group 2 – 45% of normal. In both groups, a higher intake of sodium (by 2–3.5 times) and phosphorus (by 1.4–2 times) was found. Group 1 had a lower intake of Ca (by 1.4 times), Mg (by 1.6 times), vitamins B1 (by 1.8 times), B2 (by 1.5 times) and PP (by 1.8 times). In group 2, mineral and vitamin intake was significantly higher but insufficient as well. Conclusion. Women's diets are imbalanced toward the excess of the total caloric intake, the amounts of consumed proteins and fats, sodium, potassium, phosphorus; insufficient intake of dietary fiber, Ca, Fe, and some vitamins, which is a serious risk factor for the development of chronic non-infectious diseases and should be taken into account in treatment and prevention programmes implemented at younger ages.

Vitamin D deficiency: a pandemic of the 21st century. Problems of standardization of diagnosis of vitamin D deficiency

Vitamin D deficiency is a noninfectious pandemic of the 21st century. Vitamin D, apart from its role in phosphorus-calcium metabolism, is vital for functioning of all organs and systems, and its deficiency is a risk factor of developing aging-associated extraskeletal diseases. Vitamin D deficiency is a multifactor process related to a decreased synthesis of endogenous cholecalcipherol, insufficient intake of exogenous vitamin D and its disordered metabolism. Improvement of the effectiveness of therapeutic and preventive measures for management of vitamin D deficiency is impossible without accurate laboratory diagnosis. Immunochemical methods (radioactive, enzymatic and chemiluminescent) overestimate the 25(ОН)D levels, a benchmark test for vitamin D status assessment is a high performance liquid chromatography tandem–mass spectrometry. In order to reduce the risk of socially significant diseases the adequate 25(ОН)D levels should be not less than 40 ng/mL (100 nmol/L). Key words: vitamin D, vitamin D deficiency, liquid chromatography tandem–mass spectrometry

Somatometric parameters of schoolchildren of the Yamal-Nenets Autonomous Area: results of a cohort study

Objective. To study the specificity of physical development of children, who live in the extreme weather conditions of the North. Materials and methods. We examined schoolchildren belonging to the non-indigenous population of the Yamal-Nenets Autonomous Area. The study included 1424 schoolchildren (751 boys and 673 girls) aged 7 to 16 years living in the gas-andoil producing districts of the area for not less than 3 years. In the course of the study, after measurements of the body height and weight of children in each age-gender group, the arithmetic mean and its standard error were calculated for both somatometric parameters. We performed a comparative analysis of the parameters and the standard reference values of the «WHO Growth Reference 2007» and the results of examination of children belonging to the indigenous population indicated in the literature. Discussion. We have found that during the period of intensive growth, the body height of representatives of the nonindigenous population is higher than that of their same-age peers from the indigenous population. But the definitive indicators of body height have no statistically significant difference. Conclusions. The body height values of the examined children do not significantly differ from the WHO standards, therefore, the «WHO Growth Reference 2007» and the «WHO Anthro» anthropometric calculator can be used in regular medical checkups of schoolchildren. The values of schoolchildren’s body weight are higher than the WHO standards, which necessitates a deeper analysis of the nutrition and physical activity of children. Key words: physical development, schoolchildren, children, non-indigenous population of North

Influence of TCF7L2 gene polymorphisms on the effectiveness of various variants of antihyperglycaemic therapy in patients with type 2 diabetes

Single nucleotide polymorphisms of the TCF7L2 gene demonstrate the strongest association with the risk of developing type 2 diabetes, linking its effects to changes in insulin secretion. The mechanism of action of hypoglycaemic drugs used in treatment of type 2 diabetes is, to a certain extent, related to their influence on the function of β-cells, which implies that variants of the TCF7L2 gene will affect the therapeutic effect of certain anti-hyperglycaemic drugs, including the variability in the effects of incretin-based therapy, and sulphonylurea derivatives. Along with the direct influence of the TCF7L2 gene on the function of β-cells, there is evidence of the effects of TCF7L2 gene polymorphism on the susceptibility to external risk factors associated with the development of type 2 diabetes, including the alimentary factors. Pharmacogenetic studies in diabetology have at present the greatest potential in terms of selection of the optimal comprehensive anti-hyperglycaemic therapy based on preliminary genetic testing, which might improve the outcomes of treatment and the prognosis for the course of type 2 diabetes, reducing the number of life-threatening complications. Key words: GPP-1 agonists, TCF7L2 gene, metformin, nutrition, type 2 diabetes, sulphonylureas

Autoimmune enteropathy

Autoimmune enteropathy (AIE) is a rare disease characterised by severe diarrhoea and immune-mediated damage of the intestinal mucosa. The objective: based on analysis of modern literature to describe the diagnostic criteria, etiology, pathogenesis, epidemiology, clinical features and treatment of AIE in children. Results. The diagnostic criteria of AIE include chronic diarrhoea (lasting more than 6 weeks), malabsorption syndrome, specific histological findings of small intestine biopsy when other causes of villous atrophy are excluded. An additional criterion is the presence of antibodies against enterocytes or goblet cells. The following types are singled out: (1) AIE associated with such syndromes as IPEX and APECED; (2) an isolated form of GI AIE with the presence of anti-enterocyte antibodies without diseases of the digestive system; and (3) any form of AIE in girls associated with any other autoimmune phenomena. At present, not less than five subtypes of AIE are known: Primary AIE (paediatric); Syndromal AIE (paediatric); Primary (sporadic) adult ОВОС AIE; Secondary (iatrogenic) adult AIE; Paraneoplastic AIE. Patients with AIE might have associated autoimmune diseases, including diabetes mellitus, autoimmune hepatitis, alopecia, hypothyroidism, and interstitial nephritis. AIE is a complex and potentially life-threatening disease, with the mortality rates reaching 30% in paediatric practice. The prognosis depends on the age of the disease onset, the severity of symptoms and histological lesions of the gastrointestinal tract. The use of therapy based on modern molecular biology technologies, along with nutritive support, immunosuppressive therapy, can help control the disease. Key words: autoimmune enteropathy, IPEX syndrome

Functional dyspepsia and dyspepsia associated with Helicobacter pylori infection

The article presents algorithms for diagnosing and treatment of patients with H. pylori associated dyspepsia and functional dyspepsia. The importance of testing all patients with dyspepsia for H. pylori infection is emphasized, since H. pylori status has an impact on both therapy and prognosis of disease. Dyspepsia in H. pylori-positive patients is regarded as secondary, associated with H. pylori, and this cohort of patients undergoes anti-Helicopacter therapy. Dyspepsia in H. pylori-negative patients is regarded as functional dyspepsia, if there are relevant diagnostic criteria, and this cohort of patients receives treatment with antisecretory and prokinetic drugs, as well as psychopharmacological medications. Key words: Helicobacter pylori, functional dyspepsia

Pseudo-allergy to foods or adverse reaction to histamine in foods? Problems of diagnosis and correction

The article provides a review of the literature devoted to the study of food intolerance, which frequency is increasing all over the world every year. Establishing the cause of food intolerance as an allergic reaction allows effective therapy and significant improvement the quality of life of patients. However, sometimes it is not possible to identify the offending food that causes discomfort after eating it. This type of intolerance is not detected immediately and is difficult to treat, which leads to the chronic gastrointestinal tract disorders, dermatitis. The so-called "non-allergic adverse food reactions" are of great interest. However, these reactions have not been sufficiently studied and are presented more often as histamine intolerance. Numerous studies in recent years have shown the ambiguity of this problem, which is associated with the development of food reactions with the participation of specific and pseudo-allergic reactions, when provoking non-allergenic factors become full-fledged antigens. So far, no evidence-based laboratory diagnostic methods have been developed to determine risk factors for the occurrence of intestinal dysfunction, as well as the dose of histamine in food that cause the pharmacological effects of histamine exposure. A significant contribution to the study of the problem of pseudo-allergic food intolerance was made by the German guideline for the management of adverse reactions to ingested histamine (2017), framework of which is outlined in the article. Key words: histamine, diamine oxidase, diet, intolerance, foods, pseudo-allergy

Iron metabolism in obese children and adolescents

The review presents new data about the causes and molecular mechanisms of iron metabolism in obesity. Obesity is associated with dysregulated iron metabolism. Three hypotheses of the hypoferremia of obesity have been proposed: nutrition hypothesis, large blood volume hypothesis, and the inflammation hypothesis. The latter has been better supported, it is consistent with the data about low-grade inflammation taking place in excessive accumulation of adipose tissue. The key role in the development of functional hypoferremia belongs to the hepcidin-leptin association. Key words: children, iron deficiency anaemia, iron metabolism, obesity, adolescents