Alimentary factors affecting the formation of the nutritional status of school-age children

Objective. To reveal the dependence of the alimentary factor’s influence on the formation of nutritional status disorders in organized groups of school-age children. Patients and methods. A sample questionnaire and an anthropometric survey of 488 school children aged 8–9 years (group 1), 12–13 years (group 2) and 16–17 years (group 3) were conducted. Nutritional status was analyzed by anthropometric measurements using regional modified regression scales for the Samara Region. The analysis of the results obtained, including the risk of nutritional status disorders, was performed with the use of parametric statistical procedures. Results. Hot school meals were provided to 85.6% of pupils in grades 2–3, to 55.6% of sixth graders and 36.4% of pupils in the senior classes. A rational diet was revealed in 18.3% of cases in the junior school group and only in 7.0% of cases in group 3. The consumption of bread and bakery products, vegetables, fruits, milk, and dairy products increases by high school age. The frequency of fish and seafood consumption in most cases in each age group is limited to a few meals per month. Anthropometric studies showed a significant increase in the proportion of children with nutritional status disorders (underweight or overweight) between the ages of 12 and 17. Conclusion. The risk of nutritional status disorders in the examined children was due to the high frequency of consumption of bakery and confectionery products, decreased consumption of fruits and vegetables, and infrequent meals. Key words: school meals, regimen, nutritional structure, nutritional status

Enteral nutrition for pediatric Crohn’s disease: significance and basic principles

The characteristics of the diet traditionally recommended for Crohn’s disease often reduce patients’ consumption of essential nutrients. Therefore, an important role belongs to nutritional support with specialized formulas, the effectiveness of which has been proven both for inducing remission and optimizing the parameters of physical development and puberty, bone mineralization. Nutritional support should be provided for patients with newly diagnosed Crohn’s disease in the form of full enteral nutrition, and subsequently in remission, exacerbation, in the pre- and postoperative periods as an addition to the standard diet. Of particular interest is the CDED ModuLife program, which is based on a combination of enteral nutrition with specially selected foods aimed at reducing the activity of intestinal inflammation in Crohn’s disease. Key words: inflammatory bowel disease, Crohn’s disease, full enteral nutrition, partial enteral nutrition, enteral nutrition formulas

The role of vitamin D in the development of type 2 diabetes

Vitamin D plays an important role in decreasing the risk of developing type 2 diabetes by influencing calcium metabolism, thereby reducing β-cell dysfunction and preventing insulin resistance. The findings of research works are contradictory enough, although some of them demonstrated an inverse relationship between vitamin D levels and the incidence of type 2 diabetes. The article describes the biological mechanisms of relationships between vitamin D levels and type 2 diabetes, reviews the results of the studies conducted and summarizes the available data. Key words: vitamin D, type 2 diabetes mellitus, insulin resistance

Preparation for colonoscopy in children

A literature review deals with the strategies currently employed worldwide and in Russia to prepare for paediatric colonoscopy. The most common dietary regimens, types of medications and their dosage, bowel cleanout protocols in children are considered. The literature data comparing different methods of preparation to colonoscopy in children are presented. The problems associated with the use of certain methods of intestinal cleaning in paediatric practice are discussed, including the territory of the Russian Federation. Key words: colonoscopy, children, pediatrics, preparation

Relationship between cytological features of buccal epithelial cells and biochemical parameters in obese schoolchildren

Objective. To determine the relationship between metabolic parameters and cytological characteristics of the buccal mucosa in obese children. Patients and methods. An open cross-sectional case-control study included 78 schoolchildren aged 9 to 15 years, 44 of them were obese. We determined body mass index, lipid metabolism parameters (total cholesterol, high- and low-density lipoprotein cholesterol, apolipoproteins), and also cytological characteristics of buccal epithelial cells. Results. The number of buccal epithelial cells with condensed chromatin was by 10 times higher in obese children. A correlation was found between cholesterol concentrations and certain cytological parameters, but this correlation was statistically significant only in the pair “cholesterol – number of binucleated cells” (correlation coefficient 0.925, p = 0.05) in obese children and in the pair “total protein – binucleated cells” in practically healthy children. Conclusion. We confirmed the known data about specific characteristics of lipid metabolism in obese children that correlate with certain cytological parameters of the buccal mucosa, namely, an increased number of cells with chromatin condensation. This phenomenon is suggestive of activation of apoptosis in obese children. Keywords: buccal epithelial cells, obesity, schoolchildren, cholesterol

Vitamin D status in children with inflammatory bowel disease

Objective. To study vitamin D status in children with inflammatory bowel diseases (IBD) depending on the diagnosis, gender, age and a season of examination. Patients and methods. The study included 244 children (130 boys and 114 girls) aged 3 to 18 years. The patients were divided into 2 groups depending on the nosological form of disease: Crohn’s disease (CD) – 130 children, ulcerative colitis (UC) – 114 children. Blood vitamin D levels were determined by the method of competitive electrochemiluminescence. Results. Normal levels of vitamin D (>30 ng/ml) were found only in 11.1% of children with IBD (in 11.5% with CD and 10.5% with UC). Vitamin D status corresponded to deficiency levels in 65.9% of cases, of them 15.2% had deep deficiency (<10 ng/ml). Vitamin D status decreased with increasing age of the patients (ρ = -0.2686). No statistically significant differences were found in vitamin D levels that would be dependent on the season of examination, neither were they found in groups of patients with CD and UC. Conclusion. The study showed an extremely low vitamin D status in patients with IBD. The problem of assessing vitamin D levels in children with IBD and its monitoring as well as development of individual algorithms for supplementation remains topical. Key words: vitamin D, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, children

Features of very early-onset inflammatory bowel disease: the experience of the Federal Pediatric Center

Objective. To clarify the incidence of monogenic IBD-like diseases and the features of clinical course and response to therapy of major types of inflammatory bowel diseases (IBD) among children under the age of 6 with manifestation of the disease. Patients and methods. The study included 135 children under the age of 6 with manifestation of IBD; in the comparison group, there were 128 children after the age of 6 with manifestation of IBD (97 children with ulcerative colitis (UC) and 31 children with Crohn’s disease (CD)) who were observed for at least 1 year. All children underwent a standard examination, including calprotectin and antineutrophil antibodies testing, determination of activity by the Pediatric Ulcerative Colitis Activity Index (PUCAI) or the Pediatric Crohn’s Disease Activity Index (PCDAI), depending on the nosology. Children with the onset of IBD under 6 years of age underwent a genetic testing using Primary Immunodeficiency Panel by next-generation sequencing. All children were analyzed for efficacy of therapy during catamnestic observation. Results. It was revealed that in the study group the incidence of monogenic IBD-like diseases was 6.7%, of UC – 71.1%, of CD – 22.2%. Major types of IBD with very early onset differed little in their clinical, endoscopic and laboratory features from the forms with manifestation at an older age. In most cases, both CD (57%) and UC (71%) were characterized by low activity. Very earlyonset CD was characterized by isolated localization of the colon (53%, p = 0.037) and a non-stenotic and non-penetrating behaviour of the disease (60% of cases). The leading clinical symptoms were diarrhea (67%) and blood in the stool (63%, p = 0.04). Very early-onset UC was characterized by total lesion of the colon (84%, p = 0.001) and the development of anemia (48%, p = 0.01). Among children with very early-onset UC, the percentage of glucocorticosteroid-dependence and glucocorticosteroid-resistance was high, but anti-TNFα therapy was prescribed late. Conclusion. It is advisable to observe children with very early-onset IBD in federal multidisciplinary clinics, where there is experience in managing patients with this pathology. Key words: inflammatory bowel disease, very early onset, Crohn’s disease, ulcerative colitis, primary immunodeficiency, treatment, children

Therapeutic drug monitoring of adalimumab in inflammatory bowel disease in children

Objective. To evaluate the significance of therapeutic drug monitoring of adalimumab (ADA) concentration levels and antibodies to it in inflammatory bowel disease (IBD) in children. Patients and methods. In this study, 103 children with IBD (24 patients with ulcerative colitis (UC) and 79 with Crohn’s disease (CD)) aged 3–18 years were examined during maintenance therapy with ADA (100 mg/mL in 0.4 mL). Body weight, duration of disease and therapy, use of azathioprine (AZA), achievement of clinical and endoscopic remission, albumin levels, residual levels of ADA and antibodies to the drug, circulating cytokine levels in serum were assessed. Results. A significant decrease in ADA levels in children in the absence of clinical remission in CD (5.21 [3.32; 7.43] μg/mL in remission) and in UC (2.42 [0.42; 4.51] μg/mL, p = 0.001) was shown. A high-quality separation model for residual ADA levels for exacerbation/remission conditions for clinical and endoscopic activity for children with CD and UC was obtained through ROC-analysis. The minimum residual ADA levels for maintaining clinical remission in children with CD were 8.1 μg/mL and 10.5 μg/mL for mucosal healing. In children with UC, as well as in children weighing <40 kg, these levels were higher. The formation of antibodies to ADA was minimal; combination therapy with AZA showed no efficacy. Key cytokines correlating with ADA concentration were interleukins IL-6, -13, -31, -27, -9, and tumor necrosis factor-α. Conclusion. To improve the efficacy of ADA therapy in children with IBD, therapeutic drug monitoring should be performed, considering the nosology and body weight of the child, as well as the goal of therapy (clinical and endoscopic remission). Key words: inflammatory bowel disease, Crohn’s disease, ulcerative colitis, adalimumab, therapeutic drug monitoring, tumor necrosis factor-α, cytokine profile, azathioprine

A case report of a patient with isolated Crohn’s disease of the stomach

Crohn’s disease of the esophagus, stomach or duodenum is extremely rare and characterized by an aggressive disease course with a poor prognosis. Clinical symptoms of the upper gastrointestinal tract lesion are nonspecific, therefore esophagogastroduodenoscopy with biopsy is necessary for the differential diagnosis. Crohn’s disease of the stomach is characterized by a specific endoscopic finding – bamboo-joint-like appearance of gastric folds. Granulomatous inflammation in morphological examination of gastric biopsies in patients with Crohn’s disease is rare, therefore endoscopic finding is more pathognomonic. This article presents a clinical case of a patient with isolated Crohn’s disease of stomach, differential diagnosis and treatment approaches of the disease. Key words: Crohn’s disease, Crohn’s disease with lesions of the stomach, gastroprotective agents, proton pump inhibitors, endoscopic sonography

Probiotic fermented dairy products – food or medication?

One of the main strategies for preventing chronic diseases is a balanced diet from early childhood, with the inclusion of functional ingredients: dietary fiber, vitamins and vitamin-like compounds, minerals, polyunsaturated fatty acids, prebiotics and probiotics. A combined enrichment of fermented dairy products with prebiotics and probiotics contributes to the summation of their positive effective influence. Adding prebiotics and probiotics to the diet leads to the change in the intestinal microbiota composition towards a more balanced structure, thereby increasing the intestinal barrier function and the formation of optimal immune interactions. The most commonly used in human nutrition is a combination of bifidobacteria or lactobacilli with fructo-oligosaccharides in synbiotic products. It is important that the microorganisms are safe, stable in storage and able to survive in the gastrointestinal tract. The use of probiotic fermented dairy products has a positive impact on child health: it has anti-infectious and immunomodulatory effects, helps to normalize the gastrointestinal motility. These statements are confirmed by controlled studies in which children aged 8 to 18 months, recovering from acute respiratory disease, for which antibiotic therapy was prescribed, included in the diet drinking yoghurts enriched with Bifidobacterium lactis BB12 and inulin for 3 months. The inclusion of yoghurts in the children’s diet helped to normalize the intestinal microbiota composition after antibiotic therapy, as well as to strengthen the immune system by stimulating the synthesis of protective factors – secretory immunoglobulin A and lysozyme. Key words: fermented dairy products, child nutrition, probiotics, prebiotics, synbiotics, inulin, microbiota, functional foods, immune system, Bifidobacterium lactis BB12