Efficacy of Different Dietary Patterns in the Treatment of Functional Gastrointestinal Disorders in Children and Adolescents: A Systematic Review of Intervention Studies

Functional gastrointestinal disorders (FGIDs) are common in children and adolescents. In recent years, interest in the role of diet in the treatment of FGIDs has increased. Currently, interest focuses on the low-FODMAP diet (LFD), the fructose- or lactose-restricted diet (FRD or LRD), the gluten-free diet (GFD), and the Mediterranean diet (MD). In this review, we focus on the role of these dietary patterns in the FGIDs most commonly diagnosed in clinical practice, namely irritable bowel syndrome (IBS), functional abdominal pain (FAP), functional dyspepsia (FD), and functional constipation (FC). Fifteen clinical trials were systematically reviewed (both RCTs and single-arm clinical trials). We demonstrated the lack of high-quality intervention trials. Based on current evidence, low-FODMAP diet, LRD, FRD, and GFD have no place in daily clinical practice for the management of children and adolescents with FGIDs. Nevertheless, some patients with IBS or RAP may experience some benefit from the use of a low-FODMAP diet or FRD/LRD. Limited data suggest that MD may be promising in the management of FGIDs, especially in IBS patients, but more data are required to investigate the mechanisms of its protective effects

Knowledge of Dietitians on Gut Microbiota in Health—An Online Survey of the European Federation of the Associations of Dietitians (EFAD)

Explorations of current knowledge of dietitians about gut-health interconnection and the role of diet in gut microbiota manipulation are rather scarce in the literature. In this online survey we assessed the perceived and current knowledge of dietitians across Europe about gut microbiota and systemic health, nutrition as a modulator of the gut ecosystem, and the role of probiotics and prebiotics. Pre-graduate dietetic students and other professionals were also invited to participate. A total of 179 full responses were recorded (dietitians, n = 155), mainly from Southern and Western regions. Most participants (>78.0%) reported an average to good level of perceived knowledge, with significant positive correlations between perceived and current knowledge in all sections and overall (p for all p for all <0.05). In conclusion, this online survey shed some light on the current knowledge of dietitians across Europe about gut microbiota parameters, including dietary modulation, highlighting in parallel possible knowledge determinants. Potential areas for future educational efforts in this rather unexplored field were indicated

Association of vitamin A status with lung function in children and adolescents with cystic fibrosis

ABSTRACT Importance Vitamin A (or retinol) has considerable antioxidative and anti‐inflammatory attributes and it may have protective effects on the respiratory health of patients with cystic fibrosis (CF). This issue, however, remains controversial. Objective The purpose of the present study was to investigate the relationship between serum retinol levels (SRL) and force expiratory volume in 1 second (FEV1) in patients with CF. Methods All patients with pancreatic insufficiency attending the CF Department of “Agia Sofia” Children’s Hospital in Athens, Greece, aged 6 to 19 years during the 2012–2016 period, who could perform spirometry effectively, were included in the study. The impact of SRL on FEV1 was examined longitudinally and analyzed with generalized estimating equations. Results The study included 231 patients and 851 SRL measurements were performed. In 25 (3.2%) cases the SRL were below the 5th percentile of reference distribution; none was above the 95th percentile. The analysis showed that SRL was positively correlated with the FEV1 (P < 0.001). Interpretation In this sample of children and adolescents with CF, vitamin A deficiency was rare. Our results suggest a positive relationship between SRL and FEV1

A “healthy diet-optimal sleep” lifestyle pattern is inversely associated with liver stiffness and insulin resistance in patients with non-alcoholic fatty liver disease.

Objectives: Several lifestyle habits have been described as risk factors for non-alcoholic fatty liver disease (NAFLD). Given that both healthy and unhealthy habits tend to cluster, the aim of this study was to identify lifestyle patterns and explore their potential associations with clinical characteristics of individuals with NAFLD. Methods: One hundred-thirty-six consecutive patients with ultrasound-proven NAFLD were included. Diet and physical activity level were assessed through appropriate questionnaires. Habitual night sleep hours and duration of midday naps (siesta) were recorded. Optimal sleep duration was defined as sleep hours ≥7 and ≤9 hours/day. Lifestyle patterns were identified using principal component analysis. Results: Eight components were derived explaining 67% of total variation of lifestyle characteristics. Lifestyle pattern 3, namely high consumption of low-fat dairy products, vegetables, fish and optimal sleep duration was negatively associated with insulin resistance (β=-1.66, P=0.008) and liver stiffness (β=-1.62, P=0.05), after controlling for age, sex, BMI, energy intake, smoking habits, adiponectin and tumor necrosis factor-a. Lifestyle pattern 1, namely high consumption of full-fat dairy products, refined cereals, potatoes, red meat and high television viewing time was positively associated with insulin resistance (β=1.66, P=0.005), although this association was weakened after adjusting for adiponectin and tumor necrosis factor-a. Conclusion: A “healthy diet-optimal sleep” lifestyle pattern was beneficially associated with insulin resistance and liver stiffness, in NAFLD patients, independently of body weight status and energy intake.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Malnutrition in Hospitalised Children—An Evaluation of the Efficacy of Two Nutritional Screening Tools

Nutritional risk screening (NRS) is not yet established in many clinical settings. This study aimed to evaluate the efficacy of two NRS tools; the Paediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), compared to the global dietitians’ clinical judgment. The goal of this study was also to estimate the prevalence of nutritional risk in Greek paediatric patients. Overall, 1506 children, 1–16 years, from paediatric and surgical wards of two Greek hospitals were included. NRS was performed using PYMS and STAMP based either on World Health Organization (WHOGC) or Hellenic growth charts (HGC). The first 907 children were also referred to dietitians who categorized children in low, medium and high nutritional risk according to their global clinical judgment. PYMS, either based on WHOGC or HGC, showed better agreement with dietitians’ feedback (kPYMS_WHO = 0.47; 95%CI: 0.41–0.52, kPYMS_HGC = 0.48; 95%CI: 0.43–0.53) compared to STAMP (kSTAMP_WHO = 0.28; 95%CI: 0.23–0.33, kSTAMP_HGC = 0.26; 95%CI: 0.21–0.32). PYMS also showed the best diagnostic accuracy compared to STAMP in paediatrics and surgical wards separately. Moreover, the PYMS showed similar sensitivity to the STAMP (WHOGC: 82% vs. 84.4%), but a higher positive predictive value (WHOGC: 58.2 vs. 38.7). Using PYMS, high and medium malnutrition risk was observed at 14.9%, and 13.1% of children, respectively. Almost 28% of hospitalised children were at nutritional risk. Children in hospitals should be screened with effective and feasible NRS tools such as PYMS