Dietary elimination of children with food protein induced gastrointestinal allergy – micronutrient adequacy with and without a hypoallergenic formula?

Background: The cornerstone for management of Food protein-induced gastrointestinal allergy (FPGIA) is dietary exclusion; however the micronutrient intake of this population has been poorly studied. We set out to determine the dietary intake of children on an elimination diet for this food allergy and hypothesised that the type of elimination diet and the presence of a hypoallergenic formula (HF) significantly impacts on micronutrient intake. Method: A prospective observational study was conducted on children diagnosed with FPIGA on an exclusion diet who completed a 3 day semi-quantitative food diary 4 weeks after commencing the diet. Nutritional intake where HF was used was compared to those without HF, with or without a vitamin and mineral supplement (VMS). Results: One-hundred-and-five food diaries were included in the data analysis: 70 boys (66.7%) with median age of 21.8 months [IQR: 10 - 67.7]. Fifty-three children (50.5%) consumed a HF and the volume of consumption was correlated to micronutrient intake. Significantly (p <0.05) more children reached their micronutrient requirements if a HF was consumed. In those without a HF, some continued not to achieve requirements in particular for vitamin D and zinc, in spite of VMS. Conclusion: This study points towards the important micronutrient contribution of a HF in children with FPIGA. Children, who are not on a HF and without a VMS, are at increased risk of low intakes in particular vitamin D and zinc. Further studies need to be performed, to assess whether dietary intake translates into actual biological deficiencies

ОСОБЛИВОСТІ ПЕРОКСИДНОГО ОКИСНЕННЯ ЛІПІДІВ У СИРОВАТЦІ КРОВІ Й ГОМОГЕНАТАХ ТКАНИН ЩУРІВ ЗА УМОВ КОМБІНОВАНОГО ВПЛИВУ СТРЕСОВИХ ЧИННИКІВ

The aim of the work.&nbsp;To analyze the level of active products of thiobarbituric acid in blood and homogenate of rat tissues under the condition of stress factors and their combination.. Materials and Methods.&nbsp;The experiments were conducted on 54 white non-linear male rats weighing 200–220 g. Animals were divided into 5 groups: 1 – control group (n = 6), 2 – chronic exposure to tobacco smoke (n = 12), 3 – chronic black leaf tea intoxication (n = 12), 4 – chronic immobilization stress (n = 12), 5 – combined influence of stress factors (n = 12). The principle of determining the content of TBA-active products (TBA-AP) is based on the fact that at high temperature in acidic medium malonic dialdehyde reacts with thiobarbituric acid, forming a trimethin complex. Results and Discussion.&nbsp;Chronic exposure to tobacco smoke is accompanied by activation of lipid peroxidation, in particular, the maximum changes in the content of TBA-AP are observed in the lung homogenate (3.5 times), in chronic intoxication with black tea – in the myocardial homogenate (3.5 times), with immobility – in the stomach homogenate (2.9 times) relative to the control group. With the combined effect of stressors, more pronounced changes are observed relative to the isolated effect of each factor: in the heart (6.9 times), in the lungs (6.3 times), in the stomach (6.6 times) and in periodontium (in 5.1 times) relative to the control group. Conclusions.&nbsp;The combined effect of stressors causes the activation of free radical oxidation processes, which is characterized by changes in TBA reactants, in particular, more pronounced changes are observed relative to the isolated effect of each factor relative to the control group.Мета роботи.&nbsp;Проаналізувати рівень активних продуктів тіобарбітурової кислоти в крові й гомогенаті тканин щурів за умови дії стресових чинників та їх комбінації. Матеріали і методи.&nbsp;Досліди проведено на 54 білих статевозрілих нелінійних щурах-самцях масою 200–220 г. Тварин поділили на 5 груп: перша – контрольна група (n=6), друга – хронічний вплив тютюнового диму (n=12), третя – хронічна інтоксикація чорним листковим чаєм (n=12), четверта – хронічний іммобілізаційний стрес (n=12), п’ята – комбінований вплив стресових чинників (n=12). Принцип визначення вмісту ТБК-активних продуктів (ТБК-АП) ґрунтується на тому, що при високій температурі в кислому середовищі малоновий діальдегід реагує з тіобарбітуровою кислотою, утворюючи триметиновий комплекс. Результати й обговорення.&nbsp;Хронічний вплив тютюнового диму супроводжується активацією пероксидації ліпідів, зокрема максимальні зміни вмісту ТБК-АП спостерігали у гомогенаті легень (у 3,5 раза), при хронічній інтоксикації чорним чаєм – у гомогенаті міокарда (у 3,5 раза), при іммобілізаційному стресі – в гомогенаті шлунка (у 2,9 раза) відносно контрольної групи. За умови комбінованого впливу стресових чинників більш вираженими були зміни відносно ізольованого впливу кожного чинника: у серці (в 6,9 раза), у легенях (в 6,3 раза), у шлунку (в 6,6 раза) та у пародонті (в 5,1 раза) відносно контрольної групи. Висновки.&nbsp;Комбінований вплив стресових факторів зумовлює активацію процесів вільнорадикального окиснення, що характеризується змінами ТБК-реактантів, зокрема спостерігають більш виражені зміни відносно ізольованого впливу кожного чинника щодо контрольної групи

Histological findings in infants with Gastrointestinal food allergy are associated with specific gastrointestinal symptoms; retrospective review from a tertiary centre.

BACKGROUND: Gastrointestinal food allergy (GIFA) occurs in 2 to 4 % of children, the majority of whom are infants (85 % (OR > 5.67) of having abnormal histological findings compared to those without. Those with isolated PR bleeding or diarrhoea were associated with 74 % and 68 % probability (OR: 2.85 and 2.13) of an abnormal biopsy, respectively. Conversely, children presenting with faltering growth or reflux/vomiting showed any abnormal mucosal histology in only 50.8 % and 45.3 % (OR: 1.04 and 0.82) respectively. CONCLUSIONS: Food allergy may occur in very young children and is difficult to diagnose. Since endoscopy in infants has significant risks, stratification of decision-making may be aided by symptoms. At least one mucosal biopsy demonstrated an abnormal finding in around half of cases in this selected population. Infants presenting with diarrhoea, PR bleeding, urticaria and irritability are most likely to demonstrate abnormal histological findings

A randomized controlled trial of metformin on left ventricular hypertrophy in patients with coronary artery disease without diabetes:the MET-REMODEL trial

Aim We tested the hypothesis that metformin may regress left ventricular hypertrophy (LVH) in patients who have coronary artery disease (CAD), with insulin resistance (IR) and/or pre-diabetes. Methods and results We randomly assigned 68 patients (mean age 65 ± 8 years) without diabetes who have CAD with IR and/or pre-diabetes to receive either metformin XL (2000 mg daily dose) or placebo for 12 months. Primary endpoint was change in left ventricular mass indexed to height1.7 (LVMI), assessed by magnetic resonance imaging. In the modified intention-to-treat analysis (n = 63), metformin treatment significantly reduced LVMI compared with placebo group (absolute mean difference −1.37 (95% confidence interval: −2.63 to −0.12, P = 0.033). Metformin also significantly reduced other secondary study endpoints such as: LVM (P = 0.032), body weight (P = 0.001), subcutaneous adipose tissue (P = 0.024), office systolic blood pressure (BP, P = 0.022) and concentration of thiobarbituric acid reactive substances, a biomarker for oxidative stress (P = 0.04). The glycated haemoglobin A1C concentration and fasting IR index did not differ between study groups at the end of the study. Conclusion Metformin treatment significantly reduced LVMI, LVM, office systolic BP, body weight, and oxidative stress. Although LVH is a good surrogate marker of cardiovascular (CV) outcome, conclusive evidence for the cardio-protective role of metformin is required from large CV outcomes trials

Phenotypic and genotypic characterisation of inflammatory bowel disease presenting before the age of 2 years

OBJECTIVES: Inflammatory bowel disease presenting in early childhood is extremely rare. More recently, progress has been made to identify children with monogenic forms of IBD predominantly presenting very early in life. In this study, we describe the heterogeneous phenotypes and genotypes of patients with IBD presenting before the age of two years and establish phenotypic features associated with underlying monogenicity. METHODS: Phenotype data of 62 children with disease-onset before the age of two years presenting over the last 20 years were reviewed. Children without previously established genetic diagnosis were prospectively recruited for next-generation sequencing. RESULTS: 62 patients (55% male) were identified. The median disease-onset was three months of age [IQR: 1 to 11]. Conventional IBD classification only applied to 15 patients with Crohn's disease-like (24%) and three with ulcerative colitis-like (5%) phenotype. Forty-four patients (71%) were diagnosed with otherwise unclassifiable IBD. Patients frequently required parenteral nutrition (40%), extensive immunosuppression (31%), hematopoietic stem-cell transplantation (29%) and abdominal surgery (19%). In 31% of patients underlying monogenic diseases were established (EPCAM, IL10, IL10RA, IL10RB, FOXP3, LRBA, SKIV2L, TTC37, TTC7A). Phenotypic features significantly more prevalent in monogenic IBD were: consanguinity, disease-onset before the 6(th) month of life, stunting, extensive intestinal disease and histological evidence of epithelial abnormalities. CONCLUSION: IBD in children with disease-onset before the age of two years is frequently unclassifiable into Crohn's disease and ulcerative colitis, particularly treatment resistant and can be indistinguishable from monogenic diseases with IBD-like phenotype