Uso específico de ISCI durante a nutrição enteral noturna em criança com diabetes tipo 1, tireoidite de Hashimoto e síndrome de Down

The management of insulin therapy in diabetic patients who have comorbidities that involve nutritional aspects, is a major challenge for diabetes care teams. In diabetic patients with compromised nutritional status, artificial nutrition, both enteral or parenteral, may help in the treatment of chronic and acute diseases, leading to better and faster recover of the health status but, if not adequately associated with insulin therapy, it may negatively affect blood glucose levels and lead to poorer metabolic control. In particular, evidence-based recommendations for the treatment of diabetic patients during enteral nutrition therapy are not currently available and, therefore, medical practices are often based on case reports, rather than outcomes of research. We report our experience with a diabetic patient receiving nocturnal enteral feeding due to comorbidities and malnutrition, who was followed up at our centre and precociously treated with continuous subcutaneous insulin infusion after the onset of type 1 diabetes. There is great need for adequately powered randomized controlled trials to provide scientific evidence for the insulin treatment of diabetic patients undergoing enteral feeding

Use of donkey milk in infant feeding

There are still few literature about the role of donkey milk (DM) in human nutrition and increasing knowledge is crucial in order to provide practical advice for DM consumption. The aim of this study was to monitor nutritional quality, hygiene and health risks, and the impact of DM in the feeding of children with cow’s milk protein allergy (CMPA). DM was supplied by a farm located in central Italy, conforming with EU regulation 853/2004. Eighteen pasteurised milk samples (at 65 °C for 30min) were taken monthly. Pasteurised DM showed a total average viable count of 4332.22 CFU/mL (±3046.78), a slightly alkaline pH (7.12±0.17), a lactose percentage of 6.83±0.34, a total protein percentage of 1.63±0.19, while casein was 0.81%±0.11. Fat percentage (0.51±0.52) was lower compared to ruminant milk and about 48% of the total milk fatty acids were unsaturated. In addition, DM contained 7.52±2.49 g/100 g of fat of n3 linolenic acid. Eighty-one children with CMPA referred to the Allergy Unit of the Anna Meyer Children’s Hospital were recruited. They underwent to an allergological work-up including an oral food challenge (OFC) with DM; during the OFC the palatability of the milk was also evaluated. In children ≥3 years of age, DM palatability was assessed with a specific Wong-Baker modified pain scale, while in children <3 years of age it was assessed through the physician’s judgment. The results of the allergological work-up showed that DM did not caused allergic reactions in the 98.7% of patients, in addition, a good palatability of the milk was found. DM was included for six months in nutritional plans for 16 children with IgE-mediate CMPA (mean age of 20±18.4 months at the beginning of the study) and six with Food Protein-Induced Enterocolitis Syndrome (mean age of 5.33±1.75 months). The daily dose of DM varied from a maximum of 1000mL to a minimum 200– 250mL according to the age of the children. Given the low fat of DM, the diet of the children was supplemented with extra virgin olive oil (EVO) according to the age (from a minimum of 1.5 g of EVO and 1.5 g of Medium Chain Triglycerides vegetable oil in each 100mL of milk to a maximum of 8–10mL of EVO added to the daily meals). All the children that underwent to the nutritional plans were monitored twice (at the beginning and at the end of the study) for the auxological parameters. The results showed that DM did not change the normal growth rate of allergic children

Nutritional quality and the adequacy of donkey milk in the diet of allergic children

Recent investigations have shown that donkey milk (DM) can be considered hypoallergenic in cases of cow milk protein allergies (CMA) and that it has a high acceptance rate by the children. Since DM could represent a natural alternative for allergic babies, the aim of this study was to evaluate the nutritional quality and adequacy of DM in the feeding of children with IgE-mediate cow's milk protein allergy and Food Protein Induced Enterocolitis Syndrome. DM was supplied by a donkey farm from central Italy conforming with EU regulation 853/2004. Eighteen bulk milk samples were taken monthly and analysed for gross and mineral composition, fatty acid profile, and vitamin D content. After an allergological work-up, nutritional plans including DM were prepared for 22 allergic children referring to the Allergy Unit of Meyer Children Hospital of Florence (Italy). Fat and vitamin D supplementations were supplied according to the age of the children. The nutritional state of the babies was evaluated considering weight and length/stature at the beginning and the end of the study. The gains were calculated in terms of Z-score (Z=x-X/s.d.). Mean and s.d. of milk chemical composition were calculated, and Z-score values were analysed by t-test. Similarly, to human milk, lactose was 7.05±0.150%, and proteins were 1.59±0.137%, with caseins representing about 50% of the total protein. Fat and ash were 0.31±0.053% and 0.37±0.022%, respectively. Like human milk, calcium and potassium were the main minerals and were 633.31±137.440 and 653.32±69.21 mg/L respectively, while zinc content was 3.16±1.500 mg/L. Unsaturated fatty acids were 48 g/100g of fat (Table 1). In addition, DM was richer in n3 linolenic acid (7.52±2.49 g/100g of fat) and vitamin D (1.97±0.454 μg/100ml), than both human and cow milk. The infants increased in weight and length/stature similarly to the reference population. In conclusion, DM was found to be nutritionally adequate using supplementations according to the age of the children. Further investigations in the field of farming techniques and genetic improvement of dairy donkeys are still ongoing. Table 1. Classes of fatty acids and unsaturated fatty acid profile of donkey’s milk (g/100g of fat) Fatty acid Mean s.d. Fatty acid Mean s.d. C14:1 0.40 0.114 CLA c9. t11 0.07 0.045 C15:1 0.17 0.098 C20:1 0.13 0.090 C16:1 3.86 0.840 C20:2 0.13 0.066 C17:1 0.40 0.098 C20:3n3 0.21 0.060 C18:1 t-9 0.04 0.004 C20:3 n6 0.07 0.061 C18:1 t-11 0.05 0.035 C22:1 0.25 0.052 C18:1 c-9 21.58 2.904 C20:4n6 0.07 0.035 C18:1 c-11 1.08 0.273 C22:2 0.10 0.087 C18:2 t-9.12 0.08 0.066 C20:5 0.07 0.060 C18:2 c-9.12 11.18 1.904 C24:1 0.06 0.070 C18:3n3 7.52 2.494 C22:5 0.10 0.084 C18:3 n6 0.13 0.078 C22:6 0.05 0.041 SCFA (≤C10) 11.97 2.131 SFA 52.17 3.987 MCFA(≥C11≤C17) 42.93 4.155 MUFA 28.05 3.487 LCFA(≥C18) 45.10 3.731 PUFA 19.79 2.433 n3/n6 0.72 0.274 UFA/SFA 0.93 0.141 SCFA: short-chain fatty acids (from C4:0 to C10:0); MCFA (from C11:0 to C17:0): medium-chain fatty acids; LCFA (from C18:0 to C24:0): long-chain fatty acids; SFA: saturated fatty acids; MUFA: monounsaturated fatty acids; PUFA: polyunsaturated fatty acids; UFA=unsaturated fatty acids; s.d.=standard deviatio

Italian pediatric nutrition survey

Introduction the prevalence of malnutrition in children and its impact on clinical outcomes is underrecognized by clinicians in Italy as well as worldwide. A novel definition of pediatric malnutrition has been recently proposed by a working group of the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), based on the correlation between illness and the use of zscores of anthropometric measurements. Aim to investigate the prevalence of malnutrition and related nutritional support among hospitalized children in Italy, in a nationwide survey performed in a single day (16/4/2015). Methods an open access website (http://nday.biomedia.net) was used to collected data from 73 hospitals and 101 wards in 14 Italian regions (1994 patients). Anonymous information was collected on hospitals' characteristics, patient's anthropometry, admission diagnosis, presence of chronic diseases and use of nutritional support: oral nutritional supplements (ONS), enteral nutrition (EN) or parenteral nutrition (PN). Z-scores of anthropometric measurements, calculated with Epi Info 7.1.5, defined nutritional status: wasting was identified by BMI or Weight-for-Length z-score (<−1 mild, <−2 moderate, <−3 severe), stunting by Height-for-Age Z-score <−2. WHO 2006 and CDC 2000 growth charts were used respectively for children younger and older than 2 years old. Results 1790 complete records were obtained for hospitalized patients aged 0–20 years, with median age 6.16 (0.1–20 years and 53.3% males). 52.9% were aged 0–6 years and 58.8% of children suffered from chronic diseases. Wasting was detected in 28.7% of the total sample with higher occurrence observed in age ranges 0–6 and 14–20 years, while 17.3% of patients showed stunting; surprisingly almost 27% of them were aged 0–2. A ranking of the admission diagnosis with the highest rate of malnutrition was complied. The prevalence of wasting was significantly (p < 0.005) higher amongst children with chronic diseases (34.1% vs. 27.1%); stunting prevalence tripled in patients with chronic disease (24.5% vs. 8.3%). Only 23.5% of malnourished children (17%, 25.6% and 36.7%, respectively mild, moderate and severe malnutrition) received nutritional support: 11.7% received oral nutrition supplements (ONS, modular or complete), 11.5% enteral nutrition (EN, 6.4% via nasogastric tube, 5.1% via gastrostomy) and 6.8 % received parenteral nutrition (PN); in some patients a combination of two. Nutritional support is more commonly used among stunting patients, 39.5% of children under treatment. Conclusion Malnutrition of any grade was observed in nearly 1/3 and stunting in 17% of the reported hospitalized children, and it is likely to be underrecognized as the nutritional support reached only a small part of the malnourished children

Italian pediatric nutrition survey

Introduction the prevalence of malnutrition in children and its impact on clinical outcomes is underrecognized by clinicians in Italy as well as worldwide. A novel definition of pediatric malnutrition has been recently proposed by a working group of the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), based on the correlation between illness and the use of zscores of anthropometric measurements. Aim to investigate the prevalence of malnutrition and related nutritional support among hospitalized children in Italy, in a nationwide survey performed in a single day (16/4/2015). Methods an open access website (http://nday.biomedia.net) was used to collected data from 73 hospitals and 101 wards in 14 Italian regions (1994 patients). Anonymous information was collected on hospitals' characteristics, patient's anthropometry, admission diagnosis, presence of chronic diseases and use of nutritional support: oral nutritional supplements (ONS), enteral nutrition (EN) or parenteral nutrition (PN). Z-scores of anthropometric measurements, calculated with Epi Info 7.1.5, defined nutritional status: wasting was identified by BMI or Weight-for-Length z-score (<â\u88\u921 mild, <â\u88\u922 moderate, <â\u88\u923 severe), stunting by Height-for-Age Z-score <â\u88\u922. WHO 2006 and CDC 2000 growth charts were used respectively for children younger and older than 2 years old. Results 1790 complete records were obtained for hospitalized patients aged 0â\u80\u9320 years, with median age 6.16 (0.1â\u80\u9320 years and 53.3% males). 52.9% were aged 0â\u80\u936 years and 58.8% of children suffered from chronic diseases. Wasting was detected in 28.7% of the total sample with higher occurrence observed in age ranges 0â\u80\u936 and 14â\u80\u9320 years, while 17.3% of patients showed stunting; surprisingly almost 27% of them were aged 0â\u80\u932. A ranking of the admission diagnosis with the highest rate of malnutrition was complied. The prevalence of wasting was significantly (p < 0.005) higher amongst children with chronic diseases (34.1% vs. 27.1%); stunting prevalence tripled in patients with chronic disease (24.5% vs. 8.3%). Only 23.5% of malnourished children (17%, 25.6% and 36.7%, respectively mild, moderate and severe malnutrition) received nutritional support: 11.7% received oral nutrition supplements (ONS, modular or complete), 11.5% enteral nutrition (EN, 6.4% via nasogastric tube, 5.1% via gastrostomy) and 6.8 % received parenteral nutrition (PN); in some patients a combination of two. Nutritional support is more commonly used among stunting patients, 39.5% of children under treatment. Conclusion Malnutrition of any grade was observed in nearly 1/3 and stunting in 17% of the reported hospitalized children, and it is likely to be underrecognized as the nutritional support reached only a small part of the malnourished children