Dietary supplementation with multiple micronutrients: No beneficial effects in pediatric cystic fibrosis patients

AbstractBackgroundCystic fibrosis (CF) patients are subjected to increased oxidative stress due to chronic pulmonary inflammation and recurrent infections. Additionally, these patients have diminished skeletal muscle performance and exercise capacity. We hypothesize that a mixture of multiple micronutrients could have beneficial effects on pulmonary function and muscle performance.MethodsA double-blind, randomized, placebo controlled, cross-over trial with a mixture of multiple micronutrients (ML1) was performed in 22 CF patients (12.9±2.5 yrs) with predominantly mild lung disease. Anthropometric measures, pulmonary function, exercise performance by bicycle ergometry, muscular strength and vitamins A and E were determined.ResultsAnalysis was performed using the paired Student t-test comparing the change in each parameter during ML1 and placebo. Plasma vitamin E and A levels increased during ML1 when compared to placebo. However, no significant difference between the effect of the ML1 or placebo was observed neither for FEV1, FVC, anthropometry, nor for the parameters for muscle performance.ConclusionsThe micronutrient mixture was not superior to placebo with respect to changes in pulmonary function or muscle performance in pediatric CF patients, despite a significant increase in plasma vitamin E concentrations

Differences in management of eosinophilic esophagitis in Europe : an assessment of current practice

Objectives:The aim of the study was to assess differences in the diagnosis and management of eosinophilic esophagitis (EoE) by European pediatric (PG) and adult gastroenterologists (AG), and their self-reported adherence to guidelines. Methods:A multiple-choice questionnaire gauged the diagnostic and management strategies of gastroenterologists treating children or adults in 14 European countries and the United Arab Emirates (UAE). Results:Questionnaires were completed by 465 PG and 743 AG. PG were significantly more likely to take biopsies in patients with symptoms of esophageal dysfunction (86.2% PG vs 75.4% AG, P<0.001) and to perform endoscopic follow-up (86.3% PG vs 80.6% AG, P<0.001). After failure of proton-pump inhibitors (PPIs), topical steroids were the preferred second-line therapy; however, PG opted more frequently for elimination diets (47.5% PG vs 13.7% AG, P<0.001). More PG than AG indicated having read recent guidelines (89.4% PG vs 58.2% AG, P<0.001). Geographic differences in practice were reported, with respondents from the United Kingdom, Portugal, and Spain more often adhering to recommended biopsy protocols. Physicians in the UAE, France, Lithuania, and Poland tended to opt for steroid therapy or elimination diets as first-line therapy, in contrast to most other countries. Conclusions:Significant differences in general practice between PG and AG were demonstrated with notable divergence from consensus guidelines. International practice variations are also apparent. Among other strategies, educational activities to highlight current recommendations may help harmonize and optimize clinical practice

Serum proteomics reveals hemophagocytic lymphohistiocytosis-like phenotype in a subset of patients with multisystem inflammatory syndrome in children

Children with Multisystem Inflammatory Syndrome in Children (MIS-C) can present with thrombocytopenia, which is a key feature of hemophagocytic lymphohistiocytosis (HLH). We hypothesized that thrombocytopenic MIS-C patients have more features of HLH. Clinical characteristics and routine laboratory parameters were collected from 228 MIS-C patients, of whom 85 (37%) were thrombocytopenic. Thrombocytopenic patients had increased ferritin levels; reduced leukocyte subsets; and elevated levels of ASAT and ALAT. Soluble IL-2RA was higher in thrombocytopenic children than in non-thrombocytopenic children. T-cell activation, TNF-alpha and IFN-gamma signaling markers were inversely correlated with thrombocyte levels, consistent with a more pronounced cytokine storm syndrome. Thrombocytopenia was not associated with severity of MIS-C and no pathogenic variants were identified in HLH-related genes. This suggests that thrombocytopenia in MIS-C is not a feature of a more severe disease phenotype, but the consequence of a distinct hyperinflammatory immunopathological process in a subset of children.</p

Nutrition in Cystic Fibrosis: Macro- and Micronutrients

Cystic fibrosis (CF) is the most common life-threatening autosomal recessive inherited disease in Caucasians, and is characterized by progressive lung disease, pancreatic insufficiency, malnutrition, hepatobiliary disease and elevated sweat electrolyte levels. The increased survival of CF patients during the past 20 years is the result of optimal nutrition, aggressive use of antibiotics, meticulous physiotherapy and exercise programs, and a better understanding of the disease. This thesis aimed to investigate the effect of exercise and nutrients on the physical condition of pediatric patients with cystic fibrosis. Chapter 1: Effects of anaerobic training in children with cystic fibrosis. Aerobic exercise programs have shown inconsistent effects on pulmonary function and suboptimal compliance. We found that high-intensity anaerobic training, mimicking children's natural activity pattern and containing the necessary variation, could enhance anaerobic and aerobic performance, and improve health-related quality of life in children with mild-to-moderate CF. Chapter 2: Short-term protein intake and stimulation of protein synthesis in stunted children with cystic fibrosis. Nutritional strategies in CF focus primarily on high-energy and high-fat intake, but not on optimal protein intake. The current recommendations of 1.0-1.5 g protein/kg/d, might be suboptimal, since a portion of the CF patients are stunted, and chronic inflammation and recurrent infections induce protein catabolism. Comparing 3 isoenergetic diets with different amounts of protein (1.5, 3 and 5 g protein/kg/d), we found a significantly higher whole-body protein synthesis in the group receiving the highest amount of protein. Chapter 3: Micronutrients Chronic pulmonary inflammation and infection combined with maldigestion and malabsorption cause oxidative stress. Chapter 3.1: Decreased Coenzyme Q10 concentration in plasma of children with cystic fibrosis. We found significantly diminished plasma concentrations of the lipid soluble antioxidant CoQ10, but a normal ratio between oxidized and reduced CoQ10, in CF patients with mild-to-moderate pulmonary disease. .Chapter 3.2: Dietary supplementation with multiple micronutrients mixture: no beneficial effects in pediatric cystic fibrosis. Since CF is characterized by both oxidative stress and poor exercise tolerance we investigated the effect of a mixture of multiple micronutrients (ML1) with either antioxidant and/or muscle fortifying action. We found no beneficial effects on either pulmonary function or anaerobic and aerobic muscle performance in pediatric cystic fibrosis patients compared to placebo. Chapter 4.1: Abnormal mechanical and energetic properties of skeletal muscle in a mouse model of cystic fibrosis. CF patients often demonstrate altered skeletal muscle performance and exercise intolerance. We found evidence of intrinsic abnormality in fast-twitch extensor digitorum longus (EDL) and slow-twitch soleus (SOL) muscles in a transgenic mouse, with a C57BL/6 background and the δF508 mutation, as compared to wildtype. A significantly lower absolute, but significantly higher specific isometric force (force per gram muscle) of twitch contraction was seen. Chapter 4.2: Influence of micronutrients on the contractile properties of skeletal muscle in a mouse model of cystic fibrosis. We could positively influence the 'altered' mechanical muscle performance in superfused, intact, fast-twitch EDL muscle of both wild-type FVB and transgenic FVB/ δF508 mice by direct administration of CoQ10, but not of vitamins B2 or E, nor a mixture of α-lipoic acid and acetylcarnitine

Helicobacter heilmannii gastritis caused by cat to child transmission

China - Shanghai, Whangpoo [Huangpu] River (upper) Soochow [Wusong] River (lower) junctureColorVolume 57, Page

Wheezing and infantile colic are associated with neonatal antibiotic treatment

Cohort studies have suggested that early life antibiotic treatment is associated with increased risk of atopy. We determined whether antibiotic treatment already in the first week of life increases the risk for atopic and non-atopic disorders. The INCA study is a prospective observational birth cohort study of 436 term infants, with follow-up of one year. 151 neonates received broad-spectrum antibiotics for suspected neonatal infection (AB+), versus a healthy untreated control group (N=285) (AB-). In the first year, parents recorded daily (non-) allergic symptoms. At 1 year, doctors-diagnoses were registered and a blood sample was taken (n=205). Incidence of wheezing in the first year was higher in AB+ than AB- (41.0% vs. 30.5%, p=0.026; aOR 1.56 (95%CI 0.99-2.46, p=0.06). Infantile colics were more prevalent in AB+ compared to AB- (21.9% and 14.4% p=0.048), antibiotic treatment was an independent risk factor for infantile colics (aOR 1.66 (95%CI 1.00-2.77) p=0.05). Allergic sensitization (Phadiatop >0.70kUA/L) showed a trend towards a higher risk in AB+ (aOR 3.26 (95%CI 0.95-11.13) p=0.06). Incidence of eczema, infections, and GP visits in the first year were similar in AB+ and AB-. Antibiotic treatment in the first week of life is associated with an increased risk for wheezing and infantile colics. This study may provide a rationale for early cessation of antibiotics in neonates without proven or probable infection. This article is protected by copyright. All rights reserve

Neonatal microbiota development and the effect of early life antibiotics are determined by two distinct settler types

The neonatal period, during which the initial gut microbiota is acquired, is a critical phase. The healthy development of the infant's microbiome can be interrupted by external perturbations, like antibiotics, which are associated with profound effects on the gut microbiome and various disorders later in life. The aim of this study was to investigate the development of intestinal microbiota and the effect of antibiotic exposure during the first three months of life in term infants. Fecal samples were collected from healthy infants and infants who received antibiotics in the first week of life at one week, one month, and three months after birth. Microbial composition was analyzed using IS-pro and compared between antibiotics-treated and untreated infants. In total, 98 infants, divided into four groups based on feeding type and delivery mode, were analyzed. At one week of age, samples clustered into two distinct groups, which were termed “settler types”, based on their Bacteroidetes abundance. Caesarean-born infants belonged to the low-Bacteroidetes settler type, but vaginally-born infants were divided between the two groups. The antibiotics effect was assessed within a subgroup of 45 infants, vaginally-born and exclusively breastfed, to minimize the effect of other confounders. Antibiotics administration resulted in lower Bacteroidetes diversity and/ or a delay in Bacteroidetes colonization, which persisted for three months, and in a differential development of the microbiota. Antibiotics resulted in pronounced effects on the Bacteroidetes composition and dynamics. Finally, we hypothesize that stratification of children's cohorts based on settler types may reveal group effects that might otherwise be masked