Coeliac disease : prevention and improvement of care

Coeliac disease (CD) is an immune-mediated systemic disorder elicited by gluten in genetically susceptible individuals. The aim of this thesis was to investigate the influence of infant feeding on prevention and development of childhood CD (part 1) and to explore new strategies for improvement of care for CD children and young adults (part 2). In part 1, the European multi-centre randomized double-blind placebo-controlled dietary intervention-study in high-risk children (www.preventcd.com) is presented. Based on retrospective studies suggesting a ‘window of opportunity’ for primary prevention of CD, parents were advised to introduce gluten between 4–6 months of age. Our results show that this did not reduce the risk of CD by 3 years of age and contributed to a new European guideline stating that gluten may be introduced between age 4-12 months. Part 2 shows that physicians overestimate the CD specific health-related quality-of-life (HRQOL) of CD patients, supporting implementation of self-reported CD-specific HRQOL measurements during follow-up. Compared to traditional hospital visits for treated CD, E-health was cost-saving, satisfactory, and significantly improved the CD-specific HRQOL. As E-health requires a point-of-care test suitable for follow-up of treated CD, three different tests were compared with conventional ELISA and one was found to be suitable.Maag Lever Darm StichtingLUMC / Geneeskund

Thermal runaway and bistability in microwave heated slabs, cylinders, and spheres

This study analyzes the runaway of microwave (2450 MHz) heated slabs, cylinders, and spheres in free space. It is shown that the phenomenon can be described with an S-shaped response curve of steady-state temperature versus microwave power at any position within the sample. The analysis demonstrates that the direct influence of the temperature dependent loss factor in the absorption of electromagnetic energy is canceled by the attenuation constant. Runaway can be understood from the behavior of the waves within the sample. In foodstuffs the small decrease of the phase constant with increasing temperature causes resonance at certain temperature, which can be considered as the physical origin of runaway. So characteristic dimension of food samples have to be smaller than a quarter of the temperature dependent wavelength to prevent runaway. The investigation of a slab of alumina demonstrates that thermal runaway in ceramics with a dielectric loss factor exponentially increasing with increasing temperature is caused by the strongly increasing attenuation constant at high temperatures. This means that only relatively thick ceramic objects will not be damaged by the runaway. The physical and mathematical aspects of bistability are investigated for a system with a microwave power directly proportional to time.</p

The impact of human breast milk components on the infant metabolism

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Wheat oral immunotherapy was moderately successful but was associated with very frequent adverse events in children aged 6-18 years

Aim: This study investigated oral immunotherapy (OIT) for children aged 6-18 years with wheat allergies. Methods: Well-cooked wheat spaghetti was given to 100 children with wheat allergies every day for 17 weeks, increasing from 0.3 to 2000 mg of wheat protein, followed by three- and nine-month maintenance phases. Blood samples were taken before therapy and at follow-up visits. The study was carried out in 2009-2015 in four Finnish paediatric allergology units. Results: The children (67% male) had a mean age of 11.6 years (range 6.1-18.6), and 57 were using wheat daily 16 months after the initiation of therapy. Allergic symptoms occurred in 94/100 children: mild in 34, moderate in 36 and severe in 24. Specific immunoglobulin E (IgE) for omega-5-gliadin was significantly higher in patients who did not reach the target dose and were related to the intensity of reactions. Conclusion: The majority (57%) of children with wheat allergies could use wheat in their daily diet 16 months after the initiation of OIT, but 94/100 had adverse reactions and 60 were moderate or severe. Specific IgE to omega-5-gliadin may provide a biomarker for how much wheat can be tolerated and the intensity of the reactions to immunotherapy.Peer reviewe

Telephone clinic improves gluten-free dietary adherence in adults with coeliac disease: sustained at 6 months

Background: A gluten-free (GF) diet is the only treatment for coeliac disease (CD), non-adherence to the diet is associated with greater morbidity. The study aimed to examine the effect of a telephone clinic, designed to increase GF dietary knowledge and adherence, in adults with CD. Methods: A prospective study of 125 patients with histologically confirmed CD. Patients, not adhering to a GF diet (n=30), engaged in a personalised telephone clinic. Validated questionnaires were used to assess GF dietary adherence (Coeliac Disease Adherence Test; CDAT), knowledge of GF foods and CD-related quality of life (QoL). GF dietary adherence was assessed up to 12 months post telephone clinic. The control group completed the questionnaires only. Results: GF dietary adherence (CDAT) median scores significantly improved at 3 and 6 months after the telephone clinic compared with baseline (16, 13 and 13, respectively, p<0.01). Reassuringly, the dietary burden QoL score remained similar to baseline values. No change in CDAT scores were observed in the control group. Change in GF dietary knowledge score was associated with improved GF dietary adherence CDAT score (r=−0.22; p=0.039). At 9 and 12 months, CDAT scores were similar to baseline values. Conclusions: Telephone clinics have a positive impact on dietary knowledge and GF dietary adherence in adults with CD, promoting health-benefitting behaviours in those previously not adhering to a GF diet. The study highlights the need for patients to have regular follow-up, with targeted reviews for those not adhering to a GF diet

Numerical modelling of the microwave heating behaviour of lunar regolith

The field of In Situ Resource Utilisation (ISRU) is expanding rapidly with a particular focus on developing ISRU technologies and applications to support a longer-term surface exploration of the Moon. In this respect, microwave sintering is proposed to be one of the potential fabrication methods for developing a 3D printing technique for construction processes on the Moon. Thus, understanding the behaviour of lunar regolith, available at different locations on the Moon (e.g. mare versus highlands regions), under microwave heating is crucial for developing an optimal method for microwave sintering. As the availability of real lunar regolith on Earth is highly limited, developing an appropriate numerical model of microwave heating behaviour of lunar regolith is urgently required. In this paper, three representative lunar regolith samples (selected from the database of Apollo sample collections) with pre-defined material properties have been simulated under seven input powers and three specimen sizes. This paper discusses the outcomes of these simulations and the potential contribution of the model for developing a desired 3D printing technique utilising microwave sintering of lunar regolith

The impact of human breast milk components on the infant metabolism

Background & aims Breastfeeding is beneficial for mothers and infants. Underlying mechanisms and biochemical mediators thus need to be investigated to develop and support improved infant nutrition practices promoting the child health. We analysed the relation between maternal breast milk composition and infant metabolism. Methods 196 pairs of mothers and infants from a European research project (PreventCD) were studied. Maternal milk samples collected at month 1 and month 4 after birth were analysed for macronutrient classes, hormone, and fatty acid (FA) content. Phospholipids, acylcarnitines, and amino acids were measured in serum samples of 4-month old infants. Associations between milk components and infant metabolites were analysed with spearman correlation and linear mixed effect models (LME). P-values were corrected for multiple testing (P-LME). Results Month 1 milk protein content was strongly associated with infant serum lyso-phosphatidylcholine (LPC) 14: 0 (P-LME = 0.009). Month 1 milk insulin was associated to infant acetylcarnitine (P-LME = 0.01). There were no associations between milk protein content and serum amino acids and milk total fat content and serum polar lipids. Middle- and odd-chain FA% in breast milk at both ages were significantly related to serum LPC and sphingomyelins (SM) species in infant serum (all P-LME < 0.05), while FA% 20: 5n(-3) and 22: 6n(-3) percentages were significantly associated to serum LPC 22:6 (P-LME = 1.91x10(-4)/7.93x10(-5)) in milk only at month 4. Other polyunsaturated fatty acids and hormones in milk showed only weak associations with infant serum metabolites. Conclusions Infant serum LPC are influenced by breast milk FA composition and, intriguingly, milk protein content in early but not late lactation. LPC 14:0, previously found positively associated with obesity risk, was the serum metabolite which was the most strongly associated to milk protein content. Thus, LPC 14:0 might be a key metabolite not only reflecting milk protein intake in infants, but also relating high protein content in milk or infant formula to childhood obesity risk