Nutritional status of pediatric patients with inflammatory bowel diseases is related to disease duration and clinical picture at diagnosis.

This cross-sectional study presents the nutritional status of newly diagnosed pediatric patients with Crohn's disease (CD) and ulcerative colitis (UC) and its association with the duration of the disease and selected clinical features. We analyzed the data of 41 pediatric patients with CD and 29 with UC (mean age: 13.1 y, range: 5.2-18.0 y) up to 3 mo. from diagnosis. Anthropometry included body weight, body height, body mass index (BMI), three skinfold thicknesses, mid-upper arm circumference and mid-upper arm muscle circumference adjusted for age and sex using national standards. Anthropometry was linked to the disease duration, location of the disease, symptoms, and blood test results. Both studied groups presented significantly lower BMI compared to the reference population, but only children with CD characterized with significantly worse nutritional status according to arm anthropometry. In CD, better nutritional status was associated mainly with longer disease duration and, to a lesser extent, with extraintestinal manifestations, perianal disease, and small intestinal lesions. In UC, anemia at diagnosis was associated with poor nutritional status. Our finding emphasizes the need for more attentive diagnostic care for pediatric patients who exhibit extraintestinal symptoms or perianal disease with no obvious signs of malnutrition, to avoid diagnostic delays.

The long-lasting effect of early life family structure on social position, well-being, and biological condition in adulthood.

BACKGROUND: The absence of even one parent has short- and long-term effects on the child's current and future health. The purpose of the study was to determine whether there is a long-term relationship between the type of family in which men were raised and an individual's adult social position, well-being in adulthood and their biological condition regardless of social status in adulthood. MATERIALS AND METHODS: Data for 4528 males, aged 25-80 years, were selected from the archives of the Lower Silesian Medical Centre in Wroclaw, Poland. A total of 329 men declared that they grew up in incomplete families. Height, weight, % fat, cardiovascular and respiratory systems, blood parameters, and health of men who grew up in complete or incomplete families were compared. RESULTS: Growing up in an incomplete family reduced chances for better education, decreased life satisfaction in adulthood, and negatively affected the final height. After taking into account the education achieved, the effect persisted only for diastolic blood pressure, creatinine, and serum phosphorus levels. CONCLUSIONS: Growing up in an incomplete family has a significant impact on male's socioeconomic position (SES), life satisfaction, and final height. A poorer quality of diet is proposed as an early life risk factor for adult health.

A Link between Nutritional and Growth States in Pediatric Patients with Functional Gastrointestinal Disorders.

OBJECTIVE: To investigate nutritional status and growth status of pediatric patients with functional gastrointestinal disorders (FGIDs) and to examine the relationship between nutritional status and linear growth in these children. STUDY DESIGN: In total, 102 pediatric patients diagnosed with functional constipation (FC), irritable bowel syndrome (IBS), or functional abdominal pain (FAP) in years 2013-2015 were subjected to anthropometric measurements. Anthropometry comprised body height, leg and trunk lengths, body weight, mid-upper arm circumference, and 3 skinfold thicknesses. Body fat percentage was obtained with bioelectrical impedance analysis. Indices of the nutritional status and body proportions were calculated and adjusted for age and sex. RESULTS: Excessive body weight and excessive fatness were the most common in children with IBS. Being underweight was most common in children with FAP, but fat deficiency was similarly frequent in the FAP and in FC groups. Short stature was the most common in children with FC. Children with IBS were the best nourished and the tallest for age and sex due to increased trunk length. Body height and linear body proportions adjusted for age and sex were positively associated with body weight and body fatness in the total sample. CONCLUSIONS: Children with FGIDs present various linear growth abnormalities that are associated with body weight and body fatness. Although excessive body weight and body fat are common in children with IBS, pediatricians should be aware of the risk of malnutrition in children with other FGIDs.

Hydrogen excretion in pediatric lactose malabsorbers: relation to symptoms and the dose of lactose.

INTRODUCTION: Lactose malabsorption arises from lactase deficiency and may lead to lactose intolerance - gastrointestinal symptoms after lactose ingestion. Occurrence and severity of the symptoms are influenced by many factors, including the dose of lactose and the intensity of its colonic fermentation to short chain fatty acids and gases. MATERIAL AND METHODS: The hydrogen breath test (HBT) after 30 g or 50 g of lactose was performed in 387 children. Further analysis included children who had a positive HBT result. The HBT parameters were net hydrogen concentration in each breath and total net hydrogen concentration during the HBT. The time of the first hydrogen rise was also calculated. HBT parameters were analyzed according to symptoms occurrence (lack or present), symptoms severity (lack, moderate or severe) and the dose of lactose (30 g or 50 g). RESULTS: One hundred and six children (12.1 years, 46 boys) had a positive HBT result. Symptoms occurrence was positively related to net hydrogen concentration at 30 min, 60 min and 90 min (p < 0.001 at each time point), as well as to the total net hydrogen concentration (p < 0.001). There were no differences in hydrogen excretion between subjects with moderate and severe symptoms after lactose ingestion. Symptoms were more frequent in subjects given 50 g of lactose than in those given 30 g of lactose (79% vs. 47%, p = 0.003). In both dose groups symptoms occurrence was related to hydrogen excretion. CONCLUSIONS: Symptoms occurrence is closely related to hydrogen excretion and to the dose of ingested lactose.

Growth, Nutritional Status, and Pulmonary Function in Children with Chronic Recurrent Bronchitis.

Bronchitis is a common health problem in children. Frequent bronchitis in infancy increases the risk of developing chronic respiratory diseases. The aim of the study was to assess the level of growth and the nutritional status in children and youths with special regard to the level of body fatness assessed by measuring skin-fold thickness. Relationships between somatic development, pulmonary function and the course of the disease were also explored. The study was carried out using anthropometric and spirometric measurements and also information on the severity and course of the disease in 141 children with chronic or recurrent bronchitis. All of the subjects were patients of the Pulmonary Medicine and Allergology Center in Karpacz, Poland. The mean body height did not differ significantly between the children examined and their healthy peers. However, the infection-prone children had excessive body fatness and muscle mass deficiency. The increased level of subcutaneous adipose tissue occurred especially in children with short duration of the disease, i.e. a maximum of 1 year. The functional lung parameters were generally normal. The presence of atopic diseases such as allergic rhinitis or atopic dermatitis did not impair the course of the children's somatic development. Also, long-term disease or the presence of additional allergic diseases did not impair lung function in the examined children. Taking appropriate preventive measures is recommended to achieve and maintain normal body weight in children who receive therapy due to bronchitis.

Evaluation of factors related to bone disease in Polish children and adolescents with cystic fibrosis.

PURPOSE: The aim of the study was to evaluate factors related to bone formation and resorption in Polish children and adolescents with cystic fibrosis and to examine the effect of nutritional status, biochemical parameters and clinical status on bone mineral density. MATERIALS AND METHODS: The study group consisted of 100 children and adolescents with cystic fibrosis with a mean age 13.4 years old. Anthropometric measurements, included body height, body mass and body mass index (BMI); bone mineral densitometry and biochemical testing were performed. Bone mineral density was measured using a dual-energy X-ray absorption densitometer. Biochemical tests included serum calcium, phosphorus, parathyroid hormone and vitamin D concentrations, as well as 24-h urine calcium and phosphorus excretion. Pulmonary function was evaluated using FEV1%, and clinical status was estimated using the Shwachman-Kulczycki score. RESULTS: Standardized body height, body mass and BMI were significantly lower than in the reference population. Mean serum vitamin D concentration was decreased. Pulmonary disease was generally mild, with a mean FEV1% of 81%. Multivariate linear regression revealed that the only factors that had a significant effect on bone marrow density were BMI and FEV1%. There were no significant correlations between bone mineral density and the results of any of the biochemical tests performed. CONCLUSIONS: Nutritional status and bone mineral density were significantly decreased in children and adolescents with cystic fibrosis. In spite of abnormalities in biochemical testing, the factors that were found to have the strongest effect on bone mineral density were standardized BMI and clinical status.

Dietary pattern and its relationship between bone mineral density in girls and boys with cystic fibrosis - preliminary report.

BACKGROUND: Nutrition influence on cystic fibrosis (CF) patients survival is well documented and dietary therapy is one of basic elements of their treatment. Prolonged survival of CF patients might yet emerge comorbidities, which include bone mineral disease. THE AIM: The assessment of the dietary pattern and its relationship between bone density in boys and girls with cystic fibrosis. MATERIAL AND METHODS: 89 patients aged 10-18 years from 3 Polish CF Centres were included into the study. To obtain a knowledge about quality of diet, a 3-day food record was assessed and percent of recommended for CF patients intake of energy, protein, carbohydrates, fat, vitamin D3, calcium, phosphorus was counted. Bone mineral density (BMD) in lumbar spine (L1-L4) was measured and expressed as a Z-score. To assess nutritional status, anthropometric measurements was evaluated (body weight, height and BMI). Descriptive methods, Mann-Whitney test, T-Student test, Spearman correlation and one-way ANOVA were used for statistical analyses. RESULTS: The patients with cystic fibrosis did not meet specific for CF nutritional guidelines. A deficiency in recommended intake was observed in energy (88%), protein (82%), calcium (78%) and vitamin D3 (71%). The intake of phosphorus was higher than recommended (142%). A nutritional status was significantly reduced, as compared with the reference group (p 0.001). Boys characterized significantly lower body weight (p=0.019) and height (p=0.036) than girls as well as worse caloric (p=0.023) and carbohydrates intake (p=0.005). However, girls had reduced vitamin D3 content in their diet (p 0.001). The bone mineral density in the whole group was reduced and Z-score amounted to -0.95 ± 1.17. Tendency to decreasing of BMD with age was observed. BMI showed important correlation with bone mineral density both in girls (p 0.001) and in boys (p=0.020). CONCLUSION: CF patients do not follow specific for them dietary recommendations and essential differences were observed between girls and boys. Nutritional status (BMI) showed correlation with bone mineral density in CF patients. Therefore intensive nutritional therapy according to recommendations is needed. .

A cross-sectional study of growth, nutritional status and body proportions in children and adolescents at a medical center specializing in the treatment of cystic fibrosis in Poland.

INTRODUCTION: Malnutrition, delayed growth and delayed puberty are commonly seen in children with cystic fibrosis. The aim of this study was to evaluate growth, nutritional status and body proportions in children and adolescents suffering from cystic fibrosis. MATERIAL AND METHODS: The evaluation was based on 19 somatic measurements and indices calculated from these measurements. Somatic development was evaluated in relation to several factors connected to the clinical picture or the course of the disease. Anthropometric data were extracted from the medical histories of 41 boys and 48 girls diagnosed and treated at the Institute of Mother and Child in Warsaw (Poland). Mean values for somatic parameters and body build indices for the children suffering from CF were compared to those for the reference group. RESULTS: The results revealed that growth in these children was significantly delayed in comparison to that seen in the healthy population (Z-score = -0.56, p < 0.001). Nutritional status was also adversely affected (Z-score = -0.85, p < 0.001). The children suffered more from a deficit in muscularity than in adiposity (Z-score = -0.75 and Z-score = -0.34, p < 0.01, respectively). This was especially true for boys. The children had infantile body proportions and defects in trunk and chest structure. CONCLUSIONS: The factors that most affected somatic development were infection by Pseudomonas aeruginosa and the time at which the disease was diagnosed. Chronic infection by P. aeruginosa and type of CFTR mutation were the factors that most affected pulmonary function parameters.

Prevalence of Lactose Malabsorption and Lactose Intolerance in Pediatric Patients with Selected Gastrointestinal Diseases.

BACKGROUND: Lactase is an enzyme involved in the hydrolysis of lactose. Deficiency of the enzyme (hypolactasia) may be determined genetically or arise secondarily to disease of small intestine. Under this condition, lactose enters the colon where it is fermented by intestinal microflora and turns to gases and short-chain fatty acids, causing gastrointestinal symptoms known as lactose intolerance (LI). OBJECTIVES: To investigate the incidence of lactose malabsorption (LM), LI and the coexistence of these two conditions in children with upper gastrointestinal tract diseases (UGTD), malabsorption syndrome, inflammatory bowel disease (IBD) and functional gastrointestinal disorders (FGID). MATERIAL AND METHODS: Hydrogen breath test (HBT) was conducted in 387 pediatric patients in years 2010-2013. Two hundred thirty two children with gastrointestinal tract diseases were selected and assigned to groups - UGTD, malabsorption syndrome, IBD or FGID. For each group the frequency of LM, frequency and severity of LI and the frequency of their co-occurrence were calculated. RESULTS: Lactose malabsorption was observed in 37.08% of patients with gastrointestinal diseases. Positive HBT result was the most common in children with malabsorption syndrome (52.50%) and less common in UGTD (30.85%), especially in ulcer disease (23.53%). Symptoms after lactose ingestion affected 36.64% of the subjects, and were more specific to lactose malabsorbers than to lactose absorbers (72.10% vs. 15.75%). The higher frequency of LI was noted in children with FGID, especially in irritable bowel syndrome (IBS) (65.22%). The lowest incidence of symptoms was obtained in children with UGTD, especially in those with ulcer disease (27.44%). The incidence of LM with LI was noted in 27.16% of all patients and was the highest in IBS (47.83%) and the lowest in ulcer disease (15.78%). CONCLUSIONS: Lactose malabsorption is a common problem in children with gastrointestinal diseases, especially in children with bowel diseases. Lactose intolerance is related to LM, but does not affect all malabsorbers.

Adipose tissue content and distribution in children and adolescents with bronchial asthma.

BACKGROUND: The excess of adipose tissue and the pattern of adipose tissue distribution in the body seem to play an important role in the complicated dependencies between obesity and risk of developing asthma. The aim of the present study was to determine nutritional status in children and adolescents with bronchial asthma with special emphasis on adipose tissue distribution evaluated on the basis of skin-fold thicknesses, and to determine the relationships between patterns of adipose tissue distribution and the course of the disease. METHODS: Anthropometric data on height, weight, circumferences and skin-fold thicknesses were extracted from the medical histories of 261 children diagnosed with asthma bronchitis. Values for children with asthma were compared to Polish national growth reference charts. Distribution of subcutaneous adipose tissue was evaluated using principal components analysis (PCA). Multivariate linear regression analyses tested the effect of three factors on subcutaneous adipose tissue distribution: type of asthma, the severity of the disease and the duration of the disease. RESULTS: Mean body height in the children examined in this study was lower than in their healthy peers. Mean BMI and skin-fold thicknesses were significantly higher and lean body mass was lower in the study group. Excess body fat was noted, especially in girls. Adipose tissue was preferentially deposited in the trunk in girls with severe asthma, as well as in those who had been suffering from asthma for a longer time. The type of asthma, atopic or non-atopic, had no observable effect on subcutaneous adipose tissue distribution in children examined. CONCLUSIONS: The data suggest that long-treated subjects and those with severe bronchial asthma accumulate more adipose tissue on the trunk. It is important to regularly monitor nutritional status in children with asthma, especially in those receiving high doses of systemic or inhaled glucocorticosteroids, and long-term treatment as well.

Effect of selected factors associated with the clinical course of the disease on nutritional status in children with cystic fibrosis.

BACKGROUND: Malnutrition and delayed growth are commonly seen in children with cystic fibrosis and are indicators of poor prognosis. Understanding the factors that affect growth and nutritional status may improve care, treatment and longevity. OBJECTIVES: To determine how nutritional status, as estimated using anthropometric measurements, in children with cystic fibrosis is affected by 1) the type of CFTR mutation, 2) colonization by Pseudomonas aeruginosa, and 3) age at diagnosis. The relationship between nutritional status and pulmonary function was also investigated. MATERIAL AND METHODS: Anthropometric data on height, weight, circumferences and skinfold thicknesses were extracted from the medical histories of 41 boys and 48 girls diagnosed with cystic fibrosis who were treated at the Institute of Mother and Child in Warsaw, Poland. Muscle and fat tissue area were calculated from these measurements. The values for children with CF were compared to the Polish national growth reference charts. Multivariate linear regression tested the effect of three factors on nutritional status: colonization with P. aeruginosa, age at diagnosis, and the type of CFTR mutation. RESULTS: All values for children with CF were significantly lower than in the reference population. The results show that, in the children examined, nutritional status is more adversely affected than growth. Of the factors related to the clinical picture of the disease, only the presence of respiratory tract colonization by P. aeruginosa had an effect on physical development in the children examined. Neither the type of mutation present nor age at diagnosis had any significant effect. CONCLUSIONS: Chronic colonization by P. aeruginosa interfered with growth and markedly worsened nutritional status, and was also associated with reductions in both total and lean body mass. Early nutritional intervention can improve nutritional state and pulmonary function in children with CF.

Physical development in children and adolescents with bronchial asthma.

Bronchial asthma is the most common chronic disease in children of developmental age. Data from the auxological literature indicate that children with disturbances in growth may also suffer from atopic disorders. The aim of the present study was to evaluate somatic growth in children with bronchial asthma using anthropological methods. The study was carried out using anthropometric measurements and information on the severity and course of the disease on 261 children with bronchial asthma. Mean body height was lower than in healthy peers and about 5% of subjects were short. Mean BMI and skinfold thicknesses were significantly higher and lean body mass was lower in the study group. Seventeen percent of the children were overweight or obese, and 8% were underweight. Body build was more robust in the girls examined. Longitudinal studies will help determine to what degree the disease itself directly affects physical development, and to what degree treatment does.

[Nutritional status and pulmonary function in children and adolescents with cystic fibrosis]. / Ocena stanu odzywienia oraz czynnosci pluc dzieci i mlodziezy z mukowiscydoza

INTRODUCTION: Somatic development and respiratory function are the most important prognostic factors for the course of the disease and the expected lifespan of patients suffering from cystic fibrosis (cF). Aim of the study was to evaluate nutritional status and pulmonary function in children and adolescents suffering from cystic fibrosis. Pulmonary function was evaluated in relation to several factors connected to the course of the disease. MATERIAL AND METHODS: Anthropometric and spirometric data were extracted from the medical histories of 89 children diagnosed and treated at the institute of Mother and child in Warsaw. Molecular DnA was analyzed in all the patients in order to determine the type of CFTR gene mutation. Anthropometric parameters were expressed in terms of standard deviations away from age-specific and sex-specific reference for the population of Warsaw. RESULTS: the studied children were significantly shorter than healthy children. Ten of the children (11.2%) had severe growth disturbances. nutritional status was also adversely affected. Almost 50% of the children were mal-nourished. the children suffered from a deficit in muscularity and adiposity. The percent of predicted FeV1 was highest in those children who were well-nourished, and lowest in the severely malnourished patients. the effect of the nutritional status on pulmonary function was observed. CONCLUSIONS: chronic infection by P. aeruginosa had a marked adverse effect on pulmonary function.

[Body build and body proportions in children with bronchial asthma]. / Budowa i proporcje ciala dzieci chorych na astme oskrzelowa.

This paper is a literature review of somatic development in children with chronic bronchial asthma. Asthma is the most common chronic inflammatory disease of the respiratory system in children and youth that is increasing in prevalence. In spite of significant progress in treatment, growth problems are often observed in children with asthma. Growth delay in asthmatic children, increased incidence of short stature, distorted body proportions and nutritional status impairment are reported frequently, in spite of inhaled corticosteroid drugs treatment. The severity of the asthma influences growth outcomes. The issue of growth in children with chronic asthma requires further detailed studies in its clinical and auxological aspects.

Age of menarche in girls with cystic fibrosis.

UNLABELLED: Malnutrition, delayed growth and puberty are commonly observed in children suffering from cystic fibrosis. The aim of this study was to assess the age of menarche in girls with CF using status quo analysis. The relationship between types of CFTR mutations and onset of the first menstruation was also evaluated. Material was based on somatic data gathered from medical history records of 47 girls with cystic fibrosis, aged 11-18 years. All girls were patients of the Mother and Child Institute in Warsaw (Poland). RESULTS: The age of menarche in the girls in the study group was 14.65+/-1.21 years. In comparison with the healthy child population, girls with cystic fibrosis experienced menarche with 2 years' delay. Menstruating girls were found to be statistically older and taller than their non-menstruating consorts. Regarding body mass and BMI, a marked tendency towards higher parameter values was noted in the menstruating group, although the differences did not reach statistical significance. A significant relationship between onset of menarche and type of CFTR mutation was found. Girls with cystic fibrosis enter puberty later than their peers, in spite of intensive medical care. The issue of growth and puberty in children with CF requires further detailed investigation under clinical and auxological aspects.

The relationship of Polish students' height, weight and BMI with some socioeconomic variables.

The aim of this study was to assess the variation in student body height, weight and BMI in relation to several socioeconomic factors. Data (collected in 1998) were obtained through a structured questionnaire from 2800 students (1023 men and 1777 women) from Wroclaw Universities, Poland. Information on students' age, reported height and weight and their place of residence prior to starting university, the number of siblings and parents' education were collected. Students with mothers or fathers with higher education had, on average, higher mean heights, but after correcting for other socioeconomic variables only place of residence showed a significant association with height and BMI, with those living in medium or large urban centres having a higher mean height and those living in small or medium urban areas having a lower mean BMI.

Growth retardation and delayed puberty in children and adolescents with juvenile idiopathic arthritis.

Juvenile idiopathic arthritis (JIA) is the most common joint disorder in developing children. Juvenile idiopathic arthritis is difficult to diagnose and treat. In some patients, signs and symptoms can be frustratingly inconsistent, contradictory or idiosyncratic. Short stature in patients with JIA is usually due to reduced growth in the lower extremities, and only rarely due to reduced growth in the spinal column. In some studies, children with JIA were found to have infantile body proportions. Puberty is delayed in children with JIA. In children with chronic arthritic disorders, there is a strong correlation between the activity of the disease and the age of puberty. The main goals in reducing growth retardation in children with JIA are promoting timely remission and reducing the duration and dosage of corticosteroid treatment. It is important to regularly monitor physical development. Further improvements to the treatment protocol depend on continued interdisciplinary research involving paediatricians, rheumatologists and clinical anthropologists.

Growth and menarche during remission in children with juvenile idiopathic arthritis.

BACKGROUND: Growth retardation is a common complication of juvenile chronic arthritis. AIM: The aim of this study was to determine how physical development in children with juvenile chronic arthritis is affected by the subtype and duration of the disease, and by the type of therapy used. MATERIAL AND METHODS: The study group included 71 children, 24 boys and 47 girls, ranging in age from five to eighteen years diagnosed and treated with juvenile chronic arthritis in Wroclaw. At the time the subjects were examined, the disease was in remission. Anthropometric parameters were expressed in terms of standard deviations score using age and sex-specific reference values for Warsaw children. Anthropometric parameters measured included body height, body weight and BMI. RESULTS: 4.3% of the children were short in stature. Growth was inhibited only in those subjects that had been receiving glycocorticosteroids for more than one year. This can probably be attributed both to the effects of glycocorticosteroid treatment, and to the fact that the course of the disease in these children was severe enough to warrant the use of glycocorticosteroids, in the first place. The mean age of menarche for the girls in the study group was 12.8 years. This was not statistically different from the mean for the reference group. CONCLUSION: Regular evaluation of physical development is an essential component of the protocol for monitoring the progress of the disease and the effect of the therapeutic strategy used, in children suffering from juvenile chronic arthritis.

[Puberty in certain chronic illness]. / Przebieg dojrzewania plciowego w wybranych schorzeniach przewleklych.

This paper is a literature review of puberty in certain chronic diseases. Abnormal puberty is often reported in children suffering from many chronic diseases, for example: asthma, cystic fibrosis, type 1 diabetes mellitus, inflammatory diseases, children with visual and hearing impairment, and others. Delay in the onset and progression through puberty have a deleterious effect on the normal pubertal growth spurt and contribute to the deficit in final adult height. Malnutrition, toxic substances, side effects of chronic therapy, emotional deprivation and stress are the most important mechanisms responsible for delayed puberty. Delayed puberty and growth failure frequently complicate the clinical course of this children. However, few studies confirm earlier puberty in children with sense organ impairment than in healthy children. The more severe the impairment of the sense organ, the earlier was the age at puberty--the earliest age at menarche was observed in deaf girls and blind girls. The earlier age of puberty may be the outcome of therapies applied during the treatments such as radiation of the central nervous system or surgeries. Further studies are needed to determine how growth and puberty in children with chronic illness are affected by clinical practice.