RESUMO
Pediatric Crohn's disease (CD) is commonly associated with hepatobiliary complications, including transient liver enzymes elevation (LEE). Exclusive enteral nutrition (EEN) is recommended as primary treatment in mild-to-moderate pediatric CD. Data concerning EEN and liver enzymes (LE) abnormalities are limited. The aim of this study was to assess the LEE occurrence in newly diagnosed CD pediatric patients during EEN. Retrospective analysis of 73 patients, with no previous signs of liver disease, qualified to EEN. LE were assessed at diagnosis, during EEN, after completion of the nutritional treatment, and reintroduction of free diet. Thirty-one (42%) children presented with LEE and 28 (38%) with transient LEE. The LEE cohort presented with higher percentage of protein energy (24.0% ± 29.4 IQR [interquartile range] vs. 18.6% ± 23.6 IQR, P < .05) versus nonprotein energy (fat and carbohydrates) in total energy intake (75.9% ± 29.4 IQR vs. 81.4% ± 23.6 IQR, P < .05). Also, the protein/energy ratio was higher in the LEE group compared with the group with normal LE (0.026 vs. 0.024, P = .028). At the fourth week of EEN, aspartate aminotransferase elevation correlated with higher daily protein intake (P < .018). The LEE during EEN is typically a low-grade and transient condition that may be connected to applied treatment. We hypothesize that higher protein/energy ratio during EEN may be associated with mild, temporary LEE. Careful observation with repeated measurement of LE activity may be sufficient proceeding in patients without any other symptoms of CD-associated liver disease.
Assuntos
Doença de Crohn , Criança , Doença de Crohn/terapia , Nutrição Enteral , Humanos , Indução de Remissão , Estudos RetrospectivosRESUMO
Background: The number of Europeans aged over 65 will double between 2010 and 2060, reaching 30% of the European population. Nutrition is emerging as a key element of healthy life since both obesity and malnutrition are established risk factors for morbidity and disability. The aim of this umbrella review (UR) is to summarize the findings of all current systematic reviews (SRs) and meta-analyzes (MAs) on the effectiveness of nutritional intervention designed to promote healthy aging in older individuals. Methods: Eligible articles published in English or Italian between January 2000 and May 2016 were identified in six databases. Only studies that analyzed nutritional interventions in the population of 65 years and over, or papers specifically targeting older adults were deemed eligible. Results: Twenty-eight papers, out of which twenty-five SRs and three MAs, met the inclusion criteria and were included in this umbrella SR. Supplementation with vitamin D and other kind of products was highly effective in preventing falls and fractures. Furthermore, several interventions, ranging from the prescription of supplements to environmental and organizational programs, resulted in an improvement in energy and protein intake, as well as positive weight outcomes. Positive findings were also found for the elderly at risk of malnutrition and for older patients with dementia. Conclusions: The findings of this UR indicate that the use of a wide range of supplements and environmental and organizational intervention improve a number of anthropometric, nutritional and functional indices in the elderly.