Nutritional Considerations in Pediatric Pancreatitis: A Position Paper from the NASPGHAN Pancreas Committee and ESPGHAN Cystic Fibrosis/Pancreas Working Group.

OBJECTIVES: Wide variations exist in how physicians manage the nutritional aspects of children affected by acute pancreatitis (AP), acute recurrent pancreatitis (ARP), and chronic (CP) pancreatitis. Better consensus for optimal management is needed. METHODS: This consensus statement on nutrition in pediatric pancreatic diseases was developed through a joint ESPGHAN-NASPGHAN working group that performed an evidence-based search of the literature on nutrition in AP, ARP, and CP with a focus on pediatrics. The literature was summarized, quality of evidence reviewed, and expert recommendations developed. The authorship met to discuss the evidence and statements. Voting on recommendations occurred over 2 rounds based on feedback. A consensus of at least 75% was required to approve a recommendation. Areas requiring further research were identified. RESULTS AND DISCUSSION: The literature on nutrition in pediatric pancreatitis is limited. Children with mild AP benefit from starting an early nutritional regimen in the course of the attack. Early nutrition should be attempted in severe AP when possible; enteral nutrition is preferred over parenteral nutrition. Children with ARP are likely to tolerate and benefit from a regular diet. Children with CP need ongoing assessment for growth and nutritional deficiencies, exocrine and endocrine insufficiencies. CONCLUSIONS: This document presents the first authoritative recommendations on nutritional considerations in pediatric pancreatitis. Future research should address the gaps in knowledge particularly relating to optimal nutrition for AP in children, role of diet or dietary supplements on recurrent attacks of pancreatitis and pain episodes, monitoring practices to detect early growth and nutritional deficiencies in CP and identifying risk factors that predispose children to these deficiencies.

Effects of selenium on the vessel walls and anti-elastin antibodies in spontaneously hypertensive rats.

Selenium (Se) is an exogenous antioxidant that performs its role via expression of selenoproteins. Pathological changes of the structure of the vessel wall, elastin turnover and collagen production may lead to increased stiffness of the vessels with decreased blood flow to the peripheries. The level of anti-elastin antibodies (AEABs) may give information for elastin metabolism. The aim of the study is to investigate the influence of Se intake on the vessel wall changes and production of AEABs in spontaneously hypertensive rats (SHR). Twenty-four male, 32-week-old SHR were used, divided into three groups, G1, G2 and G3. Before blood and morphological testing, G1 received a low-Se diet for eight weeks, G2 received a diet with adequate Se content and G3 received a diet with Se supplementation. The Se nutritional status was assessed by determination of glutathione peroxidase-1 (GPx-1) activity in whole blood, using the 'Ransel' kit. The rats from group G3 showed higher GPx-1 activity and lower level of AEABs than the other groups (P = 0.021), and the aortic wall histology showed slight degenerative changes compared with other rats. A low-Se diet caused severe changes to the aortic wall's ultrastructure, whereas Se supplementation slowed the changes down. The morphometry revealed a thicker abdominal aortic wall in rats of G1 compared with the other groups, and reduced thickness of the wall of the left coronary artery in G3 compared with the other groups (P < 0.05). Our results have shown that low Se intake leads to severe changes in the vessel walls in SHR, whereas selenium supplementation slows down the elastin degradation and degenerative changes of the vessel walls.