Randomised clinical trial: reducing the intake of dietary FODMAPs of breastfeeding mothers is associated with a greater improvement of the symptoms of infantile colic than for a typical diet.

BACKGROUND: Therapeutic diets for infantile colic lack evidence. In breastfed infants, avoiding "windy" foods by the breastfeeding mother is common. AIM: To examine the effects of a maternal low-FODMAP (Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, And Polyols) diet compared to a typical-Australian diet on infant crying-fussing durations of infants with colic in a randomised, double-blind, crossover feeding study. METHODS: Between 2014 and 2016 exclusively breastfed infants aged ≤9 weeks meeting Wessel criteria for colic were recruited. Mothers were provided a 10-day low-FODMAP or typical-Australian diet, then alternated without washout. Infants without colic (controls) were observed prospectively and mothers remained on habitual diet. Infant crying-fussing durations were captured using a Barr Diary. Measures of maternal psychological status and samples of breast milk and infant faeces were collected. RESULTS: Mean crying-fussing durations were 91 min/d in seven controls compared with 269 min/d in 13 colicky infants (P < 0.0001), which fell by median 32% during the low-FODMAP diet compared with 20% during the typical-Australian diet (P = 0.03), confirmed by a two-way mixed-model analyses-of-variance (ƞp 2  = 0.719; P = 0.049) with no order effect. In breast milk, lactose concentrations remained stable and other known dietary FODMAPs were not detected. Changes in infant faecal calprotectin were similar between diets and groups, and faecal pH did not change. Median maternal anxiety and stress fell with the typical-Australian diet (P < 0.01), but remained stable on the low-FODMAP diet. CONCLUSIONS: Maternal low-FODMAP diet was associated with enhanced reduction in crying-fussing durations of infants with colic. This was not related to changes in maternal psychological status, gross changes in breast milk or infant faeces. Mechanisms require elucidation. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR): 12616000512426 - anzctr.org.au.

Cognitive impairment in Crohn's disease is associated with systemic inflammation, symptom burden and sleep disturbance.

BACKGROUND: Patients with Crohn's disease (CD) frequently complain of cognitive difficulties such as problems with concentration and clouding of thought, yet this has scarcely been objectively defined and underlying mechanisms remain unknown. OBJECTIVE: The objective of this article is to objectively measure cognitive impairments in patients with CD compared with healthy controls, and if present, to identify potentially modifiable, contributing factors associated with cognitive impairment. METHODS: CD patients and healthy age-/sex-matched controls completed surveys encompassing clinical, demographic, psychiatric, fatigue and sleep parameters. Contemporaneously, disease activity assessment with serum CRP, faecal calprotectin, Harvey-Bradshaw Index and the Subtle Cognitive Impairment test (SCIT) were performed, with the primary measure of response time (SCIT-RT) compared between groups. Multiple linear regression assessed for factors associated with slower SCIT-RT, denoting subtle cognitive impairment. RESULTS: A total of 49 CD and 31 control individuals participated, with median age 44 years (range 22-65) and 43 years (21-63), respectively. Compared to controls, SCIT-RT was slower across all timepoints in CD patients (ANOVA p < 0.001). In multivariate analysis, serum CRP (standardised beta coefficient 0.27, 95% CI (0.02, 0.51)), abdominal pain (0.43 (0.16, 0.70)), plasma haemoglobin (1.55 (1.42, 1.68)), and concurrent fatigue (0.56 (0.25, 0.88)) were each independently associated with slower SCIT-RT in CD (each p < 0.05), with a trend for poorer sleep quality 0.54 (-0.03, 1.11) (p = 0.06), yet conversely, higher faecal calprotectin titres were associated with faster SCIT-RT (-1.77 (-1.79, -1.76), p < 0.01). CONCLUSIONS: Patients with CD demonstrated subtle cognitive impairment utilising the objective SCIT, correlating with systemic inflammation and other disease burden measures, although higher faecal calprotectin titres were unexpectedly associated with less cognitive impairment.

Chronic partial sleep loss increases the facilitatory role of a masked prime in a word recognition task.

Neurobehavioural performance deficits associated with sleep loss have been extensively studied, in particular, the effects on psychomotor performance. However, there is no consensus as to which, if any, cognitive functions are impaired by sleep loss. To examine how sleep loss might affect cognition, the automatic processes supporting word recognition were examined using the masked priming paradigm in participants who had been exposed to two consecutive days of sleep restriction. Twelve healthy volunteers (mean age 24.5 years) were recruited. Nocturnal sleep duration was restricted to 60% of each participant's habitual sleep duration for two consecutive nights by delaying scheduled time of sleep onset and advancing time of awakening. In controlled laboratory conditions, participants completed the Psychomotor Vigilance Task and Karolinska Sleepiness Scale and a masked priming word recognition task. As expected, significant increases in subjective sleepiness and impaired psychomotor performance were observed after sleep loss. In contrast, response times and error rate on the masked priming task were not significantly affected. However, the magnitude of the masked priming effect, which can be taken as an index of automaticity of lexical processing, increased following sleep loss. These findings suggest that while no evidence of impairment to lexical access was observed after sleep loss, an increase in automatic processing may occur as a consequence of compensatory mechanisms.

Comprehension of algebraic expressions by experienced users of mathematics.

Little is known about how people comprehend mathematical expressions. In the present study we investigate the internal representations used by experienced users of mathematics to encode algebraic expressions. Initially, a memory recognition task was conducted that examined the role of mathematical syntax in the encoding of algebraic expressions. The results indicate that participants could more readily identify those parts of a previously seen expression that were syntactically well formed than those that were not well formed, suggesting that syntax plays an important role. To determine the level of syntactic structure involved, a second recognition task was conducted. The results indicate that algebraic expressions are encoded into components that represent the phrasal constituents of the expression. However, the results of these experiments did not rule out the possibility that the visual processes of perceptual organization were used to encode the expressions, or that the data were a consequence of a mathematical "lexicon" of common mathematical "phrases". Three further experiments were conducted to examine this, the results of which indicate that the encoding of algebraic expressions is based primarily on processes that occur beyond the level of visual or "lexical" processing. This is consistent with our finding that syntactic structure plays a key role.