Análisis cuantitativo de la ingesta de nutrientes en niños menores de 3 años. Estudio ALSALMA / Quantitative analysis of nutrient intake in children under 3 years old. ALSALMA study

OBJETIVO: El objetivo del estudio fue analizar el patrón de alimentación de niños menores de 3 años y comparar los resultados con las recomendaciones de consumo energético y de nutrientes. PACIENTES Y MÉTODOS: En este estudio epidemiológico transversal, los padres completaron un diario dietético sobre el consumo de alimentos de sus hijos, durante 4 días no consecutivos. Se analizó la proporción de niños con ingestas medias inferiores a las recomendaciones para cada edad y nutriente, mediante el método «Estimated Average Requirement (EAR) cut-point method». RESULTADOS: Participaron 186 pediatras, que incluyeron a 1.701 niños. El 95,9% (n=1320) de los niños de 7 a 36 meses consumieron proteínas por encima del doble de las Recommended Dietary Allowances. Las deficiencias observadas (% < EAR) en los grupos de edad de 13-24 meses y 25-36 meses, respectivamente, fueron: vitamina D en el 81,7 y el 92,1%; vitamina E en el 39,3 y el 53,4%; ácido fólico en el el 12,5 y el 14,8%; calcio en el 10,1 y el 5,5%; yodo en el 27,1 y el 31%. Se observó que una mayor proporción en el consumo diario de proteínas (p = 0,013) y de hidratos de carbono (p < 0,0001), y una menor proporción de lípidos totales (p < 0,0001), estaban relacionadas con un mayor índice de masa corporal, independientemente del consumo energético. CONCLUSIONES: El estudio mostró una visión muy detallada de los patrones de alimentación de los niños españoles menores de 3 años. La promoción de una alimentación saludable debería ir dirigida a la corrección de los desequilibrios dietéticos detectados, para favorecer la salud futura de los niños

OBJECTIVE: The objective of the study was to analyze the nutritional patterns of children under three years of age and to compare the results against the recommendations for energy and nutrient intake. PATIENTS AND METHODS: In this cross-sectional epidemiological study, parents completed a dietary diary on their food intake of their children on 4 non-consecutive days. The percentage of children with mean intakes below the recommendations for each age and nutrient was analyzed using the 'Estimated Average Requirement (EAR) cut-point method.' RESULTS: A total of 186 pediatricians included 1701 children in the study. A total of 95.9% (n=1320) of the children between 7 and 36 months had a protein consumption more than twice that of the Recommended Daily Allowances. The deficiencies observed (% < EAR) in the age groups 13-24 months and 25-36 months, respectively, were: vitamin D in 81.7% and 92.1%; vitamin E in 39.3% and 53.4%; folic acid in 12.5% and 14.8%; calcium in 10.1% and 5.5%; iodine in 27.1% and 31%. It was observed that a higher percentage in the daily intake of proteins (P = .013) and of carbohydrates (P < .0001), and a lower percentage of total lipids (P < .0001), were related to a greater body mass index, regardless of energy intake. CONCLUSIONS: The study presents a very detailed view of the eating patterns of Spanish children less than three years of age. The encouragement of healthy feeding should be directed towards the correction of the dietary imbalances detected, in order to promote the future health of children

[Quantitative analysis of nutrient intake in children under 3 years old. ALSALMA study]. / Análisis cuantitativo de la ingesta de nutrientes en niños menores de 3 años. Estudio ALSALMA.

OBJECTIVE: The objective of the study was to analyze the nutritional patterns of children under three years of age and to compare the results against the recommendations for energy and nutrient intake. PATIENTS AND METHODS: In this cross-sectional epidemiological study, parents completed a dietary diary on their food intake of their children on 4 non-consecutive days. The percentage of children with mean intakes below the recommendations for each age and nutrient was analyzed using the "Estimated Average Requirement (EAR) cut-point method." RESULTS: A total of 186 pediatricians included 1701 children in the study. A total of 95.9% (n=1320) of the children between 7 and 36 months had a protein consumption more than twice that of the Recommended Daily Allowances. The deficiencies observed (% < EAR) in the age groups 13-24 months and 25-36 months, respectively, were: vitamin D in 81.7% and 92.1%; vitamin E in 39.3% and 53.4%; folic acid in 12.5% and 14.8%; calcium in 10.1% and 5.5%; iodine in 27.1% and 31%. It was observed that a higher percentage in the daily intake of proteins (P=.013) and of carbohydrates (P<.0001), and a lower percentage of total lipids (P<.0001), were related to a greater body mass index, regardless of energy intake. CONCLUSIONS: The study presents a very detailed view of the eating patterns of Spanish children less than three years of age. The encouragement of healthy feeding should be directed towards the correction of the dietary imbalances detected, in order to promote the future health of children.

The HLA-DQ2 genotype selects for early intestinal microbiota composition in infants at high risk of developing coeliac disease.

OBJECTIVE: Intestinal dysbiosis has been associated with coeliac disease (CD), but whether the alterations are cause or consequence of the disease is unknown. This study investigated whether the human leukocyte antigen (HLA)-DQ2 genotype is an independent factor influencing the early gut microbiota composition of healthy infants at family risk of CD. DESIGN: As part of a larger prospective study, a subset (n=22) of exclusively breastfed and vaginally delivered infants with either high genetic risk (HLA-DQ2 carriers) or low genetic risk (non-HLA-DQ2/8 carriers) of developing CD were selected from a cohort of healthy infants with at least one first-degree relative with CD. Infant faecal microbiota was analysed by 16S rRNA gene pyrosequencing and real time quantitative PCR. RESULTS: Infants with a high genetic risk had significantly higher proportions of Firmicutes and Proteobacteria and lower proportions of Actinobacteria compared with low-risk infants. At genus level, high-risk infants had significantly less Bifidobacterium and unclassified Bifidobacteriaceae proportions and more Corynebacterium, Gemella, Clostridium sensu stricto, unclassified Clostridiaceae, unclassified Enterobacteriaceae and Raoultella proportions. Quantitative real time PCR also revealed lower numbers of Bifidobacterium species in infants with high genetic risk than in those with low genetic risk. In high-risk infants negative correlations were identified between Bifidobacterium species and several genera of Proteobacteria (Escherichia/Shigella) and Firmicutes (Clostridium). CONCLUSIONS: The genotype of infants at family risk of developing CD, carrying the HLA-DQ2 haplotypes, influences the early gut microbiota composition. This finding suggests that a specific disease-biased host genotype may also select for the first gut colonisers and could contribute to determining disease risk.

Evaluación de la alimentación y consumo de nutrientes en menores de 3 años. Estudio piloto ALSALMA / Evaluation of diet and nutrient intake in children under three years old. ALSALMA pilot study

OBJETIVO: El objetivo de este estudio fue evaluar el consumo de energía y nutrientes en niños españoles menores de 3 años y comparar los resultados con las recomendaciones actuales, para comprobar si su ingesta era adecuada. PACIENTES Y MÉTODOS: Estudio piloto transversal. Las madres completaron un diario dietético sobre el consumo de alimentos de sus hijos, durante 4 días no consecutivos, registrando los productos y las cantidades consumidas. Se calcularon el consumo de nutrientes y los resultados se compararon con las Dietary Reference Intakes (DRI)) para cada grupo de edad. RESULTADOS: Se incluyó a 188 niños (93 niños, 95 niñas) con edades de 0-6 meses (41), 7-12 meses (24), 13-24 meses (57) y 25-36 meses (66). Se observaron diferencias estadísticamente significativas respecto a las DRI en el consumo de la mayoría de los nutrientes analizados. Destacó el exceso de consumo de proteínas, que alcanza el 376% de las DRI en los niños entre uno y 3 años. El 96% de los niños de 7 a 12 meses, el 88% de los niños de 13 a 24 meses y el 97% de los niños de 25 a 36 meses consumían proteínas por encima del doble de las DRI. CONCLUSIONES: La ingesta de nutrientes difirió de las DRI, especialmente en lo referido a las proteínas. Se debería evaluar si las desviaciones observadas en el estudio son extensibles a la población nacional de este grupo de edad en un estudio con una muestra representativa y las posibles repercusiones sobre la salud de los niños

OBJECTIVE: The present study evaluates energy and nutrient intake in Spanish children under three years of age, and compares the results with the current recommendations in order to identify possible inadequate nutrient intake. PATIENTS AND METHODS: A cross-sectional pilot study. The mothers completed a diet diary for four non-consecutive days, recording the products and amounts consumed by their children. Nutrient intake was calculated, and the results were compared with the dietary reference intakes (DRI) for each age group. RESULTS: A total of 188 children (93 boys and 95 girls) aged 0-6 (n=41), 7-12 (n=24), 13-24 (n=57), and 25-36 months (n=66) were included. Statistically significant differences in DRI were observed for most of the nutrients analyzed. Protein intake, in particular was 376% of DRI in children between 1-3 years of age. By age groups, 96% of the children aged 7-12 months, 88% of the children aged 13-24 months, and 97% of the children aged 25-36 months showed protein intakes more than two-fold DRI. CONCLUSIONS: Nutrient intake differed from the DRI, particularly as regards proteins. A new study is required to determine whether the observed study deviations could be representative of the national population of this age group, as well as the possible effects on child health

[Evaluation of diet and nutrient intake in children under three years old. ALSALMA pilot study]. / Evaluación de la alimentación y consumo de nutrientes en menores de 3 años. Estudio piloto ALSALMA.

OBJECTIVE: The present study evaluates energy and nutrient intake in Spanish children under three years of age, and compares the results with the current recommendations in order to identify possible inadequate nutrient intake. PATIENTS AND METHODS: A cross-sectional pilot study. The mothers completed a diet diary for four non-consecutive days, recording the products and amounts consumed by their children. Nutrient intake was calculated, and the results were compared with the dietary reference intakes (DRI) for each age group. RESULTS: A total of 188 children (93 boys and 95 girls) aged 0-6 (n=41), 7-12 (n=24), 13-24 (n=57), and 25-36 months (n=66) were included. Statistically significant differences in DRI were observed for most of the nutrients analyzed. Protein intake, in particular was 376% of DRI in children between 1-3 years of age. By age groups, 96% of the children aged 7-12 months, 88% of the children aged 13-24 months, and 97% of the children aged 25-36 months showed protein intakes more than two-fold DRI. CONCLUSIONS: Nutrient intake differed from the DRI, particularly as regards proteins. A new study is required to determine whether the observed study deviations could be representative of the national population of this age group, as well as the possible effects on child health.

Aplicación de los criterios de Oporto para el diagnóstico de enfermedad inflamatoria intestinal pediátrica en un centro pediátrico de referencia / Application of the Porto criteria for the diagnosis of paediatric inflammatory bowel disease in a paediatric reference centre

Introducción: El término enfermedad inflamatoria intestinal (EII) ha englobado clásicamente dos entidades: enfermedad de Crohn (EC) y colitis ulcerosa (CU). La diferenciación correcta entre ambas enfermedades tiene importantes implicaciones. El término EII tipo no clasificada (EIInC) describe aquellas situaciones de inflamación colónica que no pueden ser identificadas con seguridad como EC ni como CU. Esta situación se ha descrito hasta en el 20-30% de la EII pediátrica en el momento del diagnóstico. Con el fin de alcanzar un diagnóstico de seguridad ante la sospecha de EII en niños, la European Society for Pediatric Gastroenterology, Hepatology and Nutrition (EPSGHAN) estableció en julio de 2005 los denominados criterios de Oporto (CO). Dichas recomendaciones incluyen la realización de: a) colonoscopia completa con ileoscopia, b) endoscopia digestiva alta; c) biopsias múltiples de todos los trayectos explorados, y d) exploración completa del intestino delgado. Objetivo: Evaluar los procedimientos diagnósticos utilizados en nuestros pacientes con EII en relación a los CO. Pacientes y métodos: Revisión retrospectiva de los datos de nuestros pacientes con EII diagnosticados en los últimos diez años (1999-2008) en un hospital terciario español diferenciando dos periodos: antes y después de la publicación de los CO. Resultados: Ciento ocho pacientes han sido diagnosticados de EII en nuestro centro en dicho periodo (51 CU, 52 EC, 5 EIInC), 43 niñas (39,8%), 65 niños (60,1%). Según la clasificación de Montreal: a) CU, 40 (78,4%) colitis extensa, 5 colitis izquierda (9,8%), 6 proctitis (11,7%); b) EC: 44 ileo-colónico (84,6%), 13 ileal (25%) y 7 colónico (13,4%). Edad mediana al diagnóstico: 13 años 1 mes (p25-p75: 10 años 3 meses- 14 años 9 meses). Los CO se cumplieron en el 49% de los casos (en el 33,3% antes de su publicación, en el 64,8% tras ésta; p=0,001). Se realizó una endoscopia digestiva alta en 62 pacientes (58%): en 38,9% antes frente a 72,2% después, p<0,001. Se encontró afectación endoscópica o histológica relevante en tramos altos en el 51% de los pacientes con EC. Se realizó colonoscopia completa con ileoscopia en el 85,2% de los casos. El número medio de segmentos ileo-colónicos biopsiados fue de 6,6 de entre 7 segmentos posibles. Se objetivaron granulomas en el 38% de los pacientes con EC. Hasta el 38% de los pacientes con EC presentaban signos microscópicos de inflamación en segmentos de aspecto endoscópico normal. Durante el seguimiento a los pacientes con EIInC, se procedió al cambio del diagnóstico inicial en 1 paciente a EC y en 1 caso a CU, manteniéndose el diagnóstico inicial en los otros 3 pacientes. Conclusiones: Nuestra práctica clínica en el diagnóstico de EII ha cambiado tras la publicación de los CO. La endoscopia digestiva alta constituye una herramienta útil en el diagnóstico de afectación de tramos altos en la EC. La colonoscopia completa con ileoscopia y la realización de biopsias múltiples son fundamentales para delimitar la extensión de los cambios inflamatorios. No hemos observado cambios en el diagnóstico final en nuestros pacientes con EC o CU tras un seguimiento medio de 4 años (AU)

Introduction: Inflammatory bowel diseases (IBD) have classically included two entities: Crohn's disease (CD) and ulcerative colitis (UC). The correct differentiation between these two diseases has important implications. The term inflammatory bowel disease unclassified (IBDu) describes inflammatory changes of the colon that cannot be classified as ulcerative colitis or Crohn's disease. This situation has been described in 20-30% of paediatric IBD at diagnosis. In order to reach a definitive diagnosis of suspicion of inflammatory bowel disease in children, the ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) established the Porto criteria (PC) in July 2005. The recommendations include: 1) total colonoscopy with ileal intubation, 2) upper endoscopy, 3) multiple biopsies and 4) complete small bowel exploration. Aim: To evaluate the diagnostic procedures used in our IBD patients regarding the PC. Patients and methods: Retrospective review of the data of our IBD patients diagnosed in the last ten years (1999-2008) in a Spanish tertiary hospital, differentiating two periods: before and after the publication of the PC. Results: A total of 108 IBD patients had been diagnosed (51 UC, 52 CD, 5 IBDu), 43 girls (39.81%), 65 boys (60.18%). According to the Montreal classification: 1) UC, 40 (78%) extensive colitis, 5 left-sided colitis (9.8%), 6 proctitis (11%), 2) CD: 44 ileo-colonic (84%), 13 ileal, 7 colonic. Median age at diagnosis: 13 years 1 month (p25-p75: 10 years 3 months- 14 years 9months). The Porto criteria were followed in 49% of the cases (33.3% before its publication, 64.8% after, P=.001). Upper endoscopy was performed in 62 patients (58%): 38.9% versus 72.2%, P<0.001. Upper involvement was found in 51% of our CD patients. Total colonoscopy with ileoscopy was achieved in 85.2% of the cases. The mean number of ileo-colonic segments biopsied was 6.6 (7 different segments). Granulomas at biopsies were present in 38% of our CD patients. Up to 38% of the CD patients had microscopic inflammation in endoscopically normal appearing segments. During the follow-up, initial diagnosis among the IBDu patients, was changed to CD in 1, to UC in 2 and the other 3 remained with the same diagnosis. We did not observe other changes in diagnosis in the remaining 103 patients (median follow-up: 4y 8mo). Thirty patients were discharged when becoming adults. Conclusions: Our clinical practice in IBD diagnosis has changed after the PC. Upper endoscopy is a useful tool to find upper involvement in CD. Total colonoscopy with ileoscopy and performance of multiple biopsies are essential to determine extension of the inflammatory changes. We have not observed changes in the final diagnosis in our CD and UC patients after a median follow-up of 4 years (AU)

[Application of the Porto criteria for the diagnosis of paediatric inflammatory bowel disease in a paediatric reference centre]. / Aplicación de los criterios de Oporto para el diagnóstico de enfermedad inflamatoria intestinal pediátrica en un centro pediátrico de referencia.

INTRODUCTION: Inflammatory bowel diseases (IBD) have classically included two entities: Crohn's disease (CD) and ulcerative colitis (UC). The correct differentiation between these two diseases has important implications. The term inflammatory bowel disease unclassified (IBDu) describes inflammatory changes of the colon that cannot be classified as ulcerative colitis or Crohn's disease. This situation has been described in 20-30% of paediatric IBD at diagnosis. In order to reach a definitive diagnosis of suspicion of inflammatory bowel disease in children, the ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) established the Porto criteria (PC) in July 2005. The recommendations include: 1) total colonoscopy with ileal intubation, 2) upper endoscopy, 3) multiple biopsies and 4) complete small bowel exploration. AIM: To evaluate the diagnostic procedures used in our IBD patients regarding the PC. PATIENTS AND METHODS: Retrospective review of the data of our IBD patients diagnosed in the last ten years (1999-2008) in a Spanish tertiary hospital, differentiating two periods: before and after the publication of the PC. RESULTS: A total of 108 IBD patients had been diagnosed (51 UC, 52 CD, 5 IBDu), 43 girls (39.81%), 65 boys (60.18%). According to the Montreal classification: 1) UC, 40 (78%) extensive colitis, 5 left-sided colitis (9.8%), 6 proctitis (11%), 2) CD: 44 ileo-colonic (84%), 13 ileal, 7 colonic. Median age at diagnosis: 13 years 1 month (p25-p75: 10 years 3 months- 14 years 9months). The Porto criteria were followed in 49% of the cases (33.3% before its publication, 64.8% after, P=.001). Upper endoscopy was performed in 62 patients (58%): 38.9% versus 72.2%, P<.001. Upper involvement was found in 51% of our CD patients. Total colonoscopy with ileoscopy was achieved in 85.2% of the cases. The mean number of ileo-colonic segments biopsied was 6.6 (7 different segments). Granulomas at biopsies were present in 38% of our CD patients. Up to 38% of the CD patients had microscopic inflammation in endoscopically normal appearing segments. During the follow-up, initial diagnosis among the IBDu patients, was changed to CD in 1, to UC in 2 and the other 3 remained with the same diagnosis. We did not observe other changes in diagnosis in the remaining 103 patients (median follow-up: 4y 8mo). Thirty patients were discharged when becoming adults. CONCLUSIONS: Our clinical practice in IBD diagnosis has changed after the PC. Upper endoscopy is a useful tool to find upper involvement in CD. Total colonoscopy with ileoscopy and performance of multiple biopsies are essential to determine extension of the inflammatory changes. We have not observed changes in the final diagnosis in our CD and UC patients after a median follow-up of 4 years.

Long-term efficacy of adalimumab in paediatric Crohn's disease patients naïve to other anti-TNF therapies.

INTRODUCTION: Adalimumab is a fully-humanized anti-TNF a antibody that has showed its efficacy in Crohn's disease (CD) adult patients. Its less immunogenic composition seems to be an advantage compared to previous anti-TNF α, mainly infliximab. Good response to adalimumab has been reported in patients naïve to infliximab, in those in whom infliximab has shown no efficacy and in those intolerant or who have lost previous response to it. Adalimumab has shown also its efficacy as a second-line anti-TNF α in small series of paediatric CD but data regarding its use in children naïve to infliximab are scarce. AIM: To report our experience with adalimumab as first line anti-TNF α treatment in paediatric CD. PATIENTS AND METHODS: Four CD paediatric patients (2 boys) previously naïve to infliximab have received adalimumab. Mean age at diagnosis: 13 years, 4 months. Adalimumab was initiated in our patients soon after diagnosis (mean time from diagnosis: 8.5 months, range: 1 month 15 days-14 months) at decreasing loading doses (160 mg and 80 mg two weeks after) and then 40 mg subsequently every two weeks. RESULTS: The four patients entered in remission after the first dose of adalimumab (mean previous PCDAI: 35, mean PCDAI after first dose: 3.6). No adverse effects were registered. Azathioprine was stopped after 4 months of combination therapy, without loss of efficacy or adverse reactions attributable to immunogenicity. All the 4 patients have remained in remission on adalimumab monotherapy for a mean follow-up of 17 months (range 9-20 months). CONCLUSION: Adalimumab has shown its efficacy in our paediatric CD patients naïve to other anti-TNF α drugs. Early introduction of anti-TNF α antibodies in these patients could help to a better control of the disease. Its less immunogenicity and the possibility of a home-based administration are advantages when compared to other parenteral anti-TNF treatments. Change to monotherapy after prior successful combination therapy with azathioprine and adalimumab is a safe strategy that can help to minimize possible risks of intensive immunomodulation.

[Implication of the anxiety and depression in eating disorders of young obese]. / Implicación de la ansiedad y la depresión en los trastornos de alimentación de jóvenes con obesidad.

OBJECTIVES: the goals of the present study were: 1) to compare the levels of anxiety, depression, and eating disorders in young patients assisted at a children's hospital for obesity; 2) to determine whether anxiety and depression explain the symptoms of the eating disorders; and 3) to know which of these symptoms better discriminate the young people with different degrees of obesity. MATERIALS AND METHOD: Descriptive, cross-sectional study with a sample comprised by 281 youngsters (56% girls) aged 11-17 years. The BMI percentiles were calculated by using the WHO growth tables. Two study groups were created: severe obesity and overweight/light-moderate obesity. The following questionnaires were used: Eating Disorders Inventory-2 (EDI-2), depression questionnaire (DQ), and Status-Trait Anxiety Questionnaire (STAI). RESULTS: The youngsters with obesity showed more psychological problems than youngsters with overweight/light-moderate obesity, 12% had anxiety, and 11% depression. In both groups, the behaviours related with eating disorders were partially explained by the presence of symptoms of anxiety and depression. Dissatisfaction with the body and high anxiety trait increased the risk for perpetuating the obesity and were the two symptoms that better discriminated the patients with or without severe obesity. CONCLUSION: Obesity prevention programmes should include body dissatisfaction and the anxiety trait into the assessment and management protocols, and prevent anxiety getting fixed as a personality trait.

Implicación de la ansiedad y la depresión en los trastornos de alimentación de jóvenes con obesidad / Implication of the anxiety and depression in eating disorders of young obese

Objetivos: Los objetivos del presente estudio eran: 1) comparar los niveles de ansiedad, depresión y trastornos de alimentación en jóvenes atendidos en un hospital pediátrico por obesidad; 2) determinar si la ansiedad y la depresión explican los síntomas de trastornos de alimentación, y 3) conocer cuáles de esos síntomas discriminan mejor entre jóvenes con distintos grados de obesidad. Material y métodos: Estudio descriptivo, transversal con una muestra de 281 jóvenes (56% mujeres) de entre 11 y 17 años. Los percentiles de IMC se calcularon utilizando las tablas de crecimiento de la OMS. Se crearon dos grupos de estudio: obesidad severa y sobrepeso-obesidad leve-moderada. Se utilizaron los siguiente cuestionarios: Eating Disorders Inventory-2 (EDI-2), cuestionario de depresión(CDI) y cuestionario de ansiedad estado-rasgo (STAI). Resultados: Los jóvenes con obesidad severa mostraron más problemas psicológicos que los jóvenes con sobrepeso-obesidad leve-moderada, un 12% presentaban ansiedad y un 11% depresión. En ambos grupos, las conductas relacionadas con los trastornos de alimentación eran, en parte, explicadas por la mayor presencia de síntomas de ansiedad y de depresión. La insatisfacción corporal junto con una elevada ansiedad rasgo incrementaban el riesgo de perpetuar la obesidad y eran los dos síntomas que mejor discriminaban a los pacientes con o sin obesidad severa. Conclusión: Los programas de prevención de la obesidad deberían incluir la insatisfacción corporal y la ansiedad rasgo en los protocolos de evaluación y tratamiento, y prevenir que la ansiedad se instaure como rasgo de personalidad (AU)

Objectives: the goals of the present study were: 1) to compare the levels of anxiety, depression, and eating disorders in young patients assisted at a children's hospital for obesity; 2) to determine whether anxiety and depression explain the symptoms of the eating disorders; and 3) to know which of these symptoms better discriminate the young people with different degrees of obesity. Materials and method: Descriptive, cross-sectional study with a sample comprised by 281 youngsters (56% girls) aged 11-17 years. The BMI percentiles were calculated by using the WHO growth tables. Two study groups were created: severe obesity and overweight/light-moderate obesity. The following questionnaires were used: Eating Disorders Inventory-2 (EDI-2), depression questionnaire (DQ), and Status-Trait Anxiety Questionnaire (STAI). Results: The youngsters with obesity showed more psychological problems than youngsters with overweight/light-moderate obesity, 12% had anxiety, and 11% depression. In both groups, the behaviours related with eating disorders were partially explained by the presence of symptoms of anxiety and depression. Dissatisfaction with the body and high anxiety trait increased the risk for perpetuating the obesity and were the two symptoms that better discriminated the patients with or without severe obesity. Conclusion: Obesity prevention programmes should include body dissatisfaction and the anxiety trait into the assessment and management protocols, and prevent anxiety getting fixed as a personality trait (AU)

Interplay between human leukocyte antigen genes and the microbial colonization process of the newborn intestine.

Coeliac disease (CD) development involves genetic (HLA-DQ2/DQ8) and environmental factors. Herein, the influence of the HLA-DQ genotype on the gut colonization process of breast-fed children was determined. A cohort of 20 newborns, with at least one first-degree relative with CD, were classified according to their HLA-DQ genotype into high, intermediate and low genetic risk groups, showing 24-28%, 7-8% and less than 1% probability to develop CD, respectively. Faecal microbiota was analysed at 7 days, 1 and 4 months of children's age by fluorescence in situ hybridization. When considering all data, Gram-negative bacteria and Bacteroides-Prevotella group proportions were higher (P<0.05) in the high than in the intermediate and low genetic risk groups. E. coli, Streptococcus-Lactococcus, E. rectale-C. coccoides, sulphate-reducing bacteria, C. lituseburense and C. histolyticum group proportions were also significantly higher (P<0.05) in the high than in the low genetic risk group. Correlations between these bacterial groups and the genetic risk were also detected (P<0.05). In addition, the number and type of CD relative seemed to influence (P<0.050) these bacterial proportions in children at CD risk. At 4 months of age, similar relationships were established between the high genetic risk to develop CD and the proportions of Streptococcus-Lactococcus (P<0.05), E. rectale-C. coccoides (P<0.05), C. lituseburense (P<0.05), C. histolyticum (P<0.05), Bacteroides-Prevotella (P<0.10) groups and total Gram-negative bacteria (P<0.05). The results suggest a relationship between HLA-DQ genes and the gut microbial colonization process that could lead to a change in the way this disorder is investigated.

Obesidad infantil: ansiedad y síntomas cognitivos y conductuales propios de los trastornos de alimentación / Adolescent obesity: Anxiety, cognitive and behavioural symptoms characteristic of eating disorders

Objetivo: Evaluar la presencia de síntomas de ansiedad y síntomas cognitivos y conductuales característicos de los trastornos de alimentación en adolescentes con exceso de peso. Material y método: Muestra de 297 adolescentes (55,2% de mujeres y 44,8% de hombres) de entre 11 y 17 años, divididos en 4 grupos según su índice de masa corporal (IMC) percentilado: normopeso, sobrepeso, obesidad y obesidad grave. Los cuestionarios utilizados fueron el Eating Disorders Inventory-2 (EDI-2) y el cuestionario de ansiedad estado-rasgo (STAI). Resultados: Los resultados indican que los adolescentes con obesidad grave muestran más preocupación por su aspecto físico, por su entorno social, mayor sensibilidad corporal y más tensión subjetiva que los adolescentes con sobrepeso u obesidad. En nuestra muestra clínica, los adolescentes normopeso presentan factores específicos para desarrollar en un futuro trastornos de alimentación. Conclusiones: A medida que incrementa el IMC aumentan los síntomas de ansiedad y los síntomas asociados a los trastornos de alimentación (AU)

Objective: To assess the presence of symptoms of anxiety, cognitive and behavioural symptoms characteristic of eating disorders in overweight adolescents. Material and Methods: The sample consisted of 297 adolescents (55.2% female and 44.8% male) aged from 11 to 17 years, divided into four groups according to their BMI percentile: normal weight, overweight, obesity and severe obesity. The questionnaires used were the Eating Disorders Inventory-2 (EDI-2) and the state-trait anxiety questionnaire (STAI). Results: The results showed that the adolescents with severe obesity were more concerned about their physical appearance (body dissatisfaction and obsession with being thin), by their social environment (interpersonal distrust), and showed more anxiety state and anxiety trait than adolescent overweight or obese. In the clinical sample, the adolescents with normal weight showed specific factors for developing eating disorders in the future. Conclusions: As the BMI increased, symptoms of anxiety and symptoms associated with eating disorders were also increased. The findings of this study are discussed in order to improve therapeutic interventions (AU)

[Adolescent obesity: anxiety, cognitive and behavioural symptoms characteristic of eating disorders]. / Obesidad infantil: ansiedad y síntomas cognitivos y conductuales propios de los trastornos de alimentación.

OBJECTIVE: To assess the presence of symptoms of anxiety, cognitive and behavioural symptoms characteristic of eating disorders in overweight adolescents. MATERIAL AND METHODS: The sample consisted of 297 adolescents (55.2% female and 44.8% male) aged from 11 to 17 years, divided into four groups according to their BMI percentile: normal weight, overweight, obesity and severe obesity. The questionnaires used were the Eating Disorders Inventory-2 (EDI-2) and the state-trait anxiety questionnaire (STAI). RESULTS: The results showed that the adolescents with severe obesity were more concerned about their physical appearance (body dissatisfaction and obsession with being thin), by their social environment (interpersonal distrust), and showed more anxiety state and anxiety trait than adolescent overweight or obese. In the clinical sample, the adolescents with normal weight showed specific factors for developing eating disorders in the future. CONCLUSIONS: As the BMI increased, symptoms of anxiety and symptoms associated with eating disorders were also increased. The findings of this study are discussed in order to improve therapeutic interventions.

[Response to stopping azathioprine in Crohn's patients on combined treatment with infliximab]. / Respuesta a la suspensión de azatioprina en pacientes con enfermedad de Crohn en terapia combinada con infliximab.

BACKGROUND: The use of immunomodulatory agents has changed the management of inflammatory bowel disease. Immunosuppressive drugs (mainly thiopurines) and biological treatments (mainly monoclonal antibodies against TNFalpha) are currently most frequently and earlier used. The recent report of new cases of the rare and almost always fatal hepatosplenic T-cell lymphoma in young patients on combined therapy with azathioprine/6-mercaptopurine and infliximab suggests that the optimal strategies for reducing increased risk of side-effects need to be urgently assessed. PATIENTS AND METHOD: We report the effects of stopping immunosupressants in four Crohn's disease patients previously treated with azathioprine and infliximab for 6-12 months as combined therapy. The appearance of infusion reactions due to immunogenicity and the loss of efficacy of infliximab are evaluated. RESULTS: No adverse events attributable to immunosuppression cessation or changes in infliximab efficacy have been noted during a 6-month evaluation period. CONCLUSIONS: Stopping immunosuppressant therapy in Crohn's patients with a previous good response to combination therapy (azathioprine and infliximab) does not result in an increased risk of adverse events or loss of infliximab efficacy. Our results must be confirmed in larger and longer studies. Until the pathogenic role of this combined therapy in the incidence of hepatosplenic T-cell lymphoma is clearly defined, we consider that monotherapy with infliximab after a period on combined treatment is a safe and effective strategy.

Respuesta a la suspensión de azatioprina en pacientes con enfermedad de Crohn en terapia combinada con infliximab / Response to stopping azathioprine in Crohn & apos; s patients on combined treatment with infliximab

Introducción: el uso de fármacos inmunomoduladores en la enfermedad inflamatoria intestinal ha cambiado su manejo. Los tratamientos inmunosupresores (fundamentalmente tiopurinas) y biológicos (especialmente los anticuerpos monoclonales contra el factor de necrosis tumoral alfa) son utilizados cada vez con más frecuencia y más precozmente. La descripción de nuevos casos de linfoma hepatoesplénico de células T en pacientes jóvenes tratados con combinación de azatioprina/6-mercaptopurina e infliximab de manera prolongada hace necesaria la revisión de las actuales estrategias para evitar los posibles efectos secundarios de la inmunosupresión intensiva. Pacientes y método: presentamos los efectos de suspender la inmunosupresión en 4 pacientes afectos de enfermedad de Crohn tras un periodo de 6–12 meses en tratamiento combinado con azatioprina e infliximab. Se valora la aparición de reacciones adversas plausiblemente inmunogénicas y la pérdida de eficacia del infliximab tras suspender la azatioprina. Resultados: no se han producido cambios en la eficacia de infliximab en monoterapia ni se han objetivado reacciones de hipersensibilidad en los 6 meses siguientes a la suspensión. Conclusiones: la retirada del tratamiento inmunosupresor en pacientes afectos de Enfermedad de Crohn con buena respuesta previa al tratamiento combinado con azatioprina e infliximab no conlleva un mayor riesgo de reacciones de hipersensibilidad ni se acompaña de pérdida de la eficacia del infliximab. Por el tamaño reducido de nuestra muestra y el seguimiento limitado, los resultados deberán confirmarse en estudios más amplios y prolongados. Hasta que se defina exactamente el efecto patogénico de dicha combinación en la aparición de neoplasias, el paso a monoterapia con infliximab es una maniobra segura y eficaz (AU)

Background: The use of immunomodulatory agents has changed the management of inflammatory bowel disease. Immunosuppressive drugs (mainly thiopurines) and biological treatments (mainly monoclonal antibodies against TNFα) are currently most frequently and earlier used. The recent report of new cases of the rare and almost always fatal hepatosplenic T-cell lymphoma in young patients on combined therapy with azathioprine/6-mercaptopurine and infliximab suggests that the optimal strategies for reducing increased risk of side-effects need to be urgently assessed. Patients and method: We report the effects of stopping immunosupressants in four Crohn’s disease patients previously treated with azathioprine and infliximab for 6–12 months as combined therapy. The appearance of infusion reactions due to immunogenicity and the loss of efficacy of infliximab are evaluated. Results: No adverse events attributable to immunosuppression cessation or changes in infliximab efficacy have been noted during a 6-month evaluation period. Conclusions: Stopping immunosuppressant therapy in Crohn’s patients with a previous good response to combination therapy (azathioprine and infliximab) does not result in an increased risk of adverse events or loss of infliximab efficacy. Our results must be confirmed in larger and longer studies. Until the pathogenic role of this combined therapy in the incidence of hepatosplenic T-cell lymphoma is clearly defined, we consider that monotherapy with infliximab after a period on combined treatment is a safe and effective strategy (AU)

Treatment cost of ulcerative colitis is apheresis with Adacolumn cost-effective?

BACKGROUND: Scarce data are available in Europe on the cost of treatment for ulcerative colitis (UC). AIM: To assess the cost of illness of moderate-to-severe UC in two scenarios: traditional treatment versus alternative treatment incorporating granulocyte, monocyte adsorption - apheresis (GMA-Apheresis; Adacolumn). To determine the relative cost-effectiveness of both options in steroid-dependent patients. METHODS: One-year cost-of-illness and cost-effectiveness analysis from the third-payer perspective using a decision tree model was carried out. Probabilities of each event were derived from the literature and an expert panel. Direct medical costs were obtained from official sources (euro2004). Effectiveness was measured by the proportion of patients achieving clinical remission. RESULTS: The average annual cost per patient treated with traditional treatment was estimated to be euro6740; with GMA-Apheresis, the cost was estimated to be euro6959. In steroid-dependent patients, the average annual cost was euro6059 and euro11,436, respectively. The proportion of patients achieving clinical remission with GMA-Apheresis was 22.5% higher. As second- and third-line therapy, a new course of corticosteroids and surgery was avoided in 18.5 and 4% of patients, respectively. CONCLUSIONS: Incorporating GMA-Apheresis (Adacolumn) in the therapeutic management of moderate-to-severe UC patients is cost-effective and implies savings related to the reduction of adverse effects derived from corticosteroid use and to the decreased number of surgical interventions.

Treatment of severe osteoporosis with alendronate in a patient with lysinuric protein intolerance.

Lysinuric protein intolerance is an inborn error of cationic amino acid transport of which osteoporosis is a major feature. Treatment with oral bisphosphonates improves bone mineral density even in severe osteoporosis.

Documento de consenso en el uso de la granulocitoaféresis en pacientes con enfermedad inflamatoria intestinal / Consensus document on the use of granulocytapheresis in patients with inflammatory bowel disease

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