Are the nutritional status and growth parameters of children with juvenile idiopathic arthritis akin to their healthy peers? A single-center experience.

OBJECTIVE: Proper nutrition is a significant contributor to growth achievement in patients with juvenile idiopathic arthritis (JIA). In this study, the aim was to analyze the growth parameters and nutritional status of children with JIA and then compare them with their healthy peers. METHODS: A cross-sectional study was conducted with 54 patients with JIA and the same number of healthy peers. Growth parameter z-scores and nutrient distributions were analyzed and compared with a control group and among disease subgroups. RESULTS: While the average height in the control group was significantly greater than in the patient group, there was similarity in terms of body weight and body mass index (BMI) (P < 0.001, P = 0.33, P = 0.14, respectively). Body weight and BMI z-scores of patients with high disease activity at the most recent visit were significantly lower (P = 0.03, P = 0.01, respectively). Both groups had similar energy and protein requirement-meeting percentages (P = 0.62, P = 0.51). JIA atients had higher carbohydrate intake (P = 0.04), and fat intake was higher in controls (P = 0.02). Energy obtained from junk food was higher in patients with entesitis-related arthritis (ERA) compared to oligoarticular JIA and polyarticular JIA (P = 0.03). Micronutrient intake in the ERA group was significantly lower for vitamin E, C, and folate (P = 0.02, P = 0.03, P < 0.001). CONCLUSION: In our cohort, patients had a lower height score. As they have a diet characterized by adequate energy/protein, carbohydrate, and high fat intake, this may be a reflection of disease activity. Although some of the micronutrient intakes were less than normal in both groups, significant deficiencies were identified in the ERA group.

Psychometric properties and factor structure of the diabetes eating problem survey- revised (DEPS-R) among adults with type 1 diabetes mellitus.

BACKGROUND AND OBJECTIVE: Although many studies on the Diabetes Eating Problem Survey-Revised (DEPS-R) in adolescents with type 1 diabetes mellitus (T1D), the number of studies validating this questionnaire in adults with T1D is limited. Therefore, this study aimed to examine the factor structure of the Turkish version of the DEPS-R in adults with T1D and internal consistency and construct validity. METHODS: A total of 100 patients with T1D, ages 18-50 years, completed the DEPS-R and EDE-Q. In addition to tests of validity, confirmatory factor analysis was conducted to investigate the factor structure of the 6-item Turkish version of DEPS-R. RESULTS: The Cronbach's alpha coefficient of the DEPS-R Turkish version was 0.77, suggesting good internal consistency. The median (IQ) DEPS-R score was 15.0 (13.0) among all participants. DEPS-R score was significantly correlated with BMI (r = 0.210; p < 0.05) and EDE-Q (r = 0.586; p < 0.01). There was no correlation between the HbA1c values of participants and neither EDE-Q nor DEPS-R scores. The confirmatory factor analysis results show that the three-factor model was a good fit. CONCLUSION: A short, self-administered diabetes-specific screening tool for disordered eating behavior is recommended be used routinely in the clinical care of adults with T1D, and Turkish version of DEPS-R has acceptable internal consistency and construct validity in adults with T1D. LEVEL OF EVIDENCE: Level V, descriptive study. CLINICALTRIALS: gov registration number NCT05346679/ 21.04.2022 (retrospectively registered).

Lactobacillus GG is associated with mucin genes expressions in type 2 diabetes mellitus: a randomized, placebo-controlled trial.

PURPOSE: Recent studies indicate that dysbiosis of gut microbiota and low-grade inflammation are important pathogenic determinants of type two diabetes mellitus (T2DM). The aim of this study is to investigate the effects of Lactobacillus GG on glycemic control, lipid profile, inflammatory parameters, and some gene expression levels in individuals with T2DM. METHODS: In a randomized, placebo-controlled trial, 34 women, aged 30-60 years with T2DM consumed daily probiotics or placebo for 8 weeks. The probiotic group consumed 10 × 109 Cfu/day Lactobacillus rhamnosus GG ATCC 53,103 (LGG), approved by the TR Ministry of Food, Agriculture, and Livestock. Anthropometric measurements, food diary, fasting blood, and fecal samples were taken at baseline and post-treatment. RESULTS: Fasting blood glucose was significantly decreased in probiotic (p = 0.049) and placebo (p = 0.028), but there was no difference between the groups. In the probiotic group, no significant difference was observed in HbA1c, fructosamine, lipid profile, and inflammatory variables compared to baseline. In this group, with LGG supplementation, mucin 2 and 3A (MUC2 and MUC3A) gene expressions increased more than ninefolds (p = 0.046 and p = 0.008, respectively) at post-treatment. Meanwhile, there was no significant change in any of the gene expressions in the placebo group. There was no significant difference in energy, protein, dietary fiber, and cholesterol intakes between placebo and probiotic groups during the study. However, daily fat intake (p = 0.003), body weight (p = 0.014), and body fat (p = 0.015) in the probiotic group were significantly decreased. CONCLUSION: In this study, the effects of a single probiotic strain were investigated for 8 weeks. At the end of the study, although there was no finding that clearly reflected on the glycemic parameters of T2DM, its beneficial effects on the expression of mucin genes, which are responsible for weight loss and protection of intestinal barrier functions, cannot be denied. Further studies are needed to reveal the importance of these findings. CLINICAL TRIAL REGISTRATION: ID: NCT05066152, October 4, 2021 retrospectively registered in ClinicalTrials.gov PRS web site.

Frequently Asked Questions and Evidence-Based Answers on Medical Nutritional Therapy in Children with Type 1 Diabetes for Health Care Professionals

Medical nutrition therapy is a cornerstone in type 1 diabetes management and is based on the principles of healthy eating. The recommendations presented are valid for all children and their families. A number of frequently asked questions will be addressed in this article. Although carbohydrates are the main nutrient that affects postprandial blood glucose in individuals with type 1 diabetes, intake of carbohydrates (type and amount), protein and fat content of the meal, and glycemic index affect the postprandial glycemic response. In recent years, the relative increase in studies about Ramadan fasting for individuals with type 1 diabetes has indicated that health professionals should be informed about this issue. The difficulties in nutritional management of preschool children should be solved with a professional approach. The increasing frequency of celiac disease in people with type 1 diabetes and an increasing interest in a gluten-free diet for non-celiac reasons (popular diet trends for weight loss or healthy eating) further complicate diabetes management. This review provides evidence-based approaches to frequently encountered problems on medical nutrition therapy in children and adolescents with type 1 diabetes.

Recommendations for Clinical Decision-making in Children with Type 1 Diabetes and Celiac Disease: Type 1 Diabetes and Celiac Disease Joint Working Group Report

It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients' families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors' own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD.

Evaluation of Unfavorable Cardiovascular and Metabolic Risk Factors in Children and Young Adults with Haemophilia

Objective: Increased risk of unfavorable cardiovascular risk factors has been recognised in ageing patients with haemophilia (PwH), but needs further studies in younger patients. The purpose of this study was to assess obesity, hypertension (HT), metabolic variables, insulin resistance and metabolic syndrome in young PwH. Methods: Forty-eight haemophilia A and B patients and 35 age and sex matched healthy controls were included in the study. Anthropometric measurements, blood pressure (BP), fasting glucose and insulin levels, serum lipids and diet were evaluated. The metabolic syndrome was defined according to the criteria of the International Diabetes Federation for pediatric and adult age groups. Results: The mean age of PwH was 21±9 years (range, 6-40 years). Of those ≥18 years, 46% were were obese/overweight while there were no obese/overweight cases in the <18 year-old patients. Obesity was more prevalent in PwH with arthropathy (p=0.017). Seven percent of the PwH between 10 and 18 years-old and 25% of those ≥18 years had metabolic syndrome. There was no difference in metabolic syndrome frequency between PwH and controls >10 years-old (19.5% vs 10% respectively, p=0.34). Fifty percent of the PwH ≥18 years-old had elevated BP or HT. Fasting blood glucose levels of PwH were significantly higher compared to controls (p=0.02). Conclusion: Our study showed that obesity, HT and metabolic syndrome are frequent problems, especially in PwH with arthropathy. Early prevention and management of overweight, obesity and their sequelae must be addressed in clinical practice in order to maximize the overall health of the haemophilia population.