Effects of Zinc Supplementation on Nutritional Status in Children with Chronic Kidney Disease: A Randomized Trial.

BACKGROUND: Zinc is an essential micronutrient for human beings and its deficiency affects their normal growth and development. OBJECTIVE: The main aim was to evaluate the effect of two doses of zinc supplementation (ZS) on the nutritional status in chronic kidney disease (CKD) children. METHODS: A randomized-trial multicentric study was conducted in 48 CKD (23 females) patients under 18-years-old, for a year. At random, participants took 30 or 15 mg/day of ZS, respectively. Anthropometric measurements and biochemical analysis were performed. Hypozincemia was determined by serum zinc concentration (SZC) using atomic absorption spectrophotometry. The positive or negative change in patients' body mass index (BMI) Z-score, serum albumin, zinc and C-reactive protein (CRP) levels were used to evaluate the effect of ZS. RESULTS: Mean SZC was normal before and after ZS. Despite ZS, there were no significant changes in serum albumin, zinc and CRP levels. A positive and significant association was observed between SZC and serum albumin before (p = 0.000) and after (p = 0.007) ZS. In both groups of ZS, there was a small but positive and significant change in body mass and normalization in BMI Z-score, hypoalbuminemia, hypozincemia and high CRP, especially with 30 mg/day of ZS. CONCLUSIONS: Zinc supplementation may be beneficial for nutritional status in children and adolescents with CKD.

Corrigendum: Fecal Gluten Peptides Reveal Limitations of Serological Tests and Food Questionnaires for Monitoring Gluten-Free Diet in Celiac Disease Patients.

This corrects the article DOI: 10.1038/ajg.2016.439.

Fecal Gluten Peptides Reveal Limitations of Serological Tests and Food Questionnaires for Monitoring Gluten-Free Diet in Celiac Disease Patients.

OBJECTIVES: Treatment for celiac disease (CD) is a lifelong strict gluten-free diet (GFD). Patients should be followed-up with dietary interviews and serology as CD markers to ensure adherence to the diet. However, none of these methods offer an accurate measure of dietary compliance. Our aim was to evaluate the measurement of gluten immunogenic peptides (GIP) in stools as a marker of GFD adherence in CD patients and compare it with traditional methods of GFD monitoring. METHODS: We performed a prospective, nonrandomized, multicenter study including 188 CD patients on GFD and 84 healthy controls. Subjects were given a dietary questionnaire and fecal GIP quantified by enzyme-linked immunosorbent assay (ELISA). Serological anti-tissue transglutaminase (anti-tTG) IgA and anti-deamidated gliadin peptide (anti-DGP) IgA antibodies were measured simultaneously. RESULTS: Of the 188 celiac patients, 56 (29.8%) had detectable GIP levels in stools. There was significant association between age and GIP in stools that revealed increasing dietary transgressions with advancing age (39.2% in subjects ≥13 years old) and with gender in certain age groups (60% in men ≥13 years old). No association was found between fecal GIP and dietary questionnaire or anti-tTG antibodies. However, association was detected between GIP and anti-DGP antibodies, although 46 of the 53 GIP stool-positive patients were negative for anti-DGP. CONCLUSIONS: Detection of gluten peptides in stools reveals limitations of traditional methods for monitoring GFD in celiac patients. The GIP ELISA enables direct and quantitative assessment of gluten exposure early after ingestion and could aid in the diagnosis and clinical management of nonresponsive CD and refractory CD. Trial registration number NCT02711397.

Analysis of the Spanish national registry for pediatric home enteral nutrition (NEPAD): implementation rates and observed trends during the past 8 years.

BACKGROUND/OBJECTIVES: The home enteral nutrition (HEN) provides nutritional support to children with chronic diseases who are nutritionally compromised and allows them to be discharged more quickly from hospitals. In 2003, a web-based registry (Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria, Pediatric Ambulatory and Home Enteral Nutrition -NEPAD-) was created with the objective of gathering information about pediatric HEN practices in Spain. AIM: The aim of this study was to report the implementation of the NEPAD (Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria, Pediatric Ambulatory and Home Enteral Nutrition) registry of pediatric HEN in Spain and to analyze data evolution trends from 2003 to 2010. SUBJECTS/METHODS: The data from the Spanish NEPAD registry were analyzed according to the following variables: demographic data, diagnosis, indication for HEN, nutritional support regime and administration route. RESULTS: Over the study period, 952 patients (1048 episodes) from 20 Spanish hospitals were included in the NEPAD registry. The most frequent indication for HEN was decreased oral intake (64%), and neurological disease was the most prevalent illness. HEN was delivered via a nasogastric tube in 573 episodes (54.7%), by gastrostomy in 375 episodes (35.8%), oral feeding in 77 episodes (7.3%) and by jejunal access in 23 episodes (2.2%). Significant differences in the mode of administration were observed based on the pathology of the child (χ(2), P<0.0001). The cyclic feeding was the most widely used technique for the administration of HEN. Most of the patients used a pump and a polymeric formula. Transition to oral feeding was the primary reason for discontinuation of this type of support. CONCLUSIONS: Since the NEPAD registry was established in Spain, the number of documented patients has increased more than 25-fold. Many children with chronic illness benefit from HEN, mainly those suffering from neurological diseases.

Prevalence of insulin resistance and impaired glucose tolerance in a sample of obese Spanish children and adolescents.

The prevalence of obesity in children has increased in developed countries in the last decades. It is associated with alterations in glucose metabolism that may be present in childhood. To assess the frequency of glucose metabolism alterations and insulin resistance and their possible determinants in a sample of obese children from Valladolid (Spain), we retrospectively studied 100 obese children and adolescents (11.59 ± 2.73 years). Anthropometric measures, biochemical parameters, and oral glucose tolerance test (OGTT) were performed. Insulin resistance was evaluated with fasting insulin, HOMA index, and insulin values in OGTT. Impaired glucose tolerance was found in 15% of the sample, and was the most frequent of glucose metabolism alterations. Impaired fasting glucose was found in 2%. No case of type 2 diabetes was found. Acanthosis nigricans was present in 22%, with predominance in females, but not all presented insulin resistance. The prevalence of insulin resistance was 29% when HOMA index was used, and 50% when the insulin response in OGTT was used. Not all patients with impaired glucose tolerance had a pathological HOMA index, and not all with pathological HOMA index presented insulin resistance when insulin values in OGTT were used. Higher 2-h post-OGTT insulin levels were found in children with impaired glucose tolerance. It is paramount to identify young people with glucose regulation alterations for early, intensive intervention to prevent or at least postpone the onset of type 2 diabetes. OGTT is a screening tool necessary to fulfill this objective.

Niveles normales de interleucinas 6 y 8 en suero y orina de niños sanos asintomáticos / Normal levels of interleukin 6 and 8 in serum and urine in asymptomatic healthy children

Introducción: La infección urinaria es una patología muy frecuente en niños, y su diagnóstico y tratamiento precoces dependen de la sospecha clínica y la aplicación de parámetros analíticos. Algunas citocinas han despertado un gran interés en este terreno. Objetivo: Conocer los niveles de las interleucinas (IL) 6 y 8 en sangre y orina en niños sanos, y establecer el rango de normalidad de nuestro laboratorio. Material y métodos: Estudio observacional transversal, descriptivo y analítico, en niños sanos sin infección urinaria. Se analizan las variables sexo, edad, niño mayor o menor de 1 año, y nivel de IL 6 y 8 en sangre y orina (mediante ELISA). Se calcula la estadística básica de las variables cuantitativas. La comparación entre muestras independientes se llevó a cabo con el test U de Mann-Whitney, y la correlación entre las mismas con el test de Pearson. Se consideró un error alfa del 5% (SPSS 9.0). El límite superior de normalidad de las IL se estableció en la media más 2 desviaciones estándar (95% de la población). Resultados: Estudiamos 52 niños (40 varones, 76,92%) con una edad media de 51,31 + 47,98 meses (1-149 meses), sin diferencias en su distribución por sexo y grupos de edad inferior o superior a un año. Los niveles medios de IL (e intervalo de confianza IC: 95%), y el límite superior de la normalidad, fueron respectivamente, para IL-6 suero: 0,49 (IC: 0-1,05), y 3,95 pg/mL; IL-6 orina: 0,17 (IC: 0-0,51), 1,83 pg/mL; IL-8 suero: 136,66 (IC: 0,74-272,58), 974,58 pg/mL; IL-8 orina: 47,23 (14,71-79,75), 242,39 pg/mL. No hubo diferencias entre ambos sexos ni grupos de edad, salvo niveles medios de IL-8 urinaria más elevados en menores de 1 año, con una correlación negativa entre dicha variable y edad (p<0,05). Asimismo, existe una correlación positiva y muy significativa de IL-6 y 8 en orina (p<0,001) y de IL-8 entre suero y orina (p<0,01). Conclusiones: En niños sanos, no se observaron diferencias según sexos en los niveles de IL-6 y 8, pero la producción de IL-8 en orina es mayor en niños más pequeños. Adiferencia de la IL-6, se detectan niveles significativos de IL-8 en suero y orina de niños sanos, cuestionando su validez en el diagnóstico de infección. Finalmente, existe en condiciones normales una excelente correlación entre IL-6 y 8 en orina

Objective: To determine the interleukins (IL) 6 and 8 levels in serum and urine in the healthy pediatric population, and to establish our laboratory reference values, whit the purpose of subsequently to apply this determination to diagnosis of urinary tract infection. Material and methods: Observational, transversal, descriptive and analytical study, in healthy children without urinary tract infection. We analyse the following variables: sex, age, to be oldest or youngest than 1 year, and IL-6 and IL-8 levels in serum and urine (ELISA). We evaluate the basic statistics for quantitative variables. It compare the independent samples by means of Mann-Whitney U test, and its correlation with the Pearson test. We consider an alpha-error of 5% (SPSS 9.0). The upper limit of normality was established in two standard deviation more than the mean (95% of population). Results:We have studied 52 children (40 males, 76.92%). The mean of age was 51.31 + 47.98 months (1-149 months), and it didn’t have differences according to sex, or to be oldest and youngest than 1 year of age. The mean values of IL (and confidence interval IC: 95%), and the upper limit of normality, respectively were for serum IL-6: 0.49 (IC: 0-1,05), and 3.95 pg/mL; urine IL-6: 0,17 (IC: 0-0,51), 1,83 pg/mL; serum IL-8: 136,66 (IC: 0,74-272,58), 974,58 pg/mL; and urine IL-8: 47,23 (14,71-79,75), 242,39 pg/mL. It didn’t have differences neither between both sex nor age groups, except urine IL-8 mean levels greater in youngest of 1 year of age, with a negative correlation between this variable and age (p<0,05). Moreover, it exist a positive and very significant correlation of urine IL-6 and 8 (p<0,001), and serum and urine IL-8 (p<0,01). Conclusions: In healthy pediatric population, it didn’t observe differences according to sex in IL-6 and IL-8 levels, but the urine IL-8 production is greater in more little children. It observe significant serum and urine IL-8 levels in healthy children, making questionable its validity in urinary tract infection diagnosis. Finally, it exist an excellent correlation between urinary IL-6 and IL-8 in normal conditions