Valoración nutricional de la dieta sin gluten. ¿Es la dieta sin gluten deficitaria en algún nutriente? / Nutritional assessment of gluten-free diet. Is gluten-free diet deficient in some nutrient?

INTRODUCCIÓN: Clásicamente, se ha presentado la dieta sin gluten como una dieta sana, pero existen artículos que defienden que puede presentar algunas deficiencias nutricionales. En el presente estudio se valoró si existía algún cambio en los aportes de calorías, principios inmediatos, proporción de ácidos grasos, vitaminas, minerales y fibra en los niños que eran diagnosticados de celiaquía, comparando la dieta con gluten previa al diagnóstico con la dieta al año del diagnóstico sin gluten. También se valoró el grado de repercusión clínico o analítico que podrían tener los déficits nutricionales. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y prospectivo en el cual se recogieron los datos de encuesta dietéticas, antropometría y analítica previas al diagnóstico de celiaquía siguiendo dieta con gluten y al año del diagnóstico, con dieta sin gluten de los pacientes diagnosticados de enfermedad celíaca. RESULTADOS: Treinta y siete pacientes reúnen criterios de estudio. Se encontró una disminución en la ingesta de ácidos grasos saturados, con un aumento de monoinsaturados, un aumento en la ingesta de fósforo en la dieta sin gluten y un ingesta deficitaria de vitamina D en ambas dietas. Clínicamente, al año de dieta sin gluten hay mejoría en el peso y la talla. Analíticamente, hay mejoría en las cifras de hemoglobina, ferritina, vitamina D y parathormona plasmáticos. CONCLUSIÓN: La dieta sin gluten presenta mínimas deficiencias, similares a las presentes en la dieta con gluten, con una mejoría en el perfil lipídico, aumentando la proporción de ácidos grasos monoinsaturados en detrimento de los ácidos grasos saturados

INTRODUCTION: The gluten-free diet has traditionally been accepted as a healthy diet, but there are articles advocating that it may have some nutritional deficiencies. The current study assesses whether there was any change in the contributions of calories, essential elements, proportion of fatty acids, vitamins, minerals and fiber in children who were diagnosed with celiac diseases, comparing the diet with gluten prior one year after diagnosis with the diet without gluten to the year of diagnosis. The level of clinical or analytical impact that nutritional deficits could have was also assessed. MATERIAL AND METHODS: A prospective,descriptive, observational study in which information was collected from a dietary survey, anthropometric and analytical data at pre-diagnosis of celiac disease and following a gluten diet and one year after celiac disease diagnosis, under gluten-free diet. RESULTS: A total of 37 patients meet the study criteria. A decrease in the intake of saturated fatty acids was found, with an increase of monounsaturated fatty acids and an increase in the intake of phosphorus in the diet without gluten. A deficient intake of vitamin D was found in both diets. Clinically, at year of gluten-free diet there was an improvement in weight and size. Analytically, there was an improvement in hemoglobin, ferritin, vitamin D, and parathyroid hormone in plasma. CONCLUSION: The gluten-free diet has minimal deficiencies, similar to those present in the diet with gluten, with an improvement in the lipid profile by increasing the proportion of monounsaturated fatty acids to the detriment of saturated fatty acids

[Nutritional assessment of gluten-free diet. Is gluten-free diet deficient in some nutrient?]. / Valoración nutricional de la dieta sin gluten. ¿Es la dieta sin gluten deficitaria en algún nutriente?

INTRODUCTION: The gluten-free diet has traditionally been accepted as a healthy diet, but there are articles advocating that it may have some nutritional deficiencies. The current study assesses whether there was any change in the contributions of calories, essential elements, proportion of fatty acids, vitamins, minerals and fiber in children who were diagnosed with celiac diseases, comparing the diet with gluten prior one year after diagnosis with the diet without gluten to the year of diagnosis. The level of clinical or analytical impact that nutritional deficits could have was also assessed. MATERIAL AND METHODS: A prospective,descriptive, observational study in which information was collected from a dietary survey, anthropometric and analytical data at pre-diagnosis of celiac disease and following a gluten diet and one year after celiac disease diagnosis, under gluten-free diet. RESULTS: A total of 37 patients meet the study criteria. A decrease in the intake of saturated fatty acids was found, with an increase of monounsaturated fatty acids and an increase in the intake of phosphorus in the diet without gluten. A deficient intake of vitamin D was found in both diets. Clinically, at year of gluten-free diet there was an improvement in weight and size. Analytically, there was an improvement in hemoglobin, ferritin, vitamin D, and parathyroid hormone in plasma. CONCLUSION: The gluten-free diet has minimal deficiencies, similar to those present in the diet with gluten, with an improvement in the lipid profile by increasing the proportion of monounsaturated fatty acids to the detriment of saturated fatty acids.

Recomendaciones para el tratamiento del estreñimiento funcional / Guidelines for the treatment of functional constipation

El estreñimiento es un problema clínico frecuente. Afecta del 2 al 30% de los niños, según el criterio diagnóstico utilizado. El tratamiento recomendado se basa en: a) explicación-desmitificación; b) desimpactación fecal y c) mantenimiento con cambios en la dieta, modificación de los hábitos higiénicos y el uso de laxantes. En la última década ha variado el sistema de vaciado intestinal; de la clásica vía rectal hemos pasado al uso generalizado de la vía oral a base de polietilenglicol 3350.Se debe tener en cuenta las necesidades individuales y las preferencias del paciente. El tratamiento de mantenimiento se iniciará inmediatamente después de lograr el vaciado intestinal. Está basado en la modificación de los hábitos dietéticos, higiénicos y en el uso de laxantes. Una adecuada ingesta de fibra y agua, el entrenamiento del hábito defecatorio y el uso de laxantes orales logra una defecación diaria y no dolorosa, evitando la reacumulación de heces. El uso de enemas puede ser efectivo para la desimpactación, pero tiene el riesgo de lesión traumática y no es adecuado para el tratamiento de mantenimiento. Los laxantes recomendados son los osmóticos. El tratamiento de primera elección en niños de cualquier edad es el polietilenglicol 3350 por su seguridad, efectividad y tolerancia. Su dosis varia entre 0,25 a 1,5g/kg. El mejor conocimiento de la fisiología de la defecación ha permitido el desarrollo de nuevos fármacos: bloqueantes de los receptores de la serotonina o activadores de los canales del cloro (AU)

Constipation is common in childhood. It can affect around 5–30% of the child population, depending on the criteria used for diagnosis. The currently recommended treatment is based on three main points: a) explanation, b) disimpaction and c) maintenance therapy consisting of diet changes, behavioural modification, and the use of laxatives. In the last decades treatment on disimpaction have changed radically from the rectal route to the oral route with polyethylene glycol 3350 (PEG), the most used and accepted regimen nowadays. Treatment and care should take into account the individual needs and preferences of the patient. Good communication is essential, to allow patients to reach informed decisions about their care. Maintenance therapy consists of dietary interventions, toilet training, and laxatives to obtain daily painless defaecation in order to prevent re-accumulation of stools. Maintenance therapy should be start as soon as the child's bowel is disimpacted. Early intervention with oral laxatives may improve complete resolution of functional constipation. Enemas using phosphate, mineral oil, or normal saline are effective in relieving rectal impaction, but carry the risk of mechanical trauma and are not recommended for maintenance therapy in the paediatric population. Among osmotic agents, polyethylene glycol 3350 plus electrolyte solutions appear to be the first-line drug treatment to use in children of any age, as it is safe, effective, and well-tolerated. Recommended doses ranges from 0.25 to 1.5g/kg. Advances in the understanding of the gastrointestinal enteric nervous system and epithelial function have led to the development of new substances that bind to serotonin receptors or are chloride channel activators (AU)

[Guidelines for the treatment of functional constipation]. / Recomendaciones para el tratamiento del estreñimiento funcional.

Constipation is common in childhood. It can affect around 5-30% of the child population, depending on the criteria used for diagnosis. The currently recommended treatment is based on three main points: a) explanation, b) disimpaction and c) maintenance therapy consisting of diet changes, behavioural modification, and the use of laxatives. In the last decades treatment on disimpaction have changed radically from the rectal route to the oral route with polyethylene glycol 3350 (PEG), the most used and accepted regimen nowadays. Treatment and care should take into account the individual needs and preferences of the patient. Good communication is essential, to allow patients to reach informed decisions about their care. Maintenance therapy consists of dietary interventions, toilet training, and laxatives to obtain daily painless defaecation in order to prevent re-accumulation of stools. Maintenance therapy should be start as soon as the child's bowel is disimpacted. Early intervention with oral laxatives may improve complete resolution of functional constipation. Enemas using phosphate, mineral oil, or normal saline are effective in relieving rectal impaction, but carry the risk of mechanical trauma and are not recommended for maintenance therapy in the paediatric population. Among osmotic agents, polyethylene glycol 3350 plus electrolyte solutions appear to be the first-line drug treatment to use in children of any age, as it is safe, effective, and well-tolerated. Recommended doses ranges from 0.25 to 1.5g/kg. Advances in the understanding of the gastrointestinal enteric nervous system and epithelial function have led to the development of new substances that bind to serotonin receptors or are chloride channel activators.

[Is capsule endoscopy useful in children with chronic abdominal pain?]. / Es útil la cápsula endoscópica en niños con dolor abdominal crónico?

Chronic abdominal pain is highly prevalent in school-aged children and is one of the most frequent disorders in our environment. The aim of the present study was to evaluate the usefulness of capsule endoscopy (CE) in patients with chronic abdominal pain. Sixteen patients (nine boys and seven girls), aged between 5 and 16 years old, with chronic abdominal pain for at least 12 months were studied. In all patients the results of hemograms, biochemical investigations, urine sediment test, Helicobacter pylori breath test and celiac serology were normal. In all children, gastroscopy, small bowel follow-through, abdominal ultrasound and colonoscopy were normal. All patients received CE by mouth. In 43.75 % of the patients studied (7/16), the capsule showed evidence of nodular lymphoid hyperplasia, mainly located in the ileum. In one girl, oxyuriasis was observed in the cecum and in another girl aphthous lesions were observed in the ileum. These lesions suggested small bowel Crohn's disease. CE mainly showed images compatible with nodular lymphoid hyperplasia, with unknown clinical significance. Consequently, we conclude that CE does not provide useful information in patients with abdominal pain without other symptoms.

¿Es útil la cápsula endoscópica en niños con dolor abdominal crónico? / Is capsule endoscopy useful in children with chronic abdominal pain?

El dolor abdominal crónico afecta a un alto porcentaje de niños en edad escolar, lo que la convierte en una de las patologías más frecuentes en nuestro medio. El objetivo es valorar si la cápsula endoscópica (CE) permite identificar lesiones intestinales en estos pacientes. Se han incluido 16 pacientes (9 niños y 7 niñas) con edades comprendidas entre los 5 y 16 años con dolor abdominal crónico de más de 12 meses de evolución. Todos tenían realizados hemograma, bioquímica, sedimento de orina, test de aliento para Helicobacter pylori y serología para enfermedad celíaca, que eran negativos. A todos se les había realizado una gastroscopia, y una colonoscopia que resultaron negativas, así como un tránsito gastrointestinal y una ecografía abdominal, sin hallazgos de interés. En el 43,75 % de los pacientes estudiados (7/16) la CE mostró imágenes compatibles con hiperplasia folicular linfoide localizadas en el íleon. En una niña se observaron oxiuros en ciego y en otra, lesiones aftosas ileales compatibles con enfermedad de Crohn. La CE muestra en la mayoría de los casos imágenes compatibles con hiperplasia nodular linfoide intestinal, con dudosa significación clínica, por lo que podemos concluir que la CE no aporta nada específico en niños con dolor abdominal crónico

Chronic abdominal pain is highly prevalent in school-aged children and is one of the most frequent disorders in our environment. The aim of the present study was to evaluate the usefulness of capsule endoscopy (CE) in patients with chronic abdominal pain. Sixteen patients (nine boys and seven girls), aged between 5 and 16 years old, with chronic abdominal pain for at least 12 months were studied. In all patients the results of hemograms, biochemical investigations, urine sediment test, Helicobacter pylori breath test and celiac serology were normal. In all children, gastroscopy, small bowel follow-through, abdominal ultrasound and colonoscopy were normal. All patients received CE by mouth. In 43.75 % of the patients studied (7/16), the capsule showed evidence of nodular lymphoid hyperplasia, mainly located in the ileum. In one girl, oxyuriasis was observed in the cecum and in another girl aphthous lesions were observed in the ileum. These lesions suggested small bowel Crohn's disease. CE mainly showed images compatible with nodular lymphoid hyperplasia, with unknown clinical significance. Consequently, we conclude that CE does not provide useful information in patients with abdominal pain without other symptoms

[Prevention of childhood osteoporosis]. / Prevenció de la osteoporosis en la infancia.

Bone mineralization depends on genetic, nutritional, endocrine, metabolic and mechanical factors. Dairy products form the major source of dietary calcium and vitamin D, both of which are essential for optimal bone mineralization. Osteoporosis is defined as a reduction in bone mass; it is exacerbated by malnutrition, low weight, poor intake of vitamin D and calcium and lack of physical exercise. The purpose of this article is to encourage pediatricians to make an effort about the prevention of childhood osteoporosis.

Prevención de la osteoporosis en la infancia / Prevention of childhood osteoporosis

La mineralización ósea depende de factores genéticos, nutricionales, endocrinos, metabólicos y mecánicos. Los productos lácteos son la fuente más importante de calcio y vitamina D, ambos esenciales para conseguir una óptima mineralización ósea. La osteoporosis se define como una reducción de la masa ósea; esta pérdida se hace más importante en casos de malnutrición, bajo peso, una ingesta pobre de vitamina D y calcio y el sedentarismo. El objetivo de este artículo es animar a los pediatras a realizar un esfuerzo en la prevención de la osteoporosis infantil (AU)

Bone mineralization depends on genetic, nutritional, endocrine, metabolic and mechanical factors. Dairy products from the major source of dietary calcium and vitamin D, both of which are essential for optimal bone mineralization. Osteoporosis is defined as a reduction in bone mass; it is exacerbated by malnutrition, low weight, poor intake of vitamin D and calcium and lack of physical exercise. The purpose of this article is to encourage pediatricians to make an effort about the prevention of childhood osteoporosis (AU)

The value of capsule endoscopy in pediatric patients with a suspicion of Crohn's disease.

BACKGROUND AND STUDY AIMS: The aim of this study was to assess the safety and usefulness of capsule endoscopy (CE) in pediatric patients with a suspicion of Crohn's disease. PATIENTS AND METHODS: CE was used in 12 patients (four girls, eight boys; age 12-16; weight range 43-87 kg). The indication was a clinical suspicion of Crohn's disease not confirmed with traditional methods. Gastroscopy, colonoscopy, and small-bowel follow-through examinations were carried out in all of the patients, without any diagnostic findings. Ileoscopy was possible in 50 % of the patients, and the ileal mucosa and biopsies were normal in all cases. RESULTS: The capsule was easily swallowed by all of the patients. They all excreted the capsule normally, and no complications were observed in any case. CE identified lesions suggestive of Crohn's disease in seven of the 12 (58.3 %), and the majority of the lesions were in the ileum. CONCLUSIONS: CE is safe in pediatric patients over 12 years of age. The procedure appears to be a very useful diagnostic tool in children with Crohn's disease.

Utilidad de la cápsula endoscópica en gastroenterología pediátrica / Utility of capsule endoscopy in pediatric gastroenterology

La cápsula endoscópica es un nuevo método de diagnóstico no invasivo que permite visualizar de forma nítida posibles lesiones en el intestino delgado. Su tamaño es pequeño y porta una batería y una videocámara que permite tomar dos fotos por segundo del interior del tubo digestivo. Está indicada en casos de hemorragia digestiva de causa no clara y en el diagnóstico de enfermedad inflamatoria intestinal, entre otros. Hasta la fecha se ha utilizado principalmente en adultos. Creemos que en la edad pediátrica puede tener un papel muy importante, por tratarse de una prueba no invasiva, porque permite el diagnóstico de procesos intestinales, y así evitar la realización de numerosas pruebas diagnósticas inútiles. Aportamos el caso de una paciente en edad pediátrica con alta sospecha de enfermedad de Crohn no confirmada mediante las técnicas endoscópicas habituales. La cápsula muestra lesiones intestinales compatibles con esta enfermedad. Tras tratamiento corticoideo la paciente mejora clínicamente y con una evolución favorable de su proceso (AU)

[Utility of capsule endoscopy in pediatric gastroenterology]. / Utilidad de la cápsula endoscópica en gastroenterología pediátrica.

Wireless endoscopy is a new noninvasive diagnostic method that is able to visualize small bowel lesions. The instrument is small and carries a battery and microcamera that takes two photographs per second. It is indicated in cases of bleeding of unknown origin and for the diagnosis of inflammatory bowel disease, among other disorders. To date, it has mainly been used in adults. We believe that this instrument could play an important role in the pediatric age group since it is noninvasive and can be used to diagnose small bowel lesions, thus avoiding unnecessary diagnostic tests. We report the case of a girl with suspicion of Crohn's disease that was unconfirmed by conventional endoscopic techniques. The capsule showed small bowel lesions compatible with Crohn's disease. Corticosteroid treatment was initiated and the patient is now in clinical remission.

Revisión del papel de la fibra en nutrición infantil / Review over the role of fiber in infants and children nutrition

La fibra, es un componente importante de la alimentación humana y a pesar de ello es un concepto difícil de determinar, ya que se trata de un grupo de sustancias que sólo podemos unir por sus funciones en el intestino. El conocimiento de estas funciones ha ido mejorando en los últimos tiempos, aumentando progresivamente la importancia que le concedemos a la fibra para mantener la salud del ser humano y diferenciando los componentes de esta familia entre fibra soluble e insoluble. Uno de los problemas que plantea el estudio de la fibra de la dieta es unificar los criterios de análisis para evaluar el contenido de la misma en cada alimento. Esto se agrava debido a que el procesado de los alimentos altera en nivel de fibra e incluso enmascara su análisis.Sólo hace falta repasar los efectos de la fibra en diferentes puntos del tracto digestivo y en el metabolismo de glucosa y lípidos, para comprender su importancia en la alimentación normal y sus posibilidades terapéuticas. Pero es más difícil valorar si la ingesta real en nuestro medio, y sobre todo en niños, se adecua a las necesidades para cumplir con estas funciones. Por los datos existentes parece que el nivel de aporte es bajo y que los alimentos proveedores de la fibra están cambiando con la dieta actual. La idea, muy extendida, de que un bebé no toma fibra no es exactamente cierta y vale la pena estudiar su aporte el la lactancia materna y en la alimentación complementaria.Finalmente es necesario buscar una recomendación útil y correcta en nuestro medio para que sirva de guía en la alimentación infantil y en el intento de mejorar los hábitos (AU)

Valoración de un hidrolizado / Assessment of a hydrolysate

Objetivo: Valorar la respuesta inmune y los efectos que sobre la clínica tiene el uso de un hidrolizado extensivo de caseína y proteínas del suero con lactosa (H) en niños de riesgo de desarrollar enfermedades alérgicas, y determinar si dicha hidrólisis condiciona alteraciones en la absorción de macro y micronutrientes. Material y métodos: Se realiza un estudio prospectivo de 62 recién nacidos a término, sanos, hasta la edad de 6 meses. Fueron catalogados como de riesgo o no, atendien-do a los antecedentes familiares de alergo-patías y al test de liberación de histamina (TLH) en sangre de cordón, y se establecie-ron 3 grupos de alimentación: el primero formado por niños de riesgo alimentados con H; el segundo, por niños alimentados con lactancia materna (LM) exclusiva y niños de riesgo alimentados con LM suplementada con H, y el tercero, por niños sin riesgo alimentados con una fórmula adaptada. Durante el seguimiento se realiza estudio hematológico, TLH, densitometría ósea volumétrica por ultrasonidos y análisis de las heces mediante espectrofotometría. Resultados: No se evidencian diferencias en ninguna de las variables estudiadas a excepción del TLH, que se normalizó en los grupos 1 y 2. Conclusiones: La alimentación con una fórmula con hidrolizado extensivo de forma exclusiva o como complemento de la LM proporciona un crecimiento pondostatural similar al de los alimentados con LM exclusiva o una fórmula sin hidrolizar. Además se produce una modulación en la respuesta inmune frente a las proteínas de la leche de vaca, como demuestra la negativización de los valores en un principio alterados del TLH respecto a los alimentados con una fórmula adaptada (AU)

[Familial aggregation in 91 families of hypercholesterolemic children]. / Estudio de la agregación familiar en 91 familias de niños hipercolesterolémicos.

OBJECTIVE: The aim of this study was to evaluate both the importance of the screening strategy and the familial aggregation characteristics of families with hypercholesterolemic children. PATIENTS AND METHODS: Ninety-one families (369 subjects) with one hypercholesterolemic child were studied. In addition to clinical and general biochemical evaluation, lipids including apo A-I and B-100 were examined. LDL was quantified under ultracentrifugation. RESULTS: Among the 91 children studied, 10 (10.99%) suffered heterozygous hypercholesterolemia, while 81 (89.01%) suffered polygenic hypercholesterolemia. Following a diet, polygenic children exhibited normal lipid parameters. In heterozygous children a decrease of 19% for total cholesterol, 19.9% for LDL-cholesterol and 16.3% for apo B were observed. When starting the study, 77.5% of the family members thought that they had normal serum lipid values. At the end of the study it was confirmed that only 28% were really normolipemic, indicating that 49.4% of the individual did not know that they were suffering dyslipemia. The study also showed that fathers exhibited the highest incidence of hypercholesterolemia (80.2%) followed by brothers (65.6%) and mothers (61.5%). Therefore, 69.4% of the individuals studied exhibited dyslipemia. CONCLUSIONS: The screening strategy allows one to diagnose a high percentage (almost 50%) of individuals suffering hypercholesterolemia in families with a child previously diagnosed of this pathology. Moreover, in these families there is a high degree of familiar aggregation of dyslipemia.

[The clinical manifestations of peptic esophagitis in children]. / Manifestaciones clínicas de la esofagitis péptica en el niño.

OBJECTIVE: To study the clinical spectrum of peptic esophagitis during childhood. PATIENTS AND METHODS: The clinical histories of 445 cases of peptic esophagitis, diagnosed by means of endoscopy or biopsy, in children between 1 month and 14 years of age were reviewed in order to analyze the reasons for endoscopy and the clinical symptoms presented. RESULTS: In the group under 2 years of age, the main symptom was vomiting, while in those between 2 and 6 years old it was also vomiting followed by abdominal pain. However, there was no significant difference between the groups. In the group over 6 years old, the chief complaint was abdominal pain with a statistically significant difference. CONCLUSIONS: 1) We found a statistically significant relationship between age and clinical data. 2) After comparing the grades of esophagitis with clinical symptoms and the age of the patient, no statistical correlation was found. 3) There is a high frequency of esophagitis I because of an early diagnosis.

[Diagnosis of gastroesophageal reflux: ultrasonographic method]. / Diagnóstico del reflujo gastroesofágioc: método ultrasonográfico.

In this study, 63 infants, 38 males and 25 females, with pathology that suggested gastro-esophageal reflux, were studied. These patients were between one month and 7-1/2 years of age, with a mean age of 29 months and a standard deviation of 28.1 months. All patients underwent a barium study of the esophagus and the stomach, evaluated according to the criteria of Cleveland, an esophageal scintigram to detect GER, performed according to the criteria of Fernández and Argüelles, and an abdominal echography according to the technique of Naik and Moore. The test was considered a true positive if the echography was positive along with one other positive examination. A false positive was considered if only the echography were positive. A true negative was when the echography was negative along with another negative test. A false negative was when the echography was negative and some other test was positive. The following results were obtained for the echography: a sensitivity of 68%, a specificity of 84.61% and a safety factor of 71.2%. We conclude that echography can be considered as a complimentary examination for the study of GER, given it harmless nature, the availability of the equipment and the possibility of prolonging the exploration which can be recorded on videotape.