Nutritional epidemiology during school age.

Nutritional research covers different fields, two of which are of particular interest: evaluation of the nutritional status, and epidemiology of food consumption. For many years, studies in these fields have been promoted by our research group, which bases its methodology on anthropometric measurements, bioelectrical impedance measurements, and check of nutritional habits. Our studies involve more than 2500 subjects from pre-school age to adolescence. This work represents the basis for an educational approach with the ultimate aim of improving life styles. One of our first studies on school meals during nursery period and composition and application of "dietary tables" showed inadequacies of energy intakes and macronutrients distribution. In another study, aimed to evaluate the intake of soluble sugars, more than 2/3 of participating school children were found to consume more than 70 g of soluble sugars per day, while 10% of them exceeded 150 g/day. Results of the following study, in which special attention was given to salted and sweet snacks, showed that snacks can account for 34% of the total daily energy intake; although its adequacy, the energy distribution per macronutrients showed a clear imbalance. As for adolescence, a very critical age, the evaluation of weight self-perception revealed that only 62% of them had a correct perception of their weight. This research also devoted special attention to home prepared breakfast, which is consumed by the vast majority of enrolled subjects, although only rarely it is nutritionally adequate. A double age-related trend could thus be drawn: on one side, there is the tendency of the "overweight status" to decrease (from a starting-point of about 20%); on the other side, this tendency is unfortunately compensated by the increasing trend of "obesity" (which almost reaches 30%).

[Growth and chronic bronchopneumopathies]. / Accrescimento e broncopneumopatie croniche.

The relationship between growth and pulmonary disease has been studied mainly in asthma and cystic fibrosis. In asthma, the most frequent chronic pulmonary disease in childhood, results were conflicting, until the degree of severity of the disease and growth phases were taken into account. Research on 683 children has shown that the percentage of underweight was higher in chronic than intermittent asthma. Moreover, the distribution of underweight patients by ages is different in the two types of asthma: uniform in intermittent asthma; two peaks below the age of 2 and above the age of 12 respectively in chronic asthma. Further data of 65 children treated with slow-releasing theophylline for approximately two years corroborates that puberty is a particularly vulnerable period. Indeed, in the most severe asthmatic males, theophylline is able to completely normalize the growth pattern in childhood but not in puberty. In cystic fibrosis malabsorption makes the study of the relationship between growth and pulmonary disease more complex. The pattern of growth in patients with cystic fibrosis is moving away from the normal pattern with ageing, hence the worsening of pulmonary disease is responsible for the worsening in the growth pattern. The growth pattern today is far better than that of 20 years ago. However, puberty, especially in female patients, is a critical period. Often the puberal spurt is delayed for a few years or is even completely absent. In a group of patients with chronic pulmonary disease due to different causes, weight is more implicated than height and the same pattern was observed in cystic fibrosis. Moreover, as in asthma, weight and height are more implicated in females than males. The entity of alteration observed is midway between the minimal in asthma and the maximal in cystic fibrosis.

Acquired immune deficiency syndrome in childhood. Neurological aspects.

Central nervous system (CNS) involvement is very frequently observed in pediatric AIDS. Clinical manifestations include encephalopathy, cognitive deficits, acquired microcephaly, neurological signs, myelopathy, and peripheral neuropathy. Neurological complications can be related to opportunistic viral infections such as encephalitis, atypical aseptic meningitis, progressive multifocal leukoencephalopathy, and myelitis. Nonviral syndromes include: toxoplasmosis, cryptococcal meningitis, candidiasis, Mycobacterium tuberculosis meningitis, and Mycobacterium avium subacute encephalitis. Bacterial infections, tumors, cerebrovascular complications, and peripheral neuropathies are not frequently observed in pediatric AIDS. The most severe complications of HIV infection is encephalopathy resulting from HIV infection of brain tissue. Direct HIV invasion of the CNS has been demonstrated. Clinical features of HIV encephalopathy are classified into three categories: (1) normal neurological findings; (2) static encephalopathy; and (3) progressive encephalopathy. AIDS dementia complex can be differentiated from the predominance of behavioral and cognitive disabilities.

[Retrospective study on weaning in Rome and its province. Results and critical considerations]. / Indagine retrospettiva sul divezzamento a Roma e provincia. Risultati e considerazioni critiche.

The authors report and comment on the results of an epidemiological retrospective study on weaning. The study was performed in Rome and its province through the administration of a structured interview to the parents of 851 children, aged between 6 months and 3 years. Data show that most children are correctly weaned, in terms of both timing and quality of foods. In some cases, however, incorrect dietary habits were found, such as: too early (usually together with too early administration of gluten-containing foods) or too late weaning, and use of cow's milk instead of follow-up formulae during the second semester of life. Data presented here show that the early weaning significantly correlates with a maternal low degree of education and short period of breast-feeding. On the basis of their data and according to the international literature, the authors present some new weaning suggestions: these could help decrease the present gap between recommended dietary allowances and real consumption in this age group.

[Prevalence of lactose malabsorption in Roman school children. A H2 breath test study using a cow's milk]. / Prevalenza del malàssorbimento del lattosio in una popolazione scolastica romana. Un'indagine mediante H2 breath test con latte vaccino.

The aim of this study was to evaluate the prevalence of lactose malabsorption in a population of 75 (43 males, 32 females) apparently healthy school-children using the H2 breath test with cow's milk. The children, ranging in age from 8 years and 6 months to 15 years and 2 months (mean: 11 years, 7 months) were divided into 2 age groups: Group I (no. = 26): age < 11 years and Group II (no. = 49): age > 11 years. After on overnight fasting, lasting at least 8 hours, samples of expired air were collected at 0 time and at 30-min intervals following the administration of 250 ml cow's milk for a total time of 3 hours. The H2 breath concentration was then measured by gas chromatography (Micro-Lyzer Quintron Instruments Company mod. 12). A net rise of more than 20 ppm H2 was considered as lactose malabsorption. Subjects with symptoms such as excessive flatulence, abdominal pain, or diarrhoea, were considered as lactose intolerant. Two-hundred and 50 ml of cow's milk (12 g of lactose) was considered a more physiological vehicle than the traditional lactose aqueous solution. The examined children, all on free diet, showed a fasting alveolar from 0 to 43 ppm (mean +/- SD = 7.9 +/- 7.6). Sixty-six children out of 70 (93.3%), who completed the test had a total absorption of lactose. Two out of 4 children with lactose malabsorption originated from areas (East Africa and Central America), where a high incidence of this metabolic disorder is a characteristic findings.(ABSTRACT TRUNCATED AT 250 WORDS)

[The evaluation of body composition in children by anthropometry and impedance measurement]. / Valutazione della composizione corporea nel bambino mediante antropometria ed impedenziometria.

Several anthropometric parameters (weight, height, thickness skinfolds, and body circumferences) together with the bioelectric impedance (BIA) were measured in a group of 407 healthy prepuberal children (205 males, mean age +/- SD: 6.8 +/- 1.6 years; 202 females, mean age +/- SD: 6.6 +/- 1.6 years) who did not practice any competitive sport. The group was divided into six weight classes (underweight to obese 3). The average values of the anthropometric data, BIA, FM (which is derived from the thickness skinfolds and BIA), TBW (derived from BIA), AFA and AMA (both derived from the forearm circumference and triceps skinfold) were all evaluated in relation to sex and weight classes. The average values of all the measured thickness skinfolds, FM and AFA were higher in the females. When considering the body circumferences, only the wrist circumference showed a statistically significant difference between sexes, being higher in males. In contrast both the rates waist/hips circumferences and waist/thigh circumferences were higher in males. As far as the BIA and FM average values is concerned, these were higher in females. The average value of FM derived from measuring the thickness skinfolds (males = 17.65 +/- 4.89%: females = 23.81 +/- 4.72% of body weight) proved higher than that one derived from BIA (males = 17 +/- 9.02%; females = 19.27 +/- 9.18%). The analysis of anthropometric and BIA data in relation to the weight classes showed significant variations of the mean values, except the rates waist/hips circumferences and waist/thigh circumferences. Therefore our data seem to exclude the presence of any difference of the fat distribution between sexes in paediatric age.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunologic aspects of vigabatrin treatment in epileptic children.

Vigabatrin (VGB) is an antiepileptic drug (AED) that acts by irreversibly inhibiting gamma-aminobutyric acid transaminase (GABA-T). To evaluate immune responses to GVG, we studied 29 idiopathic or symptomatic epileptic children and also examined a control group (n = 15). Epileptic children were tested before and after 1 and 3 months of VGB treatment. Whole blood was used to connect subsets with commercial monoclonal antibodies. Peripheral blood mononuclear cells (PBMC) were used to assess natural killer (NK) cell activity and lymphocyte response to phytohemagglutinin (PHA) and concavalin A (Con A). Immunoglobulin (Ig) levels were tested in serum. At baseline, no immunologic abnormalities were observed in either control or treated patients. During treatment, the percentage and absolute number of B lymphocytes, serum concentration of Ig, number of T total mature lymphocytes (CD3), T-rosetting lymphocytes (CD11), T-helper cells (CD4), and mitogenic response of lymphocytes remained unchanged. Several other immunologic responses showed a statistically significant increase after 1 and 3 months of VGB treatment, however, including the percentage and absolute number of T-suppressor cells (CD8) and NK cells and NK cell activity. The correlation between number of NK cells and NK cell activity was significant. Data obtained demonstrated that VGB may interfere with the modulation of the immune system, especially cytotoxic cell populations.

Decreased serum thymic factor activity in asthmatic children.

Serum thymic factor (STF) activity was assayed in 26 young asthmatic patients and in 20 age-and sex-matched controls, in view of the increasing importance attributed to this thymic product in regulating several immune mechanisms. Determinations of total and specific IgE and of other immunoglobulins and skin tests were also performed. Decreased STF activity and high total and specific IgE concentrations were observed in the majority of asthmatic patients. In controls, STF activity was within normal limits in all cases and total and specific IgE concentrations were increased only on one case. The decreased STF activity may be responsible for a possible impairment of cell-mediated immunity and for the increased stimulation of the reaginic system observed in asthmatic patients, via its effects on some T cell subpopulation, namely, suppressor T lymphocytes, which seem particularly sensitive to STF variations. On the basis of these data and of the results of our study, a possible, although speculative, correlation between reduced STF activity and high IgE concentrations in asthmatic patients may be postulated. The reported increased occurrence of autoimmune phenomena in asthmatic patients is in agreement with the hypothesis of a STF-mediated suppressor T-lymphocyte quantitative and/or qualitative defect in this disease.

Fibrodysplasia ossificans progressiva. An 11-year-old boy treated with a diphosphonate.

Fibrodysplasia ossificans progressiva (FOP) is a severe, rare, autosomal dominant, ectopic ossifying condition, with primary involvement of the skeletal muscles associated with skeletal abnormalities. This report concerns an 11-year-old boy suffering from FOP, who presented significant modification of the musculoskeletal structure of the thorax and problems with articular movements. The patient showed progress after treatment with ethane-1-hydroxy-1,1-diphosphonate (EHDP). In fact, using a scintiscanner we were able to observe a significant improvement in symptoms and a recovery of some of the active sites of ossification.

Immunoreactive beta-endorphin levels in cerebrospinal fluid of children with acute lymphoblastic leukemia: relationship with glucocorticoid therapy and neurological complications.

Neurological disorders, such as seizures, are not infrequently associated with anti-leukemic therapy. It has been hypothesized that a disrupted peptidergic transmission between neurons could be the cellular basis of the neurological dysfunction. Since endogenous opioids have been recently found to alter neuronal function and possess anticonvulsant properties, the cerebrospinal fluid (CSF) immunoreactive beta-endorphin levels in children with Acute Lymphoblastic Leukemia (ALL) during chemotherapy and cranial irradiation have been studied. Twenty-seven children, 2 at low, 20 at medium and 5 with high risk ALL, undergoing prophylactic treatment for meningeal leukemia, entered the study. Sequential lumbar punctures with introduction of MTX combined with oral prednisone therapy were performed; each lumbar puncture sample was collected and assayed for immunoreactive beta-endorphin. All the patients studied showed a biphasic profile of the peptide with the minimum levels reached during the induction (days 14-28) and the maximum levels detected at the end of the intensification chemotherapy (days 49-55). In the 3 groups the beta-endorphin decrease corresponded to the period of prednisone therapy; the increase was concomitant with the suspension of oral glucocorticoids. 3 patients showed tonic-clonic seizures which coincided with the lowest cerebrospinal fluid beta-endorphin levels and, in the follow-up, 13 out of 27 patients displayed EEG abnormalities. From these findings a relationship between cerebrospinal fluid beta-endorphin concentrations and neuronal excitability in patients with ALL can be suggested. It is also evidenced that oral glucocorticoid therapy has profound inhibitory effects on central beta-endorphin levels.

Nonfamilial intestinal polyposis and brain tumor in a 5-year-old girl.

A 5-year-old girl with glioblastoma multiforme and simultaneous adenocarcinoma in one of multiple colonic polyps is the youngest reported case of Turcot's syndrome. A literature survey and a classification based on family pedigree and pattern of inheritance are proposed.

Benign epilepsy of childhood with centrotemporal spikes and unilateral developmental opercular dysplasia.

The case of a 15-year-old right-handed girl with developmental delay, mild retardation, astereognosis, and tactile discrimination impairment in the left arm, is reported. During sleep, right partial simple motor seizures with sialorrhea and saliva pooling were present, sometimes followed by secondary generalization. Absences and drop attacks were also observed. Electroencephalography revealed left centrotemporal spike waves spreading to the homologous contralateral region, generalized 3-Hz spike-and-wave complexes enhanced by hyperventilation, and generalized polyspike-and-wave discharges during drowsiness. Magnetic resonance imaging showed right perisylvian (opercular) malformation. Benign epilepsy of childhood with centrotemporal spikes (BECCTS) is a focal idiopathic epilepsy presumed to be of genetic origin. Although brain damage is not expected, structural lesions including opercular macrogyria have been reported. This coexistence has been considered mainly causal and only exceptionally causal. The Foix-Chavany-Marie syndrome or operculum syndrome is the result of bilateral opercular damage. In our child the right structural and the left functional lesions appeared mutually activated, yielding a transient opercular syndrome. The concomitance of BECCTS and developmental opercular dysplasia is suggestive of a common genetic substratum.

The role of IgE in childhood asthma.

The influence of age and sex has been in 208 asthmatic children on the basis of the following parameters: total serum IgE concentration (RIST), serum concentration of specific IgE antibodies (RAST), and positive prick tests against Dermatophagoides Pleronissynus, grasses, and Alternaria Tenuis. The results indicate that all these parameters are significantly influenced by age. Arithmetic values for RIST show a significant difference between the sexes which is obscured by logarithmic calculation. The data strongly suggest that IgE antibodies cannot be considered the main mechanism by which asthma is produced in small children.

Frequency and clinical pattern of celiac disease among siblings of celiac children.

To investigate the prevalence and clinical and genetic patterns of celiac disease (CD) among siblings of CD patients, 103 siblings and one twin of 80 celiac children were evaluated by means of their clinical history, physical examination, blood indices of nutritional status, and antigliadin antibodies (AGA). Antiendomysium antibody (AEA) levels were determined in 70 patients and 85 subjects were human leucocyte antigen (HLA) typed. On the basis of clinical or laboratory data or both, 21 siblings (20.2%) were submitted to intestinal biopsy, whereas intestinal biopsy in six siblings with positive serologic screening (AGA IgA or AEA or both) was not performed because of parental refusal. In a high percentage of cases (18%), all on a gluten-containing diet, the intestinal mucosa was atrophic, and CD was subsequently diagnosed. Because we could not submit all the siblings to intestinal biopsy, this figure could underestimate the real prevalence of the disease in our series; consequently, it was not possible to calculate accurately the sensitivity and specificity of AGA and AEA. Nevertheless, AEA (positive in all the nine siblings with mucosal atrophy), followed by AGA IgA, proved to be the best screening for CD. Eighteen of 19 CD siblings showed HLA-predisposing antigens. Among the 19 CD siblings, one showed a typical form with gastrointestinal symptoms, two had short stature, one suffered from recurrent vomiting, and in 15, the disease was clinically silent. On the contrary, among siblings who were first diagnosed (index cases), the majority (73.7%) had a typical form of CD, and no clinically silent cases were observed. We did not find any difference between index cases and CD siblings in food habits and distribution of HLA antigens. In 15 of 18 cases, the sibling diagnosed subsequently was the older one. Finally, the typical form of CD was significantly more frequent among the younger brother than the older. In conclusion, the high prevalence of the silent form of CD in our cases indicates that siblings of CD subjects should always be screened for CD. The combination of AGA IgA and AEA represent a good screening method to use in selecting children for the intestinal biopsy.