Prediction Models for Celiac Disease Development in Children From High-Risk Families: Data From the PreventCD Cohort.

BACKGROUND & AIMS: Screening for celiac disease (CD) is recommended in children with affected first-degree relatives (FDR). However, the frequency of screening and at what age remain unknown. The aims of this study were to detect variables influencing the risk of CD development and develop and validate clinical prediction models to provide individualized screening advice. METHODS: We analyzed prospective data from the 10 years of follow-up of the PreventCD-birth cohort involving 944 genetically predisposed children with CD-FDR. Variables significantly influencing the CD risk were combined to determine a risk score. Landmark analyses were performed at different ages. Prediction models were created using multivariable Cox proportional hazards regression analyses, backward elimination, and Harrell's c-index for discrimination. Validation was done using data from the independent NeoCel cohort. RESULTS: In March 2019, the median follow-up was 8.3 years (22 days-12.0 years); 135/944 children developed CD (mean age, 4.3 years [range, 1.1-11.4]). CD developed significantly more often in girls (P = .005) and in Human Leukocyte Antigen (HLA)-DQ2 homozygous individuals (8-year cumulative incidence rate of 35.4% vs maximum of the other HLA-risk groups 18.2% [P < .001]). The effect of homozygosity DR3-DQ2/DR7-DQ2 on CD development was only present in girls (interaction P = .04). The prediction models showed good fit in the validation cohort (Cox regression 0.81 [0.54]). To calculate a personalized risk of CD development and provide screening advice, we designed the Prediction application https://hputter.shinyapps.io/preventcd/. CONCLUSION: Children with CD-FDR develop CD early in life, and their risk depends on gender, age and HLA-DQ, which are all factors that are important for sound screening advice. These children should be screened early in life, including HLA-DQ2/8-typing, and if genetically predisposed to CD, they should get further personalized screening advice using our Prediction application. TRIAL REGISTRATION NUMBER: ISRCTN74582487 (https://www.isrctn.com/search?q=ISRCTN74582487).

Impact of house dust mite-driven asthma on children's school performance and activity.

Evidence regarding asthma's impact on children's daily lives is limited. This prospective and cross-sectional, observational, multicenter study assessed school/work and activity impairment in children and adolescents with allergic asthma and their caregivers and allergen immunotherapy (AIT) effects. Included patients were schooled children and adolescents (5 to 17 years) with allergic asthma due to house dust mites (HDM). Impairment of school/work (i.e., absenteeism and presenteeism) and activity was measured in patients and their caregivers using the Work Productivity Impairment Questionnaire plus Classroom Impairment Questions: Allergy Specific (WPAI + CIQ:AS). HDM allergic patients with school impairment received subcutaneous AIT with a MicroCrystalline Tyrosine-associated allergoid. WPAI + CIQ:AS and effectiveness variables were compared between baseline and 1-year post-AIT. Of the 113 patients included, 59 (52.2%) and 51 (45.1%) showed school and activity impairment, respectively, missing a mean (SD) of 37.6 (24.4) % and 42.6 (25.6) % of school and activity time, respectively. Twenty-six (23%) caregivers reported activity impairment and, of the 79 (69.9%) employed, 30 (38%) reported work impairment. Of the 65 patients with school/activities impairment, 41 (63.1%) received AIT, of which 21 (51.2%) completed 1 year of treatment. Effectiveness variables and WPAI + CIQ:AS significantly improved: Mean (SD) school impairment decreased from 39.7 (26.7) to 2.1 (7.1) % (p < 0.001) and activity impairment from 46.2 (34.6) to 1.4 (3.6) % (p < 0.001). CONCLUSION: Allergic asthma due to HDMs results in school/work and activity impairment in children and adolescents and their caregivers. One year of AIT provided clinical benefits and reduced school and activity impairment. WHAT IS KNOWN: • Allergic asthma impairs children's school performance and daily activities. • Allergen immunotherapy modifies allergic disease course and ameliorates its symptoms. WHAT IS NEW: • Asthma symptoms due to allergy to house dust mites impair children's school attendance and productivity and daily activity and their caregivers' work performance and daily lives. • Allergen immunotherapy with a house dust mite MicroCrystalline Tyrosine (MCT)-associated allergoid seems to provide clinical benefits, associated with decreased school and activity impairment, supporting it as an effective treatment option.

Effects of postharvest treatments on fruit quality of sweet pepper at low temperature.

BACKGROUND: Postharvest storage of sweet pepper fruits (Capsicum annuum L.) at low temperatures could impair their physical and chemical composition. Therefore, maintenance of essential nutrition support or altered gas exchange could preserve fruit quality, minimizing chilling injury. Thus our aim was to determine the response to postharvest application of a low concentration of nitrogen (urea) or antitranspirant (pinolene) during a period of 21 days at 5 °C. RESULTS: The results indicate that storage at 5 °C was effective with respect to maintaining firmness of sweet pepper fruits for 21 days, while application of antitranspirant increased firmness compared with non-sprayed fruits. Additionally, urea maintained color while increasing total phenolics and the activity of catalase and ascorbate peroxidase, lowering lipid peroxidation. Composition of free amino acids was affected to a minor extent. CONCLUSION: Maintaining quality is of paramount importance in the postharvest period. This study shows the effect of both temperature and spraying treatments with regard to maintaining fruit quality during this period, and provides new insights into the physiological role of enzymes of the antioxidant system during pepper storage at low temperature.

Assessing gastro-intestinal related quality of life in cystic fibrosis: Validation of PedsQL GI in children and their parents.

BACKGROUND: Most patients with cystic fibrosis (CF) suffer from pancreatic insufficiency, leading to fat malabsorption, malnutrition and abdominal discomfort. Until recently, no specific tool was available for assessing gastro-intestinal related quality of life (GI QOL) in patients with CF. As the Horizon2020 project MyCyFAPP aims to improve GI QOL by using a newly designed mobile application, a sensitive and reliable outcome measure was needed. We aimed to study the applicability of the existing child-specific Pediatric Quality of Life Inventory, Gastrointestinal Symptoms Scales and Module (PedsQL GI) in children with CF. METHODS: A multicenter, prospective observational study was performed in 6 European centers to validate the PedsQL GI in children with CF during 3 months. RESULTS: In total, 248 children and their parents were included. Within-patient variability of PedsQL GI was low (24.11), and there was reasonable agreement between children and parents (ICC 0.681). Nine of 14 subscales were informative (no ceiling effect). The PedsQL GI and the median scores for 4 subscales were significantly lower in patients compared to healthy controls. Positive associations were found between PedsQL GI and age (OR = 1.044, p = 0.004) and between PedsQL GI and BMI z-score (OR = 1.127, p = 0.036). PedsQL GI correlated with most CFQ-R subscales (r 0.268 to 0.623) and with a Visual Analogue Scale (r = 0.20). CONCLUSIONS: PedsQL GI is a valid and applicable instrument to assess GI QOL in children with CF. Future research efforts should examine the responsiveness of the CF PedsQL GI to change in the context of clinical interventions and trials.

The Relative Contribution of Food Groups to Macronutrient Intake in Children with Cystic Fibrosis: A European Multicenter Assessment.

BACKGROUND: Optimal nutrition for children with cystic fibrosis (CF) improves prognosis and survival, but an increased caloric intake recommendation for this population raises concerns about the nutrient profile of their diets. OBJECTIVE: Our aim was to assess the relative contribution of food groups to the total macronutrient intake of European pediatric patients with CF. DESIGN: We conducted a cross-sectional study in which the participants recorded dietary intake from 2016 to 2017. Specifically developed nutritional composition databases were used to obtain nutritional data, including macronutrients and food groups, according to previously standardized criteria. PARTICIPANTS/SETTING: Two hundred and seven pediatric patients with CF from six European centers were involved in the My App for Cystic Fibrosis self-management project. MAIN OUTCOME MEASURES: Participants reported dietary intake with a detailed 4-day food record. STATISTICAL ANALYSIS PERFORMED: Descriptive analyses of nutrient intake, food group consumption, and dietary origin of macronutrients were conducted with R software. RESULTS: Similar patterns were found in nutrient and food group intake; both sugar and saturated fatty acids contributed >10% each to the total daily energy intake in all the centers. Large mean and median percent differences were observed in the intake of other nutrient and food groups, because sweets and snacks were consumed once or twice a day, and fruit and vegetables were consumed two or three times a day. Milk, meat, sweets and snacks, and oils were the main sources of fat in all centers. CONCLUSIONS: Study findings indicated less than optimal nutrient profiles, especially for sugars and saturated fatty acids, resulting from the high consumption of meat, dairy, and processed products and low consumption of fish, nuts, and legumes. These results can serve as a basis for future tailored interventions that target improved adherence to nutritional recommendations for patients with CF.

Determination of stoichiometric coefficients and apparent formation constants for beta-cyclodextrin complexes of trans-resveratrol using reversed-phase liquid chromatography.

The complexation of trans-resveratrol with beta-cyclodextrin (beta-CD) was investigated using reversed-phase liquid chromatography and mobile phases to which beta-CD was added. The decrease in the retention times with increasing concentrations of beta-CD (0-2.5 mM) showed that trans-resveratrol forms a 1:1 complex with beta-CD, while the apparent formation constants (K(F)) were strongly dependent of the water-methanol proportion of the mobile phase employed. A slight decrease in K(F) was observed at 50-55% water in the mobile phase but a large increase from 55 to 70% water. The values of K(F) for the trans-resveratrol-beta-CD interaction decreased when the temperature was raised from 20 to 37 degrees C. In order to gain information about the mechanism aspect of the trans-resveratrol affinity for beta-CD, the thermodynamic parameters of the complexation were obtained. Complex formation of trans-resveratrol with beta-CD (DeltaG degrees =-17.01 kJ/mol) is largely driven by enthalpy (DeltaH degrees = -30.62 kJ/mol) and slightly entropy changes (DeltaS degrees = -45.68 J/mol K).

Plant growth-promoting bacteria as a tool to improve salinity tolerance in sweet pepper.

To characterise the effect of bacterial inoculants (Azospirillum brasilense and Pantoea dispersa) on the response of sweet pepper (Capsicum annuum L.) to saline stress, plants were exposed to 0, 40, 80 and 120mM NaCl in solution. The effect on plant growth; leaf gas exchange; NO3-, Cl-, K+ and Na+ accumulation; and chlorophyll fluorescence and content were investigated. Total plant DW was reduced significantly by salinity but when inoculants were applied, DW was increased. Inoculated plants showed higher DW accumulation in the roots. Salinity levels up to 80mM NaCl did not affect the net assimilation rate in inoculated plants but 40mM NaCl was enough to reduce this parameter in non-inoculated plants. The leaf area ratio was not modified substantially by inoculation. The leaf Cl- concentration of inoculated plants was reduced at the highest salinity, compared with control plants, and NO3- concentration increased markedly. A higher K+:Na+ ratio was found in inoculated plants. Leaf photosynthesis and stomatal conductance were impaired significantly at moderate, but not low, salinity, the effect of inoculation being enough to maintain higher stomatal conductance under higher stress. The photochemical efficiency of PSII and the relative chlorophyll content were not affected by the inoculants. Thus, the effects of the inoculants on the response to salinity were due mainly to stomatal regulation of photosynthesis rather than effects on biochemical limitations on photosynthesis. These results indicate the benefits of these bacterial inoculants in ameliorating the deleterious effect of NaCl in a salt-sensitive crop like sweet pepper.

Effect of foliar application of antitranspirant on photosynthesis and water relations of pepper plants under different levels of CO2 and water stress.

Strategies such as foliar application of antitranspirants have the potential to regulate transpiration, but often, the limitation of CO(2) exchange as a result of reduced stomatal conductance can impair this beneficial effect. Elevated ambient [CO(2)] could significantly improve CO(2) diffusion while effectively reducing transpiration. In this experiment, we examined the response of sweet pepper (Capsicum annuum L.) to the foliar application of antitranspirant (AT) under two [CO(2)] (380 and 2000 micromol mol(-1)) and two drought intensities (4 or 8d without irrigation). The results showed that stomatal conductance and transpiration were reduced, while AT impaired photosynthesis at standard, but not at elevated [CO(2)] of fully irrigated plants. This effect was already apparent after 4d of drought. Drought had a minor impact on chlorophyll fluorescence (F(v)/F(m)). Additionally, root respiration was increased at elevated [CO(2)] but, after 8d of drought, it was higher for plants treated with AT than for non-sprayed plants. Leaf water potential was affected more by drought at ambient compared to elevated [CO(2)], and, especially after 8d of drought, AT minimized the reductions in leaf water potential. Leaf concentrations of proline and starch were affected by both [CO(2)] and AT, especially after 8d of drought. Moreover, increasing [CO(2)] promoted the accumulation of starch, but led to decreases in the tissue concentrations of the soluble organic osmolytes, and hence diminished osmotic adjustment after 8d of water withholding, relative to ambient [CO(2)]. This study indicates that, in addition to the reported beneficial effect of elevated [CO(2)] on drought stress, AT could significantly improve drought tolerance in sweet pepper plants.