摘要:

Background:The prevalence of celiac disease (CD) in children with diabetes mellitus type 1 (DM) is significantly higher than in the nondiabetic population. Most patients with DM and associated CD do not experience typical gastrointestinal symptoms of CD. There is no agreement on the necessity of screening and management of silent CD for patients with DM or on the time scale for screening. Only few data on follow‐up evaluation of children with DM and CD‐related antibodies are available.Methods:One hundred fifty‐seven patients with DM (mean age, 14.8 years; range, 4‐21 years; male, 83) were screened with endomysial antibodies (EMA) between 1993 and 2001. A follow‐up period of at least 3 years, with at least 2 EMA measurements, was possible. Group 1 comprised 37 patients whose first measurement was at the onset of DM. Group 2 comprised 120 patients whose first measurement was during the course of the disease. In patients with positive EMA, small bowel biopsy was performed. Thyroid peroxidase (TPO), thyroglobulin (TgA), glutamate decarboxylase (GAD), antiinsulin (IAA), and islet cell antibodies (IA2) were measured in all patients.Results:EMA was positive in 16 patients, in 5 at onset of DM and in 11 during the course of DM (mean duration, 33.6 months; range, 11‐105 months). Biopsy results showed normal mucosa in seven patients, increased intraepithelial lymphocyte counts in one, and flat mucosa in eight. There was no significant difference between EMA‐positive and EMA‐negative patients regarding height, weight, HbA1c level, frequency of hypoglycemia or hyperglycemia, TPO, TgA, GAD, IAA, or IA2.Conclusion:This study emphasizes the high prevalence of CD in patients with DM. Although several patients already had positive EMA titers at the onset of DM, seroconversion may also occur during the course of the disease. Screening for CD with EMA or tissue transglutaminase should be included in the initial investigation of DM, but should also be repeated over time to detect late seroconversion.JPGN 37:67‐71, 2003.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background:A satisfactory treatment of childhood obesity has not yet been found. An individual consultation session is the usual practice while experts recommend an outpatient training program consisting of a combination of physical exercise, nutrition education, and behavior therapy.Methods:We analyzed degree of overweight (SDS‐BMI) after one and two years in overweight children (aged 6‐15 years) who had had a single consultation session (n = 66) and who had finished a one‐year, structured outpatient training program consisting of physical exercise, nutrition education, and behavior therapy (n = 81). Furthermore we collected data on changes in weight for a control group of overweight children not receiving any treatment (n = 100) over the same period of time.Results:There was no significant change in the degree of overweight over the period of two years either for the control group or for those having received single consultation. The participants of the training were in mean significantly less overweight than at the beginning of the training (P< 0.001), both after one year (mean change in SDS‐BMI ‐0.38) and after the second year (mean change in SDS‐BMI ‐0.30).Conclusions:Overweight children not receiving treatment do not reduce in weight. A single consultation session is not sufficient to achieve weight reduction in children. Weight reduction over at least two years can be achieved in part of the participants of a long‐term, specialized treatment.JPGN 37:72‐74, 2003.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background:Feeding problems are common in infants and young children. A multidisciplinary team approach contributes to better patient care. However, few quantitative data on multidisciplinary feeding assessment of children have been published.Objectives:The first aim of this study was to characterize the etiology of feeding difficulties in 700 children referred for assessment of severe feeding difficulty. The authors differentiated medical, oral, and behavioral categories. The second aim was to assess the prevalence of prematurity and dysmaturity in the patients and their relationship to the type of feeding problem.Methods:Clinical data from 700 children aged less than 10 years who were examined for severe feeding problems were analyzed.Results:Close to 50% of the children had a combined medical and oral condition underlying their feeding difficulties. More than half of the children were examined for gastrointestinal conditions, particularly gastroesophageal reflux disease. Behavioral problems were more frequently seen in children aged more than 2 years. The results indicate that oral sensory‐based feeding problems are related to past medical intervention. Children with feeding disorders had a significantly lower birthweight for gestational age. Preterm babies were overrepresented in this population.Conclusions:A multidisciplinary team approach is essential for assessment and management because combined medical and oral problems are the most frequent cause of pediatric feeding problems. A significant relationship was found between the type of feeding problem and age. Infants born preterm and/or with a birthweight below the tenth percentile for gestational age are at greater risk for developing feeding disorders.JPGN 37:75‐84, 2003.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID