- Email: [email protected]
Waist to height ratio: A simple tool to recognise children at increased risk for metabolic syndrome
Abstracts / Digestive and Liver Disease 46 (2014) e71–e84
genotyped by DMET technology, with colon cancer and GI toxicity induced by irinotecan. Conclusions: In conclusion, according to our preliminary findings, the heterozygous genotype G/A in the (rs55802895) NR1I3 gene seems to be associated with the altered gastrointestinal function in FD. http://dx.doi.org/10.1016/j.dld.2014.07.043 EFFECT OF MAGNESIUM ALGINATE PLUS SIMETHICONE ON GASTROESOPHAGEAL REFLUX IN INFANTS: A RANDOMIZED, OPEN TRIAL Dario Ummarino ∗ , Erasmo Miele, Massimo Martinelli, Elena Scarpato, Felice Crocetto, Elisa Sciorio, Annamaria Staiano Dipartimento di Scienze Mediche Traslazionale, Sezione Pediatria, Università degli Studi di Napoli Federico II, Napoli, Italy Objectives: Gastroesophageal reflux (GER) is a frequent condition in infants that can cause distressing symptoms. The aim of our study is to evaluate the efficacy of Mg-alginate plus simethicone (Gastrotuss Baby® ), compared to rice-starch-thickened formula or to reassurance alone, in the treatment of GER in infants. Methods: This randomized, controlled trial was conducted in full-term infants affected by symptoms suggestive of GER, evaluated through a validated questionnaire (I-GERQ-R). The patients were randomized in 3 groups according to treatment [Group A: Mgalginate plus simethicone (Gastrotuss Baby® ); Group B: Thickened formula; Group C: reassurance with lifestyle changes]. The evaluation of the symptom scores was performed after one month (T1) and two months (T2). Results: Sixty-four (85.3%) out of 75 enrolled infants (median age: 5 months; range: 1–10), concluded the study. After one month of treatment (T1), infants treated with Mg-alginate plus simethicone (Gastrotuss Baby® ) showed a statistically significant improvement of symptoms compared with the thickened formula and reassurance (p < 0.03; p < 0.0001, respectively). At the end of the study, all three groups of patients showed a significant reduction of the symptom scores (p < 0.002; p < 0.038; p < 0.03, respectively). Median symptom score values were more significantly reduced in Groups A than in Group B and in Group C (Group A vs Group B p < 0. 002; Group A vs Group C p < 0.0001; Group B vs Group C p < 0.001). Conclusions: Mg-alginate plus simethicone (Gastrotuss Baby® ) seems to be more efficacious on GER symptom scores than thickened formula and reassurance with lifestyle changes alone. http://dx.doi.org/10.1016/j.dld.2014.07.044
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INTESTINAL FAILURE ASSOCIATED LIVER DISEASE IN A SHORT BOWEL SYNDROME PEDIATRIC COHORT: INCIDENCE AND PROGNOSIS Antonella Diamanti 1,∗ , Teresa Capriati 1 , Vincenzo Di Ciommo Laurora 2 , Lidia Monti 1 , Giuliano Torre 1 , Manila Candusso 1 , Domenica Elia 1 , Fabio Fusaro 1 , Chiara Grimaldi 1 , Jean De Ville De Goyet 1 1 Intestinal Failure Multidisciplinary Group, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy 2 Epidemiology and Biostatistics Unit, “Bambino Gesù” Children’s Hospital, IRCSS, Rome, Italy
Objective: Intestinal failure-associated liver disease (IFALD) can affect children with short bowel disease (SBS) receiving parenteral nutrition (PN) and it can greatly impact on the outcome. Our aim was to determine the prevalence of IFALD in a cohort of SBS children and to assess its trend during the last twenty years. Methods: We evaluated 100 children with SBS followed between 1994 and 2014 in one third level pediatric center and we assessed the prevalence of IFALD (subdivided into IFALD I, II and III) during the follow-up. The prevalence of IFALD was also determined in two decades of the study (1994–2003 and 2004–2014). The occurrence of IFALD was related to overall PN days. Results: The prevalence of IFALD III at discharge from the first admission was 27% and of those seven patients are died during follow-up; the remaining showed a regression or attenuation of IFALD III. The prevalence of IFALD was significantly higher in patients with PN lasted <24 months, than in those with PN duration higher >24 months (p 0.0001) and was similar in the two decades. Conclusions: Our study showed that IFALD occurs early in the natural history of SBS. This suggests that it may depend on the underlying disease and on its early complications (repeated surgery, sepsis) rather than the factors related to the PN duration. This is also supported by the evidence of the unchanged prevalence of IFALD over the years in spite of advances in the PN management. http://dx.doi.org/10.1016/j.dld.2014.07.045 WAIST TO HEIGHT RATIO: A SIMPLE TOOL TO RECOGNISE CHILDREN AT INCREASED RISK FOR METABOLIC SYNDROME Angelo Campanozzi 1,∗ , Irene Rutigliano 1 , Donatella De Giovanni 1 , Michela Foglia 1 , Mariangela Guglielmi 1 , Gianpaolo De Filippo 2 , Luciana Romaniello 1 , Valentina De Maio 1 , Michele Conoscitore 1 , Massimo Pettoello-Mantovani 1 1 Clinica Pediatrica, Universita’ di Foggia, Foggia, Italy 2 Pediatria, Ospedale Bicetre, Parigi, France
Objective: Metabolic Syndrome (MS) is the most important comorbidity obesity-related, also in children. Visceral adiposity is part of MS cluster, so that measurement of Waist Circumference (WC) is an essential step for screening MS in adulthood and childhood. Up today, valid cut-off percentiles for WC are not available for the whole pediatric population, arising difficulties to diagnose the MS. Aim of the study: To individuate a simple clinical diagnostic tool for screening obese children at risk for MS. Methods: We enrolled in the study 803 subjects (395 girls, mean age 9.43 ± 2.5 yrs) whose mean BMI z-score was 2.2 ± 0.53. The
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entire cohort was screened for MS defined according to modified American Heart Association Criteria. For each patient we measured WC and calculate Waist to Height ratio (WHtR, WC (cm)/Height (cm)). We used Receiver Operating Characteristic (ROC) curve and Youden Index for detecting the usefulness of this parameter. Results: The prevalence rate of MS was 13.07% (105 pts). Children with MS had mean WHtR of 0.65 ± 0.09. Children without MS presented mean WHtR of 0.62 ± 0.06, this difference was statistically significant (p < 0.001). The Area Under ROC curve (AUC) was 0.690 for WCHtr (CI 95%: 0.637–0.743, p < 0.001) in detecting MS. WHtr cut-off value equal to 0.62 showed a sensibility of 76.3% and a specificity of 56% in identifying obese children affected by MS. Conclusions: WHtR is strongly related to MS and it seems to be a simple, non invasive and practical tool in detecting Paediatric MS: a cut-off value of 0.62 should suggest second-level examinations. http://dx.doi.org/10.1016/j.dld.2014.07.046 NOVEL DIETARY PRODUCTS DERIVED BY FERMENTATION OF COW MILK AND RICE WITH LACTOBACILLUS PARACASEI CBAL74 PREVENT GASTROINTESTINAL AND RESPIRATORY TRACT INFECTIONS IN YOUNG CHILDREN: A PROSPECTIVE RAN Rita Nocerino 1,∗ , Lorella Paparo 1 , Ylenia Maddalena 1 , Simona Caprio 1 , Francesco Amato 1 , Vincenza Pezzella 1 , Rosita Aitoro 1 , Linda Cosenza 1 , Andrea Budelli 2 , Francesca Fasano 2 , Carmen Di Scala 1 , Roberto Berni Canani 1 1
Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli “Federico II”, Napoli, Italy 2 R&D, Heinz Italy, Latina, Italy Background: We evaluated the preventive effects of two dietary products derived from the fermentation of cow milk or rice on winter infectious diseases in children. Methods: Prospective, double-blind, controlled trial conducted in healthy schooled children aged 12–48 m during winter season randomly allocated to receive daily for 3 m dietary products deriving from cow milk (Group A) or rice fermentation (Group B) with L. paracasei CBAL74, or placebo (Group C). Occurrence of acute gastroenteritis (AGE) and upper respiratory tract infections (URTI) were recorded by family pediatricians. Fecal defensins, cathelicidin (LL-37), and sIgA levels were also assessed. Results: 405 children were evaluated, 377 (193 male; mean age 32.5 m, 95% CI 31.4–33.5) completed the study: 137 in Group A, 118 in Group B and 122 in Group C. Demographic and anthropometric characteristics were similar among groups. During the study period 242/377 enrolled children experienced at least one infectious episode: 50.4% in Group A, 64.4% in Group B and 79.5% in Group C (p < 0.05). URTI were observed in 48.2% of subjects in Group A, 58.5% in Group B and 70.5% in Group C (p < 0.001). AGE were observed in 13.1% of Group A, 19.5% of Group B and 31.1% of Group C subjects (p < 0.05). An increase of alfa/beta-defensins, LL-37 and sIgA levels was observed only in Group A and B (p < 0.05). The interventions were well accepted. No adverse events were observed. Conclusions: Dietary supplementation with cow milk or rice fermented with L. paracasei CBAL74 efficiently prevents common infectious diseases in schooled children through an innate and acquired immunity stimulation. http://dx.doi.org/10.1016/j.dld.2014.07.047
MIR320 FAMILY REGULATES NOD2/CARD15: A NEW MECHANISM FOR CONTROLLING INFLAMMATION? Laura Stronati 1,∗ , Maria Pierdomenico 1 , Vincenzo Cesi 1 , Manuela Costanzo 1 , Marina Aloi 2 , Salvatore Oliva 2 , Fortunata Civitelli 2 , Salvatore Cucchiara 2 1 Department of Radiobiology and Human Health, ENEA Rome, Italy 2 Department of Pediatrics, Pediatric Gastroenterology & Liver Unit, Sapienza University of Rome, Italy
Background: Regulation of inflammatory responses is ensured by coordinated and controlled gene expression in immune system cells. One group of gene expression regulators is a class of short single-stranded RNA molecules termed microRNAs (miRNAs). Recent studies have suggested that miR-320 is altered in tissue samples of patients with Inflammatory Bowel Disease (IBD) [1]. We performed a bioinformatic analysis showing that miR-320 family may bind the 3 -UTR of NOD2/CARD15 (nucleotide-binding oligomerization domain), the first susceptibility gene associated to Crohn’s disease (CD), one of the two main forms of IBD. Interestingly, NOD2 has been previously identified as a functional target of other miRNAs [2]. Aims: the present study was aimed at (1) exploring the hypothesis that NOD2/CARD15 is a target of members of the miR-320 family, including miR-320a, -320b, -320c, -320d and 320e, (2) assessing the contribution of the miR-320/NOD2 axis to intestinal inflammation. Methods: The colonic adenocarcinoma cell line, HT29, was transfected with exogenous miR-320a, -320b, -320c, -320d, -320e and a miRNA negative control. In addition, miR320 family inhibitor and miRNA inhibitor negative control were transfected to inhibit endogenous miRNAs. In a second experimental setting, cells, transfected as above, were also exposed to IFN␥ + TNF␣ cytomix to induce inflammation. Results: A strong decrease of NOD2 protein expression was observed after transfections with miR-320a and -320b compared to negative control. Differently, miR-320 family inhibitor induced an increase of NOD2 expression. The exposure to cytomix induced a significant up-regulation of NOD2, which was strongly reduced by transfected miR-320a and -320b. Conclusions: In the present study, we show for the first time that NOD2 expression is under the control of two members of the miR-320 family: miR-320a and -320b. Moreover, we show that miR-320a and -320b are able to counterbalance the NOD2 increase induced by inflammation. Future work will be done to assess whether NOD2 is a direct target of both miR-320a and -320b and to analyse possible correlations between NOD2 and miR320 expression in inflamed tissues of IBD patients. References [1] Fasseu M, Tréton X, Guichard C, et al. Identification of restricted subsets of mature microRNA abnormally expressed in inactive colonic mucosa of patients with inflammatory bowel disease. PLoS ONE 2010;5:1–12. [2] Chen Y, Wang C, Liu Y, et al. miR-122 targets NOD2 to decrease intestinal epithelial cell injury in Crohn’s disease. Biochemical and Biophysical Research Communications 2013;438:133–9.
http://dx.doi.org/10.1016/j.dld.2014.07.048
genotyped by DMET technology, with colon cancer and GI toxicity induced by irinotecan. Conclusions: In conclusion, according to our preliminary findings, the heterozygous genotype G/A in the (rs55802895) NR1I3 gene seems to be associated with the altered gastrointestinal function in FD. http://dx.doi.org/10.1016/j.dld.2014.07.043 EFFECT OF MAGNESIUM ALGINATE PLUS SIMETHICONE ON GASTROESOPHAGEAL REFLUX IN INFANTS: A RANDOMIZED, OPEN TRIAL Dario Ummarino ∗ , Erasmo Miele, Massimo Martinelli, Elena Scarpato, Felice Crocetto, Elisa Sciorio, Annamaria Staiano Dipartimento di Scienze Mediche Traslazionale, Sezione Pediatria, Università degli Studi di Napoli Federico II, Napoli, Italy Objectives: Gastroesophageal reflux (GER) is a frequent condition in infants that can cause distressing symptoms. The aim of our study is to evaluate the efficacy of Mg-alginate plus simethicone (Gastrotuss Baby® ), compared to rice-starch-thickened formula or to reassurance alone, in the treatment of GER in infants. Methods: This randomized, controlled trial was conducted in full-term infants affected by symptoms suggestive of GER, evaluated through a validated questionnaire (I-GERQ-R). The patients were randomized in 3 groups according to treatment [Group A: Mgalginate plus simethicone (Gastrotuss Baby® ); Group B: Thickened formula; Group C: reassurance with lifestyle changes]. The evaluation of the symptom scores was performed after one month (T1) and two months (T2). Results: Sixty-four (85.3%) out of 75 enrolled infants (median age: 5 months; range: 1–10), concluded the study. After one month of treatment (T1), infants treated with Mg-alginate plus simethicone (Gastrotuss Baby® ) showed a statistically significant improvement of symptoms compared with the thickened formula and reassurance (p < 0.03; p < 0.0001, respectively). At the end of the study, all three groups of patients showed a significant reduction of the symptom scores (p < 0.002; p < 0.038; p < 0.03, respectively). Median symptom score values were more significantly reduced in Groups A than in Group B and in Group C (Group A vs Group B p < 0. 002; Group A vs Group C p < 0.0001; Group B vs Group C p < 0.001). Conclusions: Mg-alginate plus simethicone (Gastrotuss Baby® ) seems to be more efficacious on GER symptom scores than thickened formula and reassurance with lifestyle changes alone. http://dx.doi.org/10.1016/j.dld.2014.07.044
e81
INTESTINAL FAILURE ASSOCIATED LIVER DISEASE IN A SHORT BOWEL SYNDROME PEDIATRIC COHORT: INCIDENCE AND PROGNOSIS Antonella Diamanti 1,∗ , Teresa Capriati 1 , Vincenzo Di Ciommo Laurora 2 , Lidia Monti 1 , Giuliano Torre 1 , Manila Candusso 1 , Domenica Elia 1 , Fabio Fusaro 1 , Chiara Grimaldi 1 , Jean De Ville De Goyet 1 1 Intestinal Failure Multidisciplinary Group, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy 2 Epidemiology and Biostatistics Unit, “Bambino Gesù” Children’s Hospital, IRCSS, Rome, Italy
Objective: Intestinal failure-associated liver disease (IFALD) can affect children with short bowel disease (SBS) receiving parenteral nutrition (PN) and it can greatly impact on the outcome. Our aim was to determine the prevalence of IFALD in a cohort of SBS children and to assess its trend during the last twenty years. Methods: We evaluated 100 children with SBS followed between 1994 and 2014 in one third level pediatric center and we assessed the prevalence of IFALD (subdivided into IFALD I, II and III) during the follow-up. The prevalence of IFALD was also determined in two decades of the study (1994–2003 and 2004–2014). The occurrence of IFALD was related to overall PN days. Results: The prevalence of IFALD III at discharge from the first admission was 27% and of those seven patients are died during follow-up; the remaining showed a regression or attenuation of IFALD III. The prevalence of IFALD was significantly higher in patients with PN lasted <24 months, than in those with PN duration higher >24 months (p 0.0001) and was similar in the two decades. Conclusions: Our study showed that IFALD occurs early in the natural history of SBS. This suggests that it may depend on the underlying disease and on its early complications (repeated surgery, sepsis) rather than the factors related to the PN duration. This is also supported by the evidence of the unchanged prevalence of IFALD over the years in spite of advances in the PN management. http://dx.doi.org/10.1016/j.dld.2014.07.045 WAIST TO HEIGHT RATIO: A SIMPLE TOOL TO RECOGNISE CHILDREN AT INCREASED RISK FOR METABOLIC SYNDROME Angelo Campanozzi 1,∗ , Irene Rutigliano 1 , Donatella De Giovanni 1 , Michela Foglia 1 , Mariangela Guglielmi 1 , Gianpaolo De Filippo 2 , Luciana Romaniello 1 , Valentina De Maio 1 , Michele Conoscitore 1 , Massimo Pettoello-Mantovani 1 1 Clinica Pediatrica, Universita’ di Foggia, Foggia, Italy 2 Pediatria, Ospedale Bicetre, Parigi, France
Objective: Metabolic Syndrome (MS) is the most important comorbidity obesity-related, also in children. Visceral adiposity is part of MS cluster, so that measurement of Waist Circumference (WC) is an essential step for screening MS in adulthood and childhood. Up today, valid cut-off percentiles for WC are not available for the whole pediatric population, arising difficulties to diagnose the MS. Aim of the study: To individuate a simple clinical diagnostic tool for screening obese children at risk for MS. Methods: We enrolled in the study 803 subjects (395 girls, mean age 9.43 ± 2.5 yrs) whose mean BMI z-score was 2.2 ± 0.53. The
e82
Abstracts / Digestive and Liver Disease 46 (2014) e71–e84
entire cohort was screened for MS defined according to modified American Heart Association Criteria. For each patient we measured WC and calculate Waist to Height ratio (WHtR, WC (cm)/Height (cm)). We used Receiver Operating Characteristic (ROC) curve and Youden Index for detecting the usefulness of this parameter. Results: The prevalence rate of MS was 13.07% (105 pts). Children with MS had mean WHtR of 0.65 ± 0.09. Children without MS presented mean WHtR of 0.62 ± 0.06, this difference was statistically significant (p < 0.001). The Area Under ROC curve (AUC) was 0.690 for WCHtr (CI 95%: 0.637–0.743, p < 0.001) in detecting MS. WHtr cut-off value equal to 0.62 showed a sensibility of 76.3% and a specificity of 56% in identifying obese children affected by MS. Conclusions: WHtR is strongly related to MS and it seems to be a simple, non invasive and practical tool in detecting Paediatric MS: a cut-off value of 0.62 should suggest second-level examinations. http://dx.doi.org/10.1016/j.dld.2014.07.046 NOVEL DIETARY PRODUCTS DERIVED BY FERMENTATION OF COW MILK AND RICE WITH LACTOBACILLUS PARACASEI CBAL74 PREVENT GASTROINTESTINAL AND RESPIRATORY TRACT INFECTIONS IN YOUNG CHILDREN: A PROSPECTIVE RAN Rita Nocerino 1,∗ , Lorella Paparo 1 , Ylenia Maddalena 1 , Simona Caprio 1 , Francesco Amato 1 , Vincenza Pezzella 1 , Rosita Aitoro 1 , Linda Cosenza 1 , Andrea Budelli 2 , Francesca Fasano 2 , Carmen Di Scala 1 , Roberto Berni Canani 1 1
Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli “Federico II”, Napoli, Italy 2 R&D, Heinz Italy, Latina, Italy Background: We evaluated the preventive effects of two dietary products derived from the fermentation of cow milk or rice on winter infectious diseases in children. Methods: Prospective, double-blind, controlled trial conducted in healthy schooled children aged 12–48 m during winter season randomly allocated to receive daily for 3 m dietary products deriving from cow milk (Group A) or rice fermentation (Group B) with L. paracasei CBAL74, or placebo (Group C). Occurrence of acute gastroenteritis (AGE) and upper respiratory tract infections (URTI) were recorded by family pediatricians. Fecal defensins, cathelicidin (LL-37), and sIgA levels were also assessed. Results: 405 children were evaluated, 377 (193 male; mean age 32.5 m, 95% CI 31.4–33.5) completed the study: 137 in Group A, 118 in Group B and 122 in Group C. Demographic and anthropometric characteristics were similar among groups. During the study period 242/377 enrolled children experienced at least one infectious episode: 50.4% in Group A, 64.4% in Group B and 79.5% in Group C (p < 0.05). URTI were observed in 48.2% of subjects in Group A, 58.5% in Group B and 70.5% in Group C (p < 0.001). AGE were observed in 13.1% of Group A, 19.5% of Group B and 31.1% of Group C subjects (p < 0.05). An increase of alfa/beta-defensins, LL-37 and sIgA levels was observed only in Group A and B (p < 0.05). The interventions were well accepted. No adverse events were observed. Conclusions: Dietary supplementation with cow milk or rice fermented with L. paracasei CBAL74 efficiently prevents common infectious diseases in schooled children through an innate and acquired immunity stimulation. http://dx.doi.org/10.1016/j.dld.2014.07.047
MIR320 FAMILY REGULATES NOD2/CARD15: A NEW MECHANISM FOR CONTROLLING INFLAMMATION? Laura Stronati 1,∗ , Maria Pierdomenico 1 , Vincenzo Cesi 1 , Manuela Costanzo 1 , Marina Aloi 2 , Salvatore Oliva 2 , Fortunata Civitelli 2 , Salvatore Cucchiara 2 1 Department of Radiobiology and Human Health, ENEA Rome, Italy 2 Department of Pediatrics, Pediatric Gastroenterology & Liver Unit, Sapienza University of Rome, Italy
Background: Regulation of inflammatory responses is ensured by coordinated and controlled gene expression in immune system cells. One group of gene expression regulators is a class of short single-stranded RNA molecules termed microRNAs (miRNAs). Recent studies have suggested that miR-320 is altered in tissue samples of patients with Inflammatory Bowel Disease (IBD) [1]. We performed a bioinformatic analysis showing that miR-320 family may bind the 3 -UTR of NOD2/CARD15 (nucleotide-binding oligomerization domain), the first susceptibility gene associated to Crohn’s disease (CD), one of the two main forms of IBD. Interestingly, NOD2 has been previously identified as a functional target of other miRNAs [2]. Aims: the present study was aimed at (1) exploring the hypothesis that NOD2/CARD15 is a target of members of the miR-320 family, including miR-320a, -320b, -320c, -320d and 320e, (2) assessing the contribution of the miR-320/NOD2 axis to intestinal inflammation. Methods: The colonic adenocarcinoma cell line, HT29, was transfected with exogenous miR-320a, -320b, -320c, -320d, -320e and a miRNA negative control. In addition, miR320 family inhibitor and miRNA inhibitor negative control were transfected to inhibit endogenous miRNAs. In a second experimental setting, cells, transfected as above, were also exposed to IFN␥ + TNF␣ cytomix to induce inflammation. Results: A strong decrease of NOD2 protein expression was observed after transfections with miR-320a and -320b compared to negative control. Differently, miR-320 family inhibitor induced an increase of NOD2 expression. The exposure to cytomix induced a significant up-regulation of NOD2, which was strongly reduced by transfected miR-320a and -320b. Conclusions: In the present study, we show for the first time that NOD2 expression is under the control of two members of the miR-320 family: miR-320a and -320b. Moreover, we show that miR-320a and -320b are able to counterbalance the NOD2 increase induced by inflammation. Future work will be done to assess whether NOD2 is a direct target of both miR-320a and -320b and to analyse possible correlations between NOD2 and miR320 expression in inflamed tissues of IBD patients. References [1] Fasseu M, Tréton X, Guichard C, et al. Identification of restricted subsets of mature microRNA abnormally expressed in inactive colonic mucosa of patients with inflammatory bowel disease. PLoS ONE 2010;5:1–12. [2] Chen Y, Wang C, Liu Y, et al. miR-122 targets NOD2 to decrease intestinal epithelial cell injury in Crohn’s disease. Biochemical and Biophysical Research Communications 2013;438:133–9.
http://dx.doi.org/10.1016/j.dld.2014.07.048