• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.24 no.2
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• pp.187-196
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• 2021

Purpose: The rising prevalence of childhood obesity in the past decades has caused non-alcoholic fatty liver disease (NAFLD) to become the most common cause of pediatric chronic liver disease worldwide. This study was aimed at determining the effect of vitamin D (Vit D) on ultrasonography and laboratory indices of NAFLD and some blood biochemical indicators in children. Methods: In this interventional study liver ultrasonography was performed in 200 children with overweight and obesity. A 108 had fatty liver among which 101 were randomly divided into two groups of study (n=51) and control (n=50). The study group was treated with Vit D, 50000 U once a week whereas the control group received placebo with the same dose and package, both for 12 weeks. At the end of the intervention lab tests and ultrasound study was performed once again to evaluate the response to treatment. Results: It was found out that Vit D supplementation improved the fatty liver grade in the study group. The mean changes in hemoglobin (Hb), uric acid, highdensity lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), insulin, albumin and alanine aminotransferase (ALT) was significantly higher in the study group compared to controls (p<0.05). After the intervention and means adjustment, a significant difference was obtained in HDL-C, insulin, LDL-C and homeostasis model assessment of insulin resistance (HOMA-IR) between the two groups. Conclusion: Vit D supplementation in addition to improving the fatty liver grade in ultrasonography and increasing the blood Vit D level, increases the HDL and Hb level besides decreasing uric acid, LDL, HOMA-IR, insulin and ALT levels.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.2
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• pp.86-92
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• 2018

Purpose: Celiac disease is a common non-communicable disease with varied presentations. Purpose of this study was to find the duodeno-endoscopic features in celiac disease and to compare duodeno-endoscopic and histological findings between typical and atypical celiac disease in children. Methods: Hospital based observational study was conducted at Sir Padampat Mother and Child Health Institute, Jaipur from June 2015 to May 2016. Patients were selected and divided in two groups- typical and atypical celiac disease based upon the presenting symptoms. Upper gastrointestinal endoscopy and duodenal biopsy was performed for serology positive patients. Results were analysed using appropriate statistical test of significance. Results: Out of 101 enrolled patients, 47.5% were male. Age ranged from 1 to 18 years. Study showed that 54.5% were typical and 45.5% were atypical. Patients presenting with atypical symptoms were predominantly of older age group. On endoscopy, scalloping, mosaic pattern, reduced fold height and absent fold height; and in histology, advanced Marsh stage were significantly higher in the typical group. Conclusion: Awareness of atypical presentations as well as duodeno-endoscopic features may have considerable practical importance for the diagnosis of celiac disease in children. Scalloping, mosaic pattern, reduced fold height and nodularity are main endoscopic markers of celiac disease in children. Endoscopic markers of duodenal mucosa may be important in early diagnosis of celiac disease, in children subjected to endoscopy for atypical presentations or indication other than suspected celiac disease.

• Nutritional Sciences
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• v.3 no.2
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• pp.77-82
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• 2000

We carried out a case-control study to investigate protective effect of lactating against breast cancer in Korea. Cases (n=108) were the newly histologically identified breast cancer between December 1997 and August 1999. Hospital-based controls were selected by frequency matching method with age ($\pm$4 age) and menopausal status from the patients at the same hospital in the plastic surgery, general surgery and opthalmology department. Interviews included information on general characteristics of subjects, disease history, family history of breast cancer, vitamin supplementation, alcohol intake, food intake, and reproductive factors as well as lactation history. Odds ratio (OR) and 95% Confidence Intervals (CI) were calculated by using unconditional logistic regression. Age distribution of case control subjects were similar. Late menarche age $\geq$ 17 in premenopausal women was related to the lower risk of breast cancer OR = 0.41, 95% CI = 0.28-0.91. Family history of breast cancer was related to the higher risk of breast cancer only in premenopausal women (OR = 2.07, 95% CI = 1.35-2.71). Higher body mass index mass index (> 30) were associated with higher risk of breast cancer in postmenopausal women. For premenopausal women, women who had lactated $\geq$ 12 months to the first child had a significantly lower risk (OR = 0.53, 95% CI = 0.24-0.97) than the women had no breast feeding experience. However, results from postmenopausal women did not show an association with decreased breast cancer risk. These findings suggest that lactation may be a protective factor of breast cancer in Korean women.

• CELLMED
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• v.10 no.1
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• pp.4.1-4.4
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• 2020

Ayurveda scholars have well described about the physio-anatomical aspect of mammary gland (Stana), physiology of lactation, importance of breast milk (Stanya) in growth and development of baby, various factors affecting the lactation and causing changes in property of milk, Galactogouge (Stanyajanana), and drugs for purification of mother milk (Stanya Shodhana). The recent studies provide evidence for above descriptions of Ayurveda. Breast milk (Stanya) is the nearly complete sole source of nourishment for infants. It has been considered as subsidiary tissue (Upadhatu) of blood plasma (Rasa Dhatu) as it is formed out of Rasa Dhatu (Plasma) and its quality and quantity gets affected by quality of nutrient fraction of food formed after complete digestion (Aahar Rasa). It provides health (Aarogya), strength and immunity (Bala) to the feeding child and gives innumerable beneficial effects like protection against not only acute infections like URTI, diarrhoea but also on chronic illnesses like CVD, metabolic disorders too. The Ayurveda description related to Mammary gland and physiology of lactation still need a better understanding for its implementation on promotion of health. Thus an attempt has been made to compile and analyze the view of Ayurveda scholars on Breast (Stana), Breast milk (Stanya) and physiological aspect of lactation as well as to draw a possible scientific understanding for the relevance.

• Nutrition Research and Practice
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• v.13 no.3
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• pp.247-255
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• 2019

BACKGROUND/OBJECTIVES: Accurate, early identification of acutely malnourished children has the potential to reduce related child morbidity and mortality. The current World Health Organisation (WHO) guidelines classify non-oedematous acute malnutrition among children under five using Mid-Upper Arm Circumference (MUAC) or Weight-for-Height Z-score (WHZ). However, there is ongoing debate regarding the use of current MUAC cut-offs. This study investigates the diagnostic performance of MUAC to identify children aged 6-24 months with global (GAM) or severe acute malnutrition (SAM). SUBJECTS/METHODS: Cross-sectional, secondary data from a community sample of children aged 6-24 months in Niger were used for this study. Children with complete weight, height and MUAC data and without clinical oedema were included. Using WHO guidelines for GAM (WHZ < -2, MUAC < 12.5 cm) and SAM (WHZ < -3, MUAC < 11.5 cm), the sensitivity (Se), specificity (Sp), predictive values, Youden Index and Receiver Operating Characteristic (ROC) curves were calculated for MUAC when compared with the WHZ reference criterion. RESULTS: Of 1161 children, 23.3% were diagnosed with GAM using WHZ, and 4.4% with SAM. Using current WHO cut-offs, the Se of MUAC to identify GAM was greater than for SAM (79 vs. 57%), yet the Sp was lower (84 vs. 97%). From inspection of the ROC curve and Youden Index, Se and Sp were maximised for MUAC < 12.5 cm to identify GAM (Se 79%, Sp 84%), and MUAC < 12.0 cm to identify SAM (Se 88%, Sp 81%). CONCLUSIONS: The current MUAC cut-off to identify GAM should continue to be used, but when screening for SAM, a higher cut-off could improve case identification. Community screening for SAM could use MUAC < 12.0 cm followed by appropriate treatment based on either MUAC < 11.5 cm or WHZ < -3, as in current practice. While the practicalities of implementation must be considered, the higher SAM MUAC cut-off would maximise early case-finding of high-risk acutely malnourished children.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.4
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• pp.246-252
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• 2015

Purpose: To assess gastric pH and its relationship with urease-test positivity and histological findings in children with Helicobacter pylori infection. Methods: Fasting gastric juices and endoscopic antral biopsy specimens were collected from 562 children and subjected to the urease test and histopathological examination. The subjects were divided into 3 age groups: 0-4, 5-9, and 10-15 years. The histopathological grade was assessed using the Updated Sydney System, while the gastric juice pH was determined using a pH meter. Results: The median gastric juice pH did not differ significantly among the age groups (p=0.655). The proportion of individuals with gastric pH >4.0 was 1.3% in the 0-4 years group, 6.1% in the 5-9 years group, and 8.2% in 10-15 years (p=0.101). The proportions of moderate and severe chronic gastritis, active gastritis, and H. pylori infiltration increased with age (p<0.005). Urease-test positivity was higher in children with hypochlorhydria (77.8%) than in those with normal gastric pH (31.7%) (p<0.001). Chronic and active gastritis were more severe in the former than the latter (p<0.001), but the degree of H. pylori infiltration did not differ (20.9% vs. 38.9%; p=0.186). Conclusion: Gastric pH while fasting is normal in most children regardless of age. Urease-test positivity may be related to hypochlorhydria in children, and hypochlorhydria is in turn related to H. pylori infection.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.4
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• pp.346-355
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• 2020

Purpose: Peroxisome proliferator-activated receptor gamma (PPAR-γ) has a key role in hepatic fibrogenesis by virtue of its effect on the hepatic stellate cells (HSCs). Although many studies have shown that PPAR-γ agonists inhibit liver fibrosis, the mechanism remains largely unclear, especially regarding the cross-talk between PPAR-γ and other potent fibrogenic factors. Methods: This experimental study involved 25 male Wistar rats. Twenty rats were subjected to bile duct ligation (BDL) to induce liver fibrosis, further divided into an untreated group (BDL; n=10) and a group treated with the PPAR-γ agonist thiazolidinedione (TZD), at 14 days post-operation (BDL+TZD; n=10). The remaining 5 rats had a sham operation (sham; n=5). The effect of PPAR-γ agonist on liver fibrosis was evaluated by histopathology, protein immunohistochemistry, and mRNA expression quantitative polymerase chain reaction. Results: Histology and immunostaining showed markedly reduced collagen deposition, bile duct proliferation, and HSCs in the BDL+TZD group compared to those in the BDL group (p<0.001). Similarly, significantly lower mRNA expression of collagen α-1(I), matrix metalloproteinase-2, platelet-derived growth factor (PDGF)-B chain, and connective tissue growth factor (CTGF) were evident in the BDL+TZD group compared to those in the BDL group (p=0.0002, p<0.035, p<0.0001, and p=0.0123 respectively). Moreover, expression of the transforming growth factor beta1 (TGF-β1) was also downregulated in the BDL+TZD group (p=0.0087). Conclusion: The PPAR-γ agonist inhibits HSC activation in vivo and attenuates liver fibrosis through several fibrogenic pathways. Potent fibrogenic factors such as PDGF, CTGF, and TGF-β1 were downregulated by the PPAR-γ agonist. Targeting PPAR-γ activity may be a potential strategy to control liver fibrosis.

• Journal of the Korean Home Economics Association
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• v.44 no.3 s.217
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• pp.143-151
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• 2006

The purpose of this study was to investigate the levels of knowledge and behavior towards food hygiene among child consumers, examine the factors influencing them, and analyze the causal relationship between them. The data were collected from 521 elementary school students in Youngnam area by a self-administered questionnaire. Frequencies, Pearson's correlation analysis, multiple regression analyses, and path analysis were conducted by SPSS Windows. The results from this study were as follows. First, the level of knowledge towards food hygiene was not particularly high, and the level of behavior was somewhat more than the average. Second, the factors influencing the level of knowledge towards food hygiene were school record (upper and middle), and concerns about food hygiene. In addition, concerns about food hygiene, the frequency of food hygiene education in the family, and the level of knowledge towards food hygiene had an effect on the level of behavior towards food hygiene. Third, in the analysis of the causal relationship between the knowledge and behavior towards food hygiene, school record indirectly influenced the behavior towards food hygiene, and the frequency of food hygiene education in the family directly affected the behavior towards food hygiene. On the other hand, concerns about food hygiene had direct and indirect influence on the behavior towards food hygiene. In addition, the knowledge towards food hygiene showed a direct effect on the behavior towards food hygiene. These results imply that knowledge towards food hygiene is a very important factor to improve the children's behavior towards food hygiene and that parents' concerns and guidance for children are needed.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.17 no.2
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• pp.61-73
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• 2014

Presented are guidelines for the prevention, diagnosis, and treatment of cow's milk protein allergy (CMPA) which is the most common food allergy in infants. It manifests through a variety of symptoms that place a burden on both the infant and their caregivers. The guidelines were formulated by evaluation of existing evidence-based guidelines, literature evidence and expert clinical experience. The guidelines set out practical recommendations and include algorithms for the prevention and treatment of CMPA. For infants at risk of allergy, appropriate prevention diets are suggested. Breastfeeding is the best method for prevention; however, a partially hydrolyzed formula should be used in infants unable to be breastfed. In infants with suspected CMPA, guidelines are presented for the appropriate diagnostic workup and subsequent appropriate elimination diet for treatment. Exclusive breastfeeding and maternal dietary allergen avoidance are the best treatment. In infants not exclusively breastfed, an extensively hydrolyzed formula should be used with amino acid formula recommended if the symptoms are life-threatening or do not resolve after extensively hydrolyzed formula. Adherence to these guidelines should assist healthcare practitioners in optimizing their approach to the management of CMPA and decrease the burden on infants and their caregivers.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.24 no.4
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• pp.325-336
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• 2021

The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs. This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.