23 research outputs found
Highlights of the ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants and children with cystic fibrosis
Full text linkPrevalence of vitamin D deficiency in children with cerebral palsy and autism spectrum disorder: a comparative pilot study
Full text linkAim: This study aims to explore the prevalence of vitamin D deficiency (VDD) among children with cerebral palsy (CP) and autism spectrum disorder (ASD) in Bulgaria, while analyzing associated demographic, nutritional, and biochemical factors. Materials and methods: A cross-sectional study was conducted in Northeastern Bulgaria, involving 95 children (59 with CP and 36 with ASD). Vitamin D status was assessed using biochemical markers and categorized as deficient (<20 ng/mL), insufficient (20-29 ng/mL), or normal (≥30 ng/mL). Statistical comparisons were performed to identify differences across groups. Results: VDD was prevalent in 29.4% of children with CP and 15.8% of those with ASD, with no significant intergroup differences (p=0.492). Demographic analysis revealed significant gender (p<0.001) and ethnic differences (p=0.006). Children with VDD exhibited lower height-for-age Z scores (p=0.002), weight-for-age Z scores (p=0.021), albumin levels (p<0.001), and lymphocyte counts (p=0.011). Normal ferritin levels alongside reduced transferrin and serum iron suggested protein synthesis deficits rather than depleted iron stores. Conclusion: This study, which is the first in Bulgaria to address vitamin D deficiency in children with autism spectrum disorder and cerebral palsy, emphasizes the necessity of tailored interventions and nutritional support. The findings emphasize the role of biological and sociocultural factors in the prevalence of VDD, contributing valuable insights into pediatric health in moderate-climate regions
ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis
No full textBACKGROUND: Malnutrition is both a frequent feature and a comorbidity of cystic fibrosis (CF), with nutritional status strongly associated with pulmonary function and survival. Nutritional management is therefore standard of care in CF patients. ESPEN, ESPGHAN and ECFS recommended guidelines to cover nutritional management of patients with CF.
METHODS: The guidelines were developed by an international multidisciplinary working group in accordance with officially accepted standards. The GRADE system was used for determining grades of evidence and strength of recommendation. Statements were discussed, submitted to Delphi rounds, reviewed by ESPGHAN and ECFS and accepted in an online survey among ESPEN members.
RESULTS: The Working Group recommends that initiation of nutritional management should begin as early as possible after diagnosis, with subsequent regular follow up and patient/family education. Exclusive breast feeding is recommended but if not possible a regular formula is to be used. Energy intake should be adapted to achieve normal weight and height for age. When indicated, pancreatic enzyme and fat soluble vitamin treatment should be introduced early and monitored regularly. Pancreatic sufficient patients should have an annual assessment including fecal pancreatic elastase measurement. Sodium supplementation is recommended and a urinary sodium:creatinine ratio should be measured, corresponding to the fractional excretion of sodium. If iron deficiency is suspected, the underlying inflammation should be addressed. Glucose tolerance testing should be introduced at 10 years of age. Bone mineral density examination should be performed from age 8-10 years. Oral nutritional supplements followed by polymeric enteral tube feeding are recommended when growth or nutritional status is impaired. Zinc supplementation may be considered according to the clinical situation. Further studies are required before essential fatty acids, anti-osteoporotic agents, growth hormone, appetite stimulants and probiotics can be recommended.
CONCLUSION: Nutritional care and support should be an integral part of management of CF. Obtaining a normal growth pattern in children and maintaining an adequate nutritional status in adults are major goals of multidisciplinary cystic fibrosis centers
Mobile Apps and Challenges for Type 1 Diabetes Control in Children
Full text linkIntroduction: Mobile applications are increasingly being utilized in the management of type 1 diabetes (T1D) in children, providing tools to enhance glycemic control, self-management, and adherence to treatment protocols. However, their impact on clinical and behavioral outcomes remains understudied.Aim: This study aimed to evaluate the differences in glycemic control, hypoglycemia frequency, and related management behaviors between children who use mobile apps for carbohydrate counting and those who do not.Methods: A cross-sectional study was conducted among 76 children with T1D, divided into app users (n = 16) and non-users (n = 60). Data on demographic characteristics, glycemic control metrics, hypoglycemia frequency, blood glucose monitoring methods, and challenges in carbohydrate counting were collected. Statistical analysis included chi-square tests for categorical variables and independent t-tests for continuous variables.Results: App users had a significantly lower prevalence of abnormal glycated hemoglobin (HbA1c) levels compared to non-users (37.5% vs. 75.0%; p = 0.005) and reported no challenges in carbohydrate counting (0% vs. 26.7%; p = 0.043). Hypoglycemia frequency differed significantly between groups (p = 0.027), with daily hypoglycemia being more common among app users (37.5% vs. 10.2%), while non-users experienced more weekly or less-than-weekly hypoglycemia. Time spent outside the glycemic range was not significantly different between groups. Anthropometric and demographic characteristics, including age, BMI, height, weight, and parental education, were comparable between groups.Conclusion: Mobile apps for carbohydrate counting are associated with improved glycemic control and fewer challenges in diabetes management. However, the higher frequency of hypoglycemia among app users highlights the need for app optimization to balance glycemic control while preventing hypoglycemia. These findings underscore the importance of integrating digital tools into pediatric diabetes care and refining their functionalities to maximize their clinical benefits
Delayed Bone Age and Osteoprotegerin Levels in Pediatric Celiac Disease: A Three-Year Case–Control Study
No full textIntroduction: Celiac disease (CD) impairs bone development in children through inflammation and nutrient malabsorption. Osteoprotegerin (OPG), a decoy receptor for RANKL, plays a role in bone remodeling and is increasingly recognized as a potential biomarker of bone metabolism and inflammation. However, its clinical significance in pediatric CD remains unclear. Aim: To evaluate the relationship between OPG levels, growth parameters, and delayed bone age in children with CD, and to assess OPG’s potential as a biomarker of bone health and disease activity. Methods: This three-year case–control study included 146 children: 25 with newly diagnosed CD (Group A), 54 with established CD on a gluten-free diet (Group B), and 67 healthy controls (Group C). Participants underwent clinical, anthropometric, and laboratory assessments at baseline and after 6 months (Groups A and B). OPG and osteocalcin were measured, and bone age was assessed radiologically. Statistical analyses included ANOVA, Spearman’s correlations, and binomial logistic regression. Results: OPG levels were highest in newly diagnosed children (Group A), showing a non-significant decrease after gluten-free diet initiation. OPG correlated negatively with age and height in CD patients and controls, and positively with hemoglobin and iron in Group B. Logistic regression revealed no significant predictive value of OPG for delayed bone age, although a trend was observed in Group B (p = 0.091). Children in long-term remission exhibited bone maturation patterns similar to healthy peers. Conclusions: OPG levels reflect disease activity and growth delay in pediatric CD but lack predictive power for delayed bone age. While OPG may serve as a secondary marker of bone turnover and inflammatory status, it is not suitable as a standalone biomarker for skeletal maturation. These findings highlight the need for integrative biomarker panels to guide bone health monitoring in children with CD
USE OF THE PROBIOTIC Lactobacillus reuteri DSM 17938 IN THE PREVENTION OF ANTIBIOTIC-ASSOCIATED INFECTIONS IN HOSPITALIZED BULGARIAN CHILDREN: A RANDOMIZED, CONTROLLED TRIAL
Full text linkObjective: To evaluate the effectiveness of Lactobacillus reuteri DSM 17938 for the prevention of antibiotic-associated diarrhoea and Clostridium difficile-related infections in hospitalized children in a Bulgarian hospital.
Study design: Children (n=100, aged 3 to 12 years) admitted to the hospital for acute infections were enrolled in a randomized, double- blind, placebo-controlled trial. They were assigned to receive either a probiotic supplement containing 1 x 108 CFU Lactobacillus reuteri DSM 17938 in the form of one chewable tablet once per day (n=49) (BioGaia AB, Stockholm, Sweden) or placebo (n=48). The probiotic or placebo was taken 2 hours after lunch each day, during the entire period of antibiotic treatment at the hospital and for additional 7 days.
Results: Data from 97 children were included in the final analysis. The incidence of diarrhoea (defined as at least 3 loose or watery stools per day in a 48-hour period that occurred during or up to 21 days after cessation of antibiotic treatment) was unexpectedly low in both groups - L. reuteri (n=1) versus placebo (n=1): 2,04 vs. 2,1 per 100 (p>0,05, risk ratio 1,02, 95% CI 0,7-1,4). L reuteri DSM 17938 did not significantly affect the incidence or severity of AAD diarrhoea and Clostridium difficile infection. We found unusually high colonisation rate of non-symptomatic C. difficile measured by toxin-specific ELISA. There was no difference between the probiotic and placebo groups for any of the other secondary outcomes (i.e., incidence of mild diarrhoea, frequency of stool samples positive for C. difficile toxin A and B at the beginning and at the end of study period, frequencies of other gastrointestinal symptoms in the same study period) (p<0,05). No adverse events were reported.
Conclusion: Due to the low incidence of antibiotic-associated diarrhoea in both groups, no conclusion can be made on the efficacy of L. reuteri DSM 17938 on AAD in hospitalized Bulgarian children. The probiotic did not affect the non-symptomatic high rate of C. difficile colonisation (33.3% in the placebo and 38.8% in the L. reuteri group at baseline) in this population. There was also no difference between groups regarding different gastrointestinal side effects
Linking Dietary Patterns to Autism Severity and Developmental Outcomes: A Correlational Study Using Food Frequency Questionnaires; The Childhood Autism Rating Scale, Second Edition; And Developmental Profile 3
No full textBackground/Objectives: Autism Spectrum Disorder (ASD) is characterized by social communication challenges and repetitive behaviors. Children with ASD often exhibit selective eating habits that may result in nutritional deficiencies and exacerbate developmental issues. While food frequency questionnaires (FFQs) are effective for dietary assessment, the links between food preferences, ASD severity, and developmental outcomes remain underexplored, particularly in Bulgaria. This study examines these relationships using validated tools. Methods: The present report constitutes a pilot, hypothesis-generating substudy of the broader NutriLect project. This substudy involved 49 children aged 2–12 years diagnosed with ASD. Dietary patterns were evaluated with a modified FFQ, while ASD severity and developmental profiles were assessed using the Childhood Autism Rating Scale, Second Edition (CARS-2) and the Developmental Profile 3 (DP-3). Results: Among 49 ASD children (mean age = 6.89 ± 2.15 years; 86% boys), 73.4% consumed grains/potatoes daily. Only 34.7% met combined fruit and vegetable recommendations. Only 36.7% met the recommendation for daily milk or other dairy product consumption. Fish was consumed at least twice weekly by only 22,4%. Furthermore, children with more severe autism were approximately 9.4 times more likely to consume grains daily (χ2 = 14.319, p = 0.006). Logistic regression analyses indicated that higher cognitive scores were strongly associated with lower grain (OR ≈ 0.044) and other dairy products consumption (OR ≈ 0.337), yet with greater fish intake (OR ≈ 3.317). In contrast, better communication skills corresponded to increased milk consumption (OR ≈ 5.76), and higher physical development scores predicted more frequent egg consumption (OR ≈ 4.40). Conclusions: The pronounced preference for grain and meat products, which are frequently ultra-processed, and avoidance of nutrient-dense foods in children with severe ASD symptoms underscore the need for tailored dietary interventions. These interventions must address sensory sensitivities, nutritional inadequacies, and the risks that selective nutrition can have on the nutritional status and development of the children
Digital horizons in type 1 diabetes care: Evaluating the impact of mobile health technologies
Full text linkIntroduction: Managing type 1 diabetes (T1D) amidst a global epidemic is challenging and necessitates the introduction of digital health technologies as promising tools for revolutionizing T1D outcomes. Digital health technologies, such as mobile applications and gamified solutions, are innovative tools poised to transform T1D management by enhancing glycemic control and empowering patients with real-time data and personalized strategies.Aim: The aim of the article is to critically examine the current state of digital applications in the management of T1D, evaluating their impact on health outcomes, challenges in adoption and implementation, and identifying areas for future research.Materials and Methods: The methodology involves a comprehensive search across major databases for literature on digital applications in T1D management, employing specific keywords to ensure a broad spectrum of digital interventions is covered. The selection criteria for studies focus on those published within a specified timeframe and directly related to T1D management outcomes.Results: Findings highlight the diverse impacts of digital applications on T1D care, noting improvements in patient engagement and monitoring. The results also underscore the current challenges in digital health integration, including the need for robust, long-term studies to establish efficacy and address the regulatory landscape.Conclusion: The article concludes by emphasizing the immense potential of digital applications to alleviate the daily management burdens of T1D, calling for continued research, standardization of outcomes, and regulatory collaboration to fully realize the benefits of digital health technologies in diabetes care
Microbial Preparations (Probiotics) for the Prevention of Clostridium difficile Infection in Adults and Children: An Individual Patient Data Meta-analysis of 6,851 Participants
No full textOBJECTIVE. To determine whether probiotic prophylaxes reduce the odds of Clostridium difficile infection (CDI) in adults and children. DESIGN. Individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs), adjusting for risk factors. METHODS. We searched 6 databases and 11 grey literature sources from inception to April 2016. We identified 32 RCTs (n=8,713); among them, 18 RCTs provided IPD (n=6,851 participants) comparing probiotic prophylaxis to placebo or no treatment (standard care). One reviewer prepared the IPD, and 2 reviewers extracted data, rated study quality, and graded evidence quality. RESULTS. Probiotics reduced CDI odds in the unadjusted model (n=6,645; odds ratio [OR] 0.37; 95% confidence interval [CI], 0.25-0.55) and the adjusted model (n=5,074; OR, 0.35; 95% CI, 0.23-0.55). Using 2 or more antibiotics increased the odds of CDI (OR, 2.20; 95% CI, 1.11-4.37), whereas age, sex, hospitalization status, and high-risk antibiotic exposure did not. Adjusted subgroup analyses suggested that, compared to no probiotics, multispecies probiotics were more beneficial than single-species probiotics, as was using probiotics in clinical settings where the CDI risk is 5%. Of 18 studies, 14 reported adverse events. In 11 of these 14 studies, the adverse events were retained in the adjusted model. Odds for serious adverse events were similar for both groups in the unadjusted analyses (n=4,990; OR, 1.06; 95% CI, 0.89-1.26) and adjusted analyses (n=4,718; OR, 1.06; 95% CI, 0.89-1.28). Missing outcome data for CDI ranged from 0% to 25.8%. Our analyses were robust to a sensitivity analysis for missingness. CONCLUSIONS. Moderate quality (ie, certainty) evidence suggests that probiotic prophylaxis may be a useful and safe CDI prevention strategy, particularly among participants taking 2 or more antibiotics and in hospital settings where the risk of CDI is >= 5%
Influence of the oral mucosa condition on the nutritional status of children with neurological impairment in Varna
Full text linkIntroduction: The assessment of the causes for malnutrition in children with neurological impairment (NI) in Bulgaria is challenging due to the heterogeneity of the leading diagnosis. In the case of soreness of the oral mucosa due to inflammatory processes or mechanical irritation, children experience discomfort and this disrupts the normal course of chewing. So far, no association between undernutrition in children with NI and the condition of the oral mucosa has been examined in Bulgaria.Aim: The aim of this article is to evaluate the condition of the oral mucosa and its relationship to the nutritional status of children with NI.Materials and Methods: About 54 patients with NI were recruited for the study, which took place between April and October 2017. Twenty-five of them lived in family settings and 29 in residential care (RC) in Varna, Bulgaria. After briefing all participants (family members and caretakers) about the nature and meaning of the study, they took an informed participation in an intraoral examination of the oral cavity of their children. The nutritional status was assessed by anthropometric measurements. The study was approved by the Medical Ethical Committee of the Medical University of Varna.Results: The examination of the condition of the oral mucosa of children with NI revealed various signs of inflammatory changes of the mucous membranes, showing that among 66% of the recruited patients redness and swelling, lining on the back of the tongue, etc. were observed. There were various inflammatory changes observed in the oral mucosa in 89.28% of the cases who are raised in the RC and 40% in those living in family settings. The differences in the prevalence of inflammatory changes of the oral mucosa between the two groups of patients was statistically significant (X2 = 16.13, p = 0.001). Statistically significant was also the relationship between the oral mucosal status and the status of malnutrition, as estimated by anthropometric indicators such as weight-for-age, height-for-age and subscapular skin fold thickness following the World Health Organization criteria and standards (2006, 2007).Discussion: Many factors affect malnutrition in children with NI. One of the factors is the condition of the oral mucosa. Its improvement would most probably increase the ability of this vulnerable group of children to eat foods of varying composition and consistency, which would have a positive effect on their nutritional status.Conclusion: Our study shows a direct link between inflamed and painful oral mucosa and malnutrition in children with NI.Introduction: The assessment of the causes for malnutrition in children with neurological impairment (NI) in Bulgaria is challenging due to the heterogeneity of the leading diagnosis. In the case of soreness of the oral mucosa due to inflammatory processes or mechanical irritation, children experience discomfort and this disrupts the normal course of chewing. So far, no association between undernutrition in children with NI and the condition of the oral mucosa has been examined in Bulgaria.Aim: The aim of this article is to evaluate the condition of the oral mucosa and its relationship to the nutritional status of children with NI.Materials and Methods: About 54 patients with NI were recruited for the study, which took place between April and October 2017. Twenty-five of them lived in family settings and 29 in residential care (RC) in Varna, Bulgaria. After briefing all participants (family members and caretakers) about the nature and meaning of the study, they took an informed participation in an intraoral examination of the oral cavity of their children. The nutritional status was assessed by anthropometric measurements. The study was approved by the Medical Ethical Committee of the Medical University of Varna.Results: The examination of the condition of the oral mucosa of children with NI revealed various signs of inflammatory changes of the mucous membranes, showing that among 66% of the recruited patients redness and swelling, lining on the back of the tongue, etc. were observed. There were various inflammatory changes observed in the oral mucosa in 89.28% of the cases who are raised in the RC and 40% in those living in family settings. The differences in the prevalence of inflammatory changes of the oral mucosa between the two groups of patients was statistically significant (X2 = 16.13, p = 0.001). Statistically significant was also the relationship between the oral mucosal status and the status of malnutrition, as estimated by anthropometric indicators such as weight-for-age, height-for-age and subscapular skin fold thickness following the World Health Organization criteria and standards (2006, 2007).Discussion: Many factors affect malnutrition in children with NI. One of the factors is the condition of the oral mucosa. Its improvement would most probably increase the ability of this vulnerable group of children to eat foods of varying composition and consistency, which would have a positive effect on their nutritional status.Conclusion: Our study shows a direct link between inflamed and painful oral mucosa and malnutrition in children with NI.
