Magdalena Araya Q

Recuperación nutricional: Un desafío pendiente

Factors that modulate catch up growth influence the quantity and quality of the recovered tissue. Insulin and IGF-1 respond to dietary changes in carbohydrates and proteins; evidence shows that IGF-1 and leptin may be good indicators of nutritional recovery. The optimal diet to promote catch up growth is still controversial. There is consensus on the need to adjust the energy-protein intake to the growth velocity observed, without encouraging excessive eating, to avoid obesity. Zinc supplementation and physical activity appear as relevant factors to promote the synthesis of lean mass. In some models of early malnutrition, a better catch up growth during childhood, is associated with a higher frequency of chronic diseases and mortality in adulthood. In this context, we will review some factors that seem relevant to the modulation of catch up growth, which should be taken into account when reviewing the therapeutic guidelines to treat malnourished children (Rev Med Chile 2003; 131: 213-9)

EFECTO DE LA INFLAMACIÓN SUBCLÍNICA SOBRE EL ESTADO NUTRICIONAL DE HIERRO, COBRE Y ZINC EN ADULTOS

Resumen es: Chile se encuentra en la etapa de transicion epi¬demiologica, en la que coexisten las deficiencias de micronutrientes con las enfermedades cronicas no tr...

Mejorar el manejo de la enfermedad celíaca: Un desafío urgente

Anti endomysial and anti transglutaminase (EMA/TTG) antibodiesmeasurements in large population groups, show that celiac disease is significantly more common thanpreviously thought and 0.5-1% of the population suffer this condition. The recognition of atypicalclinical presentations by active screening of high risk groups is a successful global initiative. In Chilethere is little awareness of the enormous changes occurred in this field. Available national informationon typical presentation of the disease shows that it is found in 1:1836 live births, figure that iscomparable to European societies. Two urgent tasks are required in our country. First, to asses theChilean population using EMA and/or TTG. Second, to improve the legal aspects that regulateconsumer information about gluten content in processed foods. We here review the most relevantaspects to be considered to improve the management of celiac patients and the tasks that require theparticipation of health authorities for their implementation (Rev Med Chile 2006; 134: 361-64).(

Enfermedad celíaca en el adolescente y adulto joven.: Un desafío para gastroenterólogos de niños y adultos

Background: Follow-up of celiac patients in Chile is often interrupted when adolescents are referred to adult gastroenterologists. Aim: To study the evolution of patients with celiac disease when they reach adolescence or young adulthood. Patients and methods: Current adherence to gluten-free diet and its relation to symptoms and circulating antiendomysial antibodies were evaluated in the 58 confirmed celiac patients older than 12 years of age controlled at 3 hospitals in Santiago. Results: Mean age at the moment of this assessment was 17.8 ± 5 years, 65.5% were women, 12.5% were at nutritional risk (-IDS) while 20% were overweight/obese. Although all patients declared themselves asymptomatic, a focused questionnaire revealed that 26% suffered some symptoms. Only 24.1% followed a strict gluten-free diet. Eight of 20 patients who ate gluten-containing diets had negative antiendomysial antibodies (EMA), three of whom turned positive within 6 to 9 months. In three of four (asymptomatic) cases that accepted a new jejunal biopsy, histology was abnormal. One patient who followed a strict diet had EMA (+) and normal histology. Conclusions: These results confirm that after childhood, symptoms abate significantly in celiac patients. The observed sensitivity and specificity of EMA makes necessary to maintain small intestinal biopsies as the gold standard for diagnosis and confirmation of the disease. (Rev Med Chile 2001; 743-8)

Colitis eosinofílica por alergia a proteína de leche de vaca

Eosinophilic colitis is one of the clinical manifestations of allergy to cows milk during the first year of life. We report a series of 9 infants who, under 9 months of age and while clinically well, presented rectal bleeding of variable magnitude, with or without diarrhea, shortly after a cows milk-based formula was initiated (n = 6); yet, 3 cases received only breast feeding. Bleeding disappeared in all patients after milk withdrawal from the diet. Challenges were planned after 12 months of treatment; three patients have not yet reached this moment, 3 had a negative challenge at 12, 18 and 28 months of age and are on a complete diet, and 3 are still on cows milk free diet because ingestion of milk at 12, 18 and 25 months still induced rectal bleeding. This series of patients gathered in 3 years, follows the trend reported in many countries that there is a relative increase of patients diagnosed with allergy conditions early in life.

Estado actual del diagnóstico y presentaciones clínicas de enfermedad celíaca: Estudio multicéntrico

Background: Ample use of serological markers of high sensitivity and specificity led to relevant changes in the epidemiology of celiac disease. The impact of these changes in our country is poorly known. Aim: To assess the diagnostic procedures, clinical presentations and follow up of celiac disease as conducted in current pediatric practice. Material and methods: A multicentric retrospective study of patients diagnosed between 2000 and 2005 in five pediatric hospitals in Santiago, Chile. Data was obtained from clinical records, recorded in electronic spreadsheets and analyzed by descriptive statistics. Results: Seventy four of 83 identified patients fulfilled the inclusion criteria and were analyzed. Mean time to reach the diagnosis was 2.1 years. Cases younger than 10 years presented digestive manifestations such as chronic diarrhea and abdominal distension. Twenty one percent of older patients had atypical presentations (mainly short stature, refractory anaemia). Ten percent of cases were screened because a first degree relative had celiac disease. All patients had significant duodenal/jejunal lesion. IgA-antiendomysial antibodies (n =65) and IgA-antigliadin antibodies (n =23) were the most commonly used screening tests used but often, they were not available for follow up. A second biopsy was planned in all patients but only 26 had it due to repeated dietary transgressions, often due to unnoticed consumption of gluten in poorly labeled products. Conclusions: Digestive manifestations were the main presentation form for celiac disease among patients under 10 years of age. Atypical symptoms become relevant in patients older than 10 years. Antiendomysial and antitransglutaminase antibody measurement should be incorporated for routine screening and follow up of celiac disease in public hospitals. To improve food labeling about their gluten content is needed (Rev Med Chile 2008; 136: 296-303).

Tiempo de exposición al gluten y marcadores de riesgo de diabetes mellitus insulino dependiente en pacientes celíacos

158 celiac patients were classified as: G1, (n=30 patients)studied at the time of diagnosis; G2 (n=97 patients) exposed to gluten as a result of non compliancewith the gluten free diet and, G3 (n=31 patients) who had maintained a long term, strict gluten freediet. Isotype IgG anti-islet cell antibodies were detected by indirect immunofluorescence using mon-key pancreas; results were reported in Juvenile Diabetes Foundation (JDF) units.

Anticuerpos anti-transglutaminasa tisular: ¿una mejor prueba para detectar transgresiones menores de la dieta en pacientes celíacos?

Background: Endomysium antibodies (EMA) do not detect minor dietary transgressions in patients with celiac disease. Aim: To compare the sensitivity and specificity of tissue transglutaminase antibodies (tTGA) and endomysium antibodies (EMA) in biopsy proven celiac patients at the time of diagnosis and during gluten free diet (GFD). Patients and methods: One hundred fifty three subjects were studied: a) 30 healthy controls; b) 9 cases with cows milk allergy; c) 24 celiac patients at time of diagnosis; d) 25 celiac patients adhering to the GFD; e) 65 celiac patients with poor/no adhesion to GFD. EMA and tTGA IgA were measured by immunofluorescence and ELISA, respectively. Results: Sensitivity and specificity were 100% and 97.4% for tTGA, respectively. All patients with cows milk allergy were EMA (-) and 8 of 9 (88.9%) were tTGA (-). In celiac patients not adhering to the GFD, EMA and tTGA positivity were similar (80% and 81,5%, respectively); 95,4% of the subjects tested positive for at least one of them. All patients adhering to GFD were EMA (-) but tTGA were (+) in 28% of them. Conclusions: EMA and tTGA have similar sensitivity and specificity at the time of diagnosis of celiac disease. Positive tTGA in 28% of patients that adhered strictly to the GFD and whose EMA were negative suggest that tTGA may be helpful in detecting minor dietary transgressions and should be further evaluated (Rev Med Chile 2003; 131: 25-29)

Cryptosporidiosis: estudios en niños de comunidades de nivel socioeconómico bajo

Cryptosporidium was detected in 2 (1.5%) out of 132 children under 2 years with acute diarrhea; in 2 (3.2%) out of 63 patients under 2 years with persistent diarrhea; in 1 (3.9%) out of 26 malnourished patients younger than 2 years with an episode of acute diarrhea and in 7 (1.4%) out of 516 pediatric ambulatory patients who consulted for acute or chronic diarrhea or recurrent abdominal pain. The clinical histories of the 5 infants with cryptosporidiosis who belonged to the first 3 studies, are presented. All they had prolonged diarrhea (more than 15 days long), and one of them showed low IgG and IgA serum concentrations, but normal proportions of T lymphocyte populations.

Efecto de la estacionalidad sobre el estado nutricional de Hierro, Zinc y Cobre

Food consumption and therefore the nutritional status of micro- nutrients are influenced by various factors such as seasonality. This study aimed to determin...