Myriam Van Winckel

Long-term follow-up of a cognitive behavioral treatment program for obese children

This study presents a 4.6-year follow-up of children treated for obesity. The primary goal of the treatment program was to prevent further weight gain. In setting this modest goal, we wanted to avoid the type of dietary restraint that has been linked to the development of eating disorders. A cognitive-behavior modification (CBM) program was designed to help the child change his or her lifestyle, to enhance self-regulation skills and specific problem-solving skills in different eating situations. Three active CBM treatment interventions were compared (group therapy, individual therapy, and summer camp) to an advice in one session. At pretest, the mean age was 11 years. Mean percentage overweight was 55%); all subjects were at least 20% overweight. Data from 109 children were available at the 4.6-year follow-up, representing 80.1% of the original sample. At follow-up, 72 subjects (71.6%) showed no further increase in percentage overweight. This does not mean that these obese youngsters had become thin. In this study 18% of the obese children were no longer obese and 29% of the subjects had become moderately obese. The obese youngsters showed a mean reduction of their overweight of -11%; the mean overweight was still 42%. Eating behavior was evaluated in a subgroup of the obese childrenand a stabilization of abnormal eating behavior was noted within the subscales of the Dutch Eating Behavior Questionnaire. Using the Eating Disorder Inventory, 5 adolescents (9%) had an at-risk score on the bulimia subscale. Taking into account the pessimistic prognosis for obese adults, the trends found here are more optimistic, at least for half of the obese children.

Inpatient treatment of obese children: a multicomponent programme without stringent calorie restriction.

This prospective clinical case-control study describes the effect of an inpatient multicomponent treatment programme for obese children and adolescents on their weight and psychological well being. We studied 38 patients and 38 controls on the waiting list, matched for age and gender, referred because of obesity, with a median age of 13 years (range 10–17 years) and a median adjusted body mass index (BMI) of 173% (range 130%–257%). The treatment consisted of a 10-month inpatient programme focussing on attaining a healthy lifestyle by increasing physical activity and offering a healthy diet within a cognitive-behavioural framework. At base line, at the end of the treatment, 6 months and 14 months after completion of the treatment, the adjusted BMI was calculated and psychological variables were measured with the Dutch Eating Behaviour Questionnaire, the Eating Disorder Inventory and the Self-Perception Profile for Children. All patients lost weight during treatment (median −48% of the adjusted BMI, range −4% to −102%), in contrast to the non-treated control subjects (median +6%, range −29% to +27%). The children treated developed a higher self-esteem and were more capable of coping with external eating stimuli. They did not develop anorexia nor bulimia nervosa. At the 6-months follow-up, a median increase in the adjusted BMI of +6% (range −19% to +37%) was found; with an additional increase of +4% (range −30% to +41%) at 14-months follow-up. Conclusion: a multicomponent long-term inpatient treatment programme is a valuable treatment option for obese children, with a lasting effect up to 14 months post-treatment. Nevertheless, more research is needed to characterise those children who regain weight after treatment and how this may be prevented.

An 8-year follow-up of treated obese children: Children’s, process and parental predictors of successful outcome

OBJECTIVE This study presents an 8-year outcome of overweight children who were treated in an outpatient program and aims to identify child and familial variables associated with long-term weight regulation. METHODS A total of 90 children participated with a mean age of 10.1 years +/- 2.6 at baseline and a mean adjusted BMI (actual BMI/50th percentile of BMI for age and gender x 100) of 153.1 +/- 20.7% at baseline participated in the 8-year follow-up (retrieval rate 71%; response rate 89%). Childrens and parental factors, administered at baseline and at follow-up were related to the success of the treatment. RESULTS The children obtained a mean reduction of 8% in adjusted BMI at the 8-year follow-up. A total of 59 children (66%) were successful in obtaining weight control (i.e. maintaining their original % adjusted BMI); 40% even decreased their adjusted BMI by 10% or more. Analyses revealed that the childs age, the degree of overweight at baseline and the childs global self-worth were positive predictors of long-term weight loss 8 years after treatment, whereas psychopathology in the mother was a negative predictor. The total explained variance was R(2) = 35%. DISCUSSION Treatment of childhood obesity by means of a multidisciplinary cognitive-behavioural program enables the majority of children to control their weight in the long term. In order to predict the success of the treatment, it is recommended to take into account the childs age, its degree of overweight, its global self-worth and the occurrence of maternal psychopathology.

Clinical practice: vegetarian infant and child nutrition

The aim of this review is to give insight on the benefits and risks of vegetarianism, with special emphasis on vegetarian child nutrition. This eating pattern excluding meat and fish is being adopted by a growing number of people. A vegetarian diet has been shown to be associated with lower mortality of ischaemic heart disease and lower prevalence of obesity. Growth in children on a vegetarian diet including dairy has been shown to be similar to omnivorous peers. Although vegetarianism in adolescents is associated with eating disorders, there is no proof of a causal relation, as the eating disorder generally precedes the exclusion of meat from the diet. A well-balanced lacto-ovo-vegetarian diet, including dairy products, can satisfy all nutritional needs of the growing child. In contrast, a vegan diet, excluding all animal food sources, has at least to be supplemented with vitamin B(12), with special attention to adequate intakes of calcium and zinc and energy-dense foods containing enough high-quality protein for young children. The more restricted the diet and the younger the child, the greater the risk for deficiencies.The aim of this review is to give insight on the benefits and risks of vegetarianism, with special emphasis on vegetarian child nutrition. This eating pattern excluding meat and fish is being adopted by a growing number of people. A vegetarian diet has been shown to be associated with lower mortality of ischaemic heart disease and lower prevalence of obesity. Growth in children on a vegetarian diet including dairy has been shown to be similar to omnivorous peers. Although vegetarianism in adolescents is associated with eating disorders, there is no proof of a causal relation, as the eating disorder generally precedes the exclusion of meat from the diet. A well-balanced lacto-ovo-vegetarian diet, including dairy products, can satisfy all nutritional needs of the growing child. In contrast, a vegan diet, excluding all animal food sources, has at least to be supplemented with vitamin B12, with special attention to adequate intakes of calcium and zinc and energy-dense foods containing enough high-quality protein for young children. The more restricted the diet and the younger the child, the greater the risk for deficiencies.

Helicobacter pylori Infection: Further Evidence for the Role of Feco‐Oral Transmission

Background:  Helicobacter pylori infection is recognized as a major cause of chronic digestive diseases with a major public health impact, yet the knowledge of transmission pathways is limited. We studied the transmission in employees taking care of institutionalized persons with mental disabilities with a documented high prevalence of H. pylori.

Helicobacter pylori infection: a global occupational risk for healthcare workers?

Abstract The occupational risks from Helicobacter pylori, a major cause of gastroduodenal diseases, were reviewed for selected groups of healthcare workers (HCWs). A literature search was performed using Medline/Pubmed, 1983 to June 2003. Additional manual searches were made using reference lists from the selected articles. Current knowledge implies various pathways of agent transmission, favoring person-to-person transmission. The risks are highest for gastroenterologists, some nurses, and employees caring for persons with mental disability. Results for other groups are conflicting.

A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients.

Study design:Systematic review.Objectives:To determine the different treatment modalities aimed at achieving fecal continence in spina bifida (SB) patients and their effectiveness.Setting:International literature.Method:Electronic databases were searched (‘Pubmed’, ‘Web of science’, ‘CINAHL’ and ‘Cochrane’) identifying studies published since the mid-eighties and screened for relevance according to the Centre for Reviews and Dissemination procedure guidelines. A total of 37 studies were selected for inclusion.Results:Studies on toilet sitting, biofeedback, anal plug, retrograde colon enemas (RCE) and antegrade colon enemas were found. Fecal continence was achieved in 67% of SB patients using conservative methods (n=509). In patients using RCE (n=190) an 80% continence rate was reached. Patients following surgical treatment (n=469) reached an 81% continence rate, however, 23% needed redo surgery because of complications. Better fecal continence was associated with an improved quality of life, which was negatively influenced by the amount of time spent on bowel management.Conclusion:Evidence favors an individually tailored stepwise approach with surgery as a final step in case of failure of conservative measures. Continued specialized support throughout life remains important to maintain continence. Cross-over and comparative trials are needed in order to optimize treatment.

A bio‐analytical hydrophilic interaction LC‐MS/MS method for the simultaneous quantification of omeprazole and lansoprazole in human plasma in support of a pharmacokinetic omeprazole study in children

A hydrophilic interaction LC method with MS/MS was developed and validated for the simultaneous quantification of omeprazole and lansoprazole in human plasma. Chromatographic separation was achieved on a Betasil silica column using a high organic mobile phase (eluent A: ACN/formic acid 997.5:2.5 v/v; eluent B: water/formic acid 997.5:2.5 v/v) and gradient elution. The mass spectrometer was operated in the Multiple Reaction Monitoring mode. Prior to chromatography, liquid-liquid extraction with ethyl acetate was used and the organic layer was diluted with ACN, allowing direct injection on column. The method showed acceptable linearity, high precision (RSD%<10.5%), accuracy (88.9-109.3%) and selectivity in the two concentration ranges studied: 1.5-100 and 5-2000 ng/mL. The LOQ was established at 1.5 and 5 ng/mL for the two concentration ranges. Lack of variability in matrix effects was demonstrated and mean extraction recovery for omeprazole and lansoprazole was determined in the low (56.3-67.7%) and high (45.3-44.3%) concentration range, respectively. Additionally, plasma samples were found to be stable after three freeze-thaw cycles and for at least 15 h after extraction. This assay was successfully applied to a pharmacokinetic omeprazole study in children with cerebral palsy and mental retardation.

Changes in prescription patterns of acid-suppressant medications by Belgian pediatricians: analysis of the national database, [1997-2009].

Objective: The aim of this study was to examine the trend in the prescribing of proton pump inhibitors (PPIs) and histamine 2-receptor antagonists (H2-RAs) for children in Belgium from 1997 to 2009 to encourage discussion regarding appropriate clinical use. Methods: Monthly claim–based data for PPIs and H2-RAs were obtained from the national health insurance database (Pharmanet 1997–2009). Results: The total monthly volume of all reimbursed antireflux medications, prescribed by Belgian pediatricians, increased 7-fold from 20,782 daily defined doses (DDDs) in January 1997 to 142,912 DDDs in June 2009. During this study period, reimbursed volume of H2-RAs increased from 2575 to 38,996 DDDs and of PPIs from 3472 to 103,926 DDDs per month. Conclusions: PPI use has increased substantially in children. Its use does not seem to be commensurate with the prevalence of gastroesophageal reflux disease in children. This study encourages clinical discussion regarding well-considered use of these drugs in children.

Intake and serum profile of fatty acids are weakly correlated with global dietary quality in European adolescents

OBJECTIVE The present study assessed whether compliance with the Food-Based Dietary Guidelines is related to habitual fatty acid (FA) intake and blood lipid parameters. METHODS Dietary information was collected by two non-consecutive 24-h recalls in 1804 European adolescents. Compliance with the Food-Based Dietary Guidelines was expressed by calculating the Diet Quality Index for Adolescents (DQI-A). Blood samples were collected in a randomly selected subset (n = 552). Relations between FA intake/serum concentrations and DQI-A were tested with multilevel regression analysis to correct for the study design (clustering within cities). Analyses were stratified for gender; age was entered as a covariate. RESULTS Better DQI-A scores were related to increased proportional intakes of energy from total fat, saturated FA, monounsaturated FA, and cholesterol (P < 0.001), whereas no significant association was observed with polyunsaturated FA intakes. In adolescents with higher compared with lower DQI-A scores, dairy products contributed more (21.0% versus 12.7%) and low-nutrient, energy-dense items contributed less (17.2% versus 26.3%) to the intake of total fat. A positive association was observed between the DQI-A scores and serum concentrations of eicosapentaenoic acid and docosahexaenoic acid (all P < 0.005). The latter, however, was significant only in girls. In boys, higher DQI-A scores were inversely associated with serum cholesterol concentrations (P < 0.05). CONCLUSION Although compliance with the Food-Based Dietary Guidelines was not always associated with a favorable FA intake pattern, a significant favorable association with some serum biomarkers was observed. This outcome underlines the importance of considering dietary habits instead of single-nutrient intakes.