Philip G. Kazlow

Celiac disease in normal-weight and overweight children: clinical features and growth outcomes following a gluten-free diet.

Objectives: There are few data on pediatric celiac disease in the United States. The aim of our study was to describe the presentation of celiac disease among children with a normal and an elevated body mass index (BMI) for age, and to study their BMI changes following a gluten-free diet (GFD). Patients and Methods: One hundred forty-two children (age 13 months–19 years) with biopsy-proven celiac disease, contained in a registry of patients studied at our center from 2000 to 2008, had follow-up growth data available. Patients’ height, weight, and BMI were converted to z scores for age and grouped by BMI as underweight, normal, and overweight. Compliance was confirmed using results of serological assays, and data of noncompliant patients were analyzed separately. Data were analyzed during the observation period and were expressed as change in height, weight, and BMI z score per month of dietary treatment. Results: Nearly 19% of patients had an elevated BMI at diagnosis (12.6% overweight, 6% obese) and 74.5% presented with a normal BMI. The mean duration of follow-up was 35.6 months. Seventy-five percent of patients with an elevated BMI at diagnosis decreased their BMI z scores significantly after adherence to a GFD, normalizing it in 44% of cases. Of patients with a normal BMI at diagnosis, weight z scores increased significantly after treatment, and 13% became overweight. Conclusions: Both normal weight and overweight frequently occur in North American children presenting with celiac disease. A GFD may have a beneficial effect upon the BMI of overweight and obese children with celiac disease.

Nutritional Support in Bloom's Syndrome: The Case for Aggressive Gastrostomy Tube Feeding. 609

Nutritional Support in Blooms Syndrome: The Case for Aggressive Gastrostomy Tube Feeding. 609

Inpatient Nutritional Screening: The Need for a Multi-disciplinary Team Approach. 475

Nutrition screening is an integral part of the evaluation of the pediatric patient. In many institutions, this screening is performed by dietitians who may not have specialized pediatric training. Two pilot surveys analyzed nutritional status using information available in charts at admission to Babies & Childrens Hospital. This evaluation was done for a period of one week on two separate occasions, 3 months apart. These patient charts were reviewed for height, weight age, diagnosis, and nutritional status. We subsequently undertook a 6-month Malnutrition Screening Program in which all patients admitted to our institution were screened and treated by a multi-disciplinary team comprised of nurses, nutritionists, and physicians. Nutritional status was based upon the Waterlow Classification.Table

ASYMPTOMATIC MALNUTRITION IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE. 707

Introduction: Malnutrition, growth failure, and nutrient deficiencies are contributing factors to morbidity in children with Inflammatory Bowel Disease (IBD). Methods: A prospective preliminary study was conducted that included 14 clinically asymptomatic IBD patients and a cohort of 14 healthy children of similar age serving as controls. A 3-day dietary history of each subject was analyzed for intake of various nutrients.Results: Analysis of the diet histories revealed that a disproportionately large number of IBD patients had suboptimal intake, i.e. below 66% of the recommended daily allowances (RDA), for vitamins A, D, E and calcium when compared to controls. We observed that: for vitamin A, 36% of IBD patients failed to reach 66% of the RDA compared to 9% of controls (p < 0.03); for vitamin E, 57% of IBD patients compared to 36% of controls (p < 0.22); for vitamin D, 79% of IBD patients compared to 64% of controls (p < 0.35); and for calcium, 43% of IBD patients compared to 18% of controls (p< 0.08). Speculation: These deficiencies may be the result of poor nutritional counselling or may be a consequence of self-administered, or physician prescribed, dietary intervention. A marked decrease in nutrient intake may have potentially serious long-term consequences as newly emerging data has shown the critical role played by dietary calcium and anti-oxidants in preventing osteoporosis, cardiovascular disease and cancer.Conclusion: This preliminary study reveals that IBD patients, even when seemingly well, tend to have low dietary intake of vitamins A, D, E and calcium. This study points to the need for regular counselling of IBD patients and careful monitoring of their diets even when these patients appear clinically well.