Stephen Hardy

Fat and cholesterol in the diet of infants and young children: Implications for growth, development, and long-term health

Fat is necessary in the diets of infants and young children because of their extraordinary energy needs and limited dietary capacity. In addition, essential fatty acids provide the substrates for arachidonic acid, docosahexaenoic acid, and their metabolites. Deficiencies in the amounts of these long-chain fatty acids in the diet during infancy may affect the maturation of the central nervous system, including visual development and intelligence. Efforts to link the diet in infancy and early childhood to the development of chronic diseases in adulthood are hampered by a lack of supportive epidemiologic and clinical data. Serum cholesterol and lipid levels during childhood correlate only weakly with their levels at maturity. Studies in twins suggest that there is a large genetic component to serum lipid levels. Similarly, the correlation between obesity in early childhood and in adulthood is weak. Young children who receive fat-restricted diets in which fat accounts for 30% or less of their intake appear to grow normally but are more likely not to consume the recommended dietary allowances of many nutrients. Therefore fat should not be restricted in the diets of infants and young children. Restricting fat to approximately 30% of the calories consumed is reasonable after the age of 2 years, but the benefits of this recommendation remain to be proved.

Primary antral gastritis in young American children. Low prevalence of Helicobacter pylori infections.

AlthoughHelicobacter pylori (H. pylori) is considered by many to be the major cause of primary antral gastritis (PAG), several important questions concerning its pathogenetic role remain unanswered. The most basic unresolved issue relates to the low prevalence ofH. pylori in children in developed countries. IfH. pylori is the cause of PAG, the prevalence of PAG should also be low, but previous studies have not provided data on this issue. To answer this question, we prospectively studied 408 children who underwent esophagogastroduodenoscopy and biopsy from January 1, 1988, to December 31, 1990, for symptoms consistent with peptic disease or immunocompromise. Although the prevalence of PAG was similar (about 20%) in the four age groups of patients studied (<5, 5–9, 10–14, and 15–20 years), the prevalence ofH. pylori infections was significantly greater in the oldest age group (67%,P<0.0001). Only four of 39 children <10 years old with PAG had evidence ofH. pylori. H. pylori is an uncommon finding in our population of young American children with PAG, indicating that it does not play an important role in the pathogenesis of this disorder in this age group.

Eosinophilic Esophagitis in Children : A Pathologic or Clinicopathologic Diagnosis?

OBJECTIVE To determine the accuracy of histopathologic diagnosis in distinguishing eosinophilic esophagitis (EE) from gastroesophageal reflux disease (GERD) in children with upper aerodigestive symptoms. DESIGN Masked review of esophageal biopsy findings and comparison with each childs established clinical diagnosis. SETTING A tertiary care multidisciplinary aerodigestive center. PATIENTS Children were selected from a longitudinal database of all children referred for upper aerodigestive symptoms who underwent a comprehensive evaluation between September 1, 2004, and September 1, 2007. Three groups were recognized based on clinical presentation, initial histologic review, and therapeutic response: children with EE, GERD, or neither. INTERVENTION Review of esophageal biopsy findings by a pathologist masked to the childs clinical or previous pathologic diagnosis. MAIN OUTCOME MEASURE Masked histopathologic diagnosis of EE, GERD, or neither. RESULTS Medical records from 31 patients were reviewed (11 children with EE, 10 with GERD, and 10 with neither). Diagnostic concurrence between the masked pathologic diagnosis and the established clinicopathologic diagnosis was 64% in children with EE, 70% in children with GERD, and 100% in children with neither. The 4 cases of EE that did not concur were misclassified as GERD when esophageal specimens were evaluated by histopathologic means alone. A clinicopathologic schema for EE developed by gastroenterologists accurately identified 82% of children with EE. CONCLUSIONS The distinction between EE and GERD cannot be reliably made on histopathologic evidence alone in children with upper aerodigestive symptoms. Despite the recent gastroenterology consensus statement regarding the clinicopathologic diagnosis of EE, children with primary airway symptoms in whom EE is suspected represent a diagnostic dilemma.

Time-driven activity-based costing to estimate cost of care at multidisciplinary aerodigestive centers

Providing high‐value healthcare to patients is increasingly becoming an objective for providers including those at multidisciplinary aerodigestive centers. Measuring value has two components: 1) identify relevant health outcomes and 2) determine relevant treatment costs. Via their inherent structure, multidisciplinary care units consolidate care for complex patients. However, their potential impact on decreasing healthcare costs is less clear. The goal of this study was to estimate the potential cost savings of treating patients with laryngeal clefts at multidisciplinary aerodigestive centers.

A multidisciplinary interclerkship on hunger and malnutrition

No abstract available.

Nutrition in Children with Liver Disease: Evaluation and Management

The liver is the major organ for maintaining normal homeostasis of both macronutrients (proteins, carbohydrates, and fat including essential fatty acids) and micronutrients (vitamins and minerals). Therefore, children with significant liver disease, especially those with chronic cholestasis, cirrhosis, or end-stage liver disease, often demonstrate impaired nutrient metabolism as well as possible malabsorption or maldigestion of nutrients. Routine assessments of nutritional status, appropriate supplementations, and nutritional intervention or rehabilitation (if needed) are crucial in managing these children. The roles of various diets in children who suffer from end-stage liver disease and complications from hepatic dysfunction such as hepatic encephalopathy or ascites have been widely studied. During the past two decades, many children with chronic end-stage or life-threatening liver disease have undergone liver transplantation as a therapeutic option. Nutritional support also plays an essential role in managing these children both before and after the transplantation.