Absorption In Children Research Articles

Utilization of Kombucha Tea to Improve Children's Health and Reduce Stunting Rates in Patempuran Village, Jember Regency

In order to overcome the problem of stunting in children, a team of Jember University lecturers collaborated with the Patempuran Village community and posyandu cadres to carry out community service activities. The main focus of this activity is the mass use and dissemination of Kombucha Tea, chosen because of its important nutritional content and potential to improve intestinal health and nutrient absorption in children. This activity includes outreach to increase understanding of the benefits of Kombucha Tea, training for posyandu cadres and village mothers on how to produce Kombucha Tea, as well as the distribution process to families with children under five. Apart from that, counseling regarding healthy eating patterns and the importance of nutrition was also provided in this activity. The impact evaluation was carried out after the activity was carried out to measure the extent to which Kombucha Tea made a positive contribution in reducing stunting rates in Patempuran Village. Close collaboration between the lecturer team, the community and the local government forms a sustainable community service model, which is expected to have a positive impact in improving the welfare of children in Patempuran Village.

Haem iron versus ferrous iron salts to treat iron deficiency anaemia in Gambian children: protocol for randomised controlled trial {1}

BackgroundThe World Health Organization recommends universal iron supplementation for children aged 6–23 months in countries where anaemia is seen in over 40% of the population. Conventional ferrous salts have low efficacy due to low oral absorption in children with inflammation. Haem iron is more bioavailable, and its absorption may not be decreased by inflammation. This study aims to compare daily supplementation with haem iron versus ferrous sulphate on haemoglobin concentration and serum ferritin concentration after 12 weeks of supplementation.MethodsThis will be a two-arm, randomised controlled trial. Gambian children aged 6–12 months with anaemia will be recruited within a predefined geographical area and recruited by trained field workers. Eligible participants will be individually randomised using a 1:1 ratio within permuted blocks to daily supplementation for 12 weeks with either 10.0 mg of elemental iron as haem or ferrous sulphate. Safety outcomes such as diarrhoea and infection-related adverse events will be assessed daily by the clinical team (see Bah et al. Additional file 4_Adverse event eCRF). Linear regression will be used to analyse continuous outcomes, with log transformation to normalise residuals as needed. Binary outcomes will be analysed by binomial regression or logistic regression, Primary analysis will be by modified intention-to-treat (i.e., those randomised and who ingested at least one supplement dose of iron), with multiple imputations to replace missing data. Effect estimates will be adjusted for baseline covariates (C-reactive protein, alpha-1-acid glycoprotein, haemoglobin, ferritin, soluble transferrin receptor).DiscussionThis study will determine if therapeutic supplementation with haem iron is more efficacious than with conventional ferrous sulphate in enhancing haemoglobin and ferritin concentrations in anaemic children aged 6–12 months.Trial registrationPan African Clinical Trial Registry PACTR202210523178727

Storytelling Training in Forming of Child Character at Cambridge Binjai Kindergarten

This storytelling training is based on concern and awareness of the importance of character education in children. Through storytelling, it is hoped that it will be able to shape the character of children for the sake of creating a generation that has strong character to manage and advance the country in the future. Telling stories can be a way of communicating to children. In general, children prefer educational models that are interactive. The partner in this service is the Principal of Cambridge Binjai Kindergarten. The participants, namely Cambridge Binjai Kindergarten students, participated in this training with joy. After this training the students can retell the stories they heard or watched. The results of this training are that it has 1) trained kindergarten children's absorption or comprehension power, 2) trained children's thinking power, 3) trained kindergarten children's concentration power, 4) Developed children's imagination, 5) Created joyful situations and developed an atmosphere of intimate relationships according to the stage of its development, 6) Helping children's language development in communicating effectively and efficiently so that the conversation process becomes communicative. At the end of this activity it is also hoped that a story-telling community will be formed with the name “House of Stories” which is managed by the teachers of the Cambridge Binjai Kindergarten. This group was made a pioneer in the movement to cultivate storytelling to educate the character of children at Cambridge Binjai Kindergarten in particular and children in Binjai in general.

How macronutrients and pancreatic enzyme supplements dose variability affect fat, protein and starch absorption in children with cystic fibrosis.

low evidence on the dose of enzymatic supplements used in pancreatic enzyme replacement therapy (PERT) is available. assessing if fat, protein and starch absorption could be related to the dose of the enzymatic supplement, the intra-patient variability in the dose and macronutrient intake. Four-day food records and 3-day faecal samples were prospectively collected in 69 children with cystic fibrosis. Pearson correlations between enzyme dose and macronutrient absorption, and beta regression models were applied to explain the results. the supply of protease units per protein intake (PU/g protein) in relation to lipase units per fat intake (LU/g fat) was low and the intra-patient variability in the dose of enzymes was ±1331 LU/g fat. Fat and starch absorption was >90% while for protein it was 81.5%. The coefficient of fat absorption was associated with an interaction between the dose of LU/g fat and its variability among different days. Lipid and protein intake were also determinants of the coefficient of fat absorption. the dose of PERT should be re-adjusted to the amount of dietary fat of every meal (constant LU/g fat) to minimize variability and increase fat absorption. Also, the supply of protease should be increased to prevent from protein malabsorption.

Essential Fatty Acid Deficiency Associates with Growth Faltering and Environmental Enteric Dysfunction in Children.

Environmental enteric dysfunction (EED) is characterized by intestinal inflammation, malabsorption and growth-faltering in children with heightened exposure to gut pathogens. The aim of this study was to characterize serum non-esterified fatty acids (NEFA), in association with childhood undernutrition and EED, as potential biomarkers to predict growth outcomes. The study comprised a cohort of undernourished rural Pakistani infants (n = 365) and age-matched controls followed prospectively up to 24 months of age. Serum NEFA were quantified at ages 3-6 and 9 months and correlated with growth outcomes, serum bile acids and EED histopathological biomarkers. Serum NEFA correlated with linear growth-faltering and systemic and gut biomarkers of EED. Undernourished children exhibited essential fatty acid deficiency (EFAD), with low levels of linoleic acid and total n-6 polyunsaturated fatty acids, compensated by increased levels of oleic acid and increased elongase and desaturase activities. EFAD correlated with reduced anthropometric Z scores at 3-6 and 9 months of age. Serum NEFA also correlated with elevated BA and liver dysfunction. Essential fatty acid depletion and altered NEFA metabolism were highly prevalent and associated with acute and chronic growth-faltering in EED. The finding suggests that targeting early interventions to correct EFAD and promote FA absorption in children with EED may facilitate childhood growth in high-risk settings.

Potential Health Risks of Lead Exposure from Early Life through Later Life: Implications for Public Health Education

Lead (Pb) exposure has been a serious environmental and public health problem throughout the world over the years. The major sources of lead in the past were paint and gasoline before they were phased out due to its toxicity. Meanwhile, people continue to be exposed to lead from time to time through many other sources such as water, food, soil and air. Lead exposure from these sources could have detrimental effects on human health, especially in children. UNICEF reported that approximately 800 million children have blood lead levels (BLLs) at or above 5 micrograms per deciliter (µg/dL) globally. This paper reports on the potential risks of lead exposure from early life through later life. The articles used in this study were searched from databases such as Springer, Science Direct, Hindawi, MDPI, Google Scholar, PubMed and other academic databases. The levels of lead exposure in low income and middle-income countries (LMICs) and high-income countries (HICs) were reported, with the former being more affected. The intake of certain nutrients could play an essential role in reducing (e.g., calcium and iron) or increasing (e.g., high fat foods) lead absorption in children. Elevated blood lead levels may disturb the cells' biological metabolism by replacing beneficial ions in the body such as calcium, magnesium, iron and sodium. Once these ions are replaced by lead, they can lead to brain disorders, resulting in reduced IQ, learning difficulties, reduced attention span and some behavioral problems. Exposure to lead at an early age may lead to the development of more critical problems later in life. This is because exposure to this metal can be harmful even at low exposure levels and may have a lasting and irreversible effect on humans. Precautionary measures should be put in place to prevent future exposure. These will go a long way in safeguarding the health of everyone, most especially the young ones.

Serious Condylar Head Absorption in Children With Intracapsular Condylar Fractures Treated Operatively With Long Screws.

This study was performed to explore bone remodelling in children with intracapsular condylar fractures after the condylar fracture fragments were fixed using long screws and to offer possible explanations about the underlying mechanism. Records of children (less than 12y old) who sustained intracapsular condylar fractures and fixed with long screws from May 2012 to January 2015 were retrieved. Age, gender, dates of injury, admission, and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fractures, treatment methods, and time of review were recorded and analyzed. Image dates of pretreatments and posttreatments, including the date of review, were also recorded. A total of 8 patients completed their follow-up, and all patients (n=5) who were followed up after more than 3 months showed serious resorption of the condylar head. The condylar head resorbed until the height (or articular surface) dropped and aligned with the surface of the screw. The shortest time of absorption, as shown by the computed tomography scan was 106 days, and the longest time was 171 days (average time of 141.8d). Intracapsular condyle fractures in children should be managed conservatively as much as possible. However, if the height of the fracture fragments drops remarkably, open reduction and rigid internal fixation become possible choices.

Blood Manganese Modifies the Relationship Between Iron Status and Blood Lead in Ugandan Children

ObjectivesNinety-seven % of children living in the Katanga area of Kampala, Uganda, have elevated blood lead (Pb), and 30% have elevated manganese (Mn). Children with iron deficiency (ID) may have higher blood concentrations of both metals as each share the same intestinal transported as iron (DMT1). We characterized the iron status of children living in Katanga and determined whether children with poorer iron status had elevated blood Pb and Mn. We hypothesized that higher concentrations of Pb and Mn will be associated with iron deficiency. MethodsWe measured plasma concentrations of iron biomarkers [hemoglobin (Hb), ferritin, soluble transferrin receptor (sTfR), hepcidin] in 100 children 6–59 months living in the Katanga urban settlement who had participated in a survey environmental metals exposure. We compared whole blood concentrations of Pb and Mn by different definitions of ID and by median hepcidin (Hb < 11.0 g/dL; sTfR > 8.3 mg/L; ferritin < 12.0 μg/L; hepcidin < 14.9 ng/mL) using t-test (Pb) and Wilcoxon rank-sum test (Mn). We examined the association of each iron marker with Pb and Mn while accounting for child age using multiple linear regression. ResultsMore than one-third of children had Hb < 11.0 g/dL [n (%): 36 (36.7)], and one in five were ID by either ferritin [20 (20.4)] or sTfR [23 (23.5)]. Median Mn was higher in children with ID defined by either sTfR or ferritin [(ID, not ID): sTfR (21.8 mg/L, 11.2 mg/L); ferritin (19.7 μg/L, 12.0 μg/L), p < 0.001 for both] and in children with low hepcidin [(low, high): (16.59 ng/mL, 10.6 ng/mL), p < 0.01]. In contrast, mean Pb level was lower in children with vs. without ID defined by sTfR [(5.0 mg/L, 6.5 mg/L), p = 0.01]. Having high Mn (>18.3 μg/L) modified the association between blood lead and ID: high Mn was associated with ID and lower Pb; low Mn was associated with no ID and higher Pb. ConclusionsID was prevalent in the Katanga area. Children with ID had higher Mn and lower Pb, suggesting preferential absorption of Mn over Pb in children with ID. Mn may inhibit Pb absorption in children with ID, but because both Mn and Pb are neurotoxic, immediate environmental remedies such as the use of low-Mn cement must be implemented. Funding SourcesThis research is supported by University of Minnesota School of Medicine Innovation Award (Dr. Sarah Cusick).

Kesulitan Guru Mengembangkan Kecerdasan Kognitif Anak Usia Dini dalam Pembelajaran Online Selama Pandemic Covid-19

Unpreparedness in accepting the transformation of offline education into online is a major factor in the difficulty of accepting online learning. This causes children's acceptance of low learning concepts that cannot be separated from the role of the teacher. This paper aims to find and analyze the weak skills of teachers in managing online early childhood learning during the covid 19 pandemic at PAUD Anggrek Indah Galala 2. The research method used in this study was descriptive qualitative research. The findings indicate that the low cognitive intelligence of early childhood is caused by the lack of PAUD teachers' skills in managing and implementing online learning. Of the 2 teachers who teach, there is 1 teacher who can use and carry out online learning, and even then it is only limited to conveying learning by explaining, without presenting it in pictures on ppt. this creates boredom in the child, which ultimately has an impact on the child's lack of concentration to follow the teaching and learning process. As a result, children are less enthusiastic in participating in online learning. This has an impact on the lack of children's absorption of the material being taught. Of the 11 children, the average cognitive level achieved was at the level of starting to develop (MB) and already developing (SB) and some of them were not yet developed (BB). This data shows that the cognitive intelligence achieved by children has not reached the target of Developing according to Expectations (BSH). Research contributes to providing education for education actors who support the online learning process and other stakeholders in early childhood education in PAUD. Keywords: Cognitive intelligence, online learning

Association between faecal pH and fat absorption in children with cystic fibrosis on a controlled diet and enzyme supplements dose.

Despite treatment with pancreatic enzyme replacement therapy (PERT), patients with cystic fibrosis (CF) can still suffer from fat malabsorption. A cause could be low intestinal pH disabling PERT. The aim of this study was to assess the association between faecal pH (as intestinal pH surrogate) and coefficient of fat absorption (CFA). Additionally, faecal free fatty acids (FFAs) were quantified to determine the amount of digested, but unabsorbed fat. In a 24-h pilot study, CF patients followed a standardised diet with fixed PERT doses, corresponding to theoretical optimal doses determined by an in vitro digestion model. Study variables were faecal pH, fat and FFA excretion, CFA and transit time. Linear mixed regression models were applied to explore associations. In 43 patients, median (1st, 3rd quartile) faecal pH and CFA were 6.1% (5.8, 6.4) and 90% (84, 94), and they were positively associated (p < 0.001). An inverse relationship was found between faecal pH and total fat excretion (p < 0.01), as well as total FFA (p = 0.048). Higher faecal pH was associated with longer intestinal transit time (p = 0.049) and the use of proton pump inhibitors (p = 0.009). Although the clinical significance of faecal pH is not fully defined, its usefulness as a surrogate biomarker for intestinal pH should be further explored. Faecal pH is a physiological parameter that may be related to intestinal pH and may provide important physiopathological information on CF-related pancreatic insufficiency. Faecal pH is correlated with fat absorption, and this may explain why pancreatic enzyme replacement therapy is not effective in all patients with malabsorption related to CF. Use of proton pump inhibitors is associated to higher values of faecal pH. Faecal pH could be used as a surrogate biomarker to routinely monitor the efficacy of pancreatic enzyme replacement therapy in clinical practice. Strategies to increase intestinal pH in children with cystic fibrosis should be targeted.

Changes in nutrient absorption in children and adolescents caused by fructans, especially fructooligosaccharides and inulin

IntroductionFructans, such as inulin and fructooligosaccharides (FOS), have several effects on human health owing to their prebiotic character, including anti-microbial and anti-cancer effects, and to their influence on the absorption of minerals, which is very important in childhood and adolescence. ObjectiveOur aim was to review the role of some fructans in the absorption of vitamins and minerals in children and adolescents. MethodsWe conducted a narrative review of the absorption of nutrients with fructans. We collected quantitative data for our thematic analysis, which was performed using the electronic databases Medline, Lilacs, Web of Science, and Scopus from January 2000 and January 2019. This review comprises a total of 10 articles. ResultsFew studies were found regarding the use of prebiotics and nutrient absorption in children. Studies on calcium, iron, magnesium, and vitamin D were the most prevalent. Some studies reported that FOS appears to increase calcium uptake in the gut and stimulates the growth of bifidobacterium in the colon, reducing iron intake by enteric pathogens, and increasing the absorption of these minerals. Others reported an improvement in the absorption of vitamin D and E with inulin. ConclusionConsumption of fructans improves the health of the microbiota, altering the absorption of some nutrients.

The pre- and post-authorisation data published by the European medicines agency on the use of biologics during pregnancy and lactation.

AimsThe effects of biologics on reproduction/lactation are mostly unknown although many patients that receive biologics are women of reproductive age. The first objective of this study was to investigate the publicly available data on pregnancy/lactation before and after marketing authorization in Europe of biologics for the indications of rheumatologic inflammatory autoimmune diseases and inflammatory bowel disease. Secondary objectives included the assessment of the clinical relevance of the provided data and comparison of initial and post‐authorization data.MethodsInitial and post‐authorization data were extracted from the European Public Assessment Reports and the latest versions of Summary of Product Characteristics using publicly available documents on the European Medicines Agency's website. Four sections were categorized regarding pregnancy outcomes: pre‐clinical/animal studies, human female fertility, pregnancy‐related outcomes and congenital malformations in the human fetus. Three sections were categorized regarding lactation outcomes: pre‐clinical/animal studies, excretion in human breast milk and absorption in children through breastfeeding. The clinical applicability of each category was scored by specified criteria, based on scientific literature, and further as defined by the authors.ResultsFor the 16 included biologics, post‐authorization data were delivered only for adalimumab, certolizumab pegol, etanercept and infliximab. For the 12 remaining biologics limited data on pregnancy and lactation during the post‐marketing period of 2–21 years were available.ConclusionsIn this article several suggestions are provided for improving a multidisciplinary approach to these issues. The initiation of suitable registries by marketing authorization holders and data transparency for clinicians and academics are highly endorsed.

Role of Lactulose Rhamnose Permeability Test in Assessing Small Bowel Mucosal Damage in Children with Celiac Disease.

Increased gut permeability has been suggested in patients with celiac disease (CD). We aimed to compare gut permeability in children using the lactulose/rhamnose permeability test. We prospectively recruited 55 children into 3 groups; 27 in group 1 (children with newly diagnosed celiac disease, 12 in group 2 (siblings of children with celiac disease) and 16 in group 3 (control group). The median age of participants was 11 years 2 months in group 1, 9 years 5 months in group 2 and 10 years 3 months in group 3. Standardized median delta rhamnose was lower in CD group as compared to control group (147.5 vs 3153.1, P = 0.040). The low median rhamnose absorption in children with celiac disease as compared to other groups suggests that this test can differentiate between damaged and healthy mucosa, hence can it potentially can be used as a noninvasive test of mucosal healing in children with celiac disease.

Magnetic Resonance Imaging Quantification of Gastrointestinal Liquid Volumes and Distribution in the Gastrointestinal Tract of Children.

The volume and localization of fluid in the paediatric gastrointestinal tract is crucial to the design of in vitro and in silico models that predict the absorption of oral drugs administered to children. Previous studies have used magnetic resonance imaging (MRI) to quantify fluid volumes and localization in the intestines of adults; this study is the first to undertake similar analysis of pediatric participants. This study quantified the amount and distribution of fluid in fasted and fluid-fed children using MRI data captured during the routine clinical assessment. Data from 32 fasted children (aged 0-16 years) and 23 fluid-fed children (aged 8-16 years) were evaluated. The gastric volume ranged from 0 to 9 mL in the fasted and 19-423 mL in the fluid-fed state. The small intestinal volume was recorded to be 0-51 mL in the fasted and 6-91 mL in the fluid-fed state with an average number of 7.7 and 22.4 fluid pockets, respectively. The data showed significant differences in gastric volumes and the number of fluid pockets in the small intestine for age-matched fasted and fluid-fed children (p < 0.05). Both the number and the volume of pockets reported in children are much lower than those previously reported in adults. This study is the first to report intestinal volumes and localization in children and provides new information to achieve the design of biorelevant in vitro models and real values to update in silico models. The data available from both fluid-fed and fasted children show the extremes of fluid volumes that are present in the gastro-intestinal tract which is useful to understand the variability associated with drug absorption in children.

Modifying Serum Plant Sterol Concentrations: Effects on Markers for Whole Body Cholesterol Metabolism in Children Receiving Parenteral Nutrition and Intravenous Lipids.

Background: Non-cholesterol sterols are validated markers for fractional intestinal cholesterol absorption (cholestanol) and endogenous cholesterol synthesis (lathosterol). This study’s objective was to evaluate markers for cholesterol synthesis and absorption in children exposed to two different intravenous lipid emulsions that rapidly change serum plant sterol concentrations as part of their parenteral nutrition (PN). Methods: Serum samples from two different studies were used: (1) nine PN-dependent children with intestinal failure associated liver disease (IFALD) whose soy-based, plant sterol-rich lipid (SO) was replaced with a fish-based, plant sterol-poor (FO) lipid; and (2) five neonates prescribed SO after birth. In the first study, samples were collected at baseline (prior to FO initiation) and after 3 and 6 months of FO. In study 2, samples were collected at 1 and 3 weeks of age. Results: In study 1, a 7-fold reduction in campesterol, a 12-fold reduction in sitosterol, and a 15-fold reduction in stigmasterol was observed 6 months after switching to FO. Serum cholesterol concentrations did not change, but cholesterol-standardized lathosterol increased (3-fold) and cholesterol-standardized cholestanol decreased (2-fold). In study 2, after 3 weeks of SO, sitosterol and campesterol concentrations increased 4-5 fold. At the same time, cholesterol-standardized lathosterol increased 69% and cholesterol-standardized cholestanol decreased by 29%. Conclusion: Based on these finding we conclude that changes in serum plant sterol concentrations might have direct effects on endogenous cholesterol synthesis, although this needs to be confirmed in future studies. Moreover, we speculate that this changed synthesis subsequently affects intestinal cholesterol absorption.

Prebiotic Short‐Chain Fructooligosaccharides (scFOS) Increases Abundance of the Butyrate Producing Microbial Community Differentially When Administered With or Without Probiotic Lactobacillus rhamnosus GG (LGG) in Piglets With Short‐Bowel Syndrome (SBS)

Intraluminal butyrate production may enhance absorption in children with SBS. The objective of this study was to define changes in the intestinal microbial community associated with butyrate and lactate production.We hypothesized that scFOS would increase butyrate producing bacterial abundance, LGG would increase total Lactobacillus abundance, and synbiotic combination of the two would result in both changes.Neonatal piglets (48 hours old, n=87) underwent 80% jejunoileal resection and jugular catheter placement. Piglets received 80% parenteral and 20% enteral nutrition (EN) for 1, 3, and 7 days (d) and received 1 of 4 treatments: (1) control (CON), unsupplemented EN; (2) prebiotic (PRE), 10g scFOS/L EN; (3) probiotic (PRO), 1×109 CFU LGG/L EN, and, (4) synbiotic (SYN), scFOS + LGG. Bacterial 16s rRNA genes (V3‐V5) were PCR amplified from mucosa (MUC) and digesta (DIG) of the distal ileum (ILE) and proximal colon (COL). DNA Sequencing was performed on Illumina MiSeq. Taxonomy assignment and quality control were determined with Silva 123 and IM‐Tornado. Statistical analysis, OTU abundance correlations, and network analysis were performed with QIIME1.9.1, SparCC, and Cytoscape 3.2.1 respectively.The probiotic, L. rhamnosus, was present in samples assessed from PRO and SYN, but absent in those from CON and PRE. Orthogonal contrast for scFOS supplementation increased Chao1 alpha diversity in ILEDIG 7d (p = 0.029). 17 known butyrate producing species and 17 Lactobacillus species were identified for species level analysis. SYN increased Faecalibacterium prasnitzii (p = 0.006) and Anaerotruncuz colihominis (p = 0.02) abundance in ILEDIG 7d vs CON. scFOS tended to increase total butyrate species abundance in ILEDIG (p = 0.09), regardless of time. LGG tended to reduce total butyrate producing species in COLDIG 7d (p = 0.09). PRO, SYN increased Lactobacillus reuteri abundance in ILEMUC 7d vs CON, PRE (all p &gt; 0.05). Othogonal contrast for LGG increased total Lactobacillus species abundance in ILEDIG (p = 0.03). Correlation network analysis of ILEDIG 7d revealed that OTUs related to F. prasnitzii, A. colihominis, and L. rhamnosus were completely discrete between treatments. F. prasnitzii was positively correlated to a potential butyrate producing OTU from the Butyricimonas genus (r = 0.47) in SYN, but negatively correlated to a potential butyrate producing OTU from the Coprococcus genus (r = −0.38) in PRE. A. colihominis was positively correlated to one potential butyrate producing OTU from the Butyricimonas genus (r = 0.39) in SYN, but two potential butyrate producing OTUs from the Pseudobutyrivibrio genus (r = 0.60) and Anaerotruncus genus (r = 0.51) in PRE. L. rhamnosus was positively correlated to L. johnsonii (r = 0.77) and L. mucosae (r = 0.54) in PRO, but negatively correlated to Tetragenococcus halophilus (r = −0.51) in SYN.scFOS increases butyrate producing species in ILEDIG, but when combined with LGG F. prasnitzii and A. colihominis dominate. Therefore, it is important to evaluate combination therapies aimed at modulating microbiota to deliver intraluminal butyrate, bearing in mind changes to pH and cross feeding structures that may ultimately lead to less production of the health promoting metabolite.Support or Funding InformationThis work was partially funded by USDA Hatch Project #ILLU‐971‐367

Pancreatic Enzyme Replacement Therapy and Coefficient of Fat Absorption in Children and Adolescents With Cystic Fibrosis.

Pancreatic enzyme replacement therapy (PERT) is the proven therapy to substantially reduce fat malabsorption in patients with cystic fibrosis (CF). Few details of the daily practice regarding PERT and the resulting coefficient of fat absorption (CFA) are known. We therefore recorded the PERT and CFA in a large cohort of pancreatic insufficient pediatric patients with CF. We retrospectively studied 1719 completed 3-day dietary food records, including the pancreatic enzyme intake registrations, and 1373 CFA assessments of 224 patients with CF, ages 0-17 years. The clinical characteristics, PERT, expressed as an intake of lipase unit (LU) per gram of fat per day and LU per kilogram per day, and the CFA were described for the group as a whole and separately for those on enteral tube feeding. Cross-sectional relationship between the CFA and the LU per gram of fat per day and LU per kilogram per day were determined for each year of age. We also addressed the effect of the interventions done in patients with CFA outcomes <85%. The LU per gram of fat per day was relatively stable throughout the age groups, whereas the LU per kilogram per day fell markedly with age. The median CFA in the age group 17 varied between 86% and 91%, however, with a CFA below 85% in 325 of 1373 (24%) of the measurements. No relationship was found between PERT and CFA. The patients with persistent CFA less than 85% had significant lower z scores weight for age and weight for height (P = 0.01) than those with CFA at least 85%. In this study population, no correlation between an enzyme dosage and the degree of fat malabsorption was found; however, a CFA below 85% was found in 24% of the measurements.

Outcome of a public consultation on the Draft Scientific Opinion of the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) on Dietary Reference Values for vitamin A

Outcome of a public consultation on the Draft Scientific Opinion of the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) on Dietary Reference Values for vitamin A

Treatment of bile acid amidation defects with glycocholic acid.

Bile acid amidation defects were predicted to present with fat/fat soluble vitamin malabsorption with minimal cholestasis. We identified and treated five patients (one male, four females) from four families with defective bile acid amidation due to a genetically confirmed deficiency in bile acid CoA:amino acid N-acyl transferase (BAAT) with the conjugated bile acid, glycocholic acid (GCA). Fast atom bombardment-mass spectrometry analysis of urine and bile at baseline revealed predominantly unconjugated cholic acid and absence of the usual glycine and taurine conjugated primary bile acids. Treatment with 15 mg/kg GCA resulted in total duodenal bile acid concentrations of 23.3 ± 19.1 mmol/L (mean ± SD) and 63.5 ± 4.0% of the bile acids were secreted in bile in the conjugated form, of which GCA represented 59.6 ± 9.3% of the total biliary bile acids. Unconjugated cholic acid continued to be present in high concentrations in bile because of partial intestinal deconjugation of orally administered GCA. Serum total bile acid concentrations did not significantly differ between pretreatment and posttreatment samples and serum contained predominantly unconjugated cholic acid. These findings confirmed efficient intestinal absorption, hepatic extraction, and biliary secretion of the administered GCA. Oral tolerance tests for vitamin D2 (1,000 IU vitamin D2/kg) and tocopherol (100 IU/kg tocopherol acetate) demonstrated improvement in fat-soluble vitamin absorption after GCA treatment. Growth improved in 3/3 growth-delayed prepubertal patients. Oral glycocholic acid therapy is safe and effective in improving growth and fat-soluble vitamin absorption in children and adolescents with inborn errors of bile acid metabolism due to amidation defects.

Comparative study of fungal strains for thermostable inulinase production

Fructose and fructo-oligosaccharides (FOS) are important ingredients in the food industry. Fructose is considered an alternative sweetener to sucrose because it has higher sweetening capacity and increases iron absorption in children, and FOS's are a source of dietary fiber with a bifidogenic effect. Both compounds can be obtained by enzymatic hydrolysis of inulin. However, inulin presents limited solubility at room temperature, thus, fructose and FOS production is carried out at 60°C. Therefore, there is a growing interest to isolate and characterize thermostable inulinases. The aim of this work was to evaluate the capacity of different fungal strains to produce potential thermostable inulinases. A total of 27 fungal strains belonging to the genera Aspergillus, Penicillium, Rhizopus, Rhizomucor and Thermomyces were evaluated for production of inulinase under submerged culture using Czapek Dox medium with inulin as a sole carbon source. Strains were incubated at 37°C and 200 rpm for 96 h. Crude enzyme extract was obtained to evaluate inulinase and invertase activity. In order to select the fungal strain with the highest thermostable inulinase production, a selection criterion was established. It was possible to determine the highest inulinase activity for Rhizopus microsporus 13aIV (10.71 U/mL) at 36 h with an optimum temperature of inulinase of 70°C. After 6 h at 60°C, the enzyme did not show any significant loss of activity and retained about 87% activity, while it only retains 57% activity at 70°C. According to hydrolysis products, R. microsporus produced endo and exo-inulinase.