Prevalence of markers of celiac disease in Colombian children with diabetes mellitus type 1 / Prevalencia de marcadores de enfermedad celíaca en niños Colombianos con diabetes mellitus tipo 1

Abstract Introduction: Although the association between diabetes mellitus type 1 (T1DM) and celiac disease (CD) is well established; there are only a few studies that focus on South American children, haplotypes and their possible associations. Objective: To determine the prevalence of CD markers in a group of children with T1DM and to analyze the associated clinical, immunological and genetic manifestations. Methods: A prevalence study focusing on children with T1DM who were assessed based on variables including sociodemographics, anthropometric information, disease characteristics, laboratory results and family medical history. In partitipants a positive tTG2 (Ig A anti-transglutaminase), a duodenal biopsy and genotype were performed. The proportion of children with T1DM and CD was estimated (CI 95%). Determinations of central tendency, univariate and bivariate analysis, were also performed; p <0.05 was considered significant. Results: Thirteen (8.4%) of the 155 children (53.6% girls, 11.0 ±3.6 years, 2-18 years) with T1DM were tTG2 positive, four had CD (2.6%), seven had potential CD (4.5%) and nine were HLA DQ2/DQ8 positive (5.8%). Children with T1DM and CD had their last ketoacidotic episode (21.5 ±30.4 months versus 69.5 ±38.8 months, p= 0.0260) earlier than children with T1DM and potential CD. There were no differences with anthropometry or with the laboratory results regarding glycemic control. Conclusions: The prevalence of CD in these children with T1DM is higher than that reported in other South American countries. The prevalence of CD was found to be associated with the time of presentation of T1DM and its main allele, the DQ2/DQ8. These findings are different from what has been described in other places around the world.

Resumen Introducción: A pesar que la asociación entre diabetes mellitus tipo 1 (DMT1) y enfermedad celíaca (EC) está bien establecida; hay pocos estudios en niños suramericanos sobre haplotipos y sus posibles asociaciones. Objetivo: Determinar la prevalencia de marcadores de EC en un grupo de niños con DMT1, analizando las manifestaciones clínicas, inmunológicas y genéticas. Métodos: Estudio de prevalencia en niños con DMT1 a quienes se les tomaron variables sociodemográficas, antropométricas, de la enfermedad, paraclínicas y familiares metabólicas. A los niños con IgA anti-transglutaminasa (tTG2) positivos, se les realizó biopsia duodenal y genotipo. Se estimó la proporción de niños con DMT1 y EC y su IC 95%; medidas de tendencia central, análisis univariado y bivariado, siendo significativa una p <0.05. Resultados: Trece (8.4%) de los 155 niños (53.6% niñas, de 11.0 ±3.6 años, 2-18 años) con DMT1 fueron tTG2 positivos, cuatro presentaron EC (2.6%), siete EC potencial (4.5%) y nueve HLA DQ2/DQ8 (5.8%). Los niños con DMT1 y EC presentaron más pronto su último episodio cetoacidótico (21.5 ±30.4 meses versus 69.5 ±38.8 meses, p= 0.0260) que los niños con DMT1 y EC potencial. No hubo diferencias con la antropometría ni con los paraclínicos del control glicémico. Conclusiones: La prevalencia de EC en estos niños con DMT1 es superior a la de otros países suramericanos; estando asociada al tiempo de presentación de la DMT1 y su principal alelo el DQ2/DQ8, hallazgos diferentes a lo descrito a nivel mundial.

Consumo de fibra dietética en lactantes menores de 2 años y estreñimiento funcional / Dietary fibre consumption by infants under 2 years old and functional constipation

Antecedentes. La inclusión de la fibra dietética (FD), tiene múltiples beneficios sobre la salud del ser humano; sin embargo, en pediatría, existen grandes brechas concernientes a la relación de fibra y estreñimiento. Objetivo. Describir el hábito intestinal en lactantes <2 años de edad y su consumo de fibra. Materiales y métodos. Estudio descriptivo observacional en lactantes entre 3-24 meses de edad, con diagnósticos agudos que comprometían los sistemas respiratorio, gastrointestinal, nervioso, cutáneo, hematológico, genitourinario, osteoarticular y cardíaco, sin lactancia exclusiva, que consultaron durante seis meses a un Hospital Universitario de Tercer Nivel de Atención. Este trabajo fue aprobado por el Comité de Ética Institucional. Se realizó una encuesta nutricional por recordatorio de 24 horas antes de enfermar. Según hábito intestinal, fueron divididos en lactantes con y sin estreñimiento funcional (EF), y según grupo de edad en lactantes < y >. Se tuvo en cuenta la alimentación con leche materna, el tiempo de inicio de alimentación complementaria y el antecedente de madre o cuidador con EF. Los resultados son expresados como promedio ± desviación estándar. El análisis estadístico incluyó X². Resultados. Se estudiaron 125 lactantes de 13±7 meses, 86 masculinos. No hubo diferencias significativas en edad, sexo, consumo de gramos de fibra/d, ni con la alimentación con leche materna, el tiempo de inicio de la alimentación complementaria y el antecedente de madre o cuidador con EF. Conclusiones. No encontramos diferencias estadísticamente significativas entre hábito intestinal y gramos de fibra consumidos, ni alimentación con leche materna, inicio de la alimentación complementaria precoz y antecedente de EF en la madre o cuidador.

Background. Including dietary fibre (DF) brings many benefits for human health; however, there are large gaps in knowledge/opinion concerning the relationship between fibre and constipation in paediatrics. Objective. Describing the bowel habits of infants <2 years of age and their fibre intake. Materials and methods. This was a descriptive observational study involving 3-24 month old infants having an acute diagnosis involving compromise of the respiratory, gastrointestinal, nervous, cutaneous, hematologic, genitourinary, osteoarticular and cardiac systems without exclusive breastfeeding (EBF) who visited a third-level teaching hospital's outpatient department over a six-month period. This study was approved by the Institutional Ethics Committee. A nutritional survey involved 24-hour dietary recall before becoming ill. Infants were divided according to bowel habit into those with functional constipation (FC) and those without FC and by age group into < and > infants. Special consideration was given to breast-feeding, the start time of supplementary feeding and mother or caregiver having a history of FC. The results were expressed as mean ± standard deviation. The X² test was used for statistical analysis. Results. 125 13±7 month old infants participated in the study; 86 were male. There were no statistically significant differences regarding age, gender, consumption of grams of fibre/d or breastfeeding, starting time for supplementary feeding and/or the mother or caregiver having a background of functional constipation (FC). Conclusions. No statistically significant differences were found between bowel habits and grams of fibre consumed, or breastfeeding, complementary feeding starting early and/or the mother or caretaker having a clinical background including FC.