Food consumption based on processing level (according to Nova system) during the COVID-19 pandemic among adolescents with immunocompromised conditions: a case-control study.

The COVID-19 pandemic impacts on eating habits among adolescents may be more relevant in pediatric patients with immunocompromised chronic diseases. This case-control study conducted between June and October 2020 aimed to: (i) describe dietary patterns of adolescents with chronic conditions compared to healthy controls and (ii) determine associations between food consumption, health-related quality of life (HRQL) and sleep quality during the COVID-19 pandemic. Participants (184 immunocompromised and 58 healthy adolescents, aged 14.3 [SD 2.5]) responded to HRQL and sleep validated instruments (PedsQL and PSQI) and three 24 h food recalls via online software. Adjusted linear and logistic regressions were used to assess differences in dietary patterns and associations between food consumption (according to Nova classification) and HRQL and sleep quality. Adolescents with gastrohepatic, rheumatic, and kidney diseases had an improved dietary pattern vs. their healthy peers, showing greater consumption of unprocessed and minimally processed foods (unstandardized coefficient (b) = 7.35%[95%CI 1.59; 13.1]; b = 15.10%[95%CI 7.00; 23.1]; and b = 11.2%[95%CI 5.68; 16.8]), and lower consumption of ultraprocessed foods (b = -7.53%[95%CI-12.90; -2.18]; b = -11.4%[95%CI-18.90; -3.94]; b = -10.8%[95%CI-16.00; -5.68]). Consumption of culinary ingredients was associated with reduced psychological HRQL in controls (standardized coefficient (ß) = -0.26[95%CI-0.52; -0.004]), and processed food consumption was associated with improved sleep latency in immunocompromised participants (ß = 0.16[95%CI 0.01; 0.31]). These findings suggest diet quality may play a role in HRQL and sleep quality in this population, and may be relevant for clinical practitioners and policy makers when considering the importance of dietary quality in immunocompromised youths.

Changes in Eating Habits and Sedentary Behavior During the COVID-19 Pandemic in Adolescents With Chronic Conditions.

Introduction: Among healthy adolescents, school closures and home confinement were shown to increase unhealthier eating habits and sedentary behavior. It remains unknown to which extent the pandemic has impacted the lifestyle of adolescents with chronic conditions. Thus, the aim of this study is to report on the impact of the COVID-19 outbreak on eating habits and sedentary behavior among adolescents with multiple chronic conditions (n = 347) from a tertiary, referral hospital vs. healthy peers. Methods: This observational study was conducted in São Paulo (Brazil) between July and October 2020, period in which a set of social distancing measures to contain the pandemic. Results: The main findings of this study were that adolescents with chronic conditions and health peers showed important changes in eating habits (e.g., more often cooking and eating in front of television than before quarantine). Also, 86.8% of adolescents with chronic conditions and 91.6% of healthy adolescents reported increasing screen time during pandemic. No major differences were observed between patients and controls. Conclusions: Adolescents with chronic conditions and healthy peers exposed to pandemic showed substantial changes in lifestyle, stressing the need for specific care to mitigate poor eating habits and excessive sedentary behavior for patients and healthy adolescents.

Poor Sleep quality and health-related quality of life impact in adolescents with and without chronic immunosuppressive conditions during COVID-19 quarantine.

OBJECTIVE: To assess the possible factors that influence sleep quality in adolescents with and without chronic immunosuppressive conditions quarantined during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional study included 305 adolescents with chronic immunocompromised conditions and 82 healthy adolescents. Online surveys were completed, which included questions on socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and the following validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0), and Pediatric Outcome Data Collection Instrument (PODCI). RESULTS: The median current age [14 (10-18) vs. 15 (10-18) years, p=0.847] and frequency of female sex (62% vs. 58%, p=0.571) were similar in adolescents with chronic conditions compared with healthy adolescents. The frequency of poor sleep quality was similar in both groups (38% vs. 48%, p=0.118). Logistic regression analysis, including both healthy adolescents and adolescents with chronic conditions (n=387), demonstrated that self-reported increase in screen time (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.3-6.8; p=0.008) and intrafamilial violence report (OR 2.1; 95% CI 1.2-3.5; p=0.008) were independently associated with poor sleep quality in these adolescents. However, the PODCI global function score was associated with a lower OR for poor sleep quality (OR 0.97; 95% CI 0.94-0.99; p=0.001). Further logistic regression, including only adolescents with chronic conditions (n=305), demonstrated that self-reported increase in screen time (OR 3.1; 95% CI 1.4-6.8; p=0.006) and intrafamilial violence report (OR 2.0; 95% CI 1.2-3.4; p=0.011) remained independently associated with poor quality of sleep, whereas a lower PODCI global function score was associated with a lower OR for sleep quality (OR 0.96; 95% CI 0.94-0.98; p<0.001). CONCLUSION: Self-reported increases in screen time and intrafamilial violence report impacted sleep quality in both healthy adolescents and those with chronic conditions. Decreased health-related quality of life was observed in adolescents with poor sleep quality.

COVID-19 and coinfection with Clostridioides (Clostridium) difficile in an infant with gastrointestinal manifestation

ABSTRACT We report the clinical case of an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with gastrointestinal signs and symptoms, predominantly vomiting. The patient also had colic, poor feeding, mild diarrhea and mild rhinorrhea without fever. The child had evidence of altered coagulation, increased interleukin 10, moderate dehydration and she was admitted to the pediatric intensive care unit. Simultaneously, the patient was diagnosed as Clostridioides difficile infection, which possibly may have facilitated the persistence of SARS-CoV-2 in feces, for more than 27 days, even after the nasopharyngeal test turned negative. This coinfection might exacerbate the gastrointestinal signs and symptoms and increased the possibility of fecal-oral transmission of SARS-CoV-2 and Clostridioides . The patient was breastfed and received complementary infant formula, hydrated with intravenous fluid, and was discharged without complications, 4 days after admission. RESUMO Relatamos o caso clínico de uma lactente com infecção por coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) com sinais e sintomas gastrintestinais - predominantemente vômitos. A paciente apresentou, adicionalmente, cólica, dificuldade para mamar, evacuações amolecidas e rinorreia leve, sem febre. Houve evidências de alterações da coagulação, aumento de interleucina 10 e desidratação moderada, que justificaram internação na unidade de terapia intensiva. Simultaneamente, a paciente foi diagnosticada com infecção por Clostridioides difficile , que pode ter facilitado a persistência do SARS-CoV-2 nas fezes por mais de 27 dias, mesmo após negativação do teste nasofaríngeo. Essa coinfecção pode ter exacerbado os sinais e sintomas gastrintestinais e aumentado a possibilidade da transmissão do SARS-CoV-2 e Clostridioides . A paciente foi mantida em aleitamento materno e complemento com fórmula infantil, recebeu hidratação intravenosa e teve alta hospitalar, sem complicações, após 4 dias de internação.

COVID-19 and coinfection with Clostridioides (Clostridium) difficile in an infant with gastrointestinal manifestation

ABSTRACT We report the clinical case of an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with gastrointestinal signs and symptoms, predominantly vomiting. The patient also had colic, poor feeding, mild diarrhea and mild rhinorrhea without fever. The child had evidence of altered coagulation, increased interleukin 10, moderate dehydration and she was admitted to the pediatric intensive care unit. Simultaneously, the patient was diagnosed as Clostridioides difficile infection, which possibly may have facilitated the persistence of SARS-CoV-2 in feces, for more than 27 days, even after the nasopharyngeal test turned negative. This coinfection might exacerbate the gastrointestinal signs and symptoms and increased the possibility of fecal-oral transmission of SARS-CoV-2 and Clostridioides . The patient was breastfed and received complementary infant formula, hydrated with intravenous fluid, and was discharged without complications, 4 days after admission. RESUMO Relatamos o caso clínico de uma lactente com infecção por coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) com sinais e sintomas gastrintestinais - predominantemente vômitos. A paciente apresentou, adicionalmente, cólica, dificuldade para mamar, evacuações amolecidas e rinorreia leve, sem febre. Houve evidências de alterações da coagulação, aumento de interleucina 10 e desidratação moderada, que justificaram internação na unidade de terapia intensiva. Simultaneamente, a paciente foi diagnosticada com infecção por Clostridioides difficile , que pode ter facilitado a persistência do SARS-CoV-2 nas fezes por mais de 27 dias, mesmo após negativação do teste nasofaríngeo. Essa coinfecção pode ter exacerbado os sinais e sintomas gastrintestinais e aumentado a possibilidade da transmissão do SARS-CoV-2 e Clostridioides . A paciente foi mantida em aleitamento materno e complemento com fórmula infantil, recebeu hidratação intravenosa e teve alta hospitalar, sem complicações, após 4 dias de internação.

Gastrointestinal manifestations and nutritional therapy during COVID-19 pandemic: a practical guide for pediatricians

ABSTRACT Coronavirus disease 2019 (COVID-19) is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has spread globally in pandemic proportions. Accumulative evidence suggests SARS-CoV-2 can be transmitted through the digestive system, the so-called fecal-oral route of transmission, and may induce several gastrointestinal manifestations. MEDLINE® and Embase databases were extensively searched for major clinical manifestations of gastrointestinal involvement in children and adolescents with COVID-19 reported in medical literature, and for nutritional therapy-related data. Findings and recommendations were pragmatically described to facilitate overall pediatric approach. A total of 196 studies addressing gastrointestinal or nutritional aspects associated with the global COVID-19 pandemic were found. Of these, only 17 focused specifically on pediatric patients with regard to aforementioned gastrointestinal or nutritional aspects. Most articles were descriptive and six addressed guidelines, established protocols, or expert opinions. Children and adolescents with gastrointestinal symptoms, such as nausea, vomiting and diarrhea, should be seriously suspected of COVID-19. Gastrointestinal signs and symptoms may occur in 3% to 79% of children, adolescents and adults with COVID-19, and are more common in severe cases. These include diarrhea (2% to 50%), anorexia (40% to 50%), vomiting (4% to 67%), nausea (1% to 30%), abdominal pain (2% to 6%) and gastrointestinal bleeding (4% to 14%). Patients with inflammatory bowel disease or chronic liver disease are not at greater risk of infection by SARS-CoV-2 relative to the general population. Nutritional support plays an important role in treatment of pediatric patients, particularly those with severe or critical forms of the disease. The digestive system may be a potential route of COVID-19 transmission. Further research is needed to determine whether the fecal-oral route may be involved in viral spread. Nutritional therapy is vital to prevent malnutrition and sarcopenia in severe cases. RESUMO A doença pelo coronavírus 2019 (COVID-19) é causada pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) e foi amplamente disseminada em todo o mundo em proporções pandêmicas. Evidências crescentes sugerem que o sistema digestivo pode ser uma via potencial para a infecção pelo SARS-CoV-2, para a disseminação do vírus por via fecal-oral, e estar relacionado com vários sintomas gastrintestinais. Realizamos uma extensa revisão da literatura médica utilizando os bancos de dados MEDLINE® e Embase, com o objetivo de identificar as principais manifestações clínicas do envolvimento gastrintestinal e analisar a terapia nutricional em crianças e adolescentes com COVID-19. Os achados e as recomendações foram descritos de maneira pragmática, para facilitar a abordagem do pediatra em geral. Foram analisados 196 estudos relacionados ao envolvimento do trato gastrintestinal ou aspectos nutricionais associados à pandemia de COVID-19 em todo o mundo. Destes estudos, apenas 17 incluíram a população pediátrica exclusivamente com aspectos gastrintestinais ou nutricionais específicos. Os artigos, em sua maioria, foram descritivos, sendo seis relacionados a diretrizes, protocolos instituídos ou opiniões de especialistas. Crianças e adolescentes com sintomas gastrintestinais, como náusea, vômito e diarreia, devem ser avaliados como pacientes suspeitos de COVID-19. Os sinais e sintomas gastrintestinais podem ocorrer em 3% a 79% das crianças, adolescentes e adultos com COVID-19, estando mais frequentemente presentes em casos graves. Incluem diarreia (2% a 50%), anorexia (40% a 50%), vômitos (4% a 67%), náusea (1% a 30%), dor abdominal (2% a 6%) e sangramento gastrintestinal (4% a 14%). Pacientes com doença inflamatória intestinal ou doenças hepáticas crônicas não apresentam maior risco de infecção por SARS-CoV-2 do que a população em geral. O suporte nutricional é parte muito importante do tratamento de pacientes pediátricos, principalmente nas formas graves ou críticas da doença. O trato gastrintestinal pode ser uma via potencial para a infecção por COVID-19. Mais pesquisas são necessárias para determinar a possibilidade da transmissão fecal-oral, importante para a disseminação viral. A terapia nutricional é essencial para prevenir desnutrição e sarcopenia nos casos graves.

Gastrointestinal manifestations and nutritional therapy during COVID-19 pandemic: a practical guide for pediatricians.

Coronavirus disease 2019 (COVID-19) is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has spread globally in pandemic proportions. Accumulative evidence suggests SARS-CoV-2 can be transmitted through the digestive system, the so-called fecal-oral route of transmission, and may induce several gastrointestinal manifestations. MEDLINE® and Embase databases were extensively searched for major clinical manifestations of gastrointestinal involvement in children and adolescents with COVID-19 reported in medical literature, and for nutritional therapy-related data. Findings and recommendations were pragmatically described to facilitate overall pediatric approach. A total of 196 studies addressing gastrointestinal or nutritional aspects associated with the global COVID-19 pandemic were found. Of these, only 17 focused specifically on pediatric patients with regard to aforementioned gastrointestinal or nutritional aspects. Most articles were descriptive and six addressed guidelines, established protocols, or expert opinions. Children and adolescents with gastrointestinal symptoms, such as nausea, vomiting and diarrhea, should be seriously suspected of COVID-19. Gastrointestinal signs and symptoms may occur in 3% to 79% of children, adolescents and adults with COVID-19, and are more common in severe cases. These include diarrhea (2% to 50%), anorexia (40% to 50%), vomiting (4% to 67%), nausea (1% to 30%), abdominal pain (2% to 6%) and gastrointestinal bleeding (4% to 14%). Patients with inflammatory bowel disease or chronic liver disease are not at greater risk of infection by SARS-CoV-2 relative to the general population. Nutritional support plays an important role in treatment of pediatric patients, particularly those with severe or critical forms of the disease. The digestive system may be a potential route of COVID-19 transmission. Further research is needed to determine whether the fecal-oral route may be involved in viral spread. Nutritional therapy is vital to prevent malnutrition and sarcopenia in severe cases.

Recovery from COVID-19 Pneumonia in a Patient with Acute Severe Colitis.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has increased concern regarding SARS-CoV-2 infection in inflammatory bowel disease (IBD) patients, especially those on immunosuppressive therapies or with active disease. There are limited reports describing the clinical features of COVID-19 in an IBD population, and the impact of immunosuppression on the severity of the infection remains unclear. CASE REPORT: A 33-year-old female patient with a long history of ulcerative colitis, poorly controlled, was admitted with COVID-19 a few days after being discharged from the hospital for treatment of acute severe ulcerative colitis. High-risk factors for COVID-19 complications, i.e., high-dose steroids (40 mg prednisone) and severe active disease, were present at admission. Despite the development of extensive pulmonary involvement, the patient had a favorable outcome. DISCUSSION: Management of IBD patients during the COVID-19 pandemic has been challenging. Measures to minimize the potential risk of SARS-CoV-2 infection, including strict social distancing and self-isolation, in the IBD population have been recommended, especially for high-risk patients. Although steroid tapering and persistence of biologics are advised by professional groups, the best treatment strategy for IBD patients presenting a flare during the outbreak has yet to be defined.

Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance.

The world is fighting the COVID-19 outbreak and health workers, including inflammatory bowel diseases specialists, have been challenged to address the specific clinical issues of their patients. We hereby summarize the current literature in the management of inflammatory bowel disease (IBD) patients during the COVID-19 pandemic era that support the rearrangement of our IBD unit and the clinical advice provided to our patients.