Fast foods--are they a risk factor for functional gastrointestinal disorders?

BACKGROUND AND OBJECTIVES: Fast-food consumption has greatly increased in Taiwan. Frequent fast food intake is associated with both allergy and obesity. The aim of this study was to describe fast food habit changes, and to assess the relationship between fast food intake and the risk of functional gastrointestinal disorders (FGIDs) among Taiwanese adolescents. METHODS AND STUDY DESIGN: This analysis used data from the Nutrition and Health Survey in Taiwan (NAHSIT) of high school students conducted in 2011. A total of 2,042 adolescents (12-19 years) completed the questionnaire. The survey included the Rome III criteria for FGIDs, translated into Chinese for adolescents. Respondents with previously diagnosed chronic organic gastrointestinal diseases were excluded from the study. RESULTS: In total, 2,034 children were enrolled. 545 subjects (26.8%) had history of at least one FGID. 88.1% of the subjects reported fast foods consumption. A significantly higher prevalence of FGIDs was noted in adolescents with a history of fast foods consumption, compared with those reported not to have ingested fast foods in the past 30 days (27.6% vs 20.6%, p=0.024). An increased risk of FGIDs in children and adolescents was associated with fast food intake (OR 1.8, 95% CI: 1.78-1.83). CONCLUSIONS: FGIDs were common among Taiwanese adolescents. Fast-food consumption may contribute to a positive association with the development of functional gastrointestinal disorders. Lower fiber intake and more frozen desserts in the diet may be complicit in FGIDs. The findings have public health relevance in regard to the global increase in fast food consumption.

Recent advances in the management of pediatric intestinal failure.

Intestinal failure is a chronic condition in which the intestinal tract has lost most of its function. Prognosis depends on the severity and underlying etiologies. Although many patients survive under parenteral nutrition support, they often suffer from fatal complications such as progressive cholestasis and frequent sepsis. In addition, to decide the proper time to refer selected patients to bowel transplantation remains difficult. A noninvasive biomarker developed to evaluate functional enterocyte mass and the extent of intestinal adaptation is plasma citrulline level. It is shown that serum citrulline correlates with small bowel length, oral tolerance, and parenteral nutrition dependency. Recent evidence has revealed that the use of fish oil containing lipid emulsions to substitute traditional soybean-based formula may reverse a patient's cholestasis and improve lipid profiles. A new method used to prevent catheter-related bloodstream infection is ethanol lock therapy. With both antimicrobial and fibrinolytic activities, studies have shown that ethanol locks can effectively decrease catheter infection and replacement rate with no known resistance reported. As part of intestinal rehabilitation, auxiliary surgeries such as longitudinal intestinal lengthening and tailoring, serial transverse enteroplasty, and tapering enteroplasty can be beneficial for selected patients before bridging to bowel transplantation. With the introduction of these new medical and surgical modalities, patients with intestinal failure are having better outcomes than in the past.

Emergency department visits for food allergy in Taiwan: a retrospective study.

BACKGROUND: Little is known about the characteristics of patients who visit the emergency department (ED) due to food allergy in Taiwan. This study aims to assess the triggers, clinical presentations, and management of patients presenting to a tertiary ED for food allergy. METHODS: This is a retrospective study of 369 visits presenting to the ED of Taipei Veterans General Hospital, Taipei, Taiwan for food allergy over a 2 year period. Patients' demographics, food allergens, presenting features, and management were addressed and analyzed. Adult and pediatric cases were also compared. RESULTS: The patients had an average age of 32.9 years [standard deviation (SD) ± 20.6]; the cohort was 66.9% adult and 53.7% male. Seafood (67.5%), fish (6.2%), and fruits (4.3%) were the major foods eliciting acute allergic reactions. Overall itchy mucocutaneous lesion was the most common presentation (85.6%), followed by anaphylaxis (12.2%), respiratory distress (1.4%), and anaphylactic shock (0.8%). Mucocutaneous involvement was more common in the pediatric population (92.6% vs. 82.2%, p = 0.007), whereas anaphylaxis was more prevalent in adults (15.4% vs. 5.7%, p = 0.0068). Antihistamines (98.6%) and systemic corticosteroids (63.1%) were commonly used medications. Only 2.2% of patients with anaphylaxis received epinephrine. The average duration in the ED was 1.6 hours (SD ± 1.8). No death was documented in the current study. CONCLUSION: Seafood, fish, and fruits are common foods which cause acute allergic reactions in Taiwan. Although most food allergies are mild, anaphylactic shock still presents in about 1% of patients. Only a minority of patients with anaphylaxis receive epinephrine. As anaphylaxis may be life-threatening, prompt education and use of an epinephrine auto-injector deserves further concern.

Biliary atresia in preterm infants in Taiwan: a nationwide survey.

OBJECTIVES: To investigate the characteristics of biliary atresia (BA) in preterm infants. STUDY DESIGN: Nationwide screening for BA in Taiwan using an infant stool color card was launched in 2004. We investigated the characteristics of BA in preterm infants using the national stool card registry center database. RESULTS: We identified 197 cases of BA from January 2004 to June 2010. The overall incidence of BA was 1.51 cases per 10,000 live births. The annual incidence of BA per 10,000 live births in term and preterm infants was 1.43 and 2.37 (P < .05), respectively. The sensitivity of detecting BA using stool cards before 60 days of age was 92.8% in term, and 96.3% in preterm infants. The Kasai operation before 60 days of age was 68.7% in term, and 44.4% in preterm infants. The jaundice-free rate at 3 months after the Kasai operation among infants with BA was 62.0% in term, and 37.0% in preterm infants (P = .015). The 18-month survival rate with native liver was higher in the term infants (72.7%) than that in the preterm infants (50.0%) (P = .043). CONCLUSION: The incidence of BA in preterm infants is more frequent than in term infants. The stool color card is sensitive to detecting BA in preterm infants. Preterm infants with BA were more prone to delayed Kasai operation and had poorer outcome.

Gitelman's syndrome: report of one case.

Gitelman's syndrome (GS) is a rare autosomal recessive renal tubular disorder characterized by hypokalemia, metabolic alkalosis, hypomagnesemia, and hypocalciuria. It is primarily caused by inactivating mutations of the SLC12A3 gene encoding the thiazide-sensitive Na-Cl cotransporter (NCC) on the apical membrane of distal convoluted tubule. We report an eight-year-old girl with incidental hypokalemia prior to appendectomy. All biochemical studies were consistent with GS. Genetic analysis of the NCC gene revealed two novel mutations (N442K and IVS6-1G > A). With regular potassium and magnesium supplementation, the patient has remained normal growth and development during two years of follow-up.