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.

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.

Prevalence of functional gastrointestinal disorders in Taiwan: questionnaire-based survey for adults based on the Rome III criteria.

Functional gastrointestinal disorders (FGID) are a group of disorders of the digestive system in which the chronic or recurrent symptoms cannot be explained by the presence of structural or tissue abnormality. This survey used a modified Rome III questionnaire on the health and nutrition status of a general population in Taiwan during 2005-2008. A total of 4,275 responders completed the questionnaire. The sample was evenly distributed for men (n=2,137) and women (n=2,138). The prevalence of FGID was 26.2%. Unspecified functional bowel disorder was the most prevalent (8.9%). The second was functional dyspepsia (5.3%), and the third were irritable bowel syndrome (4.4%) and functional constipation (4.4%). Women had a greater prevalence than males (33.2% compared to 22.4%, p<0.05) with regards to total FGID. Most categories of FGID were significantly prominent in women, except functional diarrhea. The FGID groups took fewer servings of vegetables and fruits than the non-FGID group each day (vegetables 2.51 vs 2.70, p<0.001; fruits 0.82 vs 0.91, p<0.001). Smoking, alcohol consumption, and betel nut chewing had no significant impaction on prevalence of FGID. The mean BSRS (brief-symptom rating scale) for screening depression and suicide ideation was higher in the FGID group (2.86 vs 1.63, p<0.001). In conclusion, FGID diagnosed with Rome III criteria are not uncommon in Taiwan's general population. Subjects who met the Rome III criteria for FGID in Taiwan were younger, had less vegetables and fruits intake, higher BSRS scores and were of greater female predominance.

Pediatric gastrointestinal endoscopic sedation: a 2010 nationwide survey in Taiwan.

BACKGROUND: There is insufficient data on pediatric endoscopic sedation practices worldwide. This study aimed to assess nationwide data on the current pediatric endoscopic sedation practices in Taiwan. METHODS: Members of the Taiwan Society of Pediatric Gastroenterology Hepatology and Nutrition in 2010 were asked to participate in an 18-item questionnaire survey regarding current sedation practices for diagnostic esophagogastric-duodenoscopy (EGD). RESULTS: A total of 22 of 32 questionnaires were returned for a response rate of 68.8%. A majority (86.4%) of the respondents practiced in a medical center hospital setting, and 72.7% preferred sedation during EGD. The proportions of respondents applying sedative methods in cases aged < 1, 1∼12, and > 12 years old were 85.7%, 100%, and 23.7% respectively. Ketamine (27.8%) and midazolam with meperidine (22.2%) were the most commonly applied sedation agents, while the percentage of respondents using regimens that included propofol was 11.2%. Comparing complications between EGD with and without sedation, only hypoxia (Wilcoxon statistics=347.00, p=0.003) was significantly more common in sedated patients. The endoscopists' satisfaction rating was greater among respondents using sedation compared to those without (visual analog scale 9 vs. 7; p=0.0001). CONCLUSION: A majority of pediatric EGD in Taiwan was performed under sedation and applied more often to younger children. Endoscopists were more satisfied during EGD when practicing sedation. This survey should help formulate updated practice guidelines and policies regarding endoscopic sedation.

Child abuse in medical setting presenting as gross hematuria: diagnosis by DNA short tandem repeats.

Two sisters, aged 15 and 13 years, had previous epithelioid angiomyolipoma of the kidney and suspected thin basement membrane disease, respectively. They presented with 2 years of gross hematuria and new-onset heavy proteinuria. Extensive investigations failed to find an overt cause of their urinary manifestations. The diagnosis of child abuse in a medical setting was confirmed by DNA short tandem repeats analysis, which are the first documented cases in which factitious hematuria was thus diagnosed. Complex forms of child abuse in a medical setting may require forensic tests such as DNA short tandem repeats analysis for diagnosis.

Differences in serum biochemistry between breast-fed and formula-fed infants.

BACKGROUND: We investigated the differences in serum biochemistry levels between breast-fed and formula-fed infants. We provide reference values of serum biochemistry levels for 4-week-old (w/o) and 8 w/o infants for future clinical applications. METHODS: Sixty healthy infants were enrolled in this study (30 infants were included in the breast-fed and formula-fed groups, respectively). During hospital visits at 4 and 8 w/o, several parameters, including body weight, body length, and head circumference were recorded. Blood was drawn to measure 14 serum biochemistry markers. RESULTS: There were no significant differences between the two groups in terms of growth or anthropometric measurements. Serum cholesterol, triglyceride (TG), alanine aminotransferase (ALT), aspartataminotransferase (AST), gamma glutamyl transferase (GGT), total bilirubin (T-bil) and direct bilirubin (D-bil) levels were significantly higher in the breast-fed group compared with those measured in the formula-fed group at both 4 and 8 w/o. Serum blood urea nitrogen (BUN) and inorganic phosphate (IP) levels were significantly lower in the breast-fed group compared with the formula-fed group at 4 and 8 w/o. In the formula-fed group, serum total protein (TP), albumin, cholesterol, uric acid (UA), ALT, and AST levels were significantly higher in 8 w/o infants compared with 4 w/o infants; in addition, serum GGT, T-bil, D-bil, IP, and iron (Fe) levels were significantly lower in 8 w/o infants compared with 4 w/o infants. In the breast-fed group, serum TP, albumin, and UA levels were significantly higher in 8 w/o infants compared with 4 w/o infants; in addition, serum BUN, GGT, T-bil, D-bil, IP, and Fe levels were significantly lower in 8 w/o infants compared with 4 w/o infants. CONCLUSION: Different sources of nutrition may result in different metabolic responses; these differences are reflected by different serum biochemistries. The reference values for serum biochemistry levels also differ according to the infant's postnatal age.

Delirium due to scopolamine patch in a 4-year-old boy.

The scopolamine patch is usually used to reduce postoperative nausea and vomiting associated with anesthesia and/or surgery. It is also commonly used for the prevention of motion sickness. Transdermal scopolamine patches have been used for decades and there are few reports in the literature of toxic psychosis associated with the product. Most documented cases of acute psychosis following administration of scopolamine or other anticholinergic agents have been from the adult population. Here we present a 4-year-old boy with deteriorated cognitive function and changed mental status acutely. Besides flushing skin and psychotic behaviors including bizarre actions, hallucinations, aggressive behavior, hyperactivity, and incoherent speech were also noticed. Symptoms and signs were resolved after removal of scopolamine patch and conservative management. This case is possibly one of the youngest patients to exhibit such toxic effects. We hope to relay information about common agents with anticholinergic effects to clinical practitioners and remind that drug-induced psychosis should be considered in children with acute changes in behavior.

Constipation in Taiwan elementary school students: a nationwide survey.

BACKGROUND: To evaluate the prevalence and associated factors of childhood constipation in Taiwan. METHODS: Healthy children between 7 and 12 years of age were interviewed to determine the prevalence of constipation and associated demographic and dietary factors. A nationwide sample of 2,375 children was selected with complex multistaged sampling throughout Taiwan. RESULTS: In total, 2,375 individuals (1,282 boys and 1,093 girls, mean age=9.3±2.2 years) were interviewed, with a response rate of 95.1%. The prevalence of constipation was 32.2%, and girls were more likely to have constipation than boys (36.1% vs. 29.2%, p=0.0012) in this study. The prevalence of constipation was inversely related to age (24.4% for children aged 11 and 12, 34.0% for children aged 9 and 10, and 39.6% for children aged 7 and 8, p<0.001). Constipated children were more likely to report irregular bowl movements (37.2% vs. 29.3%, p=0.003), and constipated children had a significantly lower body mass index (17.5kg/m(2)vs. 18.3kg/m(2), p<0.001). The dietary intake for children with constipation was associated with lower intake of vegetables (4.2 servings/week vs. 5.8 servings/week, p<0.05), fruits (5.6 servings/week vs. 7.0 servings/week, p<0.05), soybean products (2.2 servings/week vs. 2.9 serving/week, p<0.05), and eggs (3.9 servings/week vs. 4.6 servings/week, p<0.05). CONCLUSION: Constipation is common in Taiwanese school-aged children, especially in girls. Less frequent consumption of vegetables, fruits, soybean products, and eggs is associated with childhood constipation. Establishing a regular bowel habit is encouraged to decrease the risk of constipation, and allowing the children a relaxed and sufficient time to defecate after school is essential.

Fatty acid composition of Taiwanese human milk.

BACKGROUND: The purpose of this study was to analyze quantitatively the fatty acid composition of the milk of Taiwanese women. METHODS: Two hundred and sixty-nine human milk specimens were obtained from 240 Taiwanese mothers, aged 19-41 years, and subjected to chromatographic analysis. RESULTS: Milk specimens were pooled by the mothers' districts of residence and lactation stages, at 0-11 days, 22-45 days, 46-65 days and 66-297 days after delivery. The fatty acid composition was expressed as weight percentage of all fatty acids detected with C8-C24 chain length. More than 80% of the fatty acids were composed of lauric, myristic, palmitic, stearic, oleic and linoleic acids. The amount of saturated fatty acid was 36.7%. With regard to essential fatty acids, the amount of linoleic acid (LA) was 22% and that of linolenic acid (ALA) was 1.8%, both levels being higher than in human milk from Western countries. However, the ratio of LA/ALA remained at 13:1 for the whole duration of lactation. It has been reported that mothers with high fish consumption have a high content of docosahexaenoic acid and eicosapentaenoic acid in their milk, and we found this phenomenon occurring in our study. The percentage of docosahexaenoic acid and eicosapentaenoic acid in Taiwanese human milk was 0.79% and 0.17%, respectively. CONCLUSION: Fatty acid composition in human milk varies during lactation. With regard to essential fatty acids, the amount of LA was 22% and that of ALA was 1.8%, both levels being higher than in human milk from Western and other Asian countries.

Health consequences of nutrition in childhood and early infancy.

Medical and scientific studies have proven that the body's metabolic programming can be influenced by diet and nutrition from early infancy. As a result, the incidence and outcome of several metabolic diseases such as obesity, hypertension and cardiovascular disorders have been found to be associated with birth weight, growth and feeding patterns, and the body composition in early childhood. Exclusive or partial breast feeding for at least 6 months is recommended by the World Health Organization, while the European Society of Pediatric Gastroenterology Hepatology and Nutrition Committee on Nutrition recommends the introduction of complementary foods at 4-6 months of age. The fat content of the diet should not be below 25% of the energy intake in order to maintain ideal growth while dietary proteins above 15% of the energy intake is related to future obesity. Long term benefits of breast feeding include a more ideal serum lipid profile and blood pressure, improved neuro-cognitive scores, and a decreased incidence for atopic dermatitis in children who have family members with atopic diseases. Several studies have also acknowledged the long term benefits for neuro-cognitive development from certain nutrients including long-chain polyunstaturated fatty acids and docosahexaenoic acid. Meat intake has proved to be beneficial to psychomotor development. It is suggested that early introduction for complementary foods before 4 months of age is a risk factor for atopic dermatitis; while no strong evidence showed delaying weaning foods can decrease the risk for allergic diseases.