Metabolic and Bariatric Surgery in Children: Current Practices and Outcomes.

PURPOSE OF REVIEW: This review will examine the most current evidence for Metabolic and Bariatric Surgery (MBS) in the pediatric population, specifically in terms of weight loss outcomes and improvement in comorbid conditions and complications. Additionally, we compare surgical and non-surgical interventions, review current guidelines, and propose a stepwise evidence-based approach to the management of obesity in children. RECENT FINDINGS: MBS is a safe option for appropriately selected pediatric patients which leads to significant and sustained weight loss. This weight loss is associated with improvement of related comorbid conditions. Laparoscopic sleeve gastrectomy (LSG) has emerged as the procedure of choice with a better safety profile. Despite the evidence, very few adolescents undergo MBS. New pharmacologic agents specifically the GLP-1/GIP agents have shown early promise especially in patients under body mass index 40, but the long-term effects are unknown. MBS is an effective tool in the management of pediatric obesity, and its use has been recommended by professional societies. Early referral to a multidisciplinary obesity team can help identify appropriate patients.

Review of Grain Fortification Legislation, Standards, and Monitoring Documents.

OBJECTIVE: Analyze the content of documents used to guide mandatory fortification programs for cereal grains. METHODS: Legislation, standards, and monitoring documents, which are used to mandate, provide specifications for, and confirm fortification, respectively, were collected from countries with mandatory wheat flour (n=80), maize flour (n=11), and/or rice (n=6) fortification as of January 31, 2015, yielding 97 possible country-grain combinations (e.g., Philippines-wheat flour, Philippines-rice) for the analysis. After excluding countries with limited or no documentation, 72 reviews were completed, representing 84 country-grain combinations. Based on best practices, a criteria checklist was created with 44 items that should be included in fortification documents. Two reviewers independently scored each available document set for a given country and food vehicle (a country-grain combination) using the checklist, and then reached consensus on the scoring. We calculated the percentage of country-grain combinations containing each checklist item and examined differences in scores by grain, region, and income level. RESULTS: Of the 72 country-grain combinations, the majority of documentation came from countries in the Americas (46%) and Africa (32%), and most were from upper and lower middle-income countries (73%). The majority of country-grain combinations had documentation stating the food vehicle(s) to be fortified (97%) and the micronutrients (e.g., iron) (100%), fortificants (e.g., ferrous fumarate) (88%), and fortification levels required (96%). Most (78%) stated that labeling is required to indicate a product is fortified. Many country-grain combinations described systems for external (64%) monitoring, and stated that industry is required to follow quality assurance/quality control (64%), though detailed protocols (33%) and roles and responsibilities (45%) were frequently not described. CONCLUSIONS: Most country-grain combinations have systems in place for internal, external, and import monitoring. However, documentation of other important items that would influence product compliance to national standard, such as roles and responsibilities between agencies, the cost of regulating fortification, and enforcement strategies, are often lacking. Countries with existing mandatory fortification can improve upon these items in revisions to their documentation while countries that are beginning fortification can use the checklist to assist in developing new policies and programs.

Comparison of pesticide residues in surface water and ground water of agriculture intensive areas.

The organochlorines (OClPs) and organophosphates (OPPs) pesticides in surface and ground water having intensive agriculture activity were investigated to evaluate their potential pollution and risks on human health. As per USEPA 8081 B method, liquid-liquid extraction followed by Gas-Chromatographic technique with electron capture detector and mass selective detector (GC-MS) were used for monitoring of pesticides. Among organochlorines, α,ß,γ,δ HCH's, aldrin, dicofol, DDT and its derivatives, α,ß endosulphan's and endosulphan-sulphate were analysed; dichlorovos, ethion, parathion-methyl, phorate, chlorpyrifos and profenofos were determined among organophosphates.As compared to ground water, higher concentrations of OClPs and OPPs were found in surface water. Throughout the monitoring study, α - HCH (0.39 µg/L in Amravati region),α - endosulphan (0.78 µg/L in Yavatmal region), chlorpyrifos (0.25 µg/L in Bhandara region) and parathion-methyl (0.09 µg/L in Amravati region) are frequently found pesticide in ground water, whereas α,ß,γ-HCH (0.39 µg/L in Amravati region), α,ß - endosulphan (0.42 µg/L in Amravati region), dichlorovos (0.25 µg/L in Yavatmal region), parathion-methyl (0.42 µg/L in Bhandara region), phorate (0.33 µg/L in Yavatmal region) were found in surface water.Surface water was found to be more contaminated than ground water with more number of and more concentrated pesticides. Among pesticides water samples are found to be more contaminated by organophosphate than organochlorine. Pesticides in the surface water samples from Bhandara and Yavatmal region exceeded the EU (European Union) limit of 1.0 µg/L (sum of pesticide levels in surface water) but were within the WHO guidelines for individual pesticides.