[Variability of nutritional status and of the parameters of lipid metabolism in gluten-free diet]. / Variatiile statusului ponderal si parametrii metabolismului lipidic în timpul dietei de excludere a glutenului.

UNLABELLED: Celiac disease is one of the most common forms of food intolerance in children, being an autoimmune enteropathy occurring in genetically susceptible individuals. The only treatment of celiac disease consists in a lifelong strict gluten-free diet. After gluten free diet patients with normal weight or growth failure risk become obese on the one hand because of recovery intestinal absorption and, on the other hand, nutritionally unbalanced diet, high in fat and protein. AIM: The aim of this study was to assess the nutritional status and the presence and prevalence of various changes dyslipidemia in gluten free diet. MATERIAL AND METHODS: The trial was formed by 92 patients (mean age at diagnosis 88,5 months) diagnosed with CD between January 2008 - December 2010 in 2nd and 3rd Pediatric Clinics of "Sf. Maria" Hospital Iasi. Patients were divided into two groups: group I included 36 patients younger than 2 years and group II included 52 patients aged over 2 years at time of diagnosis of celiac disease. All patients received gluten free diet. Were evaluated periodically anthropometric indices (weight, height, body mass index and Z scores in children over 2 years and weight and nutritional index in children under 2 years) and lipid profile (total lipids, total cholesterol, HDL cholesterol, triglycerides). Assessing food intake was achieved by interviewing parents and children on dietary habits and daily food ration. RESULTS: Assessment of nutritional status: group I:--after 24 months of gluten free diet 5 cases presented overweight; group II: after 24 months of gluten free diet obesity (BMI > 30) was found in 16.07% of cases (9 patients) and overweight (BMI > 25) was found in 28.57% of cases (16 patients). Food intake: in all cases was observed increased calorie intake by an excess of lipids and carbohydrates in the diet. Investigation of lipid metabolism: in group II high values of cholesterol were found in 12 cases (21,42 of cases). In conclusions, in celiac disease gluten free diet should be balanced caloric, fat and protein to ensure an optimal nutritional status and prevent long-term complications.

[Liver involvement in celiac disease in children]. / Afectarea hepatica în boala celiaca la copil.

UNLABELLED: Celiac disease (CD) is an autoimmune systemic enteropathy triggered by gluten intake in patients with genetic susceptibility, characterized by clinic polymorphism: classic forms, mainly with digestive features, and atypical forms, liver involvement being a part of them. In present, any unknown cytolysis requires screening serologic determinations for CD. AIMS: to assess the presence of liver manifestations in children diagnosed with CD, the outcome of liver function with gluten-free diet (GFD) and also to emphasize the importance of the immunological screening for CD in patients with unknown etiology liver dysfunctions. MATERIAL AND METHODS: The trial was formed by 120 patients diagnosed with CD between January 2007 - December 2010 in 2nd and 3rd Pediatric Clinics of "Sf. Maria" Hospital Iasi; liver function was assessed; viral hepatitis and autoimmune hepatitis markers were determined; all patients were given GFD, hepatoprotective agents and antivirals specific to each form of hepatitis; the transaminases level variation was followed in time. RESULTS: 12 of the CD diagnosed patients (10, 14%) had altered liver function at the onset of disease; the only abnormality was the increased transaminases level in 57, 14% of cases; HBsAg was found positive in 33, 33% (4 cases); liver biopsy in one patient evidenced steatosis. The study has shown that 4% of the patients with cryptogenetic hepatitis have a silent form of CD, the serologic screening for AGA, AEA, ATGA being essential for diagnosis. CONCLUSIONS: we have to rule out CD in patients with liver disease of unknown etiology, before we consider it as "cryptogenetic"; occurrence of cytolysis in the absence of positive viral markers requires the assessment of screening tests for CD.

[Obesity in children: new controversies and present prevention measures]. / Obezitatea copilului--noi paradigme si masuri preventive actuale.

The authors realise a synthesis on classical data and recent pathogenic explanations in childhood obesity. The obesity is a nutritional disorder of great interest nowadays and surpasses the incidence of the major problem of pediatrics until now--the malnutrition. There is documented data concerning the global incidence of obesity which is continuously growing when it comes to children. That is why the prophylaxis must become a priority by using measures in the first period of life (natural feeding, the need of late diversification, the avoidance of hyperproteic diets). The recent pathogenic data and the long term populational studies change the old conceptions regarding the risk of some categories of children. Thus mother's malnutrition, the low birth weight, children that followed hyperproteic diets paradoxically represent categories of risk for obesity. A recent recorded phenomenon, which amplifies the risk for obesity is the early adiposity rebound which is recorded nowadays even for ages lower than five years. There are described the hormonal mechanisms involved in appetite and satiety up to the receptor level: leptin, ghrelin, adiponectin, endocannabinoid receptors. There are pointed out all the long term risk elements (high birth weight, low birth weight, the pregnant woman's nutrition) and the modern medical treatments for obesity.