Objective. To evaluate the efficacy of combination therapy with a proton pump inhibitor (PPI) and rebamipide compared to PPI monotherapy in controlling nocturnal gastroesophageal reflux (GER) in patients with non-erosive reflux disease (NERD), based on 24-hour pH-impedance monitoring in the nocturnal supine position. Patients and methods. This prospective randomized study included 39 patients with NERD. All patients were divided into two groups: the study group (n = 22) received omeprazole 20 mg/day and rebamipide 300 mg/day; the comparison group (n = 17) received omeprazole 20 mg/day. The duration of treatment was 4 weeks. Efficacy was assessed functionally using 24-hour pH-impedance monitoring before and after treatment, with analysis of nocturnal parameters in the supine position. Results. In the study group, the duration of the longest nocturnal GER episode decreased by 78% (p = 0.016), and there was a notable positive trend in the percentage of time with pH <4, which decreased by 62% (p = 0.064). No significant improvement was observed in the comparison group. Intergroup analysis revealed a difference in the change in the number of GER episodes lasting >5 minutes (p = 0.039) and a trend toward a difference in the change in the percentage of time with pH <4 (p = 0.051). Conclusion. Combination therapy with rebamipide and PPI demonstrated both statistically significant and clinically meaningful superiority over PPI monotherapy in controlling nocturnal GER in patients with NERD, as evidenced by a substantial reduction in acid exposure and the number of pathologically prolonged reflux episodes in the supine position. These findings support the inclusion of rebamipide in the treatment regimen for NERD to improve control of nocturnal symptoms. Key words: proton pump inhibitors, rebamipide, non-erosive reflux disease, epithelial protective therapy
Celiac disease (CD) is a chronic autoimmune disorder that requires lifelong adherence to a gluten-free diet, which significantly impacts quality of life. The lack of validated Russian-language tools for assessing quality of life in CD patients limits the ability to provide comprehensive care for this population. Objective. To perform a comprehensive linguistic and psychometric validation of the Russian-language version of the CD-QOL (Celiac Disease Quality of Life) questionnaire for assessing quality of life in CD patients. Patients and methods. The procedure of linguistic validation was conducted in accordance with international standards (ISPOR, WHO) and involved a multistage process, including forward translation, reverse translation, expert review, cognitive testing, and a pilot study. Psychometric validation was performed on a sample of 599 patients with CD aged 0 to 18+ years, using principal component factor analysis with varimax rotation, assessment of internal consistency (Cronbach’s alpha), correlation analysis, group comparisons via t-tests and analysis of variance (ANOVA), as well as linear regression. Results. Factor analysis confirmed a two-factor structure of the questionnaire: “Social and emotional limitations” (9 items, α = 0.904) and “Health-related anxiety and fear” (6 items, α = 0.874), jointly explaining 60.2% of the variance. Mean scores for these factors were 3.39 (SD = 0.96) and 3.16 (SD = 1.07), respectively. Correlation analysis revealed a moderately strong positive association between the factors (r = 0.649, p < 0.001). Anxiety levels decreased with age (r = -0.14, p < 0.001), whereas the perception of social limitations remained stable (r = -0.06, p = 0.143). No sex-related differences were observed for the identified factors. Regression analysis showed that the perception of social limitations was a key predictor of anxiety (β = 0.636, p < 0.001), explaining 44.4% of the variance in the dependent variable in combination with age. Conclusion. The Russian-language version of the CD-QOL questionnaire demonstrated high linguistic and psychometric validity, supporting its use in both research and clinical practice for assessing quality of life in CD patients within Russianspeaking populations. These findings indicate that the instrument can be effectively applied for monitoring quality of life, evaluating the efficacy of therapeutic interventions, and developing individualized psychological support programs for patients with CD. Key words: celiac disease, quality of life, linguistic validation, CD-QOL, translation and adaptation, psychometric properties, Russian-language version
Children with severe neurological disorders frequently experience gastrointestinal problems, including dysphagia, constipation, and gastroesophageal reflux disease, which often lead to protein-energy undernutrition (PEU). Effective management of nutritional disorders is not possible without assessment of actual dietary intake. The available literature provides limited data on dietary intake in children with neurological disorders, particularly in those with cerebral palsy (CP). Objective. To perform a comprehensive assessment of actual dietary intake among children with CP according to the severity of motor impairment, disease type, and physical development. Patients and methods. This cross-sectional analytical study included 175 children aged 1–18 years with spastic forms of CP and all levels of motor impairment according to the Gross Motor Function Classification System (GMFCS). Physical development was evaluated, and dietary intake was analyzed using a questionnaire survey and a 3-day dietary record. Results. The analysis of dietary intake revealed a monotonous diet in 41% of children with CP, inadequate intake of fresh vegetables and greens in 39%, low fiber intake in 32%, and a significantly low red meat intake in 16%. Meal duration exceeding 30 minutes was observed in 31% of children. The average daily energy intake was comparable to the total energy expenditure (TEE) calculated using the Krick formula but differed significantly from age-specific requirements (p < 0.001). Overall, 81% of children had energy intake below age-specific requirements; carbohydrate intake was inadequate in 89% of cases, fat intake in 66%, and protein intake in 60%. Regarding TEE, children assigned to GMFCS levels I–II had excess energy intake (>100%) compared to those with GMFCS levels III–V (81–90% of TEE). Children with hemiparetic CP had a more optimal dietary intake than those with spastic tetraparesis (p = 0.001 for protein and carbohydrate; p = 0.012 for fat). In children with GMFCS level V, macronutrient intake was lower than in children with GMFCS levels I and II for protein (pV–I = 0.045; pV–II = 0.029) and carbohydrates (pV–I = 0.015; pV–II = 0.09). Fat intake in children with GMFCS level V was lower than in those with GMFCS level II (p < 0.001) and level III (p = 0.041). Conclusion. Most children with CP exhibited inadequate intake of energy, carbohydrates, fat, and protein. Children with spastic/ hyperkinetic CP, spastic tetraparesis, and severe motor impairments (GMFCS level V) represent a high-risk group for developing PEU. In contrast, children with hemiparetic CP and/or preserved motor function (GMFCS levels I–II) are at risk of overweight and obesity. Key words: children, cerebral palsy, energy intake, nutritional status, dietary intake, physical development
Childhood and adolescent obesity represents a significant medical and public health challenge, particularly in the northern and Arctic regions of Russia, where the combination of extreme environmental and climatic conditions, shifts in dietary patterns, and high genetic homogeneity of the population contributes to increased metabolic risk. Objective. To examine the associations between five polymorphisms in genes involved in the regulation of lipid and carbohydrate metabolism (PPARG rs1801282, FABP2 rs1799883, ADRB2 rs1042713 and rs1042714, ADRB3 rs4994) and the presence of obesity in the pediatric population of Yakutia. Patients and methods. The study included 410 children and adolescents aged 7–18 years permanently residing in Yakutia. Genotyping was performed using a quantitative real-time polymerase chain reaction (qPCR). Dominant, recessive, heterozygous, homozygous, and allelic genetic models were evaluated. Results. A significant association with obesity was observed for the rs1042713 polymorphism of the ADRB2 gene. The AG genotype (heterozygous model) was linked to an increased risk of obesity compared to the AA genotype: OR = 1.82 (95% CI: 1.07–3.11). The recessive model also demonstrated a significant correlation (GG vs. AG+AA): OR = 1.81 (95% CI: 1.10–2.98). In the allelic model, carriage of the G allele was associated with more than a two-fold increase in obesity risk: OR = 2.22 (95% CI: 1.19–4.14). The remaining polymorphisms showed no statistically significant correlation with this phenotype. Conclusion. The rs1042713 polymorphism of the ADRB2 gene may contribute to the pathogenesis of obesity in children and adolescents living in northern and Arctic regions, possibly reflecting adaptive metabolic responses to extreme climatic conditions. The lack of statistically significant associations for other genes examined supports the polygenic nature of obesity and highlights the importance of integrative strategies combining genetic, nutrigenetic, and digital approaches for early diagnosis and prevention. Key words: children, adolescents, nutrigenetics, obesity, personalized nutrition, gene polymorphisms, Arctic
Cow’s milk protein allergy (CMPA) remains the most common cause of food allergies in children. The limited efficacy of traditional elimination diets and the presence of infectious comorbidities in children with CMPA necessitate the search for new approaches to improve the immune control of allergies. A promising strategy for remodulating the immune response is to influence the gut microbiota. This article provides a review of preclinical and clinical studies, real-world clinical experience, and economic benefits for the healthcare system regarding 2FL Neocate Syneo, a new amino acid-based formula with synbiotics and human milk oligosaccharides. Key words: cow’s milk protein allergy, gut microbiota, synbiotics, Neocate Syneo
The introduction of dairy products into children’s diet is a promising and natural way to prevent iodine deficiency. Objective. To analyze the iodine content in dairy products intended for child nutrition and assess their potential for use as a source of iodine. Materials and methods. The total iodine content in dairy products (yogurt, cottage cheese, fermented beverages, milk, and milkshakes) was measured using voltammetry, and organic iodine content (mono- and diiodotyrosines) was measured using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Results. It was found that dairy products contain an average of 13 μg/100 g or 22 μg of iodine per serving, which corresponds to ~30% of the recommended daily intake for infants and ~21% for children over 3 years of age. Conclusion. Dairy products are a valuable source of iodine in children’s diet. Given the insufficient consumption of this category of products in Russia, promoting them could be a promising way to increase iodine intake among the population. Key words: iodine, iodine deficiency, young children, complementary feeding, preschool age, dairy products, cognitive development For citation: Kovalenko E.V., Shoshina O.O., Vostrikova N.L., Ivanov A.A., Volokh O.I. Role of dairy products as a source of iodine in children’s diet. Vopr. det. dietol. (Pediatric Nutrition). 2025; 23(6): 32–39. (In Russian). DOI: 10.20953/1727-5784-2025-6-32-39
The double burden of malnutrition (DBM) refers to the coexistence of undernutrition and overweight. It is attracting increasing attention, and its prevalence is growing. DBM can lead to serious diseases and reduce quality of life. Therefore, it requires timely diagnosis and correction. Objective. To study the prevalence of obesity/overweight and protein-energy undernutrition (PEU) among elementary schoolaged children. Patients and methods. This prospective cross-sectional study analyzed the body mass index (BMI) of elementary school-aged children according to WHO criteria for assessing the prevalence of nutritional disorders: obesity, overweight, and PEU. A questionnaire survey of parents/guardians was used to examine children’s dietary patterns. Results. Nutritional disorders were identified in 43.5% of elementary school-aged children in Barnaul. The distribution was as follows: PEU – 15.4% of cases, obesity – 11.7%, overweight – 16.4%. The analysis of dietary patterns revealed significant deviations: 35.0% of children miss breakfast, 17.8% do not consume enough meat and fish products, and 37.2% do not consume enough vegetables and fruits. Among the respondents, 88.0% regularly consume excessive amounts of sweet carbonated beverages. Conclusion. The prevalence of nutritional disorders among elementary school-aged children in Barnaul corresponds to global and Russian averages. The identified deviations may contribute to the development of nutritional disorders. However, a more detailed analysis of the nutritional value of children’s diets is required for a comprehensive assessment. Key words: protein-energy undernutrition, overweight, elementary school-aged children, obesity
Body roundness index (BRI) is a novel, non-traditional, alternative anthropometric tool for identifying human obesity. Current international studies have explored the utility of this index in adults, reporting a positive correlation with body fat percentage and cardiometabolic risk factors. However, its applicability in the pediatric population remains relatively limited. Objective. To review the latest and available data on the application of BRI as a predictor of pediatric obesity and its correlation with obesity-related comorbidities and complications. Materials and methods. A systematic review of the available scientific literature was conducted to identify relevant articles published up to May 2025 in PubMed, Web of Science, ScienceDirect, Scopus, ResearchGate, Google Scholar, DOAJ, and EBSCO. All found full-text publications reporting the use of BRI as an obesity predictor and its correlation with obesity-related comorbidities in children and adolescents were considered eligible and reviewed in detail. The search and selection of publications, as well as the synthesis of the reported results, was performed using PRISMA methods. Results. A systematic review of eight cross-sectional studies involving 73,065 children and adolescents, predominantly from China and USA, was carried out. Two studies included fewer than 1000 participants, which calls into question the representativeness of the samples and the reliability of the results presented. Six studies reported a positive or negative correlation between BRI predicting pediatric obesity and conditions associated with this disease, such as albuminuria, psychological symptoms, respiratory problems, cardiometabolic changes, and myopia. Conclusion. Despite the relatively small number of studies examining the association of BRI with childhood obesity and related comorbidities, most of them report a positive correlation between this predictor and conditions such as abdominal obesity, cardiometabolic alterations, myopia, and psychological symptoms. Key words: body roundness index, pediatric obesity, comorbidity
Atopic dermatitis (AD) is a systemic disease associated with chronic immune inflammation that impairs energy and nutrient metabolism. To determine the influence of monitoring the pathogenetic mechanisms of AD in children on nutritional status in later life, it is relevant to study the metabolic consequences of disease in young adults. Objective. To evaluate the parameters of body composition and metabolic status in adult patients with AD depending on sex. Patients and methods. A total of 65 patients with AD (37 women and 28 men) were examined. Body composition was assessed using bioimpedance analysis, and metabolic parameters were assessed using indirect calorimetry. Results. The study revealed significant sex differences in body composition and metabolism. Muscle mass was significantly higher in men than in women (47.4 [41.4–52.8]% vs. 37.3 [35.4–41.5]%, respectively, p < 0.001); this resulted in higher resting energy expenditure (1802 ± 225 kcal vs. 1377 ± 215 kcal, respectively, p < 0.001). Women had a significant predominance of fat mass (32.2 [21.2–35.2]% vs. 15.3 [9.3–21.4]%, p < 0.05) and fat oxidation (+19.8%, p = 0.017), while men had a predominance of carbohydrate oxidation (+22.5%, p = 0.025). A negative correlation was found between age and carbohydrate oxidation in women (ρ = -0.601, p = 0.008). A strong positive correlation was found between muscle mass and energy expenditure in men (ρ = 0.838, p < 0.001). Conclusion. The identified metabolic characteristics determine the need for a differentiated approach to diet therapy for patients with AD. For women, this means correcting carbohydrate metabolism, and for men, maintaining muscle mass. Optimizing the diet considering sex differences can be an important part of comprehensive AD therapy. Key words: atopic dermatitis, body composition, energy metabolism, bioimpedance analysis, indirect calorimetry, sex differences
The problem of obesity among children and adolescents is one of the most serious challenges facing health and educational systems. This determines the high relevance of developing methodical approaches to monitoring and evaluating a set of measures aimed at normalizing weight and height indicators in educational institutions. The following methods were used in the analytical review of methodological and methodical approaches to address this problem: induction, synthesis, structuring, causal and descriptive analysis of regulatory and scientific sources published since 2015 in the Russian Science Citation Index (RSCI), CyberLeninka, PubMed, ResearchGate, Science Direct, and ConsultantPlus databases. Firstly, it allowed us to identify leading international practices in combating childhood obesity and measures applied in the educational system; secondly, it made it possible to propose principles, criteria, and methods for evaluating the efficacy of comprehensive measures to improve students’ nutrition, weight, psycho-emotional state, and quality of life, as well as to develop stages for the implementation of group monitoring. The fundamental factors for normalizing weight and height indicators in children and adolescents include comprehensive efforts by families, healthcare professionals, educational and psychopedagogical measures, changes in the quality of food environment, as well as a combination of all conditions created in educational institutions that promote healthy eating habits. Key words: overweight, weight correction, monitoring, obesity, school nutrition
This article presents a review of recent literature on the psycho-emotional interaction between parents and infants with functional gastrointestinal disorders (FGIDs). Infant colic is a relatively common problem that can have long-term consequences for children’s health. This condition also causes anxiety, stress, and postpartum depression in mothers, depression and anger in fathers, and unsafe environment for a child. In turn, maternal depression and family stress can increase the risk of infant colic and other FGIDs. The risk factors for FGIDs identified in numerous studies confirm current understanding of the essence of functional disorders in children and help to choose timely preventive strategies. Psychological support for parents and the use of Lactobacillus reuteri DSM 17938 probiotic with proven efficacy are an important part of both the prevention and treatment of FGIDs in breastfed and formula-fed infants. Key words: quality of life, Lactobacillus reuteri DSM 17938, microbiota, infant colic, Nestogen®, NAN® Triple Comfort, stress, risk factors, functional gastrointestinal disorders
Niemann-Pick disease (NPD) is a rare inherited disease classified as a lysosomal storage disorder caused by mutations in the SMPD1 gene, which is responsible for the synthesis of acid sphingomyelinase. The disease is characterized by the accumulation of sphingomyelin in the cells of various organs, leading to severe damage and life-threatening conditions. NPD type A/B is a separate disease subtype, which has an intermediate status and is chronic with predominantly neurovisceral manifestations. The clinical symptoms of NPD type A/B most often comprise hepatosplenomegaly, impaired physical and psychomotor development, respiratory dysfunction, frequent respiratory infections, lymphadenopathy, and nosebleeds. This requires differential diagnosis, including with pulmonary tuberculosis, due to the similarity of radiographic patterns. Current treatment of NPD type A/B, in addition to symptomatic therapy, includes pathogenetic enzyme replacement therapy with recombinant human acid sphingomyelinase. This article presents a clinical case of disease in a child belonging to a small ethnic group, which demonstrates a complex and lengthy diagnostic process. Diagnosis verification and subsequent enzyme replacement therapy reduced the clinical manifestations of disease and improved the patient’s quality of life. Key words: Niemann–Pick disease, hepatosplenomegaly, enzyme replacement therapy, acid sphingomyelinase, olipudase alfa
Objective. To evaluate bone mineralization status and bone metabolism markers in schoolers with obesity. Patients and methods. The study included 99 patients with exogenous-constitutional obesity aged 6 to 18 years and 61 children without obesity (control group). The assessment was based on bone mineralization status, biochemical parameters (ionized calcium, total calcium, osteocalcin, alkaline phosphatase, acid phosphatase, C-terminal telopeptides of type I collagen, parathyroid hormone, creatinine, calcitonin), 25(OH)D concentrations, and food diaries. Results. All obese patients had normal bone mineralization status. Obesity complications (metabolic syndrome, type 2 diabetes, impaired glucose tolerance, impaired fasting glucose, arterial hypertension, hypercholesterolemia, hypertriglyceridemia) did not affect bone mineral density. 25(OH)D concentrations were below reference values in both obese patients and healthy controls – 16.1 (11.2; 22.7) ng/mL and 21.9 (14.5; 27.6) ng/mL, respectively. Compared to children in the control group, children with obesity had significantly lower levels of calcitonin (1.5 (1.5; 1.5) pg/L vs. 11.0 (11.0; 11.0) pg/L, p < 0.001), osteocalcin (77.0 (45.0; 94.0) ng/mL vs. 85.0 (67.0; 113.0) ng/mL, p = 0.029), C-terminal telopeptides (1.2 (0.8; 1.4) ng/mL vs. 1.6 (1.2; 2.0) ng/mL, p < 0.001), ionized calcium (1.3 (1.2; 1.3) mmol/L vs. 1.3 (1.3; 1.4) mmol/L, p < 0.001) and creatinine (52.9 (45.4; 64.1) μmol/L vs. 54.2 (50.2; 65.1) μmol/L, p = 0.025), while parathyroid hormone levels were higher (4.7 (3.5; 5.8) pmol/L vs. 3.6 (2.5; 4.8) pmol/L, p < 0.001). Obesity complications did not have a significant effect on biochemical markers. The dose of cholecalciferol received by obese patients (500 (62; 800) IU) was comparable to the dose received by healthy controls (500 (0; 1000) IU). Dietary calcium intake in children with obesity (139.0 (35; 322) IU/day) was lower than in children in the control group (400 (300; 800) IU/day, p < 0.001). Conclusion. Despite normal bone mineralization status in obese children and adolescents, conflicting results were obtained for biochemical parameters of bone metabolism, which requires further study. Key words: obesity, bone mineral density, vitamin D, densitometry
Objective. To determine the informative value of modern diagnostic scales for Wilson–Konovalov disease (WKD) and the criteria included in them, as well as to identify factors influencing them in pediatric practice. Patients and methods. Data from 104 medical records of children with genetically confirmed WKD, observed at the National Medical Research Center for Children’s Health between 2012 and 2023, were retrospectively analyzed. Results. The median age at onset of WKD was 6.6 [4.6;10] years, and the mean age at diagnosis was 9.2 [6.3;11.7] years. Neurological symptoms and Kayser–Fleischer rings were found at a frequency of 10.6 and 12.5%, respectively. Ceruloplasmin concentrations and 24-hour urinary copper excretion showed high diagnostic accuracy, with threshold values of 16.9 mg/dL and 48.6 μg/day, respectively. The D-penicillamine challenge test was effective at a threshold value of 557 μg/day. The parameters most dependent on age were urinary copper excretion (p = 0.002), the D-penicillamine challenge test (p = 0.047) and neurological symptoms (p = 0.011). The Leipzig scale (2001) and the Nagral A. scale (2019), without considering molecular genetic testing, showed high specificity and low sensitivity – 41.3% and 46.1%, respectively. The comparative analysis of scales revealed significant differences in their efficacy in different age groups: the Leipzig scale was less sensitive in children under 5 years of age (confirmed diagnosis in 33% of patients) compared to the Nagral A. scale, where the diagnosis was confirmed in 50% of patients in the younger age group. Conclusion. The diagnosis of WKD in children requires a comprehensive approach considering the age-related characteristics of patients. Existing diagnostic scales demonstrate limited efficacy, especially in younger children. Key words: Wilson–Konovalov disease, children, diagnosis, scoring system
Nutritional disorders in children with organic lesions of the central nervous system (CNS) accompanied by profound intellectual disability are multifactorial in nature. They are caused by difficulties in the eating process associated with specific cognitive functioning, behavioral reactions and sensory responses, eating behavior, and changes in the functional state of the gastrointestinal tract that disrupt digestion. Objective. To study the nutritional status of children with severe CNS lesions accompanied by intellectual disability. Patients and methods. Questionnaires, general clinical, laboratory, instrumental and statistical research methods were used. The study included 48 children aged 7 to 17 years living in a social institution. A comprehensive assessment of the children’s nutritional status was conducted. An analysis of anthropometric and biochemical parameters characterizing nutritional status was performed. Results. Dysphagia of varying severity was observed in all patients included in the study. One in three children had level II–V according to the EDACS scale. Significant deviations in the nutritional status of children with organic CNS lesions and profound intellectual disability were identified. Stunting was recorded in 71% of children, and in more than half of patients (56%) it was at the level of <-3SD. In more than 60% of children, body mass index-for-age Z-score corresponded to undernutrition and the risk of its development. In this group of patients, even with normal anthropometric parameters, there was a decrease in body composition Z-scores (fat and lean mass, total body water, mineral mass, etc.). Compared to the norm, 24.3% of children had low total protein levels, 69% had low albumin levels, 93% had low vitamin D levels, and 100% had low insulin-like growth factor 1 and prealbumin levels. Conclusion. This study indicates the specific nature of the nutritional status of children with profound intellectual disability and undernutrition, as well as the characteristics of their body composition, which allows for the modification of approaches to managing nutrition for children with profound intellectual disabilities, including by developing diets for organized groups. Key words: children, nutritional status, undernutrition, nutrient deficiencies, organic lesions of the central nervous system
Organic causes of chronic duodenal obstruction (CDO) in children usually include gastrointestinal congenital malformations. Due to the absence of specific complaints, children continuously undergo unsuccessful examinations and treatment by a gastroenterologist. Late diagnosis can lead to the development of severe pathological changes in the duodenum, requiring major reconstructive surgery. Objective. To improve the diagnosis of CDO in children. Patients and methods. This retrospective and prospective study analyzed the examination results in 104 patients with CDO and 20 children in the control group between 2007 and 2024. Organic causes of CDO were divided into anatomical and functional variants: obturator, compressive, rotational, and combined. Patients underwent ultrasound, gastroduodenoscopy, and X-ray examinations. Their informative value was assessed, and an algorithm for diagnosing CDO was developed. Results. The most informative diagnostic methods for CDO are ultrasound (sensitivity – 82.7%, specificity – 100%, accuracy – 85.5%), gastroduodenoscopy (sensitivity – 83.1%, specificity – 100%, accuracy – 84.8%) and hypotonic duodenography (sensitivity – 94.4%, specificity – 87.5%, accuracy – 93.2%). Conclusion. The diagnosis of CDO requires a comprehensive examination. Based on this study, an algorithm for diagnosing the causes of duodenal transit disorders was proposed. Key words: duodenum, children, chronic duodenal obstruction
Advances in neonatal surgery have increased the survival of children with short bowel syndrome (SBS), but the risk of nutrient deficiencies remains. Objective. A comprehensive assessment of physical development and body composition in children with SBS in catamnesis after bowel resection in the neonatal period. Patients and methods. This cross-sectional analytical and retrospective study included 69 children aged 1 to 7 years who were divided into 3 groups: patients with SBS (study group), children with resection of < 50% of the bowel (comparison group), and healthy peers (control group). A comprehensive assessment of nutritional status was performed using extended anthropometry and bioimpedance analysis. Results. A catamnestic study on children after bowel resection in the neonatal period revealed that among patients with SBS at the age of 1 year, 31% had mild protein-energy undernutrition (PEU) and 34% had stunting. With resection without SBS, normal physical development and growth were noted in 95% of cases. Stunting was significantly more common in children with SBS after enteroplasty (75% vs. 25%, p = 0.011). Over time, there was an increase in the frequency of PEU up to 54% and severe stunting up to 15% in the SBS group; in the comparison group, low body weight was recorded in 40%, stunting in 30%, severe stunting in 10% of children. Children with ultra-short bowel syndrome more often had low values of triceps skinfold thickness (63% vs. 37%, p = 0.027). According to the results of bioimpedance analysis, the average values of main body composition parameters did not differ statistically significantly between the groups, but the phase angle in healthy children was significantly higher, indicating good nutritional status and sufficient physical activity. Patients with SBS and with less extensive resection often have deficits in fat mass, lean body mass and body cell mass, as well as a lower phase angle. Conclusion. This catamnestic study revealed the urgent need for regular monitoring of the nutritional status in children who underwent bowel surgery, regardless of resection volume, with a focus on anthropometry and bioimpedance analysis as tools for early detection and targeted correction of nutrient deficiencies. Key words: short bowel syndrome, children, physical development, bioimpedance analysis, nutritional status
Non-celiac gluten sensitivity (NCGS) is a syndrome characterized by intestinal and extraintestinal symptoms that occur when gluten-containing foods are consumed by patients who do not have signs of celiac disease or wheat allergy. To date, NCGS has been widely described in adults, while in pediatric practice there is insufficient information about this pathology. Objective. To study the frequency of NCGS among children referred to the Republican Special-ized Scientific and Practical Medical Center of Pediatrics and to assess their intestinal permeability. Patients and methods. This single-center prospective study included 39 children aged 1 to 16 years with suspected NCGS between 2021 and 2023. After excluding patients with celiac disease and wheat allergy, the Salerno Experts’ criteria were used to diagnose NCGS. The control group consisted of 20 healthy children. The level of anti-gliadin antibodies (IgG) was determined by chemiluminescence. To assess tight junction function, the level of fecal zonulin was determined by enzyme-linked immunosorbent assay. Results. The diagnosis of NCGS was confirmed in 22 children. Clinical differences were identi-fied depending on age. Thus, extraintestinal manifestations (headaches, joint pain, sleep disorder) were more common in school-age children, while diarrhea and flatulence prevailed in preschoolers. Fecal zonulin levels were significantly higher in patients with NCGS compared to the control group, regardless of age. Conclusion. NCGS should be considered as a possible cause of continuous gastrointestinal dis-comfort and significant extraintestinal manifestations in children. Fecal zonulin can be considered as a diagnostic biomarker for NCGS in combination with clinical data. Key words: non-celiac gluten sensitivity, zonulin, intestinal barrier, permeability, celiac disease, gluten
As the prevalence of chronic non-communicable diseases related to nutrition continues to rise, dietary recommendations based on the latest scientific evidence are fundamental to strengthening public health and prevention strategies. There is an understanding of the important influence of gut microbiota on the physiological effects of nutrition, development of immunity and chronic diseases. However, not all national dietary guidelines consider scientific advances in the study of microbiome. This review examines recent scientific research investigating the association between dietary patterns and gut microbiota as a mediator of the physiological effects of nutrition on the human body. In particular, it presents data from various studies on the influence of food groups on the gut microbiota and their combined effect on the human immune system. The impact of nutrition and microbiota on the development of allergic diseases is also considered. Based on an analysis of current scientific literature on this topic, it can be concluded that research findings in the field of nutrition and microbiome should serve as the basis for understanding the pathogenesis of several non-communicable diseases and be used in clinical dietary guidelines. This may contribute to further improvements and innovations in the field of dietetics, especially in the area of child nutrition. Key words: allergic diseases, pediatric nutrition, immune-supportive diet, gut microbiota, microbiome, short-chain fatty acids, pediatrics, ultra-processed foods
