Associations between Oxidant/Antioxidant Status and Circulating Adipokines in Non-Obese Children with Prader-Willi Syndrome

Oxidative stress is implicated in the pathophysiology of Prader-Willi syndrome (PWS), but there are no data on these disorders in non-obese children with PWS. Therefore, the presented study examined total oxidant capacity (TOC), total antioxidant capacity (TAC), the oxidative stress index (OSI), and adipokine levels in 22 non-obese children with PWS during dietary intervention and growth hormone treatment compared with 25 non-obese healthy children. Serum concentrations of TOC, TAC, nesfatin-1, leptin, hepcidin, ferroportin, and ferritin were determined using immunoenzymatic methods. We found that TOC concentrations were higher by 50% (p = 0.006) in patients with PWS than in healthy children, but no significant differences in TAC concentrations were observed between these groups. The OSI was higher in children with PWS than in the controls (p = 0.002). We found positive associations between TOC values and the percentage of the Estimated Energy Requirement, body mass index (BMI) Z-score, percentage of fat mass, and leptin, nesfatin-1, and hepcidin concentrations in patients with PWS. A positive association was also found between the OSI and nesfatin-1 levels. These observations suggest that higher daily energy intake and weight gain may be accompanied by an increasing prooxidant state in these patients. Adipokines such as leptin, nesfatin-1, or hepcidin may also play a role in the prooxidant state in non-obese children with PWS.

Dietary Intake and Circulating Amino Acid Concentrations in Relation with Bone Metabolism Markers in Children Following Vegetarian and Omnivorous Diets

Scientific studies reported that most vegetarians meet the total protein requirements; however, little is known about their amino acid intakes. We aimed to assess dietary intake and serum amino acid levels in relation to bone metabolism markers in prepubertal children on vegetarian and traditional diets. Data from 51 vegetarian and 25 omnivorous children aged 4–9 years were analyzed. Dietary intake of macro- and micronutrients were assessed using the nutritional program Dieta 5®. Serum amino acid analysis was performed using high-pressure liquid chromatography technique, 25-hydroxyvitamin D and parathormone–electrochemiluminescent immunoassay, and bone metabolism markers, albumin, and prealbumin levels using enzyme-linked immunosorbent assay. Vegetarian children had a significantly lower intake of protein and amino acids with median differences of about 30–50% compared to omnivores. Concentrations of four amino acids (valine, lysine, leucine, isoleucine) in serum varied significantly by diet groups and were lower by 10–15% in vegetarians than meat-eaters. Vegetarian children also had lower (p < 0.001) serum albumin levels compared to omnivores. Among bone markers, they had higher (p < 0.05) levels of C-terminal telopeptide of collagen type I (CTX-I) than omnivores. Correlation patterns between amino acids and bone metabolism markers differed in the vegetarian and omnivore groups. Out of bone markers, especially osteoprotegerin was positively correlated with several amino acids, such as tryptophan, alanine, aspartate, glutamine, and serine, and ornithine in vegetarians. Vegetarian children consumed apparently sufficient but lower protein and amino acids compared to omnivores. In circulation these differences were less marked than in the diet. Significantly lower amino acid intake and serum levels of valine, lysine, leucine, and isoleucine as well as the observed correlations between serum amino acids and biochemical bone marker levels indicated the relations between diet, protein quality, and bone metabolism.

Does a Vegetarian Diet Affect the Levels of Myokine and Adipokine in Prepubertal Children?

Myokines are cytokines secreted by muscle and exert autocrine, paracrine, or endocrine effects. Myokines mediate communication between muscle and other organs, including adipose tissue. The aim of the study was to assess serum myokines and their relationships with adipokines and anthropometric and nutritional parameters in children following vegetarian and omnivorous diets. One hundred and five prepubertal children were examined. Among them there were 55 children on a vegetarian diet and 50 children on an omnivorous diet. Concentrations of myokines (myostatin, irisin) and adipokines (leptin, adiponectin, omentin, visfatin) in serum were determined by enzyme-linked immunosorbent assay (ELISA). We observed comparable median values of serum myokines and adipokines (except of leptin concentration) in both of the studied groups of children. We also found several correlations between myokine and adipokine levels and certain nutritional parameters. Serum myostatin was positively correlated with omentin levels in vegetarians and omnivores (p = 0.002). Serum irisin was positively associated with omentin (p = 0.045) levels in omnivores and inversely with visfatin concentration (p = 0.037) in vegetarians. Myostatin concentration was negatively correlated with the percentage of energy from protein (p = 0.014), calcium (p = 0.046), and vitamin A (p = 0.028) intakes in vegetarians and with dietary vitamin C (p = 0.041) and vitamin E (p = 0.021) intakes in omnivores. In multivariate regression analyses, positive correlations of serum myostatin with omentin levels were revealed in both study groups (β = 0.437, p < 0.001 for vegetarians; and β = 0.359, p = 0.001 for omnivores). Consuming a lacto-ovo-vegetarian diet did not influence serum levels of myokines (myostatin, irisin) and adipokines such as adiponectin, visfatin, and omentin in prepubertal children. However, leptin levels were significantly lower in vegetarians compared with omnivores. The observed significant positive correlations between myostatin and omentin concentrations might suggest tissue cross-talk between skeletal muscle and fat tissue. Further studies, carried out in a larger group of children following different dietary patterns, could be important to fully understand the relations between muscle, adipose tissues, and nutrition.

Dietary patterns in toddlers with excess weight. The 2016 pitnuts study

INTRODUCTION

Children's appropriate dietary pattern determines their optimal development, reduces the risk of childhood diseases and the risk of diet-dependent diseases, including obesity in adulthood.

AIM

To analyze the dietary patterns of children with excess weight aged 1-3 years in comparison with the main components of the safe nutrition model including: the organization of meals (frequency of meals), selection of products (food intake), energy and nutritional value of children's diets.

MATERIAL AND METHODS

The study was carried out in 2016 on a representative nationwide sample of children aged 5-36 months (n=1059). The analysis of dietary patterns covered 173 with excess weight children aged 13-36 months (BMI-z-score >1 SD). Their nutritional status was evaluated based on BMI and its standardisation according to the WHO reference child growth standards for children aged 0-5 years (BMI z-score). The diets of children were assessed using 3-day dietary records. The dietary patterns of the children who were analysed were determined using the cluster analysis (k-means method), including 11 variables concerning average daily intake of main food group products (cow's milk, junior formula, milk products, bread, groats and rice, cereals, cured meats, fats, sugar and sweets, fruits, nectars and juices).

RESULTS

Three clusters of overweight and obese children with different dietary patterns were identified. The diet of children from the first cluster (n=58) was based primarily on junior formula and foods for infants and toddlers. This dietary pattern was defined as the "baby food diet". The second cluster comprised 33 children whose diets were characterised by high consumption of cow's milk and dairy products, as well as cereal products, including bread, groats, rice and breakfast cereals. This dietary pattern was defined the "milk and cereals diet". The third cluster consisted of 82 children whose dietary pattern was characterised by high consumption of bread, cold meats and fats, sweets, juices and fruits (the "sandwich and sugar diet"). In all the clusters the average intake of vegetables and fruit by children with excess weight was significantly lower than the recommended amounts. The study showed too high intake of energy, protein, sodium, B vitamins and saccharose and an insufficient supply of calcium, fibre, vitamin D, vitamin E, LCPUFA, iodine and potassium in the children's diet in reference to nutritional recommendations. Younger children with the "baby food diet" pattern, due to the contribution of enriched food, had a more balanced diet in relation to the model of safe nutrition (nutritional norms). Older children's diets - in the third year of life, were characterized by a diversified choice of products that are a source of protein and carbohydrates (milk, breakfast cereals, meat, bread, cold meats, sugar from beverages, dairy desserts and juices).

CONCLUSION

The identified dietary patterns of toddlers with excess weight differ from the safe nutrition model in terms of product selection and nutrient profile.

Dietary Patterns of Children Aged 1-3 Years in Poland in Two Population Studies

BACKGROUND

The levels of nutrition that children receive in their first years of life greatly determine their psychosomatic development.

AIM

The study was to identify dietary patterns of children aged 1-3 years based on data on food consumption structure from 2 population studies performed in Poland (2011 and 2016) and to assess changes in product selection in the children's diets with respect to their nutritional status.

METHODS

Both studies were performed on nationwide representative samples (2011: n = 400; 2016: n = 612) using questionnaire surveys. Nutritional status was estimated using body weight-to-height z-score. Feeding practices were evaluated based on 3-day dietary/food records, including 1 weekend day.

RESULTS

Four dietary patterns of toddlers were identified and changes in the distribution of these patterns in the population after 5 years were analysed and compared. Diets of children in the second year of life were better balanced in terms of energy and nutritional value owing to young child formula content. Diets of children in the third year of life were higher in energy and protein, with a higher percentage of energy derived from saccharose. Diets of all groups of children were deficient in long-chain polyunsaturated fatty acids, vitamin D and potassium but excessive in sodium.

CONCLUSIONS

Over 5 years, the percentage of children on a diet with high intake of formula for young children significantly decreased but increased on a diet with high dairy content. Dietary patterns of toddlers were associated with their weight by height z score and nutrient profile.

Bone status and adipokine levels in children on vegetarian and omnivorous diets

BACKGROUND & AIMS

Measurements of bone mineral density (BMD) reflect bone status but not the dynamics of bone turnover. Biochemical markers, which show global skeletal activity, were validated for the assessment of bone formation and resorption processes. Adipokines also play a significant role in the regulation of bone metabolism.

OBJECTIVE

To assess body composition, bone mineral density, bone turnover markers and adipokine levels in relation to vegetarian and omnivorous diets.

METHODS

The study included 53 vegetarian and 53 omnivorous prepubertal healthy children matched for age and sex (median age 7.0 years). Body composition and BMD were assessed by dual-energy X-ray absorptiometry. 25-hydroxyvitamin D and parathormone levels were measured by chemiluminescence method. Serum carboxy-terminal propeptide of type I collagen (CICP), total osteocalcin (OC) and its forms carboxylated (c-OC) and undercarboxylated (uc-OC), C-terminal cross-linking telopeptide of collagen type I (CTX), leptin and adiponectin levels were determined using immunoenzymatic assays.

RESULTS

Both groups of children were comparable in terms of body composition, except for the percentage of fat mass, which was lower (19.24 vs. 21.77%, p = 0.018) in vegetarians. Mean values of total BMD z-score and lumbar spine BMD z-score were lower (-0.583 vs. -0.194, p = 0.009 and -0.877 vs. -0.496, p = 0.019, respectively) in vegetarians compared with omnivores. Serum leptin level was about 2-fold lower (1.39 vs. 2.94 ng/mL, p < 0.001) in vegetarians, however, adiponectin concentration was similar in both groups. Vegetarians had similar concentration of 25-hydroxyvitamin D, but higher parathormone (40.8 vs. 32.1 pg/mL, p = 0.015) and CTX (1.94 vs. 1.76 ng/mL, p = 0.077) levels than omnivores. Total osteocalcin and CICP concentrations were comparable in both groups, however, c-OC/uc-OC ratio was higher (1.43 vs. 1.04 ng/mL, p < 0.05) in vegetarians. We found positive correlation between c-OC and nutritional parameters adjusted for total energy intake (plant protein, phosphorus, magnesium and fiber intakes) in vegetarian children.

CONCLUSIONS

Prepubertal children on a vegetarian diet had significantly lower total and lumbar spine BMD z-scores, but absolute values of bone mineral density did not differ. BMD z-scores did not correlate with bone metabolism markers and nutritional variables, but were positively associated with anthropometric parameters. Lower leptin levels in vegetarian children reflect lower body fat. Longitudinal studies are necessary to evaluate the impact of the observed association on bone health at adulthood.

Serum Hepcidin and Soluble Transferrin Receptor in the Assessment of Iron Metabolism in Children on a Vegetarian Diet

The aim of this study was to assess the effect of vegetarian diet on iron metabolism parameters paying special attention to serum hepcidin and soluble transferrin receptor (sTfR) concentrations in 43 prepubertal children (age range 4.5-9.0 years) on vegetarian and in 46 children on omnivorous diets. There were no significant differences according to age, weight, height, and body mass index (BMI) between vegetarian and omnivorous children. Vegetarians had similar intake of iron and vitamin B₁₂ and a significantly higher intake of vitamin C (p < 0.05) compared with non-vegetarians. Hematologic parameters and serum iron concentrations were within the reference range in both groups of children. Serum transferrin levels were similar in all subjects; however, ferritin concentrations were significantly (p < 0.01) lower in vegetarians than in omnivores. In children on a vegetarian diet, median hepcidin levels were lower (p < 0.05) but sTfR concentrations significantly higher (p < 0.001) compared with omnivorous children. In the multivariate regression model, we observed associations between hepcidin level and ferritin concentration (β = 0.241, p = 0.05) in the whole group of children as well as between hepcidin concentration and CRP level (β = 0.419, p = 0.047) in vegetarians. We did not find significant associations with concentration of sTfR and selected biochemical, anthropometric, and dietary parameters in any of the studied groups of children. As hematologic parameters and iron concentrations in vegetarians and omnivores were comparable and ferritin level was lower in vegetarians, we suggest that inclusion of novel markers, in particular sTfR (not cofounded by inflammation) and hepcidin, can better detect subclinical iron deficiency in children following vegetarian diets.

Dietary patterns in toddlers with excess weight. The 2016 pitnuts study

INTRODUCTION

Children's appropriate dietary pattern determines their optimal development, reduces the risk of childhood diseases and the risk of diet-dependent diseases, including obesity in adulthood.

AIM

To analyze the dietary patterns of children with excess weight aged 1-3 years in comparison with the main components of the safe nutrition model including: the organization of meals (frequency of meals), selection of products (food intake), energy and nutritional value of children's diets.

MATERIAL AND METHODS

The study was carried out in 2016 on a representative nationwide sample of children aged 5-36 months (n=1059). The analysis of dietary patterns covered 173 with excess weight children aged 13-36 months (BMI-z-score >1 SD). Their nutritional status was evaluated based on BMI and its standardisation according to the WHO reference child growth standards for children aged 0-5 years (BMI z-score). The diets of children were assessed using 3-day dietary records. The dietary patterns of the children who were analysed were determined using the cluster analysis (k-means method), including 11 variables concerning average daily intake of main food group products (cow's milk, junior formula, milk products, bread, groats and rice, cereals, cured meats, fats, sugar and sweets, fruits, nectars and juices).

RESULTS

Three clusters of overweight and obese children with different dietary patterns were identified. The diet of children from the first cluster (n=58) was based primarily on junior formula and foods for infants and toddlers. This dietary pattern was defined as the "baby food diet". The second cluster comprised 33 children whose diets were characterised by high consumption of cow's milk and dairy products, as well as cereal products, including bread, groats, rice and breakfast cereals. This dietary pattern was defined the "milk and cereals diet". The third cluster consisted of 82 children whose dietary pattern was characterised by high consumption of bread, cold meats and fats, sweets, juices and fruits (the "sandwich and sugar diet"). In all the clusters the average intake of vegetables and fruit by children with excess weight was significantly lower than the recommended amounts. The study showed too high intake of energy, protein, sodium, B vitamins and saccharose and an insufficient supply of calcium, fibre, vitamin D, vitamin E, LCPUFA, iodine and potassium in the children's diet in reference to nutritional recommendations. Younger children with the "baby food diet" pattern, due to the contribution of enriched food, had a more balanced diet in relation to the model of safe nutrition (nutritional norms). Older children's diets - in the third year of life, were characterized by a diversified choice of products that are a source of protein and carbohydrates (milk, breakfast cereals, meat, bread, cold meats, sugar from beverages, dairy desserts and juices).

CONCLUSION

The identified dietary patterns of toddlers with excess weight differ from the safe nutrition model in terms of product selection and nutrient profile.

Polish Adaptation And Validation Of The Physical Appearance Comparison Scale (Pacs) - An Analysis Among Young People In Late Adolescence In The Context Of Obesity

INTRODUCTION

The PACS scale is a tool which is widely used in foreign studies to evaluate the tendency towards appearance comparisons in social situations. People inclined to make such comparisons reveal a higher level of dissatisfaction with their body and a higher inclination towards problem eating.

PURPOSE OF THE STUDY

The main purpose of the study was to adapt the PACS scale. A factor structure assessment and reliability analysis of the Polish version was carried out. The correlation between PACS and pubertal development indicators, the body mass index and psycho-social factors and eating behaviours were evaluated as part of the validity analysis.

MATERIAL AND METHODS

The data were derived from the Internet-based study of problem eating behaviours conducted by the Institute of Mother and Child during the 2014/2015 school year. The analyses covered 1285 second grade upper secondary school students (47.2% boys). The mean age was 17.59 years (SD=0.39). An exploratory and confirmatory factor analysis of the PACS questionnaire was performed. Using the Kruskal-Wallis test or the Pearson's r correlation, the association between (PACSPL) and perceived pubertal timing, BMI, the body image (BIS), self-perception of body mass, self-esteem (RSES), self-esteem in social relations (SPPA-SSE), problem eating behaviours (TFEQ-13) were evaluated. The linear regression method was used to estimate the impact of PACS-PL on selected variables in the BMI groups in order to investigate of the moderation effect.

RESULTS

The shortened 3-item Polish version of the scale (PACS-PL) was considered optimal. It is characterized by high reliability (Cronbach's α=0.868), and the main factor explains 79.1% of the variance of the scale results. The model also shows high values of fit indicators: χ2 = 1.144 (df=1, p=0.285), GFI=0.999, AGFI=0.996, CFI=1.000, NFI=0.999, TLI-1.000, RMSEA=0.011. Girls display a stronger tendency to compare their appearance with others. The PACS-PL scale demonstrates the expected correlations with developmental, psycho-social and behavioural factors, this correlation being stronger among girls. It was also shown that the PACS-PL index is a stronger predictor of dissatisfaction with the body and lower self-esteem in the group of obese adolescents.

CONCLUSIONS

The Polish version of the scale, PACS-PL, is a reliable and valid tool for evaluating the tendency to compare one's appearance with others in late adolescence. The subject of social comparison ought to become an element of prevention activities associated with acceptance of one's body and selfesteem, especially among young people with excess body weight.

Nutrition of infants and young children in Poland - Pitnuts 2016

The study evaluating the feeding practices and the nutritional status of children aged 5 to 36 months in a general, Polish, representative population (n=1059) was carried out from May to July 2016. The aim of this study was to evaluate the feeding practices in children aged 5 to 36 months with regard to models of safe nutrition on the basis of the outcome of the population study performed in 2016. The data obtained show that the feeding practices in children in their first year of life do not meet the guidelines presented in the model of safe nutrition, particularly in matters of timing of complementary feeding introduction and food choice. The analysis of nutrient profile in toddlers' diets indicated the differentiated energy and protein intake is significantly higher than population norms (EAR/AI). It is necessary to modify the nutrition of infants and young children through a better selection of products. Nutritional practice should always be monitored and modified according to the model of safe nutrition as part of medical nutritional counselling. More educational efforts are required to increase the awareness of the relation between the diet and nutritional status of young children among healthcare professionals.

Profiles of selected nutrients affecting skin condition in children with atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammation of the skin recognised to be one of the first clinical signs of allergy. In the first years of life, epidemiological evidence has demonstrated that common causative foods of a child's diet are: cow's milk, hen's eggs, wheat and soya. Children with AD being treated with elimination diets are at risk of nutritional deficiencies that include those nutrients required for ensuring proper skin structure and function.

OBJECTIVES

The aim of the study was to assess dietary intake of nutrients which affect skin condition in children with AD being treated with a milk-free diet.

MATERIAL AND METHODS

Subjects were 25 children aged 4-6 years with AD undergoing the milk exclusion diet and 25 age-matched healthy controls. The energy and nutritional value of diets were evaluated that included those components affecting skin condition; ie. vitamins A, D, E, B2 and C; minerals iron (Fe) and zinc (Zn); polyunsaturated fatty acids (PUFAs). The Dieta 5.0 programme was used for dietary assessment and outcomes were then related to dietary recommendations.

RESULTS

There were no significant differences between groups in mean energy values and mean intakes of protein, fats and carbohydrates (p>0.05). The percentage of subjects with low energy value were 44% and 36% in respectively Groups I and II. Deficiencies of fat intake were observed in 60% in Group I and 44% in Group II. There were however no risks in the dietary intakes of protein, carbohydrate, vitamins A, B2 and C nor of Fe and Zn. Deficiencies of dietary intakes were observed in respectively Groups I and II in the following; vitamin E (24% vs 64%), vitamin D (36% vs 92%), linoleic acid (36% vs 72%), α-linolenic acid (36% vs 40%) and long chain PUFAs (96% in both groups).

CONCLUSIONS

Ensuring recommended dietary supply of those nutrients affecting skin condition is required for both groups of children. Children with AD had better balanced diets in respect of the studied nutrients that may reflect the influence of continuous healthcare received from physicians and dieticians.

Dietary intake of vitamin D in obese children aged 1-3 years

BACKGROUND

Obese children are predisposed to vitamin D deficiency. Most of the findings suggest that requirement for vitamin D is increased in obese children due to this vitamin sequestration in adipose tissue.

OBJECTIVE

The aim of the study was to evaluate dietary intake of vitamin D in children with simple obesity in relation to nutritional standards.

MATERIALS AND METHODS

The study included 73 children aged 1-3 years: 38 with simple obesity (group I) and 35 non-obese ones (group II - control). The inclusion criterion for the obese group was BMI z-score > +2.0, for the control group BMI z-score between -1.0 and +1.0.The intake of vitamin D was estimated using the Dieta 5.0 software on the basis of 3-days dietary record. Outcomes were related to nutritional standards. Differences in intake of energy and nutrients between both groups were assessed using the Mann-Whitney test (statistical significance was set at p = 0.05).

RESULTS

Vitamin D intake in both groups was below the nutritional standards (10 μg/400 IU). Median values / interquartile ranges of results were 2.0 / 1.3-5.9 μg and 4.0 / 1.1-7.6 μg daily, for obese and non-obese children, respectively. The risk of deficient vitamin D intake was observed in 94.7% of obese children and in 82.4% of control group. The main dietary source of vitamin D in both groups was growing-up milk/Junior formula. The median intake of energy, protein, fat and carbohydrates in the obese children were significantly higher than in the control group (p<0.05).

CONCLUSIONS

In obese children aged 1-3 years adequate dietary intake of vitamin D was not achieved. Similarly, the intake of vitamin D by normal weight children was lower than recommended. Consequently, it is necessary to provide products rich in vitamin D in the diet of toddlers, particularly obese.

Biochemical markers of bone metabolism in children with cow's milk allergy

INTRODUCTION

Patients with cow's milk allergy (CMA) and following a cow milk protein-free diet for a long time are potentially at risk of developing bone abnormalities. To assess the balance between bone formation and resorption processes, we determined serum concentrations of osteocalcin (OC), bone alkaline phosphatase (BALP), C-terminal telopeptide of type I collagen (CTX), fetuin-A, osteoprotegerin (OPG) and receptor activator of nuclear factor κB ligand (RANKL) in children with CMA.

MATERIAL AND METHODS

The study included 50 prepubertal children with diagnosed cow's milk allergy, who were under systematic medical and nutritional care at the Institute of Mother and Child and 40 healthy counterparts as a control group. The concentrations of bone metabolism markers were determined by immunoenzymatic assays.

RESULTS

The diets of all investigated children were correct in terms of phosphorus and magnesium contents but deficient in terms of calcium and vitamin D. Serum OC and CTX as well as fetuin-A concentrations were similar in both studied groups. The BALP activity was significantly (p < 0.05) higher in children with cow's milk allergy than in the controls. Serum OPG concentration was comparable in both groups, but the RANKL level was higher (p < 0.05) in CMA children than in healthy ones. Hence, the ratio of OPG/RANKL was lower in children with CMA.

CONCLUSIONS

Our study demonstrates slight disturbances in the profile of bone metabolism markers in growing children with CMA. The increase in RANKL level and decrease in OPG/RANKL ratio may contribute to intensification of bone resorption in these patients.

Assessment of vitamin D status in children aged 1-5 with simple obesity

BACKGROUND

Proper vitamin D intake is important due to its pleiotropic effect. It seems that obese population is a groups at risk of the vitamin D deficiency.

OBJECTIVE

To assess the vitamin D status in 1-5-year-old children with simple obesity.

MATERIALS AND METHODS

The study included 100 children: classified according to their body mass index (BMI) as obese - Group I (n=50) and non-obese - Group II (n=50). Their serum 25-hydroxyvitamin D (25(OH)D) concentrations were determined in the spring-summer and autumn-winter seasons and vitamin D intake (diet/supplements) was assessed. The study results were statistically analysed by means of Statistica 10PL.

RESULTS

In Group I the mean serum 25(OH)D level was 23.6±10.8 ng/ml, while in Group II it reached 26.6±9.8 ng/ml (p=0.08). The concentration ≤30 ng/ml was observed in 80% of children in Group I and in 70% of Group II. In autumn- winter and spring-summer period, respectively, 88.5% and 70.9% of the obese children had an insufficient vitamin D status (p=0.002). The mean daily intake of vitamin D was 128 IU (3.2 µg) in Group I and 188 IU (4.7 µg) in Group II.

CONCLUSIONS

Children aged 1-5 (obese and non-obese) are a group at risk of the vitamin D deficiency, as a consequence of its insufficient intake and the lack of appropriate supplementation. Those particularly exposed to that risk are obese children in the autumn-winter season. Children aged 1-5 should be monitored with regard to their vitamin D status.

KEY WORDS

vitamin D, obesity, children, obese children, vitamin D deficiency.

Serum concentrations of sclerostin and bone turnover markers in children with cow's milk allergy

THE AIM

of this study was to assess concentrations of sclerostin and biochemical markers of bone metabolism in children with cow's milk allergy.

MATERIAL AND METHODS

The study included 45 children (age range 2-6 years) with diagnosed cow`s milk allergy, who were on a dairy-free diet and under systematic medical and dietary control at the Institute of Mother and Child in Warsaw. The control group consisted of 40 healthy children (2-6 years), who did not have any symptoms of cow`s milk allergy nor any diseases influencing bone metabolism. Their diets included milk and dairy products. Dietary intake of macro- and micronutrients was assessed based on 3-day records using the Dietetyk2® nutritional program. In the serum samples, we measured concentrations of calcium, phosphate and total alkaline phosphatase by standard methods, 25-hydroxyvitamin D3 by chemiluminescence method and bone metabolism markers by immunoenzymatic methods. The Statistica (version 10.0) computer software was used for statistical analysis.

RESULTS

The nutritional status of studied children based on BMI value was normal. In all patients, the average daily value of dietary energy and percentage of energy from protein, fat and carbohydrates were consistent with the recommended values. The intake of calcium in the diets of all children was deficient, however, the intake of vitamin D was consistent with recommendations in the children with allergy, while in the healthy children it was below the recommended values. Mean serum concentrations of calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D3, osteocalcin and C-terminal telopeptide of type I collagen were similar in both studied groups. We observed significantly lower sclerostin levels in children with cow`s milk allergy (0.295±0.116 ng/ml) than in the healthy children (0.353±0.126 ng/ml) (p<0.05). The ratio of cytokines RANKL/OPG (receptor activator of nuclear factor κB ligand/osteoprotegerin) was significantly higher in children with allergy compared with their healthy counterparts (p<0.05).

CONCLUSIONS

Basic laboratory parameters related to bone turnover in children with cow`s milk allergy, who were under medical and nutritional care, were normal. Reduced levels of sclerostin and increased ratio of cytokines RANKL/OPG may suggest disturbances in the balance between bone formation and bone resorption in these patients. Further research is needed on bone metabolism in children with food allergy, who due to the use an elimination diet may be at risk of developing abnormalities in the skeletal system.

[Vitamin D status in children with cow's milk allergy]

Children treated with a dairy-free diet are in a group of those at risk of nutritional deficiencies, including vitamin D deficiency.THE AIM of this study was to evaluate the vitamin D status in children with cow's milk allergy (CMA) treated with a dairy-free diet.

MATERIAL AND METHODS

The study involved 66 children with CMA, aged 2-5 years (mean age 3.9±1.9 yrs). The children were treated with a milk-free diet (high degree of protein hydrolysates or soy formulas/soy products) and remained under the care of the medical and nutritional team. The majority of the children lived in urban areas and their parents have mainly secondary or higher education. The supply of vitamin D in children's daily food rations was evaluated and related to Adequate Intake (AI) as well as the recommendations contained in the Medical Standard (2009) for the prophylaxis of vitamin D deficiency. Fifteen (22.7%) children in the autumn-winter season used vitamin D containing supplements. The serum 25-hydroxyvitamin D [25(OH)D] concentration was measured and related to the recommended levels from Medical Standard (2009). Taking into consideration the possibility of seasonal differences in vitamin D status, blood samples for the 25(OH)D assay were collected from April to September (spring-summer season) in 34 (51.5%) children and from October to March (autumn-winter season) in 32 (48.5%) children.

RESULTS

The mean supply of vitamin D in the diets of the children with CMA was 5.9±3.7 μg/d. The mean supply of vitamin D in supplements in the group of children receiving them was 143.6±132.9 IU/d [3.6±3.3 μg/d]. The mean 25 (OH)D serum concentration among the children without taking into account the season for blood withdrawal was 28.7±9.9 ng/ml. Taking into account the season of blood sample collection, the mean 25(OH)D serum concentration in children in spring-summer was 30.1±7.8 ng/ml, while in autumn-winter 27.5±11.2 ng/ml, p>0,05. A positive correlation between the supply of vitamin D in the children's diets and 25(OH)D serum concentration (Spearman correlation coefficient r=0.46, p<0,01) was found. The mean supply of vitamin D in the children's diets and the mean 25(OH)D serum concentration did not differ significantly depending on the place of living and the parents' education.

CONCLUSIONS

1. Vitamin D supplied by the diets of the children with CMA remaining under our care was compliant with the Adequate Intake, but lower than the recommendations contained in the Medical Standard. 2. The serum 25(OH) D concentration in these children in the spring-summer as well as autumn-winter season indicated the optimal vitamin D status. 3. Being under constant medical and nutritional care is one of the conditions for an appropriate vitamin D supply in children with CMA.

[The evaluation of selected parameters of calcium and phosphorus metabolism in children with cow's milk allergy]

THE AIM of this study was to evaluate selected parameters of calcium and phosphorus metabolism in children with CMA treated with the following milk substitute formulas: lactose-containing extensively hydrolyzed wheat protein formula, lactose-free extensively hydrolyzed casein protein formula, as well as soy-based formula.

MATERIAL AND METHODS

The study involved 66 children with CMA aged 2-5 years treated with milk-free diet for at least one year. Group I included 31 children fed with a lactose-containing formula, group II - 35 children treated with lactose-free formula. In all children the mean energy intake and nutritional value of daily food rations were assessed. Serum concentrations of calcium (Ca), phosphorus (P), sodium (Na) and magnesium (Mg) were determined using standard methods. Serum values of 25 hydroxyvitamin D (25-OH D) and parathormone (PTH) were assessed by chemiluminescence, whereas concentrations of biochemical markers of bone formation-bone alkaline phosphatase (BALP), osteocalcin (OC) and bone resorption marker-collagen type I crosslinked C-telopeptide (CTX) were determined by immunoenzymatic methods (ELISA), using specific monoclonal antibodies.

RESULTS

There were no significant differences in the mean dietary supply of calcium, phosphorus, magnesium, sodium, total protein and vitamin C in children from both groups. In the diets of children from group II, the mean content of lactose (0.5±1.0 vs 10.0±6.8 g/d) and 25-OH vitamin D (4.1±2.3 vs 8.5±4.0 ug/d) were significantly lower and dietary fibre content (14.7±3.9 vs 10.4±3.9 g/d) was higher. Calcium and vitamin D dietary supply was lower with respect to nutritional recommendations in all the studied children, whereas the dietary deficiency of vitamin D was higher in children from group II. The mean serum concentrations of evaluated biochemical parameters did not reveal any differences in children from the study groups and were in the normal ranges. There were also no differences in the mean serum concentration of 25-OH vitamin D, ALP, BALP, CTX and PTH in patients from both groups. The mean concentration of OC was significantly higher in group II (71±26.6 ng/ml) than in children from group I (61.1±23.4 ng/ml) <0.01. Positive correlation was found between OC and CTX in both study groups.

CONCLUSIONS

1. In children with CMA basic blood laboratory tests may have limited importance in the evaluation of calcium and phosphorus metabolism. 2. Our results suggest that the disturbances in the balance between bone formation and bone resorption processes may occur in children with CMA treated with lactose-free formulas. 3. In order to assure optimal conditions for achieving adequate bone mass by children with CMA, it is necessary to provide them with regular medical and nutritional care.

Analysis of nutrition of children aged 13-36 months in Poland: a nation-wide study

AIM

The aim of the study was to analyse the diets of children aged 13-36 months in Poland compared to nutritional recommendations.

MATERIAL AND METHODS

The questionnaire study was conducted between June and September 2010 on a representative, nation-wide sample of children aged 13-36 months. The study concerned 400 children from across Poland. They were selected by means of drawing their PESEL (personal identity) number. The nutritional status of children was assessed using anthropometric data, i.e. their current weight and height. The relative body mass index BMI (kg/m2) and the BMI z-score were calculated for each child and compared with the WHO child growth standards. The diets of children were assessed using an original questionnaire with 3-day diet records. Nutritional value was calculated using Dieta 4.0 computer programme.

RESULTS

The study demonstrated that 45.5% of children were in the normal BMI z-score range (from -1.0 to +1.0). Underweight children accounted for 12.5% (BMI z-score between -2.0 and -1.0) and severely underweight for 14.5% (BMI z-score < -2.0) of the studied group. The share of overweight and obese children was 14.5% and 13.0%, respectively. Large individual variation in food intake was observed in diets of the children. The intake of cereal products, meat, poultry and cold meats in daily diets was twice higher than recommended. The children ate significantly less vegetables and fruits and drank less milk and fermented milk beverages than recommended in model food rations. Energy and nutritional value of an average daily food ration differed considerably from the standards for majority of nutrients. The intake of proteins was three times higher than the current norms.

CONCLUSIONS

The diets of children aged 13-36 months differed from current recommendations but the nutritional status evaluated based on BMI was normal in 45.5% of children from the analysed group. The content of majority of macronutrients, in particular protein, in average daily food rations was incompliant with nutritional norms, which in long term may increase the risk of diet-related diseases. Current nutritional recommendations concerning the diets of children in the post-infancy period need to be verified and disseminated.

[Effect of vitamin D supplementation on serum 25-hydroxyvitamin D and bone turnover markers concentrations in vegetarian children]

PURPOSE

Vitamin D plays a key role in bone mineralization by regulating calcium and phosphate metabolism. Deficiency of this vitamin may lead to disturbances in bone metabolism as well as to osteopenia and osteoporosis.

AIM

1. Assessment of daily intake of calcium and vitamin D in children on vegetarian diet. 2. Measurement of serum 25-hydroxyvitamin D and biochemical bone turnover markers levels in vegetarian children supplemented with calcium and vitamin D, before and after the intervention.

MATERIAL AND METHODS

We examined 35 prepubertal children on vegetarian diet who were divided into two groups: group A (without supplementation) and group B in which the children received daily 400 IU vitamin D3 and 500 mg calcium. Total serum calcium, phosphate, 25-hydroxyvitamin D and bone turnover markers were measured at start and end of the intervention.

RESULTS

Concentration of calcium and phosphate in serum of all tested children were within physiological range. The mean value of 25-hydroxyvitamin D at start of supplementation was low in both the vitamin D-treated group and in the controls (about 19 ng/ml). After 4-months supplementation, the vitamin D level was significantly higher in the vitamin D-treated group (38.3+/-8.5 ng/ml) than in the control group (13.7+/-5.3 ng/ml) (p<0.001). No statistically significant differences in bone formation (osteocalcin) and resorption (carboxy-terminal telopeptide of type I collagen, isoenzyme 5b of tartrate-resistant acid phosphatase) markers were observed.

CONCLUSIONS

The presented results indicate that in vegetarian children the daily dietary intake of vitamin D in the winter months is not sufficient to maintain adequate serum vitamin D concentration. Vitamin D daily supplementation increases vitamin D concentration in these individuals to the required levels.

[Dietary assessment of pregnant women--vitamin and mineral supplementation--justified or not?]

The aim of the study was to assess the dietary intake of energy and nutrients of pregnant women in the Outpatient Clinic of Obstetrics and Gynecology of National Research Institute of Mother and Child in Warsaw. The nutrient intake, the average daily food rations and their nutritional value were evaluated on the basis of recall and record of 7-days menus. The average daily food intake was compared to the recommendations for the first and second half of pregnancy. It was found, that 44% of women changed dietary habits during pregnancy. The nutritional value of their daily food intake was closer to recommendations in the first half of pregnancy than in the second half. The food intake of pregnant women with supplementation (S-group) and taking placebo (NS-group) were also compared. In the first half of pregnancy the average food intake of women from S-group and NS-group was similar. In the second half of pregnancy the nutrient intake of S-group women was closer to recommendations than in the second group. However the deficiency of certain B vitamins and microelements (calcium, iron, zinc, magnesium) occurred in both groups. The intake of vitamin A, sodium and phosphorus exceeded the recommendations. The results of the study support the need of supplementation in the pregnant women diets with microelements and vitamins.

[Vegetarian diets of breastfeeding women in the light of dietary recommendations]

The literature review concerning selected nutritional and health aspects of applying different vegetarian diets by breastfeeding women was presented. The only two types of vegetarian diets: lactoovo- and semi-vegetarian, when properly composed, seem to be relatively safe for mother and her child. The most threatening vegetarian diets for lactating women are those including exclusively products of plant origin (so called restricted diets: vegan or macrobiotic). The results of studies performed on mothers consuming these vegetarian diets showed deficiencies in: vitamin B12 and vitamin D (in mothers and their infants) and calcium (only in lactating women). The low intake of docosahexaenoic acid (DHA) was also characteristic in this group. Additionally the endogenous metabolism of DHA is inhibited due to high proportion of linoleic vs. linolenic acid intake. It considered that lactating women on vegetarian diet should have a greater nutritional knowledge in order to avoid deficiencies which would adversely affect mother's and her child's health.

[Nutrition of preschool age children. General considerations and assessment of child nutrition]

Results of the study performed between June 1999 and January 2000 on dietary assessment of 822 pre-school children (age 3-7) showed that majority of children regularly consumed the main meals: breakfast, dinner and supper. The habit of snacks eating between the meals was observed in 91% of children. The presence and structure basic products in analysed children diets (milk, fermented milk products, fats, fish, whole grain bread, juices) was different. About 87% reported drinking of milk, 75%--yoghurt or other fermented milk products, 97%--fruit juices including nectar, water--42%. The main fat used to spreading on bread was butter. Fish products recommended as a source of n-3 polyunsaturated fatty acids were still not eaten by 23% of children. Whole grain bread was consumed daily only in 8% children. The study also showed that the diets included products being the source of unfavourable fatty acids (chips, sweet bars, cookies, hard margarine) and excess of saccharose (sweets, lollipops, chewing gum). The results of the study showed the permanent need of the dissemination of dietary recommendations for children at pre-school age.

[Evaluation of a diet and nutritional status of breast feeding women on the basis of a questionnaire study]

The subjects were 120 breast-feeding mothers whose children were admitted for outpatient or inpatient treatment at the Institute of Mother and Child in Warsaw, between March, 1998 and July, 1999. A special nutritional questionnaire was elaborated with the aim to evaluate subjects' nutritional status as well as their diet. All subjects completed the questionnaire and then selected parameters of their nutritional status and diet were evaluated. For 43 of the women under study it was the first month of lactation, for 33--the fourth month, for 23--the sixth and 21 women had been breast-feeding for more then six months. The subjects were of different age, coming from both urban and rural areas. In the studied group the nutritional status, i.e. body mass indices (BMI) before pregnancy, at the end of pregnancy and during lactation were within the normal range. 65 of the subjects had changed their diet due to pregnancy and 52 due to lactation. Women declared to be used to eating 3-4 meals per day. Having additional snacks was declared by 62.5%. Liquids' intake was on average about 2.5 l/24 hr, range 2-31. Average daily energy intake--2938 kcal/12,980 kJ, the lowest--in a diet of a mother with diabetes, the highest--in a diet of a vegetarian mother. The proportion of protein in energy intake was 15.1%, whereas fat--36.3%. Dietary practices of women under study in the period of lactation were well adjusted to nutritional recommendations for this group, as evidenced by indices of nutritional status (i.e. BMI). Among 120 women, 71 were taking supplementary preparations of vitamins and minerals. It turned out that a level of some vitamins in a daily food intake together with supplementation was definitely too high.