1
|
Crawley C, Sander SD, Nohr EA, Nybo Andersen AM, Husby S. Early environmental risk factors and coeliac disease in adolescents: a population-based cohort study in Denmark. BMJ Open 2023; 13:e061006. [PMID: 38011980 PMCID: PMC10685961 DOI: 10.1136/bmjopen-2022-061006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 10/19/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Our aim was to investigate the association between early environmental factors and the development of coeliac disease (CeD) in adolescents, recruited from a cohort nested in the Danish National Birth Cohort (DNBC). DESIGN The study was designed as a prospective cohort study, nested in DNBC PARTICIPANTS: The Glutenfunen cohort comprises 1266 participants, nested in DNBC. All participants were screened for CeD, and in total, 28 cases of biopsy proven CeD were identified. Data about breastfeeding, timing of introduction to solid food in infancy, use of antibiotics, infections and symptoms were parentally reported prospectively at 6 months and 18 months, respectively. We estimated ORs and 95% CIs of CeD in adolescents using logistic regression analysis. RESULTS Viral croup reported at 18 months of age was associated with CeD in adolescents with an OR of 3.2 (95% CI: 1.2 to 8.7). Furthermore, otitis media also reported at 18 months of age was linked with CeD with an OR of 3.2 (95% CI: 1.5 to 7.3). We were not able to find any statistical associations between CeD and breastfeeding, frequency of infections, parentally reported use of antibiotic and timing of solid foods. CONCLUSION In this study, we present an overview of the relationship between early environmental factors and occurrence of CeD in adolescents. Our findings, despite limitations due to a limited number of cases of CeD, suggest a role of viral infections in the pathogenesis of CeD.
Collapse
Affiliation(s)
- Cæcilie Crawley
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Hans Christian Anderson Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Ellen Aagaard Nohr
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Research Unit of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | | | - Steffen Husby
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Hans Christian Anderson Children's Hospital, Odense University Hospital, Odense, Denmark
| |
Collapse
|
2
|
Sparre S, Zachariassen G, Ellebæk MB, Husby S, Holm KG. Feeding Practice, Nutrition, and Growth in Infants with Abdominal Wall Defects and Esophageal Atresia: A Retrospective Case-Control Study. Eur J Pediatr Surg 2023; 33:367-376. [PMID: 36588282 DOI: 10.1055/s-0042-1757360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Infants born with abdominal wall defects and esophageal atresia (EA) are at risk of impaired growth. Little is known about the optimal nutritional strategy and its impact on growth for these infants. This study aims to explore nutrition, focusing on breastfeeding, and the presumed impact on infant growth during the first year of life. MATERIALS AND METHODS We performed a registry study. The participants comprised infants born with gastroschisis, omphalocele, or EA from 2009 to 2020. Breastfed healthy infants from the Odense Child Cohort served as the control group. Descriptive statistics were applied when presenting data on nutrition. Growth data were converted to weight z-scores at birth and at discharge, and estimated weight z-scores at 6 and 12 months were calculated. Univariate regression analysis was applied. RESULTS The study included 168 infants in the study group and 403 infants in the control group. Exclusive breastfeeding rates at discharge were as follows: 55.7% (gastroschisis), 58.3% (omphalocele), 50.9% (EA), and 7.7% (long-gap EA). For the study group our data demonstrate no difference in growth at 1 year of age when comparing mother's milk to formula feeding. During the first year of life, infants in the study group showed slower growth compared with the control group. At 12 months of age, all infants had a mean weight z-score above -2. CONCLUSION Breastfeeding in infants with abdominal wall defects and EA can be established without compromising growth. Mother's milk can be recommended for infants with abdominal wall defects and EA.
Collapse
Affiliation(s)
- Signe Sparre
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
- Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
| | - Mark Bremholm Ellebæk
- Surgical Research Unit, Odense University Hospital, Odense C, Denmark; University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Kristina Garne Holm
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
- Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
| |
Collapse
|
3
|
Husby S, Murrary J. Comment on the 2023 ACG Guideline for Celiac Disease. Am J Gastroenterol 2023; 118:1102. [PMID: 37260135 DOI: 10.14309/ajg.0000000000002230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
| | - Joseph Murrary
- Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
4
|
Dalby S, Skallerup S, Baun C, Christensen LG, Rathe M, Palner M, Husby S, Moeller JB. PET/CT imaging detects intestinal inflammation in a mouse model of doxorubicin-induced mucositis. Front Oncol 2022; 12:1061804. [PMID: 36591502 PMCID: PMC9798215 DOI: 10.3389/fonc.2022.1061804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction A severe side effect of cancer chemotherapy is the development of gastrointestinal mucositis, characterised by mucosal inflammation. We investigated if 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography combined with computed tomography (2-[18F]FDG-PET/CT) could visualise gastrointestinal mucositis in mice treated with the chemotherapeutic agent doxorubicin. Methods In this study, gastrointestinal inflammation was longitudinally evaluated by 2-[18F]FDG-PET/CT scans before and 1, 3, 6, and 10 days after treatment with doxorubicin. Doxorubicin-treated mice were compared to saline-treated littermates using the abdominal standard uptake value of 2-[18F]FDG corrected for body weight (SUVBW). Results Abdominal SUVBW was significantly increased on day 1 (p < 0.0001), day 3 (p < 0.0001), and day 6 (p < 0.05) in the doxorubicin-treated group compared to controls. Abdominal SUVBW returned to baseline levels on day 10. In the doxorubicin group, the largest weight loss was observed on day 3 (control vs doxorubicin, mean percent of baseline weight: (98.5 ± 3.2% vs 87.9 ± 4.6%, p < 0.0001). Moreover, in the doxorubicin-treated group, villus lengths were decreased by 23-28% on days 1 and 3 in the small intestine (p < 0.05), and jejunal levels of tumour necrosis factor and interleukin-1β were significantly increased on day 3 (p < 0.05). Discussion Together, these findings indicate that sequential 2-[18F]FDG-PET/CT scans can objectively quantify and evaluate the development and resolution of intestinal inflammation over time in a mouse model of doxorubicin-induced mucositis.
Collapse
Affiliation(s)
- Sina Dalby
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sofie Skallerup
- Department of Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Christina Baun
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | | | - Mathias Rathe
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mikael Palner
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Bonnet Moeller
- Department of Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
5
|
Crawley C, Savino N, Husby S. Editorial: lack of gastrointestinal symptoms caused by gluten in patients without coeliac disease-time to ditch the 'gluten' from 'non-coeliac gluten sensitivity'. Authors' reply. Aliment Pharmacol Ther 2022; 56:342. [PMID: 35748842 DOI: 10.1111/apt.16980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Caecilie Crawley
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nadia Savino
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
6
|
Crawley C, Savino N, Husby S. Letter: progressive weakening of the concept that gluten has a detrimental effect on mental health and gut symptoms in the absence of coeliac disease-authors' reply. Aliment Pharmacol Ther 2022; 56:365. [PMID: 35748833 DOI: 10.1111/apt.17051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Caecilie Crawley
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nadia Savino
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
7
|
Crawley C, Savino N, Halby C, Sander SD, Andersen AN, Arumugam M, Murray J, Christensen R, Husby S. The effect of gluten in adolescents and young adults with gastrointestinal symptoms: a blinded randomised cross-over trial. Aliment Pharmacol Ther 2022; 55:1116-1127. [PMID: 35352373 PMCID: PMC9313792 DOI: 10.1111/apt.16914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/17/2021] [Accepted: 03/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The popularity of the gluten-free diet and sales of gluten-free products have increased immensely. AIMS To investigate whether gluten induces gastrointestinal symptoms, measured by self-reported questionnaires, as well as mental health symptoms in adolescents from a population-based cohort. METHODS The eligible participants (n = 273) were recruited from a population-based cohort of 1266 adolescents and had at least four different gastrointestinal symptoms. Phase one (n = 54) was a run-in phase where the participants lived gluten-free for 2 weeks. If they improved they continued to phase 2 (n = 33), a blinded randomised cross-over trial. Participants were blindly randomised either to start with 7 days of gluten, eating two granola bars containing 10 g of gluten or to 7 days on placebo, eating two granola bars without gluten, followed by the reverse and separated by a 7-day washout period. The effects of the intervention on gastrointestinal symptoms and mental health symptoms were assessed. RESULTS In total, 54/273 participants entered the run-in phase and 35 were eligible for randomization. A total of 33 were randomised and 32 completed the trial. The median age was 20.3 (IQR 19.2-20.9) and 32/33 participants were females. Compared with a placebo, gluten did not induce gastrointestinal symptoms. The difference in the average VAS was -0.01 (95% confidence interval -2.07 to 2.05). Nor did we find a difference in the outcomes measuring mental health. CONCLUSION Compared with placebo, adding gluten to the diet did not induce gastrointestinal symptoms or worsened mental health in adolescents recruited from a population-based cohort. The trial registration number is NCT04639921.
Collapse
Affiliation(s)
- Caecilie Crawley
- Hans Christian Andersen Children’s HospitalOdense University HospitalOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Nadia Savino
- Hans Christian Andersen Children’s HospitalOdense University HospitalOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Cecilie Halby
- Hans Christian Andersen Children’s HospitalOdense University HospitalOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | | | | | - Manimozhiyan Arumugam
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Department of Gastroenterology and HepatologyOdense University HospitalOdenseDenmark
| | - Joseph Murray
- Division of Gastroenterology and Hepatology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Robin Christensen
- Section for Biostatistics and Evidence‐Based Research, the Parker InstituteBispebjerg and Frederiksberg HospitalCopenhagenDenmark,Research Unit of Rheumatology, Department of Clinical ResearchUniversity of Southern Denmark, Odense University HospitalOdenseDenmark
| | - Steffen Husby
- Hans Christian Andersen Children’s HospitalOdense University HospitalOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| |
Collapse
|
8
|
Mehlsen A, Høllund L, Boye H, Frederiksen H, Andersson AM, Bruun S, Husby S, Jensen TK, Timmermann CAG. Pregnancy exposure to bisphenol A and duration of breastfeeding. Environ Res 2022; 206:112471. [PMID: 34861228 DOI: 10.1016/j.envres.2021.112471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Bisphenol A (BPA) is frequently used in the production of plastics. It is an endocrine disruptor, and BPA exposure in mice has been associated with reduced offspring growth due to insufficient milk production. However, human studies of associations between BPA exposure and duration of breastfeeding are sparse. METHODS Pregnant women from the Odense Child Cohort (n = 725) donated a third trimester morning urine sample, which was analyzed for BPA by LC-MS/MS. Information about duration of exclusive and any breastfeeding was obtained through questionnaires three and 18 months postpartum, and a subgroup of women responded to weekly text messages about breastfeeding. Associations between pregnancy BPA exposure and duration of breastfeeding were analyzed using Cox regression adjusting for potential confounders. RESULTS The median urine BPA concentration was 1.29 ng/mL. Compared to women within the lowest tertile of BPA exposure, women in the second and third tertile were slightly more likely to terminate breastfeeding at any given time; HRs (95% CI) were 1.05 (0.87; 1.26) and 1.06 (0.89; 1.27), respectively, and to terminate exclusive breastfeeding at any time up to 20 weeks after birth, HRs (95% CI) were 1.07 (0.88; 1.28) and 1.06 (0.88; 1.27), respectively. However, confidence intervals were also compatible with no effect or even a protective effect. DISCUSSION This study indicated that high BPA exposure in pregnancy was associated with shorter duration of breastfeeding. Although our findings were not statistically significant, all estimates were above one suggesting increased risk of early breastfeeding termination with high exposure. Using a single spot morning urine sample to measure BPA has likely caused imprecision as it might not adequately reflect long term exposure. Future studies should consider measuring BPA more than once, including other timepoints during pregnancy and after birth.
Collapse
Affiliation(s)
- Agnethe Mehlsen
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Denmark
| | - Lærke Høllund
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Denmark
| | - Henriette Boye
- Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Denmark; The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Denmark; The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Signe Bruun
- Hans Christian Andersen Children's Hospital, Odense University Hospital and University of Southern, Denmark; Strategic Business Unit Pediatric, Arla Foods Ingredients Group P/S, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital and University of Southern, Denmark
| | - Tina Kold Jensen
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Denmark; Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark; Open Patient Data Exploratory Network (OPEN), Odense University Hospital, Denmark
| | - Clara Amalie Gade Timmermann
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Denmark.
| |
Collapse
|
9
|
Timmermann CAG, Andersen MS, Budtz-Jørgensen E, Boye H, Nielsen F, Jensen RC, Bruun S, Husby S, Grandjean P, Jensen TK. Pregnancy Exposure to Perfluoroalkyl Substances and Associations With Prolactin Concentrations and Breastfeeding in the Odense Child Cohort. J Clin Endocrinol Metab 2022; 107:e631-e642. [PMID: 34529060 PMCID: PMC8764222 DOI: 10.1210/clinem/dgab638] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/14/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Human exposure to perfluoroalkyl substances (PFAS) has been associated with reduced duration of breastfeeding, although not consistently so, and mechanisms by which PFAS might affect breastfeeding are unknown. OBJECTIVE To examine the association between early pregnancy serum-PFAS concentrations and breastfeeding termination and to elucidate the potential role of serum-prolactin concentrations in pregnancy. MATERIALS AND METHODS Pregnant women from the Odense Child Cohort provided blood samples for analysis of 5 major PFAS (n = 1300) and prolactin concentrations (n = 924). They subsequently provided information about the duration of breastfeeding in questionnaires at 3 and 18 months postpartum, and a subgroup also provided breastfeeding information via weekly cell phone text messages. Associations between serum-PFAS concentrations and breastfeeding termination were analyzed using Cox regressions, while linear regression was used to assess associations between serum-PFAS and prolactin concentrations. RESULTS Increased serum concentrations of perfluorooctane sulfonic acid, perfluorooctanoic acid, perfluorononanoic acid, and ∑PFAS were associated with a 16% (95% CI: 4%-30%), 14% (95% CI: 2%-26%), 14% (95% CI: 3%-27%), and 20% (95% CI: 6%-36%), respectively, increased risk of terminating breastfeeding at any given time after childbirth. Serum-PFAS concentrations were not associated with serum-prolactin concentrations. CONCLUSIONS These findings are of public health importance due to the global exposures to PFAS. Because breastfeeding is crucial to promote both child health and maternal health, adverse PFAS effects on the ability to breastfeed may have long-term health consequences.
Collapse
Affiliation(s)
- Clara Amalie Gade Timmermann
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Correspondence: Clara Amalie Gade Timmermann, MSc, PhD, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark.
| | | | | | - Henriette Boye
- Odense Child Cohort, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Flemming Nielsen
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Richard Christian Jensen
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Signe Bruun
- Hans Christian Andersen Children’s Hospital, Odense University Hospital and University of Southern Denmark, Odense, Denmark
- Strategic Business Unit Pediatric, Arla Foods Ingredients Group P/S, Viby J, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children’s Hospital, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Philippe Grandjean
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Tina Kold Jensen
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Odense Child Cohort, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| |
Collapse
|
10
|
Riis SST, Joergensen MH, Rasmussen KF, Husby S, Hasselby JP, Borgwardt L, Brusgaard K, Fagerberg CR, Christesen HT. Transient congenital hyperinsulinism and hemolytic disease of a newborn despite rhesus D prophylaxis: a case report. J Med Case Rep 2021; 15:573. [PMID: 34838142 PMCID: PMC8626963 DOI: 10.1186/s13256-021-03167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background In neonates, rhesus D alloimmunization despite anti-D immunoglobulin prophylaxis is rare and often unexplained. Rhesus D alloimmunization can lead to hemolytic disease of the newborn with anemia and unconjugated hyperbilirubinemia. In past reports, transient congenital hyperinsulinism has been described as a rare complication of rhesus D alloimmunization. Our case report illustrates that rhesus D alloimmunization can result in a pseudosyndrome with severe congenital hyperinsulinism, anemia, and conjugated hyperbilirubinemia, despite correctly administered anti-D immunoglobulin prophylaxis. Case presentation We report of a 36-year-old, Caucasian gravida 1, para 1 mother with A RhD negative blood type who received routine antenatal anti-D immunoglobulin prophylaxis. Her full term newborn boy presented with severe congenital hyperinsulinism, anemia, and conjugated hyperbilirubinemia up to 295 µmol/L (ref. < 9), accounting for 64% of the total bilirubin. Syndromic congenital hyperinsulinism was suspected. Examinations showed a positive direct antiglobulin test, initially interpreted as caused by irregular antibodies; diffuse congenital hyperinsulinism by 18F-DOPA positron emission tomography/computed tomography scan; normal genetic analyses for congenital hyperinsulinism; mildly elevated liver enzymes; delayed, but present bile excretion by Tc99m-hepatobiliary iminodiacetic acid scintigraphy; and cholestasis and mild fibrosis by liver biopsy. The maternal anti-D titer was 1:16,000 day 20 postpartum. Y-chromosome material in the mother’s blood could not be identified. This could, however, not exclude late intrapartum fetomaternal hemorrhage as the cause of immunization. No causative genetic findings were deetrmined by trio whole exome sequencing. The child went into clinical remission after 5.5 months.
Conclusion Our case demonstrates that rhesus D alloimmunization may present as a pseudosyndrome with transient congenital hyperinsulinism, anemia, and inspissated bile syndrome with conjugated hyperbilirubinaemia, despite anti-D immunoglobulin prophylaxis, possibly due to late fetomaternal hemorrhage.
Collapse
Affiliation(s)
- Sandra Simony Tornoe Riis
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Marianne Hoerby Joergensen
- The Paediatric and Adolescent Clinic 4072, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Steffen Husby
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Jane Preuss Hasselby
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lise Borgwardt
- Clinic for Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Klaus Brusgaard
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | | | - Henrik Thybo Christesen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
| |
Collapse
|
11
|
Jørgensen GØ, Favero F, Schmidt Jespersen J, Tulstrup MR, Rodriguez‐Gonzalez FG, Nielsen AF, Sørensen B, Ebbesen LH, Bæch J, Haastrup EK, Nielsen C, Josefsson PL, Thorsgaard M, El‐Galaly TC, Brown P, Weischenfeldt JL, Larsen TS, Grønbæk K, Husby S. CLINICAL IMPACT OF T‐CELL RECEPTOR REPERTOIRE DIVERSITY IN PATIENTS WITH LYMPHOMA UNDERGOING AUTOLOGOUS STEM CELL TRANSPLANTATION. Hematol Oncol 2021. [DOI: 10.1002/hon.1_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - F Favero
- Finsen laboratory Hematology‐Oncology, Rigshospitalet Copenhagen Denmark
| | | | | | | | - A. F Nielsen
- Rigshospitalet Dept. of Clinical Immunology Copenhagen Denmark
| | - B Sørensen
- Aarhus University Hospitalet Clinical Immunology Aarhus Denmark
| | - L. H Ebbesen
- Aarhus University Hospital Clinical Immunology Aarhus Denmark
| | - J Bæch
- Aalborg University Hospital Clinical Immunology Aalborg Denmark
| | - E. K Haastrup
- Rigshospitalet Dept. of Clinical Immunology Copenhagen Denmark
| | - C Nielsen
- Odense University Hospital Dept. of Clinical Immunology Copenhagen Denmark
| | | | - M Thorsgaard
- Aarhus University Hospital Hematology Aarhus Denmark
| | | | - P Brown
- Rigshospitalet Hematology Copenhagen N Denmark
| | - J. L Weischenfeldt
- Finsen laboratory Hematology‐Oncology, Rigshospitalet Copenhagen Denmark
| | - T. S Larsen
- Odense University Hospital Hematology Odense Denmark
| | - K Grønbæk
- Rigshospitalet Hematology Copenhagen N Denmark
| | - S Husby
- Rigshospitalet Hematology Copenhagen N Denmark
| |
Collapse
|
12
|
Andersen MCE, Johansen MW, Nissen T, Nexoe AB, Madsen GI, Sorensen GL, Holmskov U, Schlosser A, Moeller JB, Husby S, Rathe M. FIBCD1 ameliorates weight loss in chemotherapy-induced murine mucositis. Support Care Cancer 2021; 29:2415-2421. [PMID: 32918133 DOI: 10.1007/s00520-020-05762-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Chemotherapy-induced gastrointestinal toxicity is a common adverse event during chemotherapeutic treatment. No uniformly applicable strategies exist to predict, prevent, or treat gastrointestinal toxicity. Thus, a goal of mucositis research is to identify targets for therapeutic interventions and individualized risk prediction. Fibrinogen C domain containing 1 (FIBCD1) is a transmembrane protein expressed in human intestinal epithelial cells with functions in the innate immune system. Previous observations have shown that FIBCD1 ameliorates dextran sulfate sodium (DSS)-induced intestinal inflammation in vivo. We evaluated the effect of FIBCD1 in a murine model of chemotherapy-induced gastrointestinal toxicity and inflammation. METHODS Transgenic (Tg) mice overexpressing FIBCD1 in the intestinal epithelium (Fibcd1Tg) and wild-type (WT) littermates (C57BL/6N) were randomized to receive an intraperitoneal injection of doxorubicin 20 mg/kg or saline and were terminated 2 or 7 days after the injection. Gastrointestinal toxicity was evaluated by weight change, intestinal length, villus height/crypt depth, and histological mucositis score. Expression of inflammatory markers (IL-6, IL-1β, and Tnfα) was measured by quantitative real-time PCR in intestinal tissue samples. RESULTS Following doxorubicin treatment, WT mice exhibited an increased weight loss compared with Tg littermates (p < 0.001). No differences between genotypes were seen in mucositis score, intestinal length, villus height/crypt depth, or IL-6, IL-1β, and Tnfα expression. CONCLUSION Our findings suggest that FIBCD1 could ameliorate chemotherapy-induced gastrointestinal toxicity by reducing weight loss; however, the mechanism of this possible protective effect remains to be defined warranting additional investigations.
Collapse
Affiliation(s)
- Maria C E Andersen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Malene W Johansen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Nissen
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Anders B Nexoe
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Gunvor I Madsen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Grith L Sorensen
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Uffe Holmskov
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Anders Schlosser
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Jesper B Moeller
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mathias Rathe
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| |
Collapse
|
13
|
Diemar SS, Lylloff L, Rønne MS, Møllehave LT, Heidemann M, Thuesen BH, Johannesen J, Schou AJ, Husby S, Wedderkopp N, Mølgaard C, Jørgensen NR. Reference intervals in Danish children and adolescents for bone turnover markers carboxy-terminal cross-linked telopeptide of type I collagen (β-CTX), pro-collagen type I N-terminal propeptide (PINP), osteocalcin (OC) and bone-specific alkaline phosphatase (bone ALP). Bone 2021; 146:115879. [PMID: 33561588 DOI: 10.1016/j.bone.2021.115879] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Bone turnover markers (BTM) are gaining ground in clinical practice but to fully use their potential there is a need for establishing valid reference intervals (RI). Consequently, the purpose of the study was to establish general RI as well as suggested clinical RI for carboxy-terminal cross-linked telopeptide of type I collagen (β-CTX), pro-collagen type I N-terminal propeptide (PINP), osteocalcin (OC) and bone-specific alkaline phosphatase (bone ALP) in children and adolescents. METHOD BTM were measured on Danish children and adolescents participating in the CHAMPS-study DK. A total of 762 participants were included (8-18 years, 50.4% girls) contributing a total of 1410 study visits. The RI was calculated based on 2-years age spans. Participants with biochemical signs of metabolic bone disease were excluded. RESULTS The differences in RI between age groups clearly reflect changes in growth with an initial increase in BTM, greatest in boys, and a subsequent decrease most pronounced in girls. β-CTX and PINP are markers most affected by these changes, compared to OC and bone ALP. The suggested clinical 95% RI included participants with vitamin D insufficiency but no biochemical signs of metabolic bone disease which did not markedly alter the RI. CONCLUSION RI for β-CTX, PINP, OC and bone ALP varies with age and sex. β-CTX and PINP which reflect bone resorption and formation processes are mostly affected by these changes. We suggest a set of clinically applicable 95% RI for the four BTM to heighten the usefulness and generalizability of the RI.
Collapse
Affiliation(s)
- Sarah Seberg Diemar
- Department of Clinical Biochemistry, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark.
| | - Louise Lylloff
- Department of Clinical Biochemistry, Regional Hospital West Jutland, Gl. Landevej 61, 7400 Herning, Denmark
| | - Maria Sode Rønne
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000 Odense, Denmark
| | - Line Tang Møllehave
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Malene Heidemann
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000 Odense, Denmark
| | - Betina Heinsbæk Thuesen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Jesper Johannesen
- Department of Children and Adolescents, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Anders J Schou
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000 Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000 Odense, Denmark; Clinical Institute, University of Southern Denmark, Campusvej 55, 5000 Odense, Denmark
| | - Niels Wedderkopp
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5000 Odense, Denmark; Department of Orthopaedics, Hospital of Southwest Jutland, Finsensgade 35, 6700 Esbjerg, Denmark
| | - Christian Mølgaard
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000 Odense, Denmark; Clinical Institute, University of Southern Denmark, Campusvej 55, 5000 Odense, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, 2200 Copenhagen, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| |
Collapse
|
14
|
Dalsager L, Christensen N, Halekoh U, Timmermann CAG, Nielsen F, Kyhl HB, Husby S, Grandjean P, Jensen TK, Andersen HR. Exposure to perfluoroalkyl substances during fetal life and hospitalization for infectious disease in childhood: A study among 1,503 children from the Odense Child Cohort. Environ Int 2021; 149:106395. [PMID: 33508532 DOI: 10.1016/j.envint.2021.106395] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/10/2020] [Accepted: 01/09/2021] [Indexed: 05/14/2023]
Abstract
INTRODUCTION The immunosuppressive properties of PFASs are widely recognized. Early-life exposure to PFAS has been linked to reduced immune response to childhood vaccinations and increased rates of common infectious diseases, but implications for hospitalizations are unclear. OBJECTIVES To investigate the association between maternal serum concentrations of five PFASs during pregnancy and the child's rate of hospitalization due to common infectious diseases between birth and 4 years of age. METHODS Serum samples from first trimester pregnant women from the Odense Child Cohort (OCC) collected in 2010-2012 were analyzed for concentrations of perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA) and three other PFASs. Data on child hospitalizations with an ICD-10 code for infectious disease was obtained from the Danish National Patient Register. The following were identified: upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), gastrointestinal infections (GI), and other infections. The Andersen-Gill Cox proportional hazard model for recurrent events was used to investigate the association between PFAS exposure and hospitalizations. The resulting estimates were hazard ratios (HRs), which express the relative change in the instantaneous risk of hospitalization with a doubling in maternal PFAS concentration. RESULTS A total of 1,503 mother-child pairs were included, and 26% of the children were hospitalized at least once for infectious disease. A doubling in maternal PFOS concentration was associated with a 23% increase in the risk of hospitalization due to any infection (HR: 1.23 (95% CI: 1.05, 1.44). There was indication of an interaction between child sex and PFOS (p = 0.07) and PFDA (p = 0.06), although in opposite directions. Further, every doubling of PFOA or PFOS increased the risk of LRTI by 27% (HR: 1.27 (1.01, 1.59)) and 54% (HR: 1.54 (1.11, 2.15)), respectively. Similar tendencies were seen for URTI and the group of other infections. For GIs, the opposite pattern of association was seen as HR's were consistently below 1 (PFOA, HR: 0.55 (0.32, 0.95)). DISCUSSION We found an association between PFOS and the overall risk of infectious disease, and between PFOS and PFOA exposures and the risk of LRTI's. These results are in agreement with previous findings from the OCC, in which maternal PFOS and PFOA concentrations were positively associated with the number of days that the children experienced fever, thereby suggesting that PFOS and PFOA may affect the prevalence of both mild and more severe infectious diseases even in a rather low-exposed population.
Collapse
Affiliation(s)
- Louise Dalsager
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Nikolas Christensen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Ulrich Halekoh
- Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Clara Amalie Gade Timmermann
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Flemming Nielsen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Philippe Grandjean
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Tina Kold Jensen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Odense Patient data Explorative Network (OPEN), Odense, Denmark
| | - Helle Raun Andersen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
15
|
Bech AS, Nexoe AB, Dubik M, Moeller JB, Soerensen GL, Holmskov U, Madsen GI, Husby S, Rathe M. Peptidoglycan Recognition Peptide 2 Aggravates Weight Loss in a Murine Model of Chemotherapy-Induced Gastrointestinal Toxicity. Front Oncol 2021; 11:635005. [PMID: 33833993 PMCID: PMC8021894 DOI: 10.3389/fonc.2021.635005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/22/2021] [Indexed: 01/24/2023] Open
Abstract
Introduction: Chemotherapy-induced gastrointestinal toxicity (CIGT) is a frequent, severe and dose-limiting side effect. Few treatments have proven effective for CIGT. CIGT is characterized by activation of the nuclear factor kappa B pathway which, leads to upregulation of proinflammatory cytokines. The innate immune protein peptidoglycan recognition peptide 2 (PGLYRP2) binds to and hydrolyzes microbial peptidoglycan. Expression of PGLYRP2 is upregulated in the intestine of chemotherapy-treated piglets. In this experimental study, we investigated the role of Pglyrp2 in the development and severity of murine CIGT. Methods: Pglyrp2 wildtype and Pglyrp2 knockout mice received intraperitoneal injections of chemotherapy (Doxorubicin 20 mg/kg) to induce CIGT. Weight was monitored daily, and animals were euthanized after 2 or 7 days. Expression of proinflammatory cytokines in the jejunum was measured by quantitative real-time polymerase-chain reaction and enzyme-linked immunosorbent assay. Villus height, crypt depth, and histologic inflammation were evaluated on haematoxylin and eosin stained tissue specimens. Results: Chemotherapeutic treatment induced weight loss (p < 0.05), shortening of the small intestine (p < 0.05), elongation of villus height (p < 0.05), increased crypt depth (p < 0.05), and led to elevated mRNA levels of II1β (p < 0.05), II6 (p < 0.05), and Tnf (p < 0.001) at day 2. Protein levels of IL1β, IL6, and TNFα did not change after exposure to chemotherapy. Doxorubicin treated wildtype mice had a more pronounced weight loss compared to knockout mice from day 3 to day 7 (D3-D6: p < 0.05 and D7: p < 0.01). No other phenotypic differences were detected. Conclusion: Pglyrp2 aggravates chemotherapy-induced weight loss but does not induce a specific pattern of inflammation and morphological changes in the small intestine.
Collapse
Affiliation(s)
- Ann-Sophie Bech
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Anders Bathum Nexoe
- Department of Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Magdalena Dubik
- Department of Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Jesper Bonnet Moeller
- Department of Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Danish Institute for Advanced Study (D-IAS), University of Southern Denmark, Odense, Denmark
| | - Grith Lykke Soerensen
- Department of Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Uffe Holmskov
- Department of Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Mathias Rathe
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
16
|
Dalby S, Andersen TL, Greisen PW, Petersen H, Husby S. Abdominal Positron Emission Tomography Combined With Magnetic Resonance Imaging in Chronic Granulomatous Disease. JPGN Rep 2021; 2:e047. [PMID: 37206931 PMCID: PMC10191468 DOI: 10.1097/pg9.0000000000000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/15/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Sina Dalby
- From the Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | | | | | - Henrik Petersen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Steffen Husby
- From the Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| |
Collapse
|
17
|
Dingemann C, Eaton S, Aksnes G, Bagolan P, Cross KM, De Coppi P, Fruithof J, Gamba P, Husby S, Koivusalo A, Rasmussen L, Sfeir R, Slater G, Svensson JF, Van der Zee DC, Wessel LM, Widenmann-Grolig A, Wijnen R, Ure BM. ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Follow-up and Framework. Eur J Pediatr Surg 2020; 30:475-482. [PMID: 31777030 DOI: 10.1055/s-0039-3400284] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Improvements in care of patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) have shifted the focus from mortality to morbidity and quality-of-life. Long-term follow-up is essential, but evidence is limited and standardized protocols are scarce. Nineteen representatives of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) from nine European countries conducted a consensus conference on the surgical management of EA/TEF. MATERIALS AND METHODS The conference was prepared by item generation (including items of surgical relevance from the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN)-The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines on follow-up after EA repair), item prioritization, formulation of a final list containing the domains Follow-up and Framework, and literature review. Anonymous voting was conducted via an internet-based system. Consensus was defined as ≥75% of those voting with scores of 6 to 9. RESULTS Twenty-five items were generated in the domain Follow-up of which 17 (68%) matched with corresponding ESPGHAN-NASPGHAN statements. Complete consensus (100%) was achieved on seven items (28%), such as the necessity of an interdisciplinary follow-up program. Consensus ≥75% was achieved on 18 items (72%), such as potential indications for fundoplication. There was an 82% concordance with the ESPGHAN-NASPGHAN recommendations. Four items were generated in the domain Framework, and complete consensus was achieved on all these items. CONCLUSION Participants of the first ERNICA conference reached significant consensus on the follow-up of patients with EA/TEF who undergo primary anastomosis. Fundamental statements regarding centralization, multidisciplinary approach, and involvement of patient organizations were formulated. These consensus statements will provide the cornerstone for uniform treatment protocols and resultant optimized patient care.
Collapse
Affiliation(s)
- Carmen Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Simon Eaton
- Department of Paediatric Surgery & Metabolic Biochemistry, UCL Great Ormond Street Institute of Child Health, University College London Institute of Child Health, London, United Kingdom
| | - Gunnar Aksnes
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital-Research Institute, Rome, Italy
| | - Kate M Cross
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Paolo De Coppi
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom.,Department of Paediatric Surgery & Metabolic Biochemistry, UCL Great Ormond Street Institute of Child Health Library, London, United Kingdom
| | - JoAnne Fruithof
- Esophageal Atresia and Tracheo-Esophageal Fistula Support Federation & - VOKS, Lichtenvoorde, The Netherlands
| | | | - Steffen Husby
- Department of Pediatric Gastroenterology, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Antti Koivusalo
- Department of Pediatric Surgery, University of Helsinki, Helsinki, Finland
| | - Lars Rasmussen
- Department of Pediatric Surgery, Odense University Hospital, Odense, Denmark
| | - Rony Sfeir
- Department of Pediatric Surgery CRACMO, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Graham Slater
- Esophageal Atresia and Tracheo-Esophageal Fistula Support Federation & - TOFS, Nottingham, United Kingdom
| | - Jan F Svensson
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - David C Van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucas M Wessel
- Department of Pediatric Surgery, University of Mannheim, Medical Faculty of Heidelberg, Mannheim, Germany
| | - Anke Widenmann-Grolig
- Esophageal Atresia and Tracheo-Esophageal Fistula Support Federation & - KEKS, Stuttgart, Germany
| | - Rene Wijnen
- Department of Pediatric Surgery, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
18
|
Christensen N, Bruun S, Søndergaard J, Christesen HT, Fisker N, Zachariassen G, Sangild PT, Husby S. Breastfeeding and Infections in Early Childhood: A Cohort Study. Pediatrics 2020; 146:peds.2019-1892. [PMID: 33097658 DOI: 10.1542/peds.2019-1892] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Studies on the association between breastfeeding and infections in children beyond the first year of life reveal conflicting results. In a population-based birth cohort, we investigated whether the duration of breastfeeding was associated with the number of hospitalizations due to infection and symptoms of infection at home. METHODS In the Odense Child Cohort, text message questionnaires were used to register information on breastfeeding (weekly until end of weaning) and symptoms of infection (biweekly; 12-36 months of age). Hospitalization data were obtained from the Danish National Patient Registry. RESULTS Of the 1087 invited, 815 mother-infant pairs were included. The median duration of any breastfeeding was 7.6 (interquartile range: 3.5-10.4) months and of exclusive breastfeeding was 2.1 (interquartile range: 0.7-4.4) months. Hospitalization due to infection was seen in 207 (25.4%) infants during the first 3 years of life. The adjusted incidence rate ratio (IRR) for hospitalization due to any infection decreased with a longer duration of any breastfeeding (adjusted IRR: 0.96; 95% confidence interval 0.93-0.99; P < .001). The strongest associations between the duration of any breastfeeding and hospitalizations due to infection were found within the first year of life, for lower respiratory tract infections, and other infections (P ≤ .05). For infants exclusively breastfed, the adjusted IRR for hospitalization was 0.88 (95% confidence interval: 0.80-0.96; P = .006). No protective associations were present between breastfeeding and infection symptoms registered at home from ages 12 to 36 months. CONCLUSIONS The results suggest that increased duration of breastfeeding, especially exclusive breastfeeding, protects against infections requiring hospitalization in the first year of life but not hospitalizations or symptoms of infection at home beyond the first year.
Collapse
Affiliation(s)
- Nikolas Christensen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and
| | - Signe Bruun
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and.,Strategic Business Unit Pediatric, Arla Foods Ingredients Group P/S, Viby, Denmark; and
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Henrik Thybo Christesen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and
| | - Niels Fisker
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and
| | - Per Torp Sangild
- Department of Clinical Research, Faculty of Health Sciences and.,Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; .,Department of Clinical Research, Faculty of Health Sciences and
| |
Collapse
|
19
|
Dingemann C, Eaton S, Aksnes G, Bagolan P, Cross KM, De Coppi P, Fruithof J, Gamba P, Husby S, Koivusalo A, Rasmussen L, Sfeir R, Slater G, Svensson JF, Van der Zee DC, Wessel LM, Widenmann-Grolig A, Wijnen R, Ure BM. ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Diagnostics, Preoperative, Operative, and Postoperative Management. Eur J Pediatr Surg 2020; 30:326-336. [PMID: 31266084 DOI: 10.1055/s-0039-1693116] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Many aspects of the management of esophageal atresia (EA) and tracheoesophageal fistula (TEF) are controversial and the evidence for decision making is limited. Members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) conducted a consensus conference on the surgical management of EA/TEF based on expert opinions referring to the latest literature. MATERIALS AND METHODS Nineteen ERNICA representatives from nine European countries participated in the conference. The conference was prepared by item generation, item prioritization by online survey, formulation of a final list containing the domains diagnostics, preoperative, operative, and postoperative management, and literature review. The 2-day conference was held in Berlin in October 2018. Anonymous voting was conducted via an internet-based system. Consensus was defined when 75% of the votes scored 6 to 9. RESULTS Fifty-two items were generated with 116 relevant articles of which five studies (4.3%) were assigned as level-1evidence. Complete consensus (100%) was achieved on 20 items (38%), such as TEF closure by transfixing suture, esophageal anastomosis by interrupted sutures, and initiation of feeding 24 hours postoperatively. Consensus ≥75% was achieved on 37 items (71%), such as routine insertion of transanastomotic tube or maximum duration of thoracoscopy of 3 hours. Thirteen items (25%) were controversial (range of scores, 1-9). Eight of these (62%) did not reach consensus. CONCLUSION Participants of the conference reached significant consensus on the management of patients with EA/TEF. The consensus may facilitate standardization and development of generally accepted guidelines. The conference methodology may serve as a blueprint for further conferences on the management of congenital malformations in pediatric surgery.
Collapse
Affiliation(s)
- Carmen Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Simon Eaton
- Department of Paediatric Surgery and Metabolic Biochemistry, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Gunnar Aksnes
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesu Children's Research Hospital, Rome, Italy
| | - Kate M Cross
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Paolo De Coppi
- Department of Paediatric Surgery and Metabolic Biochemistry, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - JoAnne Fruithof
- Esophageal Atresia and Tracheo-Esophageal Fistula Support Federation and-VOKS, Lichtenvoorde, The Netherlands
| | | | - Steffen Husby
- Department of Pediatric Gastroenterology, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Antti Koivusalo
- Department of Pediatric Surgery, University of Helsinki, Children's Hospital, Helsinki, Finland
| | - Lars Rasmussen
- Department of Pediatric Surgery, Odense University hospital, Odense, Denmark
| | - Rony Sfeir
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Graham Slater
- Esophageal Atresia and Tracheo-Esophageal Fistula Support Federation and-TOFS, Nottingham, United Kingdom
| | - Jan F Svensson
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - David C Van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucas M Wessel
- Department of Pediatric Surgery, University of Mannheim, Medical Faculty of Heidelberg, Mannheim, Germany
| | - Anke Widenmann-Grolig
- Esophageal Atresia and Tracheo-Esophageal Fistula Support Federation and KEKS, Stuttgart, Germany
| | - Rene Wijnen
- Department of Pediatric Surgery, Erasmus MC Sophia Ringgold standard institution, Rotterdam, The Netherlands
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| |
Collapse
|
20
|
van Rossem L, Smit HA, Armand M, Bernard JY, Bisgaard H, Bønnelykke K, Bruun S, Heude B, Husby S, Kyhl HB, Michaelsen KF, Stark KD, Thijs C, Vinding RK, Wijga AH, Lauritzen L. Breast milk n-3 long-chain polyunsaturated fatty acids and blood pressure: an individual participant meta-analysis. Eur J Nutr 2020; 60:989-998. [PMID: 32564149 PMCID: PMC7900030 DOI: 10.1007/s00394-020-02310-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
Purpose It is controversial whether a higher intake of n-3 long-chain polyunsaturated fatty acids (n-3 LC PUFA) through breastfeeding is associated or not to a lower blood pressure (BP) during childhood. We aimed to clarify this point by undertaking a meta-analysis involving the data from seven European birth cohorts. Methods We searched https://www.birthcohort.net for studies that had collected breast milk samples, and had at least one BP measurement in childhood. Principal investigators were contacted, and all agreed to share data. One additional study was identified by contacts with the principal investigators. For each cohort, we analyzed the association of breast milk n-3 LC PUFAs with systolic and diastolic BP with linear mixed effects models or linear regression, and pooled the estimates with a random effects model. We also investigated age-specific and sex-specific associations. Results A total of 2188 participants from 7 cohorts were included. Overall, no associations between breast milk n-3 LC PUFAs and BP were observed. In the pooled analysis, each 0.1 wt% increment in breast milk docosahexaenoic acid (DHA) was associated with a 1.19 (95% CI − 3.31, 0.94) mmHg lower systolic BP. Associations were similar for boys and girls and at different ages. Conclusion In this individual participant meta-analysis, we found no evidence for an association between breast milk n-3 LC PUFAs and BP. Electronic supplementary material The online version of this article (10.1007/s00394-020-02310-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lenie van Rossem
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 GA, Utrecht, The Netherlands. .,Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Henriette A Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 GA, Utrecht, The Netherlands
| | | | - Jonathan Y Bernard
- Université de Paris, Centre for Research in Epidemiology and StatisticS (CRESS), INSERM, INRA, 75004, Paris, France
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Signe Bruun
- Strategic Business Unit Pediatric, Arla Foods Ingredients Group P/S, Viby J, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Barbara Heude
- Université de Paris, Centre for Research in Epidemiology and StatisticS (CRESS), INSERM, INRA, 75004, Paris, France
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Henriette B Kyhl
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Ken D Stark
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Canada
| | - Carel Thijs
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Rebecca K Vinding
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alet H Wijga
- Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
21
|
Jøhnk C, Høst A, Husby S, Schoeters G, Timmermann CAG, Kyhl HB, Beck IH, Andersson AM, Frederiksen H, Jensen TK. Maternal phthalate exposure and asthma, rhinitis and eczema in 552 children aged 5 years; a prospective cohort study. Environ Health 2020; 19:32. [PMID: 32169083 PMCID: PMC7069194 DOI: 10.1186/s12940-020-00586-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/28/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Prenatal phthalate exposure has been suggested to alter immune responses and increase the risk of asthma, eczema and rhinitis. However, few studies have examined the effects in prospective cohorts and only one examined rhinitis. We therefore studied associations between maternal urinary concentrations of phthalate metabolites and asthma, eczema and rhinitis in offspring aged 5 years. METHODS From 552 pregnant women in the Odense Child Cohort, we quantified urinary concentrations of 12 phthalate metabolites in third trimester. We assessed asthma, rhinitis and eczema in their offspring at age 5 years with a questionnaire based on the International Study of Asthma and Allergies in Childhood (ISAAC), and conducted logistic regression adjusting for relevant confounders. RESULTS 7.4% of the children had asthma, 11.7% eczema and 9.2% rhinitis. Phthalate exposure was low compared to previous cohorts. No significant associations between prenatal phthalate exposure and asthma were found. Odds ratios (ORs) of child rhinitis with a doubling in ΣDiNPm and di-2-ethylhexyl phthalate metabolite (ΣDEHPm) concentrations were, respectively, 1.15 (95% confidence interval (CI) 0.97,1.36) and 1.21 (CI 0.93,1.58). The OR of eczema when doubling ΣDiNPm was 1.24 (CI 1.00,1.55), whereas the OR of using medicine against eczema when doubling a di-ethyl phthalate (DEP) metabolite was 0.81 (CI 0.68,0.96). CONCLUSION The lack of association between maternal phthalate exposure and asthma in the offspring may be due to low exposure and difficulties in determining asthma in 5-year-olds. The higher odds of rhinitis may raise public concern but further research in larger cohorts of older children is warranted.
Collapse
Affiliation(s)
- Camilla Jøhnk
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark
| | - Arne Høst
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Greet Schoeters
- Environmental Risk and Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
- Department of Biomedical Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Clara Amalie Gade Timmermann
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark
| | - Henriette Boye Kyhl
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), Odense, Denmark
| | - Iben Have Beck
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tina Kold Jensen
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 17A, 5000 Odense, Denmark
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), Odense, Denmark
| |
Collapse
|
22
|
Abstract
Purpose: The treatment for coeliac disease (CD) is a gluten-free diet (GFD), which impacts the health-related quality of life (HRQoL). The aim of the study was to develop the Gluten-Free Diet Perceived Competence Scale (GFD-PCS): a short and precise CD-specific patient-reported outcome measure.Methods: The GFD-PCS was developed from the scales 'Perceived Competence (Maintaining a Healthy Diet)' and 'Perceived Competence for Diabetes'. The scale was then programmed into a web-based questionnaire and distributed together with generic quality of life (WHO-5) and CD-specific HRQoL (CDQL) questionnaires.Results: There were 931 respondents. The 831 who reported 'diagnosed CD' were retained. The average age was 37.6 years (SD = 16.5). There was no statistically significant difference between males (M = 5.9, SD = 1.6) and females (M = 6.2, SD = 1.4) in GFD-PCS score. Respondents younger than 18 years (n = 104) scored lower (M = 5.8, SD = 1.4) than adults (M = 6.2, SD = 1.4). The psychometric properties of the GFD-PCS showed excellent internal reliability (α = .96) and satisfied construct and criterion validity.Conclusion: The GFD-PCS measures patient-perceived dietary competence for maintaining a GFD. The scale is psychometrically robust and provides a useful tool in assessing patients' difficulties with a GFD.
Collapse
Affiliation(s)
- Thomas O Kipp
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Halfdan Skjerning
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| |
Collapse
|
23
|
Nexoe AB, Pilecki B, Von Huth S, Husby S, Pedersen AA, Detlefsen S, Marcussen N, Moeller JB, Holmskov U, Sorensen GL. Colonic Epithelial Surfactant Protein D Expression Correlates with Inflammation in Clinical Colonic Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1349-1356. [PMID: 30753482 DOI: 10.1093/ibd/izz009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) are chronic disorders of the gastrointestinal tract. Surfactant protein D (SP-D) is expressed in the intestinal epithelium and is essential for innate host defense and regulation of inflammatory responses. Genetic variations of SP-D are associated with IBD, but the effects of SP-D in clinical disease development have not been clarified. We hypothesized that colonic epithelial SP-D expression is increased in parallel with intestinal inflammation with the capacity to dampen deleterious effects. METHODS Surgical specimens from IBD patients including Crohn's disease (n = 9) and ulcerative colitis (n = 18) were scored for expression of SP-D and inflammatory activity. Cohoused Sftpd+/+ and Sftpd-/- mouse littermates were subjected to dextran sodium sulfate (DSS) for 7 days to induce colitis. Colonic tissue was scored for histologic damage and analyzed for inflammatory markers and expression of SP-D. RESULTS Surgical specimens from IBD patients showed a strong positive correlation between immunoscore for SP-D and inflammatory activity (R2 = 0.78, P < 0.0001). In mice, colonic epithelial SP-D expression was very low, and DSS-induced colitis was unaffected by SP-D deficiency, although DSS induced transcription of colonic SP-D to a mild degree. CONCLUSIONS A strong positive correlation between inflammatory activity and epithelial expression of SP-D was observed in surgical specimens from IBD patients supporting a role for SP-D in clinical disease. The in vivo study was inconclusive due to very low intestinal SP-D expression in the mouse. Further studies are warranted to support that increased SP-D expression in the human colonic epithelium is protective against intestinal inflammation.
Collapse
Affiliation(s)
- Anders B Nexoe
- Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Bartosz Pilecki
- Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Sebastian Von Huth
- Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Andreas A Pedersen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Niels Marcussen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Jesper B Moeller
- Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Uffe Holmskov
- Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Grith L Sorensen
- Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
24
|
Husby S, Favero F, Nielsen C, Sørensen B, Baech J, Hansen J, Rodriguez-Gonzalez F, Arboe B, Andersen P, Haastrup E, Fischer-Nielsen A, Saekmose S, Hansen P, Christiansen I, Clasen-Linde E, Knudsen L, Grell K, Segel E, Ebbesen L, Thorsgaard M, Josefsson P, El-Galaly T, Brown P, Weischenfeldt J, Larsen T, Grønbaek K. HIGH RISK OF ADVERSE EVENTS AFTER AUTOLOGOUS STEM-CELL TRANSPLANTATION IN LYMPHOMA PATIENTS WITH DNA REPAIR PATHWAY MUTATIONS: A NATION-WIDE COHORT STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.5_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- S. Husby
- Dept. of Hematology; Rigshospitalet; Copenhagen N Denmark
| | - F. Favero
- Biotech Research & Innovation Center (BRIC); University of Copenhagen; Copenhagen Denmark
| | - C. Nielsen
- Dept. of Immunology; Odense University Hospital; Odense Denmark
| | - B. Sørensen
- Dept. of Immunology; Aarhus University Hospital; Aarhus Denmark
| | - J. Baech
- Dept. of Immunology; Aalborg University Hospital; Aalborg Denmark
| | - J.W. Hansen
- Dept. of Hematology; Rigshospitalet; Copenhagen N Denmark
| | | | - B. Arboe
- Dept. of Hematology; Rigshospitalet; Copenhagen N Denmark
| | - P.L. Andersen
- Dept. of Immunology; Herlev University Hospital; Herlev Denmark
| | - E.K. Haastrup
- Dept. of Immunology; Rigshospitalet; Copenhagen Denmark
| | | | - S.G. Saekmose
- Dept. of Immunology; Roskilde University Hospital; Naestved Denmark
| | - P.B. Hansen
- Dept. of Hematology; Roskilde University Hospital; Roskilde Denmark
| | - I. Christiansen
- Dept. of Hematology; Aalborg University Hospitale; Aalborg Denmark
| | | | - L.M. Knudsen
- Dept. of Hematology; Herlev University Hospital; Herlev Denmark
| | - K. Grell
- Dept. of Biostatistics; University of Copenhagen; Copenhagen Denmark
| | - E.K. Segel
- Dept. of Hematology; Aarhus University Hospital; Aarhus Denmark
| | - L.H. Ebbesen
- Dept. of Hematology; Aarhus University Hospital; Aarhus Denmark
| | - M. Thorsgaard
- Dept. of Hematology; Aarhus University Hospital; Aarhus Denmark
| | - P.L. Josefsson
- Dept. of Hematology; Herlev University Hospital; Herlev Denmark
| | - T.C. El-Galaly
- Dept. of Hematology; Aalborg University Hospitale; Aalborg Denmark
| | - P.D. Brown
- Dept. of Hematology; Rigshospitalet; Copenhagen N Denmark
| | - J. Weischenfeldt
- Biotech Research & Innovation Center (BRIC); University of Copenhagen; Copenhagen Denmark
| | - T.S. Larsen
- Dept. of Hematology; Odense University Hospital; Odense Denmark
| | - K. Grønbaek
- Dept. of Hematology; Rigshospitalet; Copenhagen N Denmark
| |
Collapse
|
25
|
Rodrigues J, Freiburghaus C, Carlsson A, Husby S, Eskelund C, Lokhande L, Kolstad A, Grønbaek K, Jerkeman M, Ek S. THE IMMUNE MICROENVIRONMENT AS A PROGNOSTIC TOOL FOR MCL PATIENTS. Hematol Oncol 2019. [DOI: 10.1002/hon.6_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J.M. Rodrigues
- Department of Immunotechnology; Lund University; Lund Sweden
| | - C. Freiburghaus
- Department of Immunotechnology; Lund University; Lund Sweden
| | | | - S. Husby
- Department of Haematology; Rigshospitalet; Copenhagen Denmark
| | - C.W. Eskelund
- Department of Haematology; Rigshospitalet; Copenhagen Denmark
| | - L. Lokhande
- Department of Immunotechnology; Lund University; Lund Sweden
| | - A. Kolstad
- Department of Oncology; Division of Cancer Medicine, Oslo University Hospital; Oslo Norway
| | - K. Grønbaek
- Department of Haematology; Rigshospitalet; Copenhagen Denmark
| | - M. Jerkeman
- Department of Oncology; Lund University; Lund Sweden
| | - S. Ek
- Department of Immunotechnology; Lund University; Lund Sweden
| |
Collapse
|
26
|
Dydensborg Sander S, Nybo Andersen AM, Murray JA, Karlstad Ø, Husby S, Størdal K. Association Between Antibiotics in the First Year of Life and Celiac Disease. Gastroenterology 2019; 156:2217-2229. [PMID: 30836095 DOI: 10.1053/j.gastro.2019.02.039] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The intestinal microbiota is believed to be involved in the pathogenesis of celiac disease, in addition to genetic variants and dietary gluten. The gut microbiota is strongly influenced by systemic antibiotics-especially in early life. We explored the association between exposure to a systemic antibiotic in the first year of life and risk of diagnosed celiac disease. METHODS We performed an observational nationwide register-based cohort study. We included all children born in Denmark from 1995 through 2012 or Norway from 2004 through 2012. Children born in Denmark were followed until May 8, 2015 (age at end of follow-up was 2.3-20.3 years) and children born in Norway were followed until December 31, 2013 (age at end of follow-up was 1-10 years). We collected medical information from more than 1.7 million children, including 3346 with a diagnosis of celiac disease. Exposure to systemic antibiotics was defined as a dispensed systemic antibiotic in the first year of life. RESULTS Exposure to systemic antibiotics in the first year of life was positively associated with diagnosed celiac disease in the Danish and Norwegian cohorts (pooled odds ratio 1.26, 95% confidence interval 1.16-1.36). We found a dose-dependent relation between an increasing number of dispensed antibiotics and the risk of celiac disease (pooled odds ratio for each additional dispensed antibiotic 1.08, 95% confidence interval 1.05-1.11). No specific type of antibiotic or age period within the first year of life was prominent. Adjustment for hospital admissions with an infectious disease in the first year of life did not change the estimates; adjustment for the number of maternally reported infections in the child in 2 large sub-cohorts decreased the association slightly (pooled odds ratio 1.18, 95% confidence interval 0.98-1.39). CONCLUSION In a nationwide study of children in Denmark and Norway, we found exposure to systemic antibiotics in the first year of life to be associated with a later diagnosis of celiac disease. These findings indicate that childhood exposure to systemic antibiotics could be a risk factor for celiac disease.
Collapse
Affiliation(s)
- Stine Dydensborg Sander
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | | | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Øystein Karlstad
- Department of Non-Communicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ketil Størdal
- Department of Non-Communicable Diseases, Norwegian Institute of Public Health, Oslo, Norway; Department of Pediatrics, Ostfold Hospital Trust, Fredrikstad, Norway
| |
Collapse
|
27
|
Husby S, Eskelund C, Favero F, Rodriguez-Gonzalez F, Kolstad A, Pedersen L, Räty R, Geisler C, Jerkeman M, Weischenfeldt J, Grønbaek K. EVOLUTION OF CLONAL HEMATOPOIESIS IN MANTLE CELL LYMPHOMA PATIENTS BEFORE, DURING, AND AFTER INDUCTION CHEMOTHERAPY AND AUTOLOGOUS STEM CELL TRANSPLANTATION. Hematol Oncol 2019. [DOI: 10.1002/hon.50_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Husby
- Dept. of Hematology; Rigshospitalet; Copenhagen N Denmark
| | - C.W. Eskelund
- Dept. of Hematology; Rigshospitalet; Copenhagen N Denmark
| | - F. Favero
- Biotech Research & Innovation Center (BRIC); University of Copenhagen; Copenhagen N Denmark
| | | | - A. Kolstad
- Dept. of Oncology; Oslo University Hospital; Oslo Norway
| | - L.B. Pedersen
- Dept. of Hematology; Rigshospitalet; Copenhagen N Denmark
| | - R. Räty
- Dept. of Hematology; Helsinki University Hospital; Helsinki Finland
| | - C.H. Geisler
- Dept. of Hematology; Rigshospitalet; Copenhagen N Denmark
| | - M. Jerkeman
- Dept. of Oncology; Lund University Hospital; Lund Sweden
| | - J. Weischenfeldt
- Biotech Research & Innovation Center (BRIC); University of Copenhagen; Copenhagen N Denmark
| | - K. Grønbaek
- Dept. of Hematology; Rigshospitalet; Copenhagen N Denmark
| |
Collapse
|
28
|
Rønne MS, Heidemann M, Lylloff L, Schou AJ, Tarp J, Bugge A, Laursen JO, Jørgensen NR, Husby S, Wedderkopp N, Mølgaard C. Bone mass development is sensitive to insulin resistance in adolescent boys. Bone 2019; 122:1-7. [PMID: 30738213 DOI: 10.1016/j.bone.2019.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/29/2019] [Accepted: 02/05/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Insulin resistance may exert a negative influence on bone mass in childhood and adolescence. The objective was to assess the association between insulin resistance and total body less head (TBLH) bone mineral content (BMC) and to investigate whether body composition, physical activity or osteocalcin levels may influence this association. METHODS A longitudinal study with follow-up over more than 6 years was performed and included 562 apparently healthy participants with a mean age of 9.6 years at baseline. Participants underwent DXA scanning at baseline. At the two follow-ups, participants had performed another DXA scanning, had blood samples taken for fasting insulin, glucose and osteocalcin and had physical activity measured with an accelerometer. HOMA-IR was calculated as an index of insulin resistance. RESULTS HOMA-IR was negatively associated with TBLH BMC in boys at follow-ups (β = -31.4, p < 0.001) after adjustment for maturity, height, bone area, and baseline level of TBLH BMC. The negative association remained almost unchanged after further adjustments for body composition and physical activity. No association between HOMA-IR and TBLH BMC was found in girls. CONCLUSION Insulin resistance may be detrimental for bone development through puberty in boys independent of body composition and the level of physical activity.
Collapse
Affiliation(s)
- Maria Sode Rønne
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000 Odense C, Denmark.
| | - Malene Heidemann
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000 Odense C, Denmark
| | - Louise Lylloff
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark; Department of Clinical Biochemistry, Hospital Unit West, Gl. Landevej 61, 7400 Herning, Denmark
| | - Anders J Schou
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000 Odense C, Denmark
| | - Jakob Tarp
- Research Unit for Exercise Epidemiology, Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Anna Bugge
- Research Unit for Exercise Epidemiology, Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, University College Copenhagen, Sigurdsgade 26, 2200 København N, Denmark
| | - Jens Ole Laursen
- Emergency Department, Hospital of South Jutland, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark; OPEN, Odense Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, J.B.Winsløws Vej 9 A, 3, 5000 Odense C, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000 Odense C, Denmark
| | - Niels Wedderkopp
- Research Unit for Exercise Epidemiology, Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Orthopaedics, Hospital of Southwestern Denmark, Finsensgade 34, 6700 Esbjerg, Denmark
| | - Christian Mølgaard
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000 Odense C, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, 2200 København N, Denmark
| |
Collapse
|
29
|
Peterslund P, Rasmussen L, Qvist N, Hansen TP, Husby S, Detlefsen S. Frequencies of Immune Cells in the Human Small Bowel During Normal Gestation and in Necrotizing Enterocolitis. Fetal Pediatr Pathol 2019; 38:153-166. [PMID: 30689475 DOI: 10.1080/15513815.2018.1561774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Only few studies have quantitated the frequencies of immune cells in the small bowel mucosa and submucosa during gestation. The aims of this study were to describe the frequencies of T and B cells, eosinophils and mast cells in the normal small bowel mucosa and submucosa (NSB) in relation to gestational age (GA) and in the uninvolved small bowel (USB) of premature newborns with necrotizing enterocolitis (NEC). METHODS We obtained 36 NSB specimens (GA 12-41 weeks) and 8 NEC-USB specimens (GA 24-32 weeks) from autopsies and surgeries and performed immunostaining for CD3, CD79a, BMK-13 and tryptase as well as the histochemical stains giemsa and toluidine blue. Qualitative histological evaluation and two different quantitative cell-samplings were performed using digital imaging analysis with both TissuemorphDP® and newCAST® software. Linear regression analysis was performed with cell frequency as the dependent variable and GA and USB as the independent variables. RESULTS In the NSB specimens, we found significant linear correlations between cell frequencies and GA for all examined cell types, though B cell frequencies reached a plateau midway through gestation. In the USB cases, submucosal mast cell frequencies were higher than in the NSB specimens, while T cell frequencies were lower. In USB of NEC patients, we found a significant increase of mast cells and a significant decrease of T cells compared to NSB. CONCLUSION Throughout gestation, we found an increase of all examined immune cell types in the normal small bowel, while the number of B cells came to a standstill at midway. Future studies should examine subtypes of T cells and also include histiocytes. A larger amount of small bowel specimens, covering the full gestational age, would be of great value.
Collapse
Affiliation(s)
- Paul Peterslund
- a Department of Pathology , Odense University Hospital , Odense , Denmark
| | - Lene Rasmussen
- b Department of Internal Medicine , Hospital Lillebaelt Kolding Hospital , Kolding , Denmark
| | - Niels Qvist
- c Department of Surgery , Odense University Hospital , Odense , Denmark
| | | | - Steffen Husby
- e Hans Christian Andersen Children's Hospital , Odense University Hospital , Odense , Denmark
| | - Sönke Detlefsen
- a Department of Pathology , Odense University Hospital , Odense , Denmark.,f Department of Clinical Research , Faculty of Health Sciences, University of Southern Denmark , Odense , Denmark
| |
Collapse
|
30
|
Rathe M, De Pietri S, Wehner PS, Frandsen TL, Grell K, Schmiegelow K, Sangild PT, Husby S, Müller K. Bovine Colostrum Against Chemotherapy-Induced Gastrointestinal Toxicity in Children With Acute Lymphoblastic Leukemia: A Randomized, Double-Blind, Placebo-Controlled Trial. JPEN J Parenter Enteral Nutr 2019; 44:337-347. [PMID: 30861163 DOI: 10.1002/jpen.1528] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/28/2019] [Accepted: 02/17/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND The toxic effect of chemotherapy on the gastrointestinal tract may lead to mucositis and is associated with the pathogenesis of other treatment-related complications. We hypothesized that nutrition supplementation with bovine colostrum, rich in bioactive factors, would ameliorate gastrointestinal toxicity and reduce the incidence of fever and infectious complications during induction treatment for childhood acute lymphoblastic leukemia (ALL). METHODS Children with newly diagnosed ALL were included in a 2-center, randomized, double-blind, placebo-controlled clinical trial. Patients were randomized to receive a daily colostrum or placebo supplement during 4 weeks of induction treatment. Data on fever, bacteremia, need for antibiotics, and mucosal toxicity were prospectively collected. (Trial registration: www.clinicaltrials.gov NCT01766804). RESULTS Sixty-two patients were included. No differences were found for the primary outcome (number of days with fever). No difference was observed for neutropenic fever, intravenous antibiotics, or incidence of bacteremia. Peak severity of oral mucositis was significantly reduced by colostrum (7/29 patients, 24% mild; 6/29, 21% moderate; 1/29, 3% severe) compared with placebo (12/31, 39% mild; 1/31, 3% moderate; 7/31, 23% severe) (P = 0.02). Among patients receiving at least 1 dose of supplement (colostrum: n = 22; placebo: n = 30), the peak weekly self-reported oral mucositis score was overall significantly less severe in the colostrum group (P = 0.009). CONCLUSION The use of prophylactic bovine colostrum showed no effect on fever, infectious morbidity, or inflammatory responses. Nevertheless, these data may suggest protective effects on the oral mucosa during induction therapy in childhood ALL, encouraging additional studies confirming these findings.
Collapse
Affiliation(s)
- Mathias Rathe
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Silvia De Pietri
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peder Skov Wehner
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Thomas Leth Frandsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kathrine Grell
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Per Torp Sangild
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Section of Comparative Pediatrics and Nutrition, Department of Clinical Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Klaus Müller
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Institute of Inflammation Research, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
31
|
Husby S, Murray JA, Katzka DA. AGA Clinical Practice Update on Diagnosis and Monitoring of Celiac Disease-Changing Utility of Serology and Histologic Measures: Expert Review. Gastroenterology 2019; 156:885-889. [PMID: 30578783 PMCID: PMC6409202 DOI: 10.1053/j.gastro.2018.12.010] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this clinical practice update is to define key modalities in the diagnosis and monitoring of celiac disease (CD) in adults as well as in children and adolescents. METHODS The recommendations outlined in this expert review are based on available published evidence, including cohort and case-control studies of the diagnostic process as well as controlled and descriptive studies of disease management. Best Practice Advice 1: Serology is a crucial component of the detection and diagnosis of CD, particularly tissue transglutaminase-immunoglobulin A (TG2-IgA), IgA testing, and less frequently, endomysial IgA testing. Best Practice Advice 2: Thorough histological analysis of duodenal biopsies with Marsh classification, counting of lymphocytes per high-power field, and morphometry is important for diagnosis as well as for differential diagnosis. Best Practice Advice 2a: TG2-IgA, at high levels (> ×10 upper normal limit) is a reliable and accurate test for diagnosing active CD. When such a strongly positive TG2-IgA is combined with a positive endomysial antibody in a second blood sample, the positive predictive value for CD is virtually 100%. In adults, esophagogastroduodenoscopy (EGD) and duodenal biopsies may then be performed for purposes of differential diagnosis. Best Practice Advice 3: IgA deficiency is an infrequent but important explanation for why patients with CD may be negative on IgA isotype testing despite strong suspicion. Measuring total IgA levels, IgG deamidated gliadin antibody tests, and TG2-IgG testing in that circumstance is recommended. Best Practice Advice 4: IgG isotype testing for TG2 antibody is not specific in the absence of IgA deficiency. Best Practice Advice 5: In patients found to have CD first by intestinal biopsies, celiac-specific serology should be undertaken as a confirmatory test before initiation of a gluten-free diet (GFD). Best Practice Advice 6: In patients in whom CD is strongly suspected in the face of negative biopsies, TG2-IgA should still be performed and, if positive, repeat biopsies might be considered either at that time or sometime in the future. Best Practice Advice 7: Reduction or avoidance of gluten before diagnostic testing is discouraged, as it may reduce the sensitivity of both serology and biopsy testing. Best Practice Advice 8: When patients have already started on a GFD before diagnosis, we suggest that the patient go back on a normal diet with 3 slices of wheat bread daily preferably for 1 to 3 months before repeat determination of TG2-IgA. Best Practice Advice 9: Determination of HLA-DQ2/DQ8 has a limited role in the diagnosis of CD. Its value is largely related to its negative predictive value to rule out CD in patients who are seronegative in the face of histologic changes, in patients who did not have serologic confirmation at the time of diagnosis, and in those patients with a historic diagnosis of CD; especially as very young children before the introduction of celiac-specific serology. MANAGEMENT Best Practice Advice 10: Celiac serology has a guarded role in the detection of continued intestinal injury, in particular as to sensitivity, as negative serology in a treated patient does not guarantee that the intestinal mucosa has healed. Persistently positive serology usually indicates ongoing intestinal damage and gluten exposure. Follow-up serology should be performed 6 and 12 months after diagnosis, and yearly thereafter. Best Practice Advice 11: Patients with persistent or relapsing symptoms, without other obvious explanations for those symptoms, should undergo endoscopic biopsies to determine healing even in the presence of negative TG2-IgA.
Collapse
Affiliation(s)
- Steffen Husby
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Joseph A. Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - David A. Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
32
|
Abstract
Currently, the only effective treatment for celiac disease is complete removal of gluten from the diet. However, patients need to follow a strict gluten-free diet that results in symptomatic, serologic, and histologic remission in most patients. Histologic remission is usually complete in children, but recovery is slower and more frequently incomplete in adults. When remission has been achieved, yearly follow-up is recommended for adults, children, and adolescents. This article deals with conventional strategies used in order to follow-up patients on treatment and aiming to obtain the best clinical outcome.
Collapse
Affiliation(s)
- Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervaenget 23C, Odense C, DK-5000, Denmark.
| | - Julio C Bai
- Hospital de Gastroenterología Dr. C. Bonorino Udaondo, Av. Caseros 2061, Buenos Aires 1236, Argentina
| |
Collapse
|
33
|
Rønne MS, Heidemann M, Lylloff L, Schou AJ, Tarp J, Laursen JO, Jørgensen NR, Husby S, Wedderkopp N, Mølgaard C. Bone Mass Development in Childhood and Its Association with Physical Activity and Vitamin D Levels. The CHAMPS-Study DK. Calcif Tissue Int 2019; 104:1-13. [PMID: 30178125 DOI: 10.1007/s00223-018-0466-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/12/2018] [Indexed: 12/12/2022]
Abstract
This longitudinal study examined associations of bone mass with physical activity and vitamin D level over more than 6 years through puberty. A total of 663 participants (320 boys) with mean age 9.6 years at baseline (10-17 years at follow-up), underwent dual energy X-ray absorptiometry, anthropometry and blood samples for vitamin D at least twice during the study period (with three possible time-points). Physical activity was assessed using accelerometers at follow-up. A positive association was found between percent time spent at vigorous physical activity and total-body less head bone mineral content (β = 5.8, p = 0.002). The magnitude of this association increased with maturational development; thus physical activity may have a greater influence on bone mass in the more mature participants. The vitamin D levels were also positively associated with bone mass. A high degree of tracking was observed with changes in anthropometric Z scores predictive of deviation from tracking. No environmental factor predicted deviation from tracking.
Collapse
Affiliation(s)
- Maria Sode Rønne
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark.
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000, Odense C, Denmark.
| | - Malene Heidemann
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
| | - Louise Lylloff
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- Department of Clinical Biochemistry, Hospital Unit West, Gl. Landevej 61, 7400, Herning, Denmark
| | - Anders J Schou
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
| | - Jakob Tarp
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jens Ole Laursen
- Emergency Department, Hospital of South Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- OPEN, Odense Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, J.B.Winsløws Vej 9 A, 3, 5000, Odense C, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000, Odense C, Denmark
| | - Niels Wedderkopp
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Department of Orthopaedics, Hospital of Southwestern Denmark, Finsensgade 34, 6700, Esbjerg, Denmark
| | - Christian Mølgaard
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000, Odense C, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, 2200, Copenhagen, Denmark
| |
Collapse
|
34
|
Rønne MS, Heidemann M, Schou A, Laursen JO, Bojesen AB, Lylloff L, Husby S, Wedderkopp N, Mølgaard C. Tracking of bone mass from childhood to puberty: a 7-year follow-up. The CHAMPS study DK. Osteoporos Int 2018; 29:1843-1852. [PMID: 29947870 DOI: 10.1007/s00198-018-4556-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/27/2018] [Indexed: 02/07/2023]
Abstract
UNLABELLED Bone mass in childhood is highly influenced by puberty. At the same age, bone mass was higher for pubertal than pre-pubertal children. A high level of tracking during 7 years from childhood through puberty was shown, indicating that early levels of bone mass may be important for later bone health. INTRODUCTION Bone mass development in childhood varies by sex and age, but also by pubertal stage. The objectives of this study were to (1) describe bone mass development in childhood as it relates to pubertal onset and to (2) determine the degree of tracking from childhood to adolescence. METHODS A longitudinal study with 7 years of follow-up was initiated in 2008 to include 831 children (407 boys) aged 8 to 17 years. Participants underwent whole body dual-energy X-ray absorptiometry (DXA) scanning, blood collection to quantify luteinizing hormone levels, and Tanner stage self-assessment three times during the 7-year follow-up. Total body less head bone mineral content, areal bone mineral density, and bone area were used to describe development in bone accrual and to examine tracking over 7 years. RESULTS Bone mass in pubertal children is higher than that of pre-pubertal children at the same age. Analysing tracking with quintiles of bone mass Z-scores in 2008 and 2015 showed that more than 80% of participants remained in the same or neighbouring quintile over the study period. Tracking was confirmed by correlation coefficients between Z-scores at baseline and 7-year follow-up (range, 0.80-0.84). CONCLUSIONS Bone mass is highly influenced by pubertal onset, and pubertal stage should be considered when examining children's bone health. Because bone mass indices track from childhood into puberty, children with low bone mass may be at risk of developing osteoporosis later in life.
Collapse
Affiliation(s)
- M S Rønne
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark.
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000, Odense C, Denmark.
| | - M Heidemann
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
| | - A Schou
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
| | - J O Laursen
- Emergency Department, Hospital of South Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | - A B Bojesen
- Hospital of South Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | - L Lylloff
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- Department of Clinical Biochemistry, Hospital Unit West, Gl. Landevej 61, 7400, Herning, Denmark
| | - S Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000, Odense C, Denmark
| | - N Wedderkopp
- Research in Childhood Health, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - C Mølgaard
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, 2200, Copenhagen N, Denmark
| |
Collapse
|
35
|
Christensen ME, Beck-Nielsen SS, Dalgård C, Larsen SD, Lykkedegn S, Kyhl HB, Husby S, Christesen HT. A novel inverse association between cord 25-hydroxyvitamin D and leg length in boys up to three years. An Odense Child Cohort study. PLoS One 2018; 13:e0198724. [PMID: 29889866 PMCID: PMC5995352 DOI: 10.1371/journal.pone.0198724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 05/24/2018] [Indexed: 01/15/2023] Open
Abstract
Background and aim Long standing vitamin D deficiency in children causes rickets with growth impairment. We investigated whether sub-ischial leg length (SLL) is shorter, and cephalo-caudal length:length (CCL:L) ratio and sitting height:height (SH:H) ratio larger, with lower cord s-25-hydroxyvitamin D (25OHD) in the population-based prospective Odense Child Cohort, Denmark. Methods We included healthy singletons born to term with available measures of cord 25OHD and anthropometrics up to three years’ age. Linear regression was stratified by sex a priori and adjusted for maternal ethnicity, pre-pregnancy body mass index and smoking during pregnancy, season of blood sampling and child age. Results Median (IQR) cord 25OHD was 48.0 (34.0–62.4) nmol/L. At mean age 19.1 months, n = 504, mean (SD) SLL was 31.7 (1.7) cm; CCL:L-ratio 0.62 (0.01). At 36.3 months, n = 956, mean SLL was 42.9 (2.0) cm; SH:H-ratio 0.56 (0.01). No participants had rickets. In adjusted analyses, 19-months-old boys had 0.1 cm shorter SLL (p = 0.009) and 0.1% higher CCL:L-ratio (p = 0.04) with every 10 nmol/L increase in cord 25OHD. Similar findings were seen for late pregnancy 25OHD. In the highest cord 25OHD quartile (>60.7 nmol/L), SLL was 0.8 cm shorter (95% C.I.: 1.36;-0.29, linear trend, p = 0.004), and CCL:L-ratio 0.8% higher (95% C.I. 8.0x10-05;0.01, linear trend, p = 0.01), compared to lowest quartile (<30.7 nmol/L). Similar associations with cord 25OHD were observed in 3-year-old boys. No consistent associations between 25OHD and anthropometrics were seen in girls at either age. Conclusion No leg shortening was found with decreasing cord s-25OHD in a healthy population of infants. A small, yet significant inverse association between cord 25OHD and SLL in boys 1½-3 years warrants further investigations.
Collapse
Affiliation(s)
- Mathilde Egelund Christensen
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Signe Sparre Beck-Nielsen
- Department of Pediatrics, Kolding Hospital a part of Lillebaelt Hospital, Kolding, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Christine Dalgård
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Søs Dragsbæk Larsen
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Sine Lykkedegn
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Henriette Boye Kyhl
- Odense Child Cohort, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Odense Child Cohort, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Henrik Thybo Christesen
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Odense Child Cohort, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- * E-mail:
| |
Collapse
|
36
|
Abstract
Purpose The purpose of this study was to investigate the association between mode of delivery and the risk of celiac disease in two large population-based birth cohorts with different prevalence of diagnosed celiac disease. Patients and methods This is an observational register-based cohort study using two independent population cohorts. We used data from administrative registers and health administrative registers from Denmark and Norway and linked the data at the individual level. We included all children who were born in Denmark from January 1, 1995 to December 31, 2010 and all children who were born in Norway from January 1, 2004 to December 31, 2012. Results We included 1,051,028 children from Denmark. Cesarean sections were registered for 196,512 children (18.9%). Diagnosed celiac disease was registered for 1,395 children (0.13%). We included 537,457 children from Norway. Cesarean sections were registered for 90,128 children (16.8%). Diagnosed celiac disease was registered for 1,919 children (0.35%). We found no association between the mode of delivery and the risk of diagnosed celiac disease. The adjusted odds ratio for celiac disease for children delivered by any type of cesarean section compared to vaginal delivery was 1.11 (95% CI: 0.96–1.29) in the Danish cohort and 0.96 (95% CI: 0.84–1.09) in the Norwegian cohort. The adjusted odds ratio for celiac disease for children delivered by elective cesarean section compared to vaginal delivery was 1.20 (95% CI: 1.00–1.43) in the Danish cohort and 0.96 (95% CI: 0.79–1.17) in the Norwegian cohort. Conclusion In this large registry-based study, mode of delivery was not associated with an increased risk of diagnosed celiac disease.
Collapse
Affiliation(s)
- Stine Dydensborg Sander
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Anne Vinkel Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Statistics Denmark, Copenhagen, Denmark
| | - Ketil Størdal
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Pediatrics, Ostfold Hospital Trust, Grålum, Norway
| | | | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
37
|
Aunsholt L, Qvist N, Sangild PT, Vegge A, Stoll B, Burrin DG, Jeppesen PB, Eriksen T, Husby S, Thymann T. Minimal Enteral Nutrition to Improve Adaptation After Intestinal Resection in Piglets and Infants. JPEN J Parenter Enteral Nutr 2017; 42:446-454. [PMID: 28786308 DOI: 10.1177/0148607117690527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/01/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Minimal enteral nutrition (MEN) may induce a diet-dependent stimulation of gut adaptation following intestinal resection. Bovine colostrum is rich in growth factors, and we hypothesized that MEN with colostrum would stimulate intestinal adaptation, compared with formula, and would be well tolerated in patients with short bowel syndrome. METHODS In experiment 1, 3-day-old piglets with 50% distal small intestinal resection were fed parenteral nutrition (PN, n = 10) or PN plus MEN given as either colostrum (PN-COL, n = 5) or formula (PN-FORM, n = 9) for 7 days. Intestinal nutrient absorption and histomorphometry were performed. In experiment 2, tolerance and feasibility of colostrum supplementation were tested in a pilot study on 5 infants who had undergone intestinal resection, and they were compared with 5 resected infants who served as controls. RESULTS In experiment 1, relative wet-weight absorption and intestinal villus height were higher in PN-COL vs PN (53% vs 23% and 362 ± 13 vs 329 ± 7 µm, P < .05). Crypt depth and tissue protein synthesis were higher in PN-COL (233 ± 7 µm, 22%/d) and PN-FORM (262 ± 13 µm, 22%/d) vs PN (190 ± 4 µm, 9%/d, both P < .05). In experiment 2, enteral colostrum supplementation was well tolerated, and no infants developed clinical signs of cow's milk allergy. CONCLUSION Minimal enteral nutrition feeding with bovine colostrum and formula induced similar intestinal adaptation after resection in piglets. Colostrum was well tolerated by newly resected infants, but the clinical indication for colostrum supplementation to infants subjected to intestinal resection remains to be determined.
Collapse
Affiliation(s)
- Lise Aunsholt
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Niels Qvist
- Department of Surgery, University Hospital of Odense, Odense, Denmark
| | - Per T Sangild
- Department of Veterinary Clinical and Animal Sciences, Frederiksberg C, Denmark.,Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen Ø, Denmark
| | - Andreas Vegge
- Department of Veterinary Clinical and Animal Sciences, Frederiksberg C, Denmark.,Global Research, Novo Nordisk, Måløv, Denmark
| | - Barbara Stoll
- Children's Nutrition Research Centre, Department of Paediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Douglas G Burrin
- Children's Nutrition Research Centre, Department of Paediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Thomas Eriksen
- Department of Veterinary Clinical and Animal Sciences, Frederiksberg C, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Thomas Thymann
- Department of Veterinary Clinical and Animal Sciences, Frederiksberg C, Denmark
| |
Collapse
|
38
|
Bruun S, Buhl S, Husby S, Jacobsen LN, Michaelsen KF, Sørensen J, Zachariassen G. Breastfeeding, Infant Formula, and Introduction to Complementary Foods-Comparing Data Obtained by Questionnaires and Health Visitors' Reports to Weekly Short Message Service Text Messages. Breastfeed Med 2017; 12:554-560. [PMID: 28832183 DOI: 10.1089/bfm.2017.0054] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Studies on prevalence and effects of breastfeeding call for reliable and precise data collection to optimize infant nutrition, growth, and health. Data on breastfeeding and infant nutrition are at risk of, for example, recall bias or social desirability bias. OBJECTIVE The aim of the present analysis was to compare data on infant nutrition, that is, breastfeeding, use of infant formula, and introduction to complementary foods, obtained by four different methods. We assumed that weekly short message service (SMS) questions were the most reliable method, to which the other methods were compared. DESIGN The study population was part of the Odense Child Cohort. The four methods used were: (a) self-administered questionnaire 3 months postpartum, (b) self-administered questionnaire 18 months postpartum, (c) registrations from health visitors visiting the families several times within the first year of life, and (d) weekly SMS questions introduced shortly after birth. RESULTS In total, 639 singleton mothers with data from all four methods were included. The proportion of mothers initiating breastfeeding varied from 86% to 97%, the mean duration of exclusive breastfeeding from 12 to 19 weeks, and the mean age when introduced to complementary foods from 19 to 21 weeks. The mean duration of any breastfeeding was 33 weeks across methods. CONCLUSIONS Compared with the weekly SMS questions, the self-administered questionnaires and the health visitors' reports resulted in a greater proportion of mothers with an unknown breastfeeding status, a longer duration of exclusive breastfeeding and later introduction to complementary foods, while the duration of any breastfeeding did not differ.
Collapse
Affiliation(s)
- Signe Bruun
- 1 Strategic Business Unit Pediatric , Arla Foods Ingredients Group P/S, Viby J, Denmark .,2 Hans Christian Andersen Children's Hospital, Odense University Hospital , Odense, Denmark .,3 Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark
| | - Susanne Buhl
- 4 Odense City Government and Administration , Department for Child and Family, Centre for Health, Odense, Denmark
| | - Steffen Husby
- 2 Hans Christian Andersen Children's Hospital, Odense University Hospital , Odense, Denmark .,3 Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark .,5 OPEN, Odense Patient Data Explorative Network, Odense University Hospital , Odense, Denmark
| | | | - Kim F Michaelsen
- 6 Department of Nutrition, Exercise and Sports, University of Copenhagen , Copenhagen, Denmark
| | - Jan Sørensen
- 7 Department of Public Health, Centre of Health Economics Research (COHERE), University of Southern Denmark , Odense, Denmark .,8 Healthcare Outcome Research Centre, Royal College of Surgeons in Ireland , Dublin, Ireland
| | - Gitte Zachariassen
- 2 Hans Christian Andersen Children's Hospital, Odense University Hospital , Odense, Denmark .,3 Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark
| |
Collapse
|
39
|
Werkstetter KJ, Korponay-Szabó IR, Popp A, Villanacci V, Salemme M, Heilig G, Lillevang ST, Mearin ML, Ribes-Koninckx C, Thomas A, Troncone R, Filipiak B, Mäki M, Gyimesi J, Najafi M, Dolinšek J, Dydensborg Sander S, Auricchio R, Papadopoulou A, Vécsei A, Szitanyi P, Donat E, Nenna R, Alliet P, Penagini F, Garnier-Lengliné H, Castillejo G, Kurppa K, Shamir R, Hauer AC, Smets F, Corujeira S, van Winckel M, Buderus S, Chong S, Husby S, Koletzko S. Accuracy in Diagnosis of Celiac Disease Without Biopsies in Clinical Practice. Gastroenterology 2017. [PMID: 28624578 DOI: 10.1053/j.gastro.2017.06.002] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The guidelines of the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition allow for diagnosis of celiac disease without biopsies in children with symptoms and levels of immunoglobulin A against tissue-transglutaminase (TGA-IgA) 10-fold or more the upper limit of normal (ULN), confirmed by detection of endomysium antibodies (EMA) and positivity for HLA-DQ2/DQ8. We performed a large, international prospective study to validate this approach. METHODS We collected data from consecutive pediatric patients (18 years or younger) on a gluten-containing diet who tested positive for TGA-IgA from November 2011 through May 2014, seen at 33 pediatric gastroenterology units in 21 countries. Local centers recorded symptoms; measurements of total IgA, TGA, and EMA; and histopathology findings from duodenal biopsies. Children were considered to have malabsorption if they had chronic diarrhea, weight loss (or insufficient gain), growth failure, or anemia. We directly compared central findings from 16 antibody tests (8 for TGA-IgA, 1 for TGA-IgG, 6 for IgG against deamidated gliadin peptides, and 1 for EMA, from 5 different manufacturers), 2 HLA-DQ2/DQ8 tests from 2 manufacturers, and histopathology findings from the reference pathologist. Final diagnoses were based on local and central results. If all local and central results were concordant for celiac disease, cases were classified as proven celiac disease. Patients with only a low level of TGA-IgA (threefold or less the ULN) but no other results indicating celiac disease were classified as no celiac disease. Central histo-morphometry analyses were performed on all other biopsies and cases were carefully reviewed in a blinded manner. Inconclusive cases were regarded as not having celiac disease for calculation of diagnostic accuracy. The primary aim was to determine whether the nonbiopsy approach identifies children with celiac disease with a positive predictive value (PPV) above 99% in clinical practice. Secondary aims included comparing performance of different serological tests and to determine whether the suggested criteria can be simplified. RESULTS Of 803 children recruited for the study, 96 were excluded due to incomplete data, low level of IgA, or poor-quality biopsies. In the remaining 707 children (65.1% girls; median age, 6.2 years), 645 were diagnosed with celiac disease, 46 were found not to have celiac disease, and 16 had inconclusive results. Findings from local laboratories of TGA-IgA 10-fold or more the ULN, a positive result from the test for EMA, and any symptom identified children with celiac disease (n = 399) with a PPV of 99.75 (95% confidence interval [CI], 98.61-99.99); the PPV was 100.00 (95% CI, 98.68-100.00) when only malabsorption symptoms were used instead of any symptom (n = 278). Inclusion of HLA analyses did not increase accuracy. Findings from central laboratories differed greatly for patients with lower levels of antibodies, but when levels of TGA-IgA were 10-fold or more the ULN, PPVs ranged from 99.63 (95% CI, 98.67-99.96) to 100.00 (95% CI, 99.23-100.00). CONCLUSIONS Children can be accurately diagnosed with celiac disease without biopsy analysis. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide. HLA analysis is not required for accurate diagnosis. Clinical Trial Registration no: DRKS00003555.
Collapse
Affiliation(s)
- Katharina Julia Werkstetter
- Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, LMU Munich, Munich, Germany
| | - Ilma Rita Korponay-Szabó
- Celiac Disease Center Heim Pál Children's Hospital, Budapest and Department of Pediatrics, University of Debrecen, Debrecen, Hungary; Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Alina Popp
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland; University of Medicine and Pharmacy "Carol Davila" and National Institute for Mother and Child Health "Alessandrescu-Rusescu," Bucharest, Romania
| | | | | | - Gabriele Heilig
- Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, LMU Munich, Munich, Germany
| | | | - Maria Luisa Mearin
- Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Carmen Ribes-Koninckx
- Department of Pediatric Gastroenterology and Hepatology, La Fe University Hospital, Valencia, Spain
| | - Adrian Thomas
- Department of Pediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Riccardo Troncone
- Department of Translational Medical Sciences & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
| | - Birgit Filipiak
- Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, LMU Munich, Munich, Germany
| | - Markku Mäki
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Judit Gyimesi
- Celiac Disease Center Heim Pál Children's Hospital, Budapest and Department of Pediatrics, University of Debrecen, Debrecen, Hungary
| | - Mehri Najafi
- Department of Pediatric Gastroenterology & Hepatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jernej Dolinšek
- Department of Pediatrics, University Medical Center (UMC), Maribor, Slovenia
| | | | - Renata Auricchio
- Department of Translational Medical Sciences & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
| | - Alexandra Papadopoulou
- Division of Gastroenterology, Hepatology and Nutrition, First Department of Pediatrics, Children's Hospitals "Agia Sophia," University of Athens, Athens, Greece
| | - Andreas Vécsei
- Gastroenterology Outpatient Clinic, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Peter Szitanyi
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Ester Donat
- Department of Pediatric Gastroenterology and Hepatology, La Fe University Hospital, Valencia, Spain
| | - Rafaella Nenna
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | | | - Francesca Penagini
- Department of Pediatric Gastroenterology, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Hélène Garnier-Lengliné
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hôpital Necker-Enfants Malades, Paris, France
| | - Gemma Castillejo
- Department of Pediatric Gastroenterology and Nutrition, Hospital Universitari Sant Joan, Reus, Spain
| | - Kalle Kurppa
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Françoise Smets
- Université Catholique de Louvain, IREC, PEDI, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Susana Corujeira
- Department of Pediatric Gastroenterology, Hospital S. João, Porto, Portugal
| | - Myriam van Winckel
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ghent University Hospital, Ghent, Belgium
| | - Stefan Buderus
- Department of Pediatrics, St. Marien Hospital, Bonn, Germany
| | - Sonny Chong
- Queen Mary's Hospital for Children, Carshalton, United Kingdom
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Sibylle Koletzko
- Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, LMU Munich, Munich, Germany.
| | | |
Collapse
|
40
|
Skjerning H, Hourihane J, Husby S, DunnGalvin A. A comprehensive questionnaire for the assessment of health-related quality of life in coeliac disease (CDQL). Qual Life Res 2017; 26:2831-2850. [DOI: 10.1007/s11136-017-1632-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 12/18/2022]
|
41
|
Lund-Blix NA, Dydensborg Sander S, Størdal K, Nybo Andersen AM, Rønningen KS, Joner G, Skrivarhaug T, Njølstad PR, Husby S, Stene LC. Infant Feeding and Risk of Type 1 Diabetes in Two Large Scandinavian Birth Cohorts. Diabetes Care 2017; 40:920-927. [PMID: 28487451 PMCID: PMC5481976 DOI: 10.2337/dc17-0016] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/11/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our aim was to study the relation between the duration of full and any breastfeeding and risk of type 1 diabetes. RESEARCH DESIGN AND METHODS We included two population-based cohorts of children followed from birth (1996-2009) to 2014 (Denmark) or 2015 (Norway). We analyzed data from a total of 155,392 children participating in the Norwegian Mother and Child Cohort Study (MoBa) and the Danish National Birth Cohort (DNBC). Parents reported infant dietary practices when their child was 6 and 18 months old. The outcome was clinical type 1 diabetes, ascertained from nationwide childhood diabetes registries. Hazard ratios (HRs) were estimated using Cox regression. RESULTS Type 1 diabetes was identified in 504 children during follow-up, and the incidence of type 1 diabetes per 100,000 person-years was 30.5 in the Norwegian cohort and 23.5 in the Danish cohort. Children who were never breastfed had a twofold increased risk of type 1 diabetes compared with those who were breastfed (HR 2.29 [95% CI 1.14-4.61] for no breastfeeding vs. any breastfeeding for ≥12 months). Among those who were breastfed, however, the incidence of type 1 diabetes was independent of duration of both full breastfeeding (HR per month 0.99 [95% CI 0.97-1.01]) and any breastfeeding (0.97 [0.92-1.03]). CONCLUSIONS Suggestive evidence supports the contention that breastfeeding reduces the risk of type 1 diabetes. Among those who were breastfed, however, no evidence indicated that prolonging full or any breastfeeding was associated with a reduced risk of type 1 diabetes.
Collapse
Affiliation(s)
- Nicolai A Lund-Blix
- Department of Pediatric Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway .,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Ketil Størdal
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne-Marie Nybo Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kjersti S Rønningen
- Department of Pediatric Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Geir Joner
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Torild Skrivarhaug
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål R Njølstad
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Lars C Stene
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
42
|
Rathe M, Sorensen GL, Wehner PS, Holmskov U, Sangild PT, Schmiegelow K, Müller K, Husby S. Chemotherapeutic treatment reduces circulating levels of surfactant protein-D in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2017; 64. [PMID: 27667327 DOI: 10.1002/pbc.26253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Surfactant protein D (SP-D) is a host defense molecule of the innate immune system that enhances pathogen clearance and modulates inflammatory responses. We hypothesized that circulating SP-D levels are associated with chemotherapy-induced mucositis and infectious morbidity in children with acute lymphoblastic leukemia (ALL). PROCEDURE In a prospective study, 43 children receiving treatment for ALL were monitored for mucosal toxicity from diagnosis through the induction phase of treatment. Serial blood draws were taken to determine the levels of SP-D, interleukin-6 (IL-6), C-reactive protein, and white blood cells. Data on fever, antibiotics, and bacteremia were collected. Baseline levels of circulating SP-D were compared with healthy controls. RESULTS Baseline values of circulating SP-D were similar to levels in healthy controls (median: 829 ng/ml vs. 657 ng/ml, respectively, P > 0.05). After initiation of chemotherapy, a significant reduction in SP-D levels was observed at all time points: 704 ng/ml at day 8, 413 ng/ml at day 15, 395 ng/ml at day 22, and 520 ng/ml at day 29 (all, P < 0.05). No significant associations between SP-D values, the occurrence of mucosal toxicity, or infectious morbidity were observed. However, loss of circulating SP-D from days 8 to 15 was associated with more systemic inflammation, and lower SP-D values at day 15 were associated with elevated intestinal mucositis scores (P < 0.05). CONCLUSIONS The current study supports the hypothesis that the detrimental effect of chemotherapy on patients' immune functions includes decreased circulating levels of innate mucosal molecules such as SP-D, potentially aggravating mucosal and systemic inflammatory responses.
Collapse
Affiliation(s)
- Mathias Rathe
- Department of pediatric hematology and oncology, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Grith L Sorensen
- Department of Cancer and Inflammation, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Peder S Wehner
- Department of pediatric hematology and oncology, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Uffe Holmskov
- Department of Cancer and Inflammation, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Per T Sangild
- Section of Comparative Pediatrics and Nutrition, Department of Clinical Veterinary and Animal Science, University of Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Klaus Müller
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Denmark.,Department of Rheumatology, The Institute of Inflammation Research, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Steffen Husby
- Department of pediatric hematology and oncology, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| |
Collapse
|
43
|
Risby K, Husby S, Qvist N, Jakobsen MS. High mortality among children with gastroschisis after the neonatal period: A long-term follow-up study. J Pediatr Surg 2017; 52:431-436. [PMID: 27665495 DOI: 10.1016/j.jpedsurg.2016.08.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/26/2016] [Accepted: 08/28/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND During the last decades neonatal outcomes for children born with gastroschisis have improved significantly. Survival rates >90% have been reported. Early prenatal diagnosis and increased survival enforce the need for valid data for long-term outcome in the pre- and postnatal counseling of parents with a child with gastroschisis. METHODS Long-term follow-up on all newborns with gastroschisis at Odense University Hospital (OUH) from January 1 1997-December 31 2009. Follow-up included neonatal chart review for neonatal background factors, including whether a GORE®DUALMESH was used for staged closure, electronic questionnaires, interview and laboratory investigations. Cases were divided into complex and simple cases according to the definition by Molik et al. (2001). Survival status was determined by the national personal identification number registry. Because of the consistency of the registration, survival status was obtained from all children participating in the study. RESULTS A total of 71 infants (7 complex and 64 simple) were included. Overall seven out of the 71 children (9.9%, median age: 52days (25-75% percentile 0-978days) had died at the time of follow-up. Three died during the neonatal period and four died after the neonatal period. Parenteral nutrition (PN) induced liver failure and suspected adhesive small bowel obstruction were the causes of deaths after the neonatal period. Overall mortality was high in the "complex" group compared to the simple group (3/7 (42.9%) vs 4/64 (6.3%), p = 0.04). Forty (62.5%) of the surviving children consented to participate in the follow-up. A total of 12 children had had suspected adhesive small bowel obstruction. Prevalence of small bowel obstruction was not related to the number of operations needed for neonatal closure of the defect. Staged closure was done in 5/12 (41.7%) who developed small bowel obstruction vs 11/35 (31.43%) without small bowel obstruction, p=0.518. A GORE®DUALMESH was used in 16 children (22.5%). Of these 2 were complex and 14 were simple cases. Prevalence of recurrent abdominal pain was 22.5% (9/40) among children with gastroschisis compared to 12% in a study on Danish school children, p=0.068. Gastrointestinal symptoms had led to hospital admission after primary discharge in significantly more children with gastroschisis 16 (40.0%) than children younger than 16years old in the general Danish population 129.419/1.081.542 (12.0%), p=0.000. Fecal calprotectin level was above the reference level (>50mg/kg) in 6/16 (37.5%) children >8years old with gastroschisis compared to 1/7 (14.3%) healthy children. (Fisher's exact=0.366). Only 8/38 (21.1%) children with gastroschisis reported to have an umbilicus. CONCLUSION Mortality among children with gastroschisis is still significant with the highest risk among complicated cases. The majority of the deaths is potentially preventable as PN-related causes and suspected adhesive small bowel obstruction counted for five of seven deaths. Neither categorization upon method of abdominal wall closure nor categorization into simple and complex cases can predict the risk of adhesive small bowel obstruction. With improved administration of PN and timely information and attention to the risk of the small bowel obstruction there is good possibility that the associated mortality could decrease. Type of study and level of evidence: Prognosis study, level II.
Collapse
Affiliation(s)
- Kirsten Risby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, 5000, Odense C, Denmark.
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, 5000, Odense C, Denmark.
| | - Niels Qvist
- Department of Surgery, Odense University Hospital, 5000, Odense C, Denmark.
| | | |
Collapse
|
44
|
Bager H, Christensen LP, Husby S, Bjerregaard L. Biomarkers for the Detection of Prenatal Alcohol Exposure: A Review. Alcohol Clin Exp Res 2017; 41:251-261. [PMID: 28098942 DOI: 10.1111/acer.13309] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/03/2016] [Indexed: 01/06/2023]
Abstract
Alcohol exposure during pregnancy can cause adverse effects to the fetus, because it interferes with fetal development, leading to later physical and mental impairment. The most common clinical tool to determine fetal alcohol exposure is maternal self-reporting. However, a more objective and useful method is based on the use of biomarkers in biological specimens alone or in combination with maternal self-reporting. This review reports on clinically relevant biomarkers for detection of prenatal alcohol exposure (PAE). A systematic search was performed to ensure a proper overview in existing literature. Studies were selected to give an overview on clinically relevant neonatal and maternal biomarkers. The direct biomarkers fatty acid ethyl esters (FAEEs), ethyl glucuronide (EtG), ethyl sulfate, and phosphatidylethanol (PEth) were found to be the most appropriate biomarkers in relation to detection of PAE. To review each biomarker in a clinical context, we have compared the advantages and disadvantages of each biomarker, in relation to its window of detectability, ease of collection, and the ease and cost of analysis of each biomarker. The biomarkers PEth, FAEEs, and EtG were found to be applicable for detection of even low levels of alcohol exposure. Meconium is an accessible matrix for determination of FAEEs and EtG, and blood an accessible matrix for determination of PEth.
Collapse
Affiliation(s)
- Heidi Bager
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
| | - Lars Porskjaer Christensen
- Department of Chemical Engineering, Biotechnology and Environmental Technology, University of Southern Denmark, Odense M, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
| | - Lene Bjerregaard
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
| |
Collapse
|
45
|
Pedersen RN, Markøw S, Kruse-Andersen S, Qvist N, Gerke O, Husby S, Agertoft L. Long-term pulmonary function in esophageal atresia-A case-control study. Pediatr Pulmonol 2017; 52:98-106. [PMID: 27164020 DOI: 10.1002/ppul.23477] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 04/06/2016] [Accepted: 04/24/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Esophageal atresia (EA) is a congenital anomaly associated with substantial pulmonary morbidity throughout childhood. AIM The aim of this study was to evaluate pulmonary complications among 59 five to 15-year-old children and adolescents with surgically corrected congenital EA. METHODS Participants underwent a structured interview, spirometry, body plethysmography, mannitol challenge test, skin prick test, as well as measurements of the diffusion capacity, airway resistance, fraction of exhaled NO, and specific immunoglobulin E in serum. A control group consisted of 25 children being evaluated for gastroesophageal reflux disease. RESULTS Among the EA patients 33 (55.9%) had respiratory symptoms, 31 (53.4%) had a history of at least three pneumonias, and 32 (54.2%) reported more frequent cough episodes than peers. The Forced Vital Capacity (FVC) was 84.9% ± 13.2% of predicted, forced expiratory volume 1 sec (FEV1) was 78.2% ± 12.4% of predicted, and forced expiratory fraction 25-75% (FEF25-75%) was 71.5 ± 17.8% of predicted in EA patients, lower than disease controls (P < 0.0001 for all). In addition, the total lung capacity (TLC) was lower in patients with EA than in the controls (P < 0.0001). Fifteen patients (28.8%) with EA had obstructive ventilatory impairment, compared to nine patients (17.3%) with restrictive ventilatory impairment, while one had a combination. CONCLUSIONS The present study demonstrated significantly decreased pulmonary characteristics in EA patients. Restrictive ventilatory impairment occurring in EA is probably due to poor lung growth after thoracotomy. No single factor predicted ventilatory impairment in children and adolescents with EA. Pediatr Pulmonol. 2017;52:98-106. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Rikke N Pedersen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Simone Markøw
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Niels Qvist
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital and Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Lone Agertoft
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| |
Collapse
|
46
|
Dydensborg Sander S, Størdal K, Plato Hansen T, Nybo Andersen AM, Murray JA, Lillevang ST, Husby S. Validation of celiac disease diagnoses recorded in the Danish National Patient Register using duodenal biopsies, celiac disease-specific antibodies, and human leukocyte-antigen genotypes. Clin Epidemiol 2016; 8:789-799. [PMID: 28008283 PMCID: PMC5167452 DOI: 10.2147/clep.s122300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose The purpose of this study was to validate the celiac disease diagnoses recorded in the Danish National Patient Register. To validate the diagnoses, we used information on duodenal biopsies from a national register of pathology reports (the Patobank) and information on celiac disease-specific antibodies and human leukocyte antigen (HLA) genotypes obtained from patient medical records. Patients and methods We included all the children who were born from 1995 to 2012 and who were registered as having celiac disease in the Danish National Patient Register. We reviewed all the pathology reports on duodenal biopsies in the Patobank and the information in the medical records on celiac disease-specific antibodies (ie, anti-tissue transglutaminase 2 IgA and IgG, endomysial antibodies IgA, and anti-deamidated gliadin peptide IgG) and HLA genotypes. Results We identified 2,247 children who were registered in the Danish National Patient Register with celiac disease. Duodenal biopsies for 1,555 of the children (69%) were registered in the Patobank; 1,127 (50%) had a biopsy that was compatible with celiac disease (ie, Marsh 2–3). We accessed the medical records of 95% of the children who were registered in the Danish National Patient Register with celiac disease. We found that 1,510 (67%) had one or more positive antibody-test results; 1,120 (50%) had anti-tissue transglutaminase 2, IgA at tenfold or greater the upper limit of the normal range and/or positive endomysial antibody results. The positive predictive value depended on the criteria used for validation and the types and numbers of registrations that were included in the analysis and ranged from 62% (95% confidence interval: 60%–64%) to 86% (95% confidence interval: 84%–87%). Conclusion Our findings indicate that the Danish National Patient Register is a valuable source to identify patients who have been diagnosed with celiac disease. However, validation of the diagnoses is warranted before data on the patients are used for research purposes.
Collapse
Affiliation(s)
- Stine Dydensborg Sander
- Hans Christian Andersen Children's Hospital, Odense University Hospital; Institute of Clinical Research, University of Southern Denmark; Odense Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Ketil Størdal
- Mental and Physical Health, Norwegian Institute of Public Health, Oslo; Department of Pediatrics, Ostfold Hospital Trust, Fredrikstad, Norway
| | | | | | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital; Institute of Clinical Research, University of Southern Denmark
| |
Collapse
|
47
|
Dalsager L, Christensen N, Husby S, Kyhl H, Nielsen F, Høst A, Grandjean P, Jensen TK. Association between prenatal exposure to perfluorinated compounds and symptoms of infections at age 1-4years among 359 children in the Odense Child Cohort. Environ Int 2016; 96:58-64. [PMID: 27608427 DOI: 10.1016/j.envint.2016.08.026] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/19/2016] [Accepted: 08/25/2016] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Perfluorinated alkylated substances (PFAS) are persistent industrial chemicals that have resulted in global environmental exposures. Previous epidemiological studies have reported possible effects on the immune system after developmental PFAS exposure, but the possible impact on childhood infectious disease is unclear. OBJECTIVES To investigate the association between prenatal exposure to PFAS and symptoms of infections at age 1-4years. METHODS The Odense Child Cohort is an on-going prospective study on children's health, where serum concentrations of perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorodecanoic acid (PFDA) and perfluorononanoic acid (PFNA) were measured in 649 pregnant women before gestational week 16. Of these women, 359 reported on symptoms of infection in their child every two weeks for a one-year period. The association between prenatal exposure to PFAS and the symptoms was estimated using a logistic regression model and a negative binomial regression model. For the latter, the outcome was reported as an incidence rate-ratio (IRR), and all models were adjusted for maternal age, educational level, parity and child age. RESULTS On average, the children experienced symptoms of infection 23% of the time during one year. PFOS exposure in the high tertile compared to the low tertile was associated with a statistically significant increased proportion of days with fever (IRR: 1.65 (95% CI: 1.24, 2.18), P-trend<0.001) and an increased odds of experiencing days with fever above the median (OR: 2.35 (95% CI: 1.31, 4.11). The latter tendency was also apparent for PFOA (OR: 1.97 (95% CI: 1.07, 3.62). Further, higher concentrations of PFOS and PFOA tended to increase the number of episodes of co-occurrence of fever and coughing and fever and nasal discharge during the one-year study period. CONCLUSION We found a positive association between prenatal exposure to PFOS and PFOA and the prevalence of fever, which may be a sensitive marker of infection. This finding is in agreement with an immunotoxic effect of prenatal exposure to PFAS. The wider implications for childhood infectious disease deserve attention.
Collapse
Affiliation(s)
- Louise Dalsager
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, J.B. Winsløwsvej 17A, 5000 Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Department of Growth and Reproduction, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Nikolas Christensen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Henriette Kyhl
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark; Odense Patient data Exploratory Network (OPEN), Odense, Denmark
| | - Flemming Nielsen
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, J.B. Winsløwsvej 17A, 5000 Odense, Denmark
| | - Arne Høst
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Philippe Grandjean
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, J.B. Winsløwsvej 17A, 5000 Odense, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tina Kold Jensen
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, J.B. Winsløwsvej 17A, 5000 Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Department of Growth and Reproduction, Blegdamsvej 9, 2100 Copenhagen, Denmark
| |
Collapse
|
48
|
Lassen TH, Frederiksen H, Kyhl HB, Swan SH, Main KM, Andersson AM, Lind DV, Husby S, Wohlfahrt-Veje C, Skakkebæk NE, Jensen TK. Prenatal Triclosan Exposure and Anthropometric Measures Including Anogenital Distance in Danish Infants. Environ Health Perspect 2016; 124:1261-8. [PMID: 26908126 PMCID: PMC4977040 DOI: 10.1289/ehp.1409637] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 09/24/2015] [Accepted: 02/12/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Triclosan (TCS) is widely used as an antibacterial agent in consumer products such as hand soap and toothpaste, and human exposure is widespread. TCS is suspected of having endocrine-disrupting properties, but few human studies have examined the developmental effects of prenatal TCS exposure. OBJECTIVES We prospectively examined associations between prenatal TCS exposure and anthropometric measures at birth and anogenital distance (AGD) at 3 months of age. METHODS Pregnant women from the Odense Child Cohort (n = 514) provided urine samples at approximately gestational week 28 (median 28.7 weeks, range 26.4-34.0), and urinary TCS concentration was measured by isotope dilution TurboFlow-liquid chromatography-tandem mass spectrometry. Multiple linear regression analysis was used to examine associations between prenatal TCS exposure and measures of size at birth (birth weight, length, head and abdominal circumference) and AGD at 3 months of age (median 3.3 months, range 2.3-6.7 months), controlling for potential confounders. RESULTS Newborn boys in the highest quartile of prenatal TCS exposure had a 0.7-cm [95% confidence interval (CI): -1.2, -0.1, p = 0.01] smaller head circumference than boys in the lowest quartile. Additionally in boys, inverse associations of borderline statistical significance were observed between prenatal TCS exposure and abdominal circumference at birth and AGD at 3 months of age (p-values < 0.10). Prenatal TCS exposure was not significantly associated with any of the outcomes in girls. However, AGD was measured in fewer girls, and we observed no significant interactions between a child's sex and prenatal TCS exposure in anthropometric measures at birth. CONCLUSION Prenatal TCS exposure was associated with reduced head and abdominal circumference at birth and with reduced AGD at 3 months of age in boys, although the last two findings were statistically nonsignificant. These findings require replication but are compatible with an anti-androgenic effect of prenatal TCS exposure on fetal growth in boys. CITATION Lassen TH, Frederiksen H, Kyhl HB, Swan SH, Main KM, Andersson AM, Lind DV, Husby S, Wohlfahrt-Veje C, Skakkebæk NE, Jensen TK. 2016. Prenatal triclosan exposure and anthropometric measures including anogenital distance in Danish infants. Environ Health Perspect 124:1261-1268; http://dx.doi.org/10.1289/ehp.1409637.
Collapse
Affiliation(s)
- Tina Harmer Lassen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henriette Boye Kyhl
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Odense Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Shanna H. Swan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katharina M. Main
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dorte Vesterholm Lind
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Christine Wohlfahrt-Veje
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels E. Skakkebæk
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tina Kold Jensen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Address correspondence to T.K. Jensen, Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Winsløwsparken 17, 5000 Odense, Denmark. Telephone: 4565503077. E-mail:
| |
Collapse
|
49
|
Ludvigsson JF, Agreus L, Ciacci C, Crowe SE, Geller MG, Green PHR, Hill I, Hungin AP, Koletzko S, Koltai T, Lundin KEA, Mearin ML, Murray JA, Reilly N, Walker MM, Sanders DS, Shamir R, Troncone R, Husby S. Transition from childhood to adulthood in coeliac disease: the Prague consensus report. Gut 2016; 65:1242-51. [PMID: 27196596 PMCID: PMC4975833 DOI: 10.1136/gutjnl-2016-311574] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/27/2016] [Indexed: 12/20/2022]
Abstract
The process of transition from childhood to adulthood is characterised by physical, mental and psychosocial development. Data on the transition and transfer of care in adolescents/young adults with coeliac disease (CD) are scarce. In this paper, 17 physicians from 10 countries (Sweden, Italy, the USA, Germany, Norway, the Netherlands, Australia, Britain, Israel and Denmark) and two representatives from patient organisations (Association of European Coeliac Societies and the US Celiac Disease Foundation) examined the literature on transition from childhood to adulthood in CD. Medline (Ovid) and EMBASE were searched between 1900 and September 2015. Evidence in retrieved reports was evaluated using the Grading of Recommendation Assessment, Development and Evaluation method. The current consensus report aims to help healthcare personnel manage CD in the adolescent and young adult and provide optimal care and transition into adult healthcare for patients with this disease. In adolescence, patients with CD should gradually assume exclusive responsibility for their care, although parental support is still important. Dietary adherence and consequences of non-adherence should be discussed during transition. In most adolescents and young adults, routine small intestinal biopsy is not needed to reconfirm a childhood diagnosis of CD based on European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) or North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) criteria, but a biopsy may be considered where paediatric diagnostic criteria have not been fulfilled, such as, in a patient without biopsy at diagnosis, additional serology (endomysium antibody) has not been performed to confirm 10-fold positivity of tissue transglutaminase antibodies or when a no biopsy strategy has been adopted in an asymptomatic child.
Collapse
Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Paediatrics, Örebro University Hospital, Örebro, Sweden,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lars Agreus
- Division of Family Medicine, Karolinska Institutet, Sweden
| | - Carolina Ciacci
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Sheila E Crowe
- University of California, San Diego (UCSD), San Diego, California, USA
| | | | - Peter H R Green
- Celiac Disease Center at Columbia University, New York, New York, USA
| | - Ivor Hill
- Division of Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - A Pali Hungin
- Primary Care and General Practice, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | - Sibylle Koletzko
- Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Tunde Koltai
- Hungary (for the Association of European Coeliac Societies, AOECS), Budapest, Hungary
| | - Knut E A Lundin
- Department of Gastroenterology and Centre for Immune Regulation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - M Luisa Mearin
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Department of Immunology Mayo Clinic, Rochester, Minnesota, USA
| | - Norelle Reilly
- Columbia University Medical Center-Division of Paediatric Gastroenterology, New York, New York, USA
| | - Marjorie M Walker
- Anatomical Pathology, Faculty of Health and Medicine, University of Newcastle, School of Medicine & Public Health, Newcastle, Australia
| | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital & University of Sheffield, Sheffield, UK
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases Schneider Children's Medical Center of Israel, Tel-Aviv University, Tel Aviv, Israel
| | - Riccardo Troncone
- Department of Medical Translational Sciences & European Laboratory for the Investigation of Food Induced Diseases, University Federico II, Naples, Italy
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
| |
Collapse
|
50
|
Jensen TK, Frederiksen H, Kyhl HB, Lassen TH, Swan SH, Bornehag CG, Skakkebaek NE, Main KM, Lind DV, Husby S, Andersson AM. Prenatal Exposure to Phthalates and Anogenital Distance in Male Infants from a Low-Exposed Danish Cohort (2010-2012). Environ Health Perspect 2016; 124:1107-13. [PMID: 26672060 PMCID: PMC4937858 DOI: 10.1289/ehp.1509870] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 11/30/2015] [Indexed: 05/02/2023]
Abstract
BACKGROUND Phthalates comprise a large class of chemicals used in a variety of consumer products. Several have anti-androgenic properties, and in rodents prenatal exposure has been associated with reduced anogenital distance (AGD)-the distance from the anus to the genitals in male offspring. Few human studies have been conducted, but associations between the anti-androgenic phthalates and male AGD have been reported. OBJECTIVE We aimed to study the association between phthalate exposure in late pregnancy in Danish women pregnant in 2010-2012 and AGD in their male infants at 3 months of age (n = 273). METHODS In the Odense child cohort study, urinary concentrations of 12 phthalate metabolites of diethyl, di-n-butyl, diisobutyl, di(2-ethylhexyl), butylbenzyl, and diisononyl phthalate (DEP, DnBP, DiBP, DEHP, BBzP, and DiNP, respectively) were measured among 245 mothers of boys at approximately gestational week 28 (range, 20.4-30.4) and adjusted for osmolality. AGD, penile width, and weight were measured 3 months after the expected date of birth. Associations between prenatal phthalate and AGD and penile width were estimated using multivariable linear regression adjusting for age and weight-for-age standard deviation score. RESULTS Phthalate levels were lower in this population than in a recent Swedish study in which phthalates were measured in the first trimester. No consistent associations were seen between any prenatal phthalate and AGD or penile width. Most associations were negative for exposures above the first quartile, and for ln-transformed exposures modeled as continuous variables, but there were no consistent dose-response patterns, and associations were not statistically significant (p > 0.05). CONCLUSION We found no significant trends towards shorter AGD in boys with higher phthalates exposures in this low exposed Danish population. CITATION Jensen TK, Frederiksen H, Kyhl HB, Lassen TH, Swan SH, Bornehag CG, Skakkebaek NE, Main KM, Lind DV, Husby S, Andersson AM. 2016. Prenatal exposure to phthalates and anogenital distance in male infants from a low-exposed Danish cohort (2010-2012). Environ Health Perspect 124:1107-1113; http://dx.doi.org/10.1289/ehp.1509870.
Collapse
Affiliation(s)
- Tina Kold Jensen
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Odense University Hospital, Hans Christian Andersen Children’s Hospital, Odense, Denmark
- Address correspondence to T.K. Jensen, Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Winsløwsparken 17, 5000 Odense, Denmark. Telephone: 4565503077. E-mail:
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henriette Boye Kyhl
- Odense University Hospital, Hans Christian Andersen Children’s Hospital, Odense, Denmark
| | - Tina Harmer Lassen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Shanna H. Swan
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | | | - Niels E. Skakkebaek
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Katharina M. Main
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dorte Vesterholm Lind
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Odense University Hospital, Hans Christian Andersen Children’s Hospital, Odense, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|