Early histological and functional effects of chronic copper exposure in rat liver

Cu is an essential trace element capable of producing toxic effects in animals and man when ingested acutely or chronically in excess. Although chronic Cu exposure is increasingly recognized as a public health issue, its early effects remain largely unknown. We approached the significance of a moderate chronic Cu load in young rats to correlate early hepatic histopathological changes with functional alterations of liver cells. For this purpose, supplementation with 1,200 ppm of Cu in rat food for 16 weeks was chosen. In these conditions, Cu load elicited a significant decrease in growth curves. There were mild light microscopy alterations in Cu-treated rats, although increasing intracellular Cu storage was correlated with longer Cu exposure both by histological and biochemical measurements. Ultrastructural alterations included lysosomal inclusions as well as mitochondrial and nuclear changes. Liver perfusion studies revealed higher rates of basal O(2) consumption and colloidal carbon-induced O(2) uptake in Cu-treated rats, with enhanced carbon-induced O(2)/carbon uptake ratios and NF-kappaB DNA binding activity. These changes were time-dependent and returned to control values after 12 or 16 weeks. It is concluded that subchronic Cu loading in young rats induces early hepatic morphological changes, with enhancement in Küpffer cell-dependent respiratory burst activity and NF-kappaB DNA binding, cellular responses that may prevent or alleviate the hepatotoxicity of the metal.

Differential response of interleukin-2 production to chronic copper supplementation in healthy humans

BACKGROUND

Copper (Cu) is an essential trace element for many biological processes including maintenance of both innate and acquired branches of immunity.

OBJECTIVE

To measure the effect of copper supplementation on IL-2 and TNF-alpha production in subjects with lower and higher ceuloplasmin (Cp) values within normal range.

DESIGN

Healthy adults (17 men and 16 women) with normal-low (low Cp) and normal-high Cp (high Cp) values were supplemented with 10 mg Cu/day (as CuSO(4)) during 2 months.

METHOD

Before and after supplementation blood mononuclear cells were incubated in the absence or presence of phytohaemagglutinin or lipopolysaccharide for induction of IL-2 and TNF-alpha, respectively. The secretion of cytokines was measured by ELISA. Cu supplementation did not modify classical biochemical markers of Cu status.

RESULTS

After supplementation, a significant increase in IL-2 production was found only in subjects with normal-low plasma Cp. Before and after Cu supplementation geometric mean and range +/- 1 SEM values were 1,566 (1,287-1,905) and 2,514 (2,159-2,927) pg/mL, respectively (two-way ANOVA for repeated measures: Cp level p < 0.001; time = NS; interaction Cp level and time p < 0.05). We did not observe changes in TNF-alpha production after Cu supplementation.

CONCLUSIONS

Cu supplementation increased secretion of IL-2 and not TNF-alpha, which suggests an activation of proliferative but not inflammatory cytokines. These results support hypothesis that IL-2 may be a good indicator to identify a subgroup of individuals (polymorphism) who differs in Cu metabolism.

Upper limits on a stochastic background of gravitational waves

The Laser Interferometer Gravitational-Wave Observatory has performed a third science run with much improved sensitivities of all three interferometers. We present an analysis of approximately 200 hours of data acquired during this run, used to search for a stochastic background of gravitational radiation. We place upper bounds on the energy density stored as gravitational radiation for three different spectral power laws. For the flat spectrum, our limit of omega0 < 8.4 x 10(-4) in the 69-156 Hz band is approximately 10(5) times lower than the previous result in this frequency range.

Supplementing copper at the upper level of the adult dietary recommended intake induces detectable but transient changes in healthy adults

The health consequences of mild copper excess in humans are unknown. In a previous study, 2 mo of supplementation with up to 6 mg Cu/L in drinking water did not induce detectable changes. Here we assessed a copper supplement at the upper level of dietary recommendations for "healthy" adults. The study was a prospective controlled trial; participants (women and men, 18-50 y old), represented the upper and lower 5% of the ceruloplasmin distribution curve obtained from a community-based sample of 800 healthy adults (n = 41/group, each approximately 50% men). Individuals received a single daily dose of 10 mg Cu for 60 d. Before and after supplementation, blood [copper, ceruloplasmin protein, homocysteine, liver aminotranferases, Cu-Zn -superoxide dismutase activity in erythrocytes (eSOD), and glutathione in peripheral mononuclear cells] and urine [copper excretion after a 5-h administration of a chelator 2,3-dimercapto-1-propano-sodium sulfonate (DMPS)] analyses were performed. After 2 mo, liver enzyme activities remained below the clinical cutoff value used to diagnose liver dysfunction, but had increased significantly in both groups and genders. These increases were no longer present 12 mo after the copper loading period was completed. Glutathione in mononuclear cells (mmol/g of protein) also increased after the 2-mo copper loading in both groups and in both genders (P = 0.01). eSOD activity, serum homocysteine concentration, and urinary copper excretion 5 h after DMPS administration were not affected. We conclude that copper administered as described induced a transient, mild, but significant elevation of aminotransferases.

Prebiotic ingestion does not improve gastrointestinal barrier function in burn patients

Prebiotics increase intestinal levels of health-promoting bacteria implicated in decreasing pathogen colonization, stimulating immune functions and stabilizing gut barrier functions, parameters which are altered in burn patients. We propose that regular intake of a prebiotic, oligofructose (OF), might help to improve the altered gastrointestinal (GI) permeability observed in burn patients. A randomized, double-blind, controlled clinical trial was carried out in 41 burn patients (mean burn surface area=17.1+/-8.2%) who ingested daily 6 g of oligofructose (OF group) or sucrose as placebo (Control group) during 15 days. Gastrointestinal permeability to sucrose and lactulose/mannitol (L/M) was evaluated on days 1 (before treatment) 3, 7, 14 and 21. A permeability test was also performed in 18 healthy subjects as controls. Thirty-one patients completed the protocol (dropout rate=24.4%). Healthy subjects had a basal sucrose excretion of 21.3 mg (14.0-32.5 mg) and a basal L/M ratio of 0.017% (0.009-0.022%). Sucrose excretion increased 5-fold and L/M ratio 4.4-fold in burn patients on day 1 and these high levels of marker excretion decreased significantly throughout the study (p=0.016 and 0.000001, respectively). No differences between the OF and Control groups were observed for sucrose excretion or L/M ratio. In conclusion, the normalization of gastrointestinal permeability is not accelerated by prebiotic intake.

Limits on gravitational-wave emission from selected pulsars using LIGO data

We place direct upper limits on the amplitude of gravitational waves from 28 isolated radio pulsars by a coherent multidetector analysis of the data collected during the second science run of the LIGO interferometric detectors. These are the first direct upper limits for 26 of the 28 pulsars. We use coordinated radio observations for the first time to build radio-guided phase templates for the expected gravitational-wave signals. The unprecedented sensitivity of the detectors allows us to set strain upper limits as low as a few times 10(-24). These strain limits translate into limits on the equatorial ellipticities of the pulsars, which are smaller than 10(-5) for the four closest pulsars.

Effects of chronic copper exposure during early life in rhesus monkeys

BACKGROUND

Whether infants regulate copper absorption and the potential effects of excess copper in early life remain poorly defined.

OBJECTIVE

The objective of the study was to assess copper retention, liver copper content, and liver function in infant rhesus monkeys fed infant formula containing 6.6 mg Cu/L.

DESIGN

From birth to 5 mo of age, infant rhesus monkeys were fed formula that was supplemented with copper (0.6 mg Cu/L; n = 5) or not supplemented (n = 4). In all animals, weight and crown-rump length (by anthropometry), hemoglobin, hematocrit, plasma ceruloplasmin activity, and zinc and copper concentrations were measured monthly (birth to 6 mo) and at 8 and 12 mo. When the animals were 1, 5, and 8 mo old, liver copper and metallothionein concentrations, liver histology (by light and electron microscopy), and the number of Kupffer cells were assessed, and 67Cu retention was measured. Liver function was assessed by measurement of plasma alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and alkaline phosphatase activities and protein, albumin, bilirubin, and blood urea nitrogen concentrations.

RESULTS

67Cu retention was 19.2% and 10.9% after 1 and 5 mo of copper treatment, respectively, compared with approximately 75% in controls at age 2 mo. At age 8 mo, 67Cu retention was 22.9% in copper-treated animals and 31.5% in controls. Liver histology remained normal by light microscopy, with mild ultrastructural signs of cell damage at 5 mo. Liver copper concentration was 4711, 1139, and 498 microg/g dry tissue at 1, 5, and 8 mo, respectively, in copper-treated animals and 250 microg/g at 2 mo in controls. Measurements could not be completed in all animals.

CONCLUSIONS

No clinical evidence of copper toxicity was observed. Copper absorption was down-regulated; increases in liver copper content at ages 1 and 5 mo did not result in histologic damage. Ultrastructural changes at age 5 mo could signal early cellular damage.

Sex and ceruloplasmin modulate the response to copper exposure in healthy individuals

Previous studies indicated that sex might influence the response to copper exposure. Ceruloplasmin (Cp) is an indicator of Cu status, but it is not clear whether and how it reflects changes of Cu status among healthy individuals. In this study, 82 apparently healthy women and men were chosen from 800 individuals because their Cp values belonged to the higher and lower 10% of the group Cp distribution curve. Before and after receiving a supplement of 10mg Cu/day (upper limit of daily intake) for 2 months, we performed blood and urinary biochemical measurement of potential Cu markers. We used principal component analysis and linear discriminant analysis to identify blood and/or urinary Cu indicators that showed a differential response to copper. Results showed that Cp values in serum represent a reliable indicator to differentiate subgroups within the normal population in their response to Cu exposure. The response depends on Cp values and on sex, such that women with higher and men with lower Cp values exhibit the greatest response.

[Risk markers for insulin-dependent diabetes mellitus and duration of exposure to gluten in celiac patients]

BACKGROUND

Celiac patients are at high risk of developing insulin-dependent diabetes mellitus, a condition that has a long pre-diabetic period. During this lapse, anti-islet cell antibodies serve as markers for future disease. This may be related with the duration of the exposure to gluten.

AIM

To test the hypothesis that long term adherence to a gluten free diet decreases the frequency of risk markers for insulin dependent diabetes mellitus during adolescence and early adulthood.

PATIENTS AND METHODS

158 celiac patients were classified as: G1, (n=30 patients) studied at the time of diagnosis; G2 (n=97 patients) exposed to gluten as a result of non compliance with the gluten free diet and, G3 (n=31 patients) who had maintained a long term, strict gluten free diet. Isotype IgG anti-islet cell antibodies were detected by indirect immunofluorescence using monkey pancreas, results were reported in Juvenile Diabetes Foundation (JDF) units.

RESULTS

Celiac patients exposed to a gluten containing diet had a significantly higher prevalence of anti-islet cell antibodies than those who had been exposed only briefly (p < 0.017). In addition, a significantly higher prevalence of anti-islet cell antibodies was observed in those patients whose exposure to gluten was longer than 5 years than in those whose exposure was shorter (p < 0.02).

CONCLUSIONS

Celiac patients long exposed to gluten have a significantly higher prevalence of anti-islet cell antibodies than those exposed for a short period. This fact supports the hypothesis that the development of these antibodies is associated with the length of the exposure to gluten.

Community-based randomized double-blind study of gastrointestinal effects and copper exposure in drinking water

We assessed gastrointestinal effects in 1,365 adults exposed to either < 0.01 (controls), 2, 4, or 6 mg copper/L of drinking water for 2 months in a randomized, double-blind community-based study. The risk of symptoms increased with increasing Cu exposure and decreased with time. The best model by counting-process analysis included Cu concentration and sex. The risk of symptoms remained significantly higher in women than in men during weeks 1-4 for all concentrations tested; at week 1 comparison with the < 0.01-mg/L group showed that differences became significant in women at 4 mg/L [relative risk (RR) = 1.53; 95% confidence interval (CI), 1.02-2.05), and in men at 6 mg/L (RR = 1.9; 95% CI, 1.02-2.79). At week 2 for men and week 4 in women, the Cu concentration required to obtain significant differences on symptom report was > 6 mg Cu/L. We conclude that exposure to Cu in drinking water results in gastrointestinal symptoms, which are modulated by Cu concentration, time, and sex.

Iron, zinc, and copper: contents in common Chilean foods and daily intakes in Santiago, Chile

OBJECTIVES

We determined the iron (Fe), zinc (Zn), and copper (Cu) contents of common Chilean foods and assessed the intakes of these elements in a population living in Santiago, Chile.

METHODS

We selected foods most consumed by a Chilean population (n = 108). We performed wet digestion of the sample by using nitric, perchloric, and sulfuric acids. Fe, Zn, and Cu were determined by atomic absorption spectrophotometry. Fe, Zn, and Cu intakes were evaluated by a dietary survey (24-h recall questionnaire for 4 non-consecutive days) in a representative sample of the population of Santiago, Chile (n = 252 subjects).

RESULTS

Fe intakes (mg/d) were 7.8 +/- 9.6 (in infants), 8.1 +/- 5.3 (in 1- to 10-y-olds), 15.1 +/- 7.3 (11- to 19-y-old males), 9.5 +/- 4.3 (11- to 19-y-old females), 13.5 +/- 6.5 (20- to 64-y-old males), 9.1 +/- 3.9 (20- to 64-y-old females), 11.4 +/- 4.9 (> or =65-y-old males), and 11.3 +/- 5.0 (> or =65-y-old females). Zn intakes (mg/d) were 3.8 +/- 1.8 (infants), 6.2 +/- 3.1 (1- to 10-y-old subjects), 8.9 +/- 4.1 (11- to 19-y-old males), 5.7 +/- 2.0 (11- to 19-y-old females), 7.6 +/- 3.4 (20- to 64-y-old males), 6.4 +/- 3.5 (20- to 64-y-old females), 6.6 +/- 2.9 (> or =65-y-old males), and 6.9 +/- 2.4 (> or =65-y-old females). Cu intakes (mg/d) were 0.5 +/- 0.3 (infants), 0.8 +/- 0.5 (1- to 10-y-old subjects), 1.4 +/- 0.7 (11- to 19-y-old males), 1.2 +/- 0.3 (11- to 19-y-old females), 0.9 +/- 0.4 (20- to 64-y-old males), 1.0 +/- 0.4 (20- to 64-y-old females), 1.1 +/- 0.3 (> or =65-y-old males), and 0.9 +/- 0.4 (> or =65-y-old females).

CONCLUSIONS

Fe deficiency was greater in infants and women of fertile age. All age and sex groups had a high risk of Zn deficiency, whereas adults of both sexes had a moderate increased risk of Cu deficiency.

Health and aesthetic impacts of copper corrosion on drinking water

Traditional research has focused on the visible effects of corrosion--failures, leaks, and financial debits--and often overlooked the more hidden health and aesthetic aspects. Clearly, corrosion of copper pipe can lead to levels of copper in the drinking water that exceed health guidelines and cause bitter or metallic tasting water. Because water will continue to be conveyed to consumers worldwide through metal pipes, the water industry has to consider both the effects of water quality on corrosion and the effects of corrosion on water quality. Integrating four key factors--chemical/biological causes, economics, health and aesthetics--is critical for managing the distribution system to produce safe water that consumers will use with confidence. As technological developments improve copper pipes to minimize scaling and corrosion, it is essential to consider the health and aesthetic effects on an equal plane with chemical/biological causes and economics to produce water that is acceptable for public consumption.

Confirmation of an acute no-observed-adverse-effect and low-observed-adverse-effect level for copper in bottled drinking water in a multi-site international study

In a double blind, 3x3 factorial (volumexdose) study, 70 adult females (18-60 years of age) at four different international sites (total pooled n=269) were given 100, 150, or 200ml of bottled drinking water with 0.4, 0.8, or 1.2mg of copper (Cu) as the sulfate salt once each week. Two additional doses (0 and 1.6mg Cu) were added at the 200ml volume to determine a dose-response relationship and corroborate previously reported results. All subjects completed a questionnaire at 0, 0.25, and 1h post-dosing that screened for positive gastrointestinal (GI) effects (nausea, vomiting, abdominal pain, and diarrhea). Nausea was the most prevalent symptom reported and was generally reported within the first 15min (water volume, p<0.032; copper dose, p<0.0001; and water volumexcopper interaction, p<0.97). As volume increased, the effect of Cu-induced nausea decreased; as Cu dose increased, the incidence of nausea increased. At 200ml, a significant increase in reported incidence of nausea at 0.25h occurred at 1.2 mg Cu (6mg Cu/L), indicating a NOAEL of 0.8mg Cu (4mg Cu/L) for adult females. These data confirm a previously determined human acute NOAEL for Cu added to distilled water, and provide additional, controlled human data for determining safe concentrations of Cu in drinking water.

Copper deficiency and excess in infancy: developing a research agenda

Copper deficiency and excess have been recognized as potential health problems for infants and children worldwide. Clinical manifestations of copper deficiency and excess are well characterized but the precise sequence by which high copper intake interacts with genetic control systems, leading to liver damage in infants, is unknown. The possibility that genetic mutations or epigenetic factors related to the functional development of copper homeostasis, could make otherwise normal infants on normal copper intake more susceptible to copper toxicity has been an issue of concern. In January 2001 a group of pediatricians and researchers interested in this area met at Tegernsee, Bavaria, Germany, to reviewing the state of knowledge on the topic. They addressed six main issues: 1) The relevance of copper deficit and excess as health problems. 2) The appropriate biomarkers to identify and characterize copper status 3) The genetic variability in copper metabolism 4) The mechanisms of whole body copper homeostasis in early life and their changes with age 5) The development of experimental and animal models to address research questions on copper homeostasis in infants. 6) The safe upper and lower limits of copper intake/exposure from water and food. We present here the highlights of the discussions and the main conclusions of the meeting.

Assessment of the trace element status of individuals and populations: the example of zinc and copper

This paper describes the proceedings of a workshop that was convened at the 11th International Symposium on Trace Elements in Man and Animals (TEMA-11) symposium to review recent advances concerning the assessment of the trace element status of individuals and populations, using zinc and copper as the primary examples to illustrate basic principles and recent advances in assessment methods. The workshop was initiated with a brief review of the importance of zinc nutriture for human health and a discussion of the likely common occurrence of zinc deficiency worldwide. This overview was followed by presentations on selected issues concerning the assessment of zinc status, with particular attention devoted to dietary assessment techniques, the use of isotopic tracers to assess zinc homeostasis and the relationship of these methods to biochemical indicators of zinc status. Because relatively little information is available on zinc toxicity, the discussion concerning the definition of excess intake of trace elements focused primarily on recent work concerning risk assessment of copper toxicity.

Gastrointestinal symptoms and blood indicators of copper load in apparently healthy adults undergoing controlled copper exposure

BACKGROUND

Mild and moderate effects of marginally low and marginally high copper exposure are poorly understood in humans.

OBJECTIVE

The objective was to assess acute gastrointestinal effects and blood markers of copper status in apparently healthy adults who underwent controlled copper exposure for 2 mo.

DESIGN

This was a 2-mo, randomized, controlled, double-blind study of 1365 apparently healthy adults in whom acute gastrointestinal symptoms (nausea, vomiting, diarrhea, and abdominal pain) were assessed as responses to copper exposure (<0.01, 2, 4, or 6 mg/L water). Blood markers were measured in 240 participants at the end of the survey. Subjects with anemia, inflammation, or infection were excluded. Serum and erythrocyte copper, peripheral mononuclear cell copper, serum ceruloplasmin, the nonceruloplasmin bound copper fraction, superoxide dismutase activity, hemoglobin, mean corpuscular volume, serum ferritin, and liver enzyme activities were measured.

RESULTS

The percentage of subjects reporting gastrointestinal symptoms was higher in the 6-mg Cu group than in the <0.01-mg Cu group (P < 0.02). One hundred ninety-five subjects fulfilled the inclusion criteria for the blood studies. Although a significant relation between copper intake and total gastrointestinal symptoms was observed, no relation was found between copper intake or reported symptoms and copper-load variables.

CONCLUSIONS

Gastrointestinal symptoms increased significantly in response to 6 mg Cu/L water. No detectable changes were observed in indicators of copper status, which suggests competent homeostatic regulation. The results of liver function tests remained normal in all subjects. The lack of change in superoxide dismutase activity supports the Food and Nutrition Board's latest recommendation of 0.9 mg Cu/d for adults.

Copper exposure and potential biomarkers of copper metabolism

Relevant biological effects associated with mild to moderate copper deficiency and copper excess are unknown. It is difficult to identify markers of these early changes because limits of the homeostatic range are still undefined and early changes may represent adaptive responses that do not imply necessarily risk of damage. We report here a series of studies carried out to shed light on the responses within the homeostatic range, by assessing classic parameters of copper status in humans at different copper exposure. In adult healthy volunteers that had an estimated daily intake of 0.9 mg Cu/day (approximately 15 microg/kg/d), exposure to additional 50-60 microg of copper/kg/day for three months or up to 150 microg/kg/d for two months resulted in no significant changes of SOD activity in erythrocytes, of copper concentration (in serum, erythrocytes and mononuclear cells) and of serum ceruloplasmin (ANOVA). Neither were found differences by gender or age. As in previous studies in infants, the non-ceruloplasmin copper fraction was positively correlated to serum copper (r = 0.58). Assessing variations on copper absorption, infants supplemented/not supplemented with oral copper (80 ug/kg/14 days), at age 1 and 3 months, showed copper absorption close to 80% at both ages; no effect was observed for age or supplementation, suggesting that either these concentrations do not elicit regulatory mechanisms or that at this age down regulation for copper absorption is not efficient. These studies indicate that in the range of the copper homeostasis area the markers tested are not suitable to detect mild changes (within the homeostatic range) of copper metabolism.

[Challenge testes for diagnosis and follow-up of children with food allergy]

BACKGROUND

The prevalence of food allergy increased worldwide in the last century. In Chile we became aware of this increase 10-15 years ago, after an epidemiological transition on health.

AIM

To assess the most frequent clinical presentations of food allergy, results of circulating immunologlobulins (total IgE, specific IgE and IgG4 against cow's milk) and usefulness of a standardized challenge test.

PATIENTS AND METHODS

Cross sectional assessment of 49 patients with cow's milk allergy (9 months-8 years of age), diagnosed at INTA, University of Chile between 1991-2001.

RESULTS

All patients had cow's milk allergy and 37% of them were additionally intolerant to other allergens. Seventy eight percent had digestive symptoms and 84% had non digestive symptoms. The cause of consultation was a non-digestive manifestation in 16% of cases. At least one of the immunoglobulins (total IgE total, specific IgE or IgG4) was over the cut off point in 92% of patients. Between 1990-1995 six patients were diagnosed with cow's milk allergy and malabsorption syndrome. Suppression of the specific allergen resulted in disappearance of symptoms in 78% of patients; when a second dietary modification was necessary 87% of cases showed a good response. Thirty five of 56 challenge tests performed were done at home, by relatives, in a non-controlled fashion. All of them were aimed to determine the desensitization of the child.

CONCLUSIONS

Digestive and non-digestive manifestations were observed in these patients with food allergy. Although not designed to assess laboratory tests, results show that serum immunoglobulin determinations were helpful in guiding diagnosis. Mothers and relatives should be educated to accept diagnostic challenges and avoid carrying out non-controlled challenges.

Gastric response to acute copper exposure

Early effects of acute copper exposure consist mainly of nausea and altered gastric permeability. To assess copper effects on gastric response 30 apparently healthy volunteers underwent two controlled trials receiving a solution with (10 mg Cu/l) and without (<0.01 mg Cu/l) copper sulfate after overnight fasting, in random order. Ultrasonography was chosen to follow indirectly the gastric emptying pattern for 120 min. Measurements were expressed as z scores [z=(mean-Xi)/S.D.]. Results showed that nobody presented symptoms after drinking water without added copper while 9 subjects presented nausea after receiving the 10 mg Cu/l solution. The group receiving drinking water with 10 mg Cu/l presented greater antral areas during the first 60 min of observation. Individual and mean fitted curves for antral area, calculated and compared using the linear mixed-effects model fit by REML, showed a group effect of copper on antral area over time (L. Ratio=23.98, P<0.0001); the effect was due to delay in decreasing antral area in the copper treated group during the first hour after ingestion. No differences were found by gender or nausea. Results show a copper effect on gastric response suggesting that acute exposure to copper in water modify the first phase of gastric emptying.

[Nutritional recovery. An unresolved challenge]

Factors that modulate catch up growth influence the quantity and quality of the recovered tissue. Insulin and IGF-1 respond to dietary changes in carbohydrates and proteins; evidence shows that IGF-1 and leptin may be good indicators of nutritional recovery. The optimal diet to promote catch up growth is still controversial. There is consensus on the need to adjust the energy-protein intake to the growth velocity observed, without encouraging excessive eating, to avoid obesity. Zinc supplementation and physical activity appear as relevant factors to promote the synthesis of lean mass. In some models of early malnutrition, a better catch up growth during childhood, is associated with a higher frequency of chronic diseases and mortality in adulthood. In this context, we will review some factors that seem relevant to the modulation of catch up growth, which should be taken into account when reviewing the therapeutic guidelines to treat malnourished children.

[Tissue anti-transglutaminase antibodies: a better test to detect minor dietary transgressions in celiac patients?]

BACKGROUND

Endomysium antibodies (EMA) do not detect minor dietary transgressions in patients with celiac disease.

AIM

To compare the sensitivity and specificity of tissue transglutaminase antibodies (tTGA) and endomysium antibodies (EMA) in biopsy proven celiac patients at the time of diagnosis and during gluten free diet (GFD).

PATIENTS AND METHODS

One hundred fifty three subjects were studied: a) 30 healthy controls; b) 9 cases with cow's milk allergy; c) 24 celiac patients at time of diagnosis; d) 25 celiac patients adhering to the GFD; e) 65 celiac patients with poor/no adhesion to GFD. EMA and tTGA IgA were measured by immunofluorescence and ELISA, respectively.

RESULTS

Sensitivity and specificity were 100% and 97.4% for tTGA, respectively. All patients with cow's milk allergy were EMA (-) and 8 of 9 (88.9%) were tTGA (-). In celiac patients not adhering to the GFD, EMA and tTGA positivity were similar (80% and 81.5%, respectively); 95.4% of the subjects tested positive for at least one of them. All patients adhering to GFD were EMA (-) but tTGA were (+) in 28% of them.

CONCLUSIONS

EMA and tTGA have similar sensitivity and specificity at the time of diagnosis of celiac disease. Positive tTGA in 28% of patients that adhered strictly to the GFD and whose EMA were negative suggest that tTGA may be helpful in detecting minor dietary transgressions and should be further evaluated.