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Roy SM, Rafferty D, Trejo A, Hamilton L, Bohonowych JE, Strong TV, Ambartsumyan L, Cantu S, Scheimann A, Duis J. Feeding tube use and complications in Prader-Willi syndrome: Data from the Global Prader-Willi Syndrome Registry. Am J Med Genet A 2024; 194:e63546. [PMID: 38303141 DOI: 10.1002/ajmg.a.63546] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/03/2024]
Abstract
Guidance on indications for, and types of, feeding tubes recommended in Prader-Willi syndrome (PWS) is needed. A Global PWS Registry survey was developed to investigate nasogastric (NG) and gastrostomy (G) tube use and associated complications. Of 346 participants, 242 (69.9%) had NG-tubes, 17 (4.9%) had G-tubes, and 87 (25.1%) had both NG- and G-tubes. Primary indication for placement was "feeding difficulties and/or poor weight gain" for both NG- (90.2%) and G-tubes (71.2%), while "aspiration/breathing difficulties" was the procedural indication for 6.4% of NG-tubes and 23.1% of G-tubes. NG-tubes were generally removed by age 6 months (NG Only: 82.9%; NG/G: 98.8%), while G-tubes were often removed by age 2 years (G Only: 85.7%; NG/G: 70.5%). The severe complication rate from G-tubes was 31.7% and from NG-tubes was 1.2%. Overall, caregivers indicated the presence of an NG- or G-tube had a positive effect on quality of life. Feeding difficulties in PWS are largely managed by NG-tube alone. The severe complication rate from G-tubes was about 25 times higher than from NG-tubes; yet, G-tube placement rates have generally increased. G-tube placement puts individuals with PWS at risk for anesthesia and surgery-related complications and should be considered judiciously by a multidisciplinary team.
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Affiliation(s)
- Sani M Roy
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | | | - Amy Trejo
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Luke Hamilton
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | | | | | | | - Samson Cantu
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Ann Scheimann
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Texas Children's Hospital, Houston, Texas, USA
| | - Jessica Duis
- Children's Hospital Colorado, Aurora, Colorado, USA
- SequenceMD, Denver, Colorado, USA
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Rodrigo ML, Heubi C, Chiou E, Scheimann A. Laryngeal clefts in Prader-Willi syndrome: Feeding difficulties and aspiration not always caused by hypotonia. Am J Med Genet A 2024:e63634. [PMID: 38619072 DOI: 10.1002/ajmg.a.63634] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024]
Abstract
Feeding difficulties, aspiration, and failure to thrive in infancy are commonly seen in patients with Prader-Willi Syndrome (PWS) and attributed to hypotonia. Patients with PWS and laryngeal clefts were identified by review of medical records at three tertiary care children's hospitals between 2017 and 2022. We present three patients with PWS with feeding difficulties who were also found to have laryngeal clefts which likely contributed to their feeding difficulties. Additional factors such as airway anomalies should be considered in patients with PWS, especially when swallowing dysfunction, dysphagia, or abnormal swallow evaluations are present.
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Affiliation(s)
- Minna L Rodrigo
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Christine Heubi
- Division of Pediatric Otolaryngology - Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology - Head & Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Eric Chiou
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Ann Scheimann
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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3
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Jain AK, Buchannan P, Yates KP, Belt P, Schwimmer JB, Rosenthal P, Murray KF, Molleston JP, Scheimann A, Xanthakos SA, Behling CA, Hertel P, Nilson J, Neuschwander-Tetri BA, Tonascia J, Vos MB. Nutrition assessment and MASH severity in children using the Healthy Eating Index. Hepatol Commun 2023; 7:e0320. [PMID: 38055641 PMCID: PMC10984667 DOI: 10.1097/hc9.0000000000000320] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/19/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Pediatric metabolic-associated fatty liver disease (MAFLD) is a global health problem, with lifestyle modification as its major therapeutic strategy. Rigorous characterization of dietary content on MAFLD in children is lacking. We hypothesized an objectively measured healthier diet would positively modulate MAFLD. METHODS Diet was assessed using the Nutrition Data System for Research in children enrolled from 10 tertiary clinical centers to determine the Healthy Eating Index (HEI, 0-100) and individual food components. RESULTS In all, 119 children were included (13.3 ± 2.7 y), 80 (67%) male, 67 (18%) White, and 90 (76%) Hispanic, with an average body mass index Z-score of 2.2 ± 0.5. Diet was classified as low HEI < 47.94 (n = 39), mid HEI ≥ 47.94 and < 58.89 (n = 41), or high HEI ≥ 58.89 (n=39). Children with high HEI (healthier diet) had lower body weight (p = 0.005) and more favorable lipids. Mean serum triglycerides for low, mid, and high HEI were 163, 148, and 120 mg/dL, respectively; p = 0.04 mid versus high, p = 0.01 low versus high. Mean HDL was 38, 41 and 43 mg/dL; p = 0.02 low vs high. Less severe steatosis was noted with added sugar ≤ 10% of calories (p = 0.03). Higher lobular inflammation is associated with a higher percentage of calories from fat (OR (95% CI) = 0.95 (0.91-1.00), p = 0.04). CONCLUSIONS In children with MAFLD, high HEI is associated with lower body weight and more favorable lipids, while added sugar and fat intake has individual histologic features. Differential consumption of major dietary components may modify both metabolic risk factors and histologic liver injury, highlighting the importance of objective diet assessments in children with MAFLD.
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Affiliation(s)
- Ajay Kumar Jain
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Saint Louis University, St. Louis, Missouri, USA
| | - Paula Buchannan
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Saint Louis University, St. Louis, Missouri, USA
| | - Katherine P. Yates
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Patricia Belt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeffrey B. Schwimmer
- Department of Pediatrics, Division of Gastroenterology, UC San Diego, La Jolla, California, USA
- Department of Gastroenterology, Rady Children’s Hospital, San Diego, California, USA
| | - Philip Rosenthal
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California, San Francisco Benioff Children’s Hospital, San Francisco, California, USA
| | - Karen F. Murray
- Pediatrics Institute, Cleveland Clinic and Cleveland Clinic Children’s Hospital, Cleveland, Ohio
| | - Jean P. Molleston
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Ann Scheimann
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stavra A. Xanthakos
- Steatohepatitis Center, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cynthia A. Behling
- Department of Pediatrics, Division of Gastroenterology, UC San Diego, La Jolla, California, USA
- Department of Gastroenterology and Pacific Rim Pathology, San Diego, California, USA
| | - Paula Hertel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Jamie Nilson
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Saint Louis University, St. Louis, Missouri, USA
| | | | - James Tonascia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Miriam B. Vos
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
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Natale V, Pruette C, Gerohristodoulos K, Scheimann A, Allen L, Kim JM. Journey Mapping to Improve Patient-Family Experience and Teamwork: Applying a Systems Thinking Tool to a Pediatric Ambulatory Clinic. Qual Manag Health Care 2023; 32:61-64. [PMID: 36579687 DOI: 10.1097/qmh.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Veronica Natale
- Departments of Quality Improvement (Ms Natale) and Specialty Clinic (Ms Gerohristodoulos), Johns Hopkins Hospital, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland (Drs Pruette, Scheimann, and Kim); Department of Service Excellence, Johns Hopkins Health System, Baltimore, Maryland (Dr Allen); Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland (Drs Allen and Kim); and Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (Dr Kim)
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Jerome GJ, Fink T, Brady T, Young DR, Dickerson FB, Goldsholl S, Findling RL, Stepanova EA, Scheimann A, Dalcin AT, Terry A, Gennusa J, Cook C, Daumit GL, Wang NY. Physical Activity Levels and Screen Time among Youth with Overweight/Obesity Using Mental Health Services. Int J Environ Res Public Health 2022; 19:ijerph19042261. [PMID: 35206449 PMCID: PMC8871648 DOI: 10.3390/ijerph19042261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 12/10/2022]
Abstract
Youth with mental illness have higher levels of obesity than children in the general population. Both regular physical activity and limited screen time have been recommended to reduce and prevent childhood obesity. This study examines accelerometer-based moderate-vigorous physical activity (MVPA) and screen time among youth with overweight/obesity issues who are receiving mental health care. This study looked at a 12-month weight management randomized clinical trial for overweight/obese youth aged 8-18 years who are receiving mental health services. At baseline, MVPA was assessed using accelerometers, and screen time was self-reported. Among 100 youth, 43% were female, 44% were Black, and 48% were <13 years old. In an adjusted general linear model, higher levels of MVPA were associated with the younger age group (p = 0.012), male participants (p = 0.013), and lower BMI z-scores (p = 0.014). In a separate model, higher screen time was associated with participants who were Black (p = 0.007). Achieving optimal cardiovascular health at the population level requires an understanding of the groups that are most in need of additional assistance. These data reinforce that targeted lifestyle approaches to promote increased physical activity and decreased screen time among overweight/obese youth using mental health services may need additional tailoring for sex, age, and race subgroups.
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Affiliation(s)
- Gerald J. Jerome
- Department of Kinesiology, Towson University, Towson, MD 21252, USA
- Correspondence:
| | - Tyler Fink
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (T.F.); (S.G.); (A.T.D.); (A.T.); (J.G.); (C.C.); (G.L.D.); (N.-Y.W.)
| | - Tammy Brady
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (T.B.); (A.S.)
| | | | | | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (T.F.); (S.G.); (A.T.D.); (A.T.); (J.G.); (C.C.); (G.L.D.); (N.-Y.W.)
| | - Robert L. Findling
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23284, USA; (R.L.F.); (E.A.S.)
| | - Ekaterina A. Stepanova
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23284, USA; (R.L.F.); (E.A.S.)
| | - Ann Scheimann
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (T.B.); (A.S.)
| | - Arlene T. Dalcin
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (T.F.); (S.G.); (A.T.D.); (A.T.); (J.G.); (C.C.); (G.L.D.); (N.-Y.W.)
| | - Alison Terry
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (T.F.); (S.G.); (A.T.D.); (A.T.); (J.G.); (C.C.); (G.L.D.); (N.-Y.W.)
| | - Joseph Gennusa
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (T.F.); (S.G.); (A.T.D.); (A.T.); (J.G.); (C.C.); (G.L.D.); (N.-Y.W.)
| | - Courtney Cook
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (T.F.); (S.G.); (A.T.D.); (A.T.); (J.G.); (C.C.); (G.L.D.); (N.-Y.W.)
| | - Gail L. Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (T.F.); (S.G.); (A.T.D.); (A.T.); (J.G.); (C.C.); (G.L.D.); (N.-Y.W.)
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (T.F.); (S.G.); (A.T.D.); (A.T.); (J.G.); (C.C.); (G.L.D.); (N.-Y.W.)
- Department of Biostatistics and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Bernstein R, Getzoff E, Gelfand K, Demeule-Hayes M, Scheimann A. Interaction and influence of child and family characteristics upon success of weight management treatment. Eat Weight Disord 2021; 26:2033-2041. [PMID: 33128165 DOI: 10.1007/s40519-020-01052-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Interventions to address childhood obesity demonstrate moderate effects at best. Previous research has focused on factors of the intervention that influence success. Yet, effective overweight and obesity interventions require an interaction between family and individual factors. It is vital to characterize those who are successful vs. those who are not within treatment based on these factors. METHODS This study utilized data from an existing multidisciplinary (i.e., nutrition, physical therapy, psychology, and medicine) group treatment for children with overweight and obesity. Children (N = 113) were given the Behavior Assessment System for Children, the Pediatric Quality of Life Inventory, and completed an interview at baseline, then height and weight were measured at 6 months and 12 months post-intervention. Latent class analysis was used to determine how family and individual characteristics and behavior interact and group together to characterize individuals who lose weight vs. do not lose weight during treatment. RESULTS The four-cluster model was the best fit for the data. The four identified groups delineated one for whom treatment was successful, and three for whom treatment was not successful. Those three were differentiated by families who appeared to have inconsistent engagement with treatment, families who appeared to not be engaged with treatment, and families who had baseline risk factors that likely require a significantly higher level of treatment. CONCLUSION Characterizing the differences between those who successfully respond to this treatment from those who were unsuccessful can help identify those most likely to benefit from treatment. Future research and treatment considerations should include treatment modifications for nonresponders. LEVEL OF EVIDENCE Level III, longitudinal cohort study.
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Affiliation(s)
- Ruth Bernstein
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA. .,Department of Pediatric Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA.
| | - E Getzoff
- Department of Pediatric Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - K Gelfand
- Department of Pediatric Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - M Demeule-Hayes
- Department of Weigh Smart, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - A Scheimann
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Felix G, Kossoff E, Barron B, Krekel C, Testa EG, Scheimann A. The modified Atkins diet in children with Prader-Willi syndrome. Orphanet J Rare Dis 2020; 15:135. [PMID: 32493369 PMCID: PMC7268481 DOI: 10.1186/s13023-020-01412-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/26/2019] [Accepted: 05/18/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Prader-Willi Syndrome (PWS) is the most common genetic cause of obesity. Various dietary strategies have been used for weight management for people with PWS. METHODS This was a clinical feasibility study to test the use of the Modified Atkins Diet (low carbohydrate and high fat) for children with PWS ages 6-12 years who were overweight/obese. Participants went on the Modified Atkins Diet for 4 months and then returned to have anthropometry repeated including repeat labs and behavior questionnaires. RESULTS Seven children (ages 6-12) were enrolled in the study. Four participants completed the 4-month diet trial; two were unable to comply with the diet and stopped prematurely. One patient lost 2.9 kg; the others maintained their weight. Adverse effects were increases in LDL (expected based on larger studies) and hypercalciuria (with no renal stones) for one patient. Positive effects on hyperphagia and behavior were noted subjectively by families. CONCLUSION The Modified Atkins Diet can be a feasible low carbohydrate option for children with Prader-Willi Syndrome for weight management. Long-term use of the diet in patients with Prader-Willi Syndrome needs to be studied further.
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Affiliation(s)
- Grace Felix
- Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Pediatric Specialists of Virginia/INOVA Children's Hospital, Fairfax, Virginia, USA
| | - Eric Kossoff
- Department of Pediatric Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bobbie Barron
- Institute of Clinical and Translational Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Caitlin Krekel
- Institute of Clinical and Translational Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth Getzoff Testa
- Department of Psychology, Center for Pediatric Weight Management & Healthy Living, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - Ann Scheimann
- Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins Hospital, 600 N. Wolfe Street Brady 320, Baltimore, MD, 21287-2631, USA.
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8
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Chumpitazi BP, Lewis J, Cooper D, D’Amato M, Lim J, Gupta S, Miranda A, Terry N, Mehta D, Scheimann A, O’Gorman M, Tipnis N, Davies Y, Friedlander J, Smith H, Punati J, Khlevner J, Setty M, Di Lorenzo C. Hypomorphic SI genetic variants are associated with childhood chronic loose stools. PLoS One 2020; 15:e0231891. [PMID: 32433684 PMCID: PMC7239456 DOI: 10.1371/journal.pone.0231891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/02/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The SI gene encodes the sucrase-isomaltase enzyme, a disaccharidase expressed in the intestinal brush border. Hypomorphic SI variants cause recessive congenital sucrase-isomaltase deficiency (CSID) and related gastrointestinal (GI) symptoms. Among children presenting with chronic, idiopathic loose stools, we assessed the prevalence of CSID-associated SI variants relative to the general population and the relative GI symptom burden associated with SI genotype within the study population. METHODS A prospective study conducted at 18 centers enrolled 308 non-Hispanic white children ≤18 years old who were experiencing chronic, idiopathic, loose stools at least once per week for >4 weeks. Data on demographics, GI symptoms, and genotyping for 37 SI hypomorphic variants were collected. Race/ethnicity-matched SI data from the Exome Aggregation Consortium (ExAC) database was used as the general population reference. RESULTS Compared with the general population, the cumulative prevalence of hypomorphic SI variants was significantly higher in the study population (4.5% vs. 1.3%, P < .01; OR = 3.5 [95% CI: 6.1, 2.0]). Within the study population, children with a hypomorphic SI variant had a more severe GI symptom burden than those without, including: more frequent episodes of loose stools (P < .01), higher overall stool frequency (P < .01), looser stool form (P = .01) and increased flatulence (P = .02). CONCLUSION Non-Hispanic white children with chronic idiopathic loose stools have a higher prevalence of CSID-associated hypomorphic SI variants than the general population. The GI symptom burden was greater among the study subjects with a hypomorphic SI variant than those without hypomorphic SI variants.
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Affiliation(s)
| | - Jeffery Lewis
- Children’s Center for Digestive Health Care, Atlanta, GA, United States of America
| | - Derick Cooper
- QOL Medical, LLC, Vero Beach, FL, United States of America
| | - Mauro D’Amato
- School of Biological Sciences, Monash University, Clayton, VIC, Australia
| | - Joel Lim
- Children's Mercy Hospital, Kansas City, MO, United States of America
| | - Sandeep Gupta
- Sacramento Pediatric Gastroenterology, Sacramento, CA, United States of America
| | - Adrian Miranda
- Children’s Hospital of Wisconsin, Milwaukee, WI, United States of America
| | - Natalie Terry
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Devendra Mehta
- Arnold Palmer Children's Hospital, Orlando, FL, United States of America
| | - Ann Scheimann
- Johns Hopkins University, Baltimore, MD, United States of America
| | - Molly O’Gorman
- Primary Children's Medical Center, Salt Lake City, UT, United States of America
| | - Neelesh Tipnis
- University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Yinka Davies
- Sacramento Pediatric Gastroenterology, Sacramento, CA, United States of America
| | - Joel Friedlander
- Children’s Hospital Colorado, Digestive Health Institute, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Heather Smith
- QOL Medical, LLC, Vero Beach, FL, United States of America
| | - Jaya Punati
- Children’s Hospital of Los Angeles, Los Angeles, CA, United States of America
| | - Julie Khlevner
- Columbia University Medical Center, New York, NY, United States of America
| | - Mala Setty
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | - Carlo Di Lorenzo
- Department of Pediatrics, The Ohio State University, Columbus, OH, United States of America
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Korotkaya Y, Dunn E, Aybar A, Crino J, Alaish S, Scheimann A. Cecal Duplication Presenting With Hematochezia in an Infant. Clin Pediatr (Phila) 2019; 58:1338-1340. [PMID: 31402694 DOI: 10.1177/0009922819867456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yelena Korotkaya
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Dunn
- Division of Pediatric Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmet Aybar
- Annapolis Pediatric Gastroenterology and Nutrition, Annapolis, MD, USA
| | - Jude Crino
- Department of Obstetrics and Gynecology, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Samuel Alaish
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann Scheimann
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Duis J, van Wattum PJ, Scheimann A, Salehi P, Brokamp E, Fairbrother L, Childers A, Shelton AR, Bingham NC, Shoemaker AH, Miller JL. A multidisciplinary approach to the clinical management of Prader-Willi syndrome. Mol Genet Genomic Med 2019; 7:e514. [PMID: 30697974 PMCID: PMC6418440 DOI: 10.1002/mgg3.514] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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: 04/23/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background Prader–Willi syndrome (PWS) is a complex neuroendocrine disorder affecting approximately 1/15,000–1/30,000 people. Unmet medical needs of individuals with PWS make it a rare disease that models the importance of multidisciplinary approaches to care with collaboration between academic centers, medical homes, industry, and parent organizations. Multidisciplinary clinics support comprehensive, patient‐centered care for individuals with complex genetic disorders and their families. Value comes from improved communication and focuses on quality family‐centered care. Methods Interviews with medical professionals, scientists, managed care experts, parents, and individuals with PWS were conducted from July 1 to December 1, 2016. Review of the literature was used to provide support. Results Data are presented based on consensus from these interviews by specialty focusing on unique aspects of care, research, and management. We have also defined the Center of Excellence beyond the multidisciplinary clinic. Conclusion Establishment of clinics motivates collaboration to provide evidence‐based new standards of care, increases the knowledge base including through randomized controlled trials, and offers an additional resource for the community. They have a role in global telemedicine, including to rural areas with few resources, and create opportunities for clinical work to inform basic and translational research. As a care team, we are currently charged with understanding the molecular basis of PWS beyond the known genetic cause; developing appropriate clinical outcome measures and biomarkers; bringing new therapies to change the natural history of disease; improving daily patient struggles, access to care, and caregiver burden; and decreasing healthcare load. Based on experience to date with a PWS multidisciplinary clinic, we propose a design for this approach and emphasize the development of “Centers of Excellence.” We highlight the dearth of evidence for management approaches creating huge gaps in care practices as a means to illustrate the importance of the collaborative environment and translational approaches.
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Affiliation(s)
- Jessica Duis
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Pieter J van Wattum
- Department of Psychiatry, Child Study Center, Yale School of Medicine, New Haven, Connecticut.,Clifford Beers Clinic, New Haven, Connecticut
| | - Ann Scheimann
- Pediatric Gastroenterology, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Parisa Salehi
- Division of Endocrinology and Diabetes, Seattle Children's, University of Washington, Seattle, Washington
| | - Elly Brokamp
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Laura Fairbrother
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Anna Childers
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Althea Robinson Shelton
- Neuro-Sleep Division, Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Nathan C Bingham
- Division of Pediatric Endocrinology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ashley H Shoemaker
- Division of Pediatric Endocrinology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jennifer L Miller
- Pediatric Endocrinology, University of Florida, Gainesville, Florida
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11
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Perito ER, Ajmera V, Bass NM, Rosenthal P, Lavine JE, Schwimmer JB, Yates KP, Diehl AM, Molleston JP, Murray KF, Scheimann A, Gill R, Glidden D, Aouizerat B. Association Between Cytokines and Liver Histology in Children with Nonalcoholic Fatty Liver Disease. Hepatol Commun 2017; 1:609-622. [PMID: 29130075 PMCID: PMC5679472 DOI: 10.1002/hep4.1068] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Reliable non-invasive markers to characterize inflammation, hepatocellular ballooning, and fibrosis in nonalcoholic fatty liver disease (NAFLD) are lacking. We investigated the relationship between plasma cytokine levels and features of NAFLD histology to gain insight into cellular pathways driving NASH and to identify potential non-invasive discriminators of NAFLD severity and pattern. Methods Cytokines were measured from plasma obtained at enrollment in pediatric participants in NASH Clinical Research Network studies with liver biopsy-proven NAFLD. Cytokines were chosen a priori as possible discriminators of NASH and its components. Minimization of Akaike Information Criterion (AIC) was used to determine cytokines retained in multivariable models. Results Of 235 subjects, 31% had "Definite NASH" on liver histology, 43% had "Borderline NASH", and 25% had NAFLD but not NASH. Total plasminogen activator inhibitor 1 (PAI1) and activated PAI1 levels were higher in pediatric participants with Definite NASH and with lobular inflammation. Interleukin-8 (IL-8) was higher in those with stage 3-4 fibrosis and lobular inflammation. sIL-2rα was higher in children with stage 3-4 fibrosis and portal inflammation. In multivariable analysis, PAI1 variables were discriminators of Borderline/Definite NASH, definite NASH, lobular inflammation and ballooning. IL-8 increased with steatosis and fibrosis severity; sIL-2rα increased with fibrosis severity and portal inflammation. IL-7 decreased with portal inflammation and fibrosis severity. Conclusions Plasma cytokines associated with histology varied considerably among NASH features, suggesting promising avenues for investigation. Future, more targeted analysis is needed to identify the role of these markers in NAFLD and to evaluate their potential as non-invasive discriminators of disease severity.
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Affiliation(s)
- Emily R Perito
- University of California, San Francisco, San Francisco, CA
| | - Veeral Ajmera
- University of California, San Francisco, San Francisco, CA
| | - Nathan M Bass
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | | | | | | | | | - Ryan Gill
- University of California, San Francisco, San Francisco, CA
| | - David Glidden
- University of California, San Francisco, San Francisco, CA
| | - Bradley Aouizerat
- University of California, San Francisco, San Francisco, CA.,New York University, New York, NY
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12
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Scheimann A. NASPGHAN 2015 Distinguished Service Award. J Pediatr Gastroenterol Nutr 2016; 63:310. [PMID: 27276433 DOI: 10.1097/mpg.0000000000001292] [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: 12/10/2022]
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13
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Yeung KA, Taylor T, Scheimann A, Carvalho R, Reinhardt E, Girolami P, Wood R. The Prevalence of Food Allergies in Children Referred to a Multidisciplinary Feeding Program. Clin Pediatr (Phila) 2015; 54:1081-6. [PMID: 26130398 DOI: 10.1177/0009922815593499] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 01/07/2023]
Abstract
OBJECTIVE To assess the prevalence of food allergy in children presenting to a multidisciplinary feeding program. METHODS A retrospective chart review was conducted from 302 patients. We recorded history of food reaction, family history of any atopic disease, radioallergosorbent testing, prematurity, birth weight, breastfeeding history, Z-scores, age, and gastrointestinal mucosal biopsy reports with eosinophilic infiltrate. Three categories of possible food allergy were stratified based on increasing evidence of allergy. RESULTS Possible food allergy was found for 18% (n = 54), likely food allergy for 6% (n = 18), and very likely food allergy for 16% (n = 47) for a total of 40% classified in a food allergy group. Having been breastfed correlated with likelihood of food allergy but tube-feeding dependence did not. CONCLUSION This study revealed a higher proportion of children in a feeding program with food allergy compared to the general population, but larger prospective studies are needed to confirm the association.
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Affiliation(s)
| | - Tessa Taylor
- Johns Hopkins School of Medicine, Baltimore, MD, USA Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ann Scheimann
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ryan Carvalho
- Ohio State University School of Medicine, Columbus, OH, USA
| | | | - Peter Girolami
- Johns Hopkins School of Medicine, Baltimore, MD, USA Kennedy Krieger Institute, Baltimore, MD, USA
| | - Robert Wood
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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14
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Suthutvoravut U, Abiodun PO, Chomtho S, Chongviriyaphan N, Cruchet S, Davies PSW, Fuchs GJ, Gopalan S, van Goudoever JB, Nel EDLR, Scheimann A, Spolidoro JV, Tontisirin K, Wang W, Winichagoon P, Koletzko B. Composition of Follow-Up Formula for Young Children Aged 12-36 Months: Recommendations of an International Expert Group Coordinated by the Nutrition Association of Thailand and the Early Nutrition Academy. Ann Nutr Metab 2015; 67:119-32. [PMID: 26360877 DOI: 10.1159/000438495] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/07/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are no internationally agreed recommendations on compositional requirements of follow-up formula for young children (FUF-YC) aged 1-3 years. AIM The aim of the study is to propose international compositional recommendations for FUF-YC. METHODS Compositional recommendations for FUF-YC were devised by expert consensus based on a detailed literature review of nutrient intakes and unmet needs in children aged 12-36 months. RESULTS AND CONCLUSIONS Problematic nutrients with often inadequate intakes are the vitamins A, D, B12, C and folate, calcium, iron, iodine and zinc. If used, FUF-YC should be fed along with an age-appropriate mixed diet, usually contributing 1-2 cups (200-400 ml) of FUF-YC daily (approximately 15% of total energy intake). Protein from cow's milk-based formula should provide 1.6-2.7 g/100 kcal. Fat content should be 4.4-6.0 g/100 kcal. Carbohydrate should contribute 9-14 g/100 kcal with >50% from lactose. If other sugars are added, they should not exceed 10% of total carbohydrates. Calcium should provide 200 mg/100 kcal. Other micronutrient contents/100 kcal should reach 15% of the World Health Organization/Food and Agriculture Organization recommended nutrient intake values. A guidance upper level that was 3-5 times of the minimum level was established. Countries may adapt compositional requirements, considering recommended nutrient intakes, habitual diets, nutritional status and existence of micronutrient programs to ensure adequacy while preventing excessive intakes.
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Affiliation(s)
- Umaporn Suthutvoravut
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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15
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Demeule-Hayes M, Hogan K, Winters M, Getzoff E, Parrish J, Rogers V, Scheimann A. Dietary Intake Quality Improvements after Participation in a Multi-Disciplinary Pediatric Weight Management Program. J Acad Nutr Diet 2013. [DOI: 10.1016/j.jand.2013.06.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Suzuki A, Abdelmalek MF, Schwimmer JB, Lavine JE, Scheimann A, Unalp-Arida A, Yates K, Sanyal A, Guy CD, Diehl AM. Association between puberty and features of nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2012; 10:786-94. [PMID: 22343513 PMCID: PMC3382041 DOI: 10.1016/j.cgh.2012.01.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [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: 06/28/2011] [Revised: 01/23/2012] [Accepted: 01/29/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Physiological changes that occur during puberty might affect pathologic features of nonalcoholic fatty liver disease (NAFLD). We investigated associations between pubertal development and clinical and histopathologic features of NAFLD. METHODS We studied 186 children (age <18 years, 143 boys) with biopsy-proven NAFLD. The population was divided into 3 groups on the basis of Tanner stage (prepuberty, puberty, and postpuberty). Clinical characteristics and histologic features were compared among groups. Multivariable regression models were used to adjust for potential confounders. RESULTS After adjusting for other factors, hyperuricemia and low levels of high-density-lipoprotein cholesterol were more prevalent among children who entered puberty with lower levels of quantitative insulin sensitivity check index (P < .05). The degree of steatosis, numbers of Mallory-Denk bodies, and diagnostic categories of NAFLD differed among groups (P < .05). There were potential sex differences in associations between stages of puberty and lobular inflammation, hepatocyte ballooning, and borderline steatohepatitis of zone 3; these were therefore not included in multivariable analyses of the overall population. After adjustment for different sets of confounders, patients at or beyond puberty were less likely to have high-grade steatosis, severe portal inflammation, borderline steatohepatitis (zone 1), or a high stage of fibrosis than patients who had not entered puberty (P < .05). On the contrary, the prevalence of Mallory-Denk body was greater among postpuberty subjects (P = .06). CONCLUSIONS Steatosis, portal inflammation, and fibrosis are less severe during or after puberty than before puberty among subjects with NAFLD. Postpubescent individuals have a lower prevalence of borderline steatohepatitis of zone 1 but are more likely to have Mallory-Denk bodies. These findings indicate that puberty affects the pathologic features of NAFLD.
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Affiliation(s)
- Ayako Suzuki
- Division of Gastroenterology, Duke University, Durham, NC 27710, USA.
| | | | - Jeffrey B. Schwimmer
- Department of Pediatrics, University of California San Diego, La Jolla, CA,Department of Gastroenterology, Rady Children’s Hospital, San Diego, CA
| | - Joel E. Lavine
- Division of Pediatric Gastroenterology and Nutrition, Columbia College of Physicians and Surgeons, New York, NY
| | - Ann Scheimann
- Pediatric Gastroenterology, Johns Hopkins Children’s Center, Baltimore, MD
| | - Aynur Unalp-Arida
- NASH CRN Data Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine Yates
- NASH CRN Data Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Arun Sanyal
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA
| | - Cynthia D Guy
- Department of Pathology, Duke University, Durham, NC
| | - Anna Mae Diehl
- Division of Gastroenterology, Duke University, Durham, NC
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17
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Butler MG, Sturich J, Lee J, Myers SE, Whitman BY, Gold JA, Kimonis V, Scheimann A, Terrazas N, Driscoll DJ. Growth standards of infants with Prader-Willi syndrome. Pediatrics 2011; 127:687-95. [PMID: 21402637 PMCID: PMC3065075 DOI: 10.1542/peds.2010-2736] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [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: 11/24/2022] Open
Abstract
OBJECTIVE To generate and report standardized growth curves for weight, length, head circumference, weight/length, and BMI for non-growth hormone-treated white infants (boys and girls) with Prader-Willi syndrome (PWS) between 0 and 36 months of age. The goal was to monitor growth and compare data with other infants with PWS. METHODS Anthropometric measures (N = 758) were obtained according to standard methods and analyzed from 186 non-growth hormone-treated white infants (108 boys and 78 girls) with PWS between 0 and 36 months of age. Standardized growth curves were developed and the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles were calculated by using the LMS (refers to λ, μ, and σ) smoothing procedure method for weight, length, head circumference, weight/length, and BMI along with the normative 50th percentile using Centers for Disease Control and Prevention national growth data from 2003. The data were plotted for comparison purposes. RESULTS Five separate standardized growth curves (weight, length, head circumference, weight/length, and BMI) representing 7 percentile ranges were developed from 186 non-growth hormone-treated white male and female infants with PWS aged 0 to 36 months, and the normative 50th percentile was plotted on each standardized infant growth curve. CONCLUSIONS We encourage the use of these growth standards when examining infants with PWS and evaluating growth for comparison purposes, monitoring for growth patterns, nutritional assessment, and recording responses to growth hormone therapy, commonly used in infants and children with PWS.
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Affiliation(s)
- Merlin G. Butler
- Departments of Psychiatry, Behavioral Sciences and Pediatrics, Kansas University Medical Center, Kansas City, Kansas
| | - Jennifer Sturich
- Departments of Psychiatry, Behavioral Sciences and Pediatrics, Kansas University Medical Center, Kansas City, Kansas
| | - Jaehoon Lee
- Center for Research Methods and Data Analysis, University of Kansas, Lawrence, Kansas
| | - Susan E. Myers
- Division of Endocrinology, ,Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri
| | - Barbara Y. Whitman
- Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri
| | - June-Anne Gold
- Division of Genetics and Metabolism, Department of Pediatrics, University of California, Irvine, California; ,Division of Medical Genetics and Metabolism, Department of Pediatrics, Loma Linda University Medical School, Loma Linda, California
| | - Virginia Kimonis
- Division of Genetics and Metabolism, Department of Pediatrics, University of California, Irvine, California
| | - Ann Scheimann
- Division of Pediatric Nutrion and Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Norma Terrazas
- Section of Gastroenterology, Hepatology, and nutrition, Texas Children's Hospital, Houston, Texas; and
| | - Daniel J. Driscoll
- Division of Genetics and Metabolism, Department of Pediatrics, University of Florida, Gainesville, Florida
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18
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Oliva-Hemker M, Yeung KA, Cuffari C, Scheimann A, Wilson L. Annual update of pediatric digestive diseases. Expert Rev Gastroenterol Hepatol 2011; 5:21-3. [PMID: 21309668 DOI: 10.1586/egh.10.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/08/2022]
Abstract
The 24th Annual Meeting of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition provided a comprehensive overview of pediatric digestive diseases. The meeting and its adjunct events, including a postgraduate course and 1-day symposium, enabled a diverse group of physicians, trainees and nurses to have the opportunity to discuss the latest developments in pediatric gastrointestinal, liver and nutritional disorders.
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Affiliation(s)
- Maria Oliva-Hemker
- Division of Pediatric Gastroenterology and Nutrition, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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19
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Williams K, Scheimann A, Sutton V, Hayslett E, Glaze DG. Sleepiness and sleep disordered breathing in Prader-Willi syndrome: relationship to genotype, growth hormone therapy, and body composition. J Clin Sleep Med 2008; 4:111-118. [PMID: 18468308 PMCID: PMC2335405] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
STUDY OBJECTIVES Patients with Prader-Willi syndrome (PWS) suffer from excessive sleepiness and sleep disordered breathing (SDB). We reviewed the polysomnograms (PSGs) and multiple sleep latency tests (MSLTs) in a cohort of PWS patients to determine the relationship of BMI(Z) scores, daytime sleepiness, growth hormone (GH) treatments, and SDB. METHODS Attended overnight PSGs were performed for PWS patients referred for concern for SDB between January 2000 and January 2005. Age at time of study, genotype, use and dose of GH, sleepiness scale, normalized body-mass index (BMI(Z)), total sleep time, latency to stage I and REM sleep, sleep stage percentages, apnea-hypopnea index (AHI), central apnea (CA) frequency, oxygen saturation nadir, maximum carbon dioxide tension, periodic limb movement index, presence of snoring, normality of EEG, and, in several patients, mean sleep latency testing were determined. RESULTS All patients exhibited some form of SDB. There was a positive correlation between the BMI(Z) and AHI. The BMI(Z) was significantly different between GH-treated and -untreated groups, but there was not a significant difference between AHI, CA, oxygen nadir, or maximum carbon dioxide tension of the GH-treated and -untreated groups. There was no significant correlation between the MSLT and the sleepiness scale or AHI. There was also no significant difference between the AHIs of patients with different genetic defects. CONCLUSIONS There should be a low threshold for obtaining PSG to evaluate SDB, but the type and severity of SDB were not predictable based on a sleepiness scale score, BMI(Z), or underlying genetic defect.
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Affiliation(s)
- Korwyn Williams
- Division of Neurology, Phoenix Children's Hospital, Phoenix, AZ 85016, USA.
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20
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Williams K, Scheimann A, Sutton V, Hayslett E, Glaze DG. Sleepiness and Sleep Disordered Breathing in Prader-Willi Syndrome: Relationship to Genotype, Growth Hormone Therapy, and Body Composition. J Clin Sleep Med 2008. [DOI: 10.5664/jcsm.27126] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Korwyn Williams
- Division of Neurology, Phoenix Children's Hospital, Phoenix, AZ
| | - Ann Scheimann
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
- Division of Pediatric Gastroenterology and Nutrition, Texas Children's Hospital, Houston, TX
| | - Vernon Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Elizabeth Hayslett
- Division of Pediatric Gastroenterology and Nutrition, Texas Children's Hospital, Houston, TX
| | - Daniel G. Glaze
- Division of Pediatric Neurology, Department of Pediatrics, Division of Neurophysiology, Department of Neurology, Baylor College of Medicine, Houston, TX
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Abstract
Hyperphagia and obesity are common features in individuals with Prader-Willi syndrome (PWS). Demographic and cause-of-death data from individuals with PWS were obtained through a national support organization. Four reports of unexpected mortality due to gastric rupture and necrosis were found in 152 reported deaths, accounting for 3% of the causes of mortality. Four additional individuals were suspected to have gastric rupture. Vomiting and abdominal pain, although rare in PWS, were frequent findings in this cohort. The physician should consider an emergent evaluation for gastric rupture and necrosis in individuals with PWS who present with vomiting and abdominal pain.
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Affiliation(s)
- David A Stevenson
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT 84132, USA.
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22
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Touzé E, Saillour-Glenisson F, Durieux P, Verdier A, Leyshon S, Bendavid S, Attard T, Scheimann A, Mas JL, Coste J. Lack of validity of a French adaptation of a scale measuring attitudes towards clinical practice guidelines. Int J Qual Health Care 2006; 18:195-202. [PMID: 16484314 DOI: 10.1093/intqhc/mzi104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Valid instruments to measure practitioners' attitudes towards clinical practice guidelines need to be developed. However, few of the available instruments have been thoroughly validated. OBJECTIVE To adapt into French and to test the reliability and validity of a scale for measurement of attitudes towards guidelines developed by Elovainio et al. METHODS A 27-item scale (divided into six dimensions) measuring attitudes towards guidelines was translated into French by two English native translators, reviewed and finalized by expert committee and administered to 314 practitioners who agreed to participate. Main practitioners' characteristics were collected. Item and dimension reproducibility were assessed for 62 practitioners by calculation of intraclass correlation coefficients. Internal construct validity was assessed by principal components analyses. Convergent and discriminant validity were analysed. RESULTS Item response rates ranged from 82 to 100%. In the test-retest procedure, intraclass correlation coefficients for separate items ranged from 0.1 to 0.7 and those for dimensions were 0.7 [95% confidence interval (CI): 0.5-0.8] for usefulness, 0.5 (0.3-0.6) for reliability, 0.4 (0.2-0.5) for individual competence, 0.5 (0.3-0.6) for organizational competence, 0.7 (0.5-0.8) for impracticality and 0.4 (0.3-0.6) for availability. The factorial structure after Varimax rotation showed that none of the different solutions obtained had a strictly comparable structure to that of the original scale. External construct validity was satisfactory. CONCLUSION This scale does not have satisfactory psychometric properties and therefore cannot confidently be used in future research assessing whether attitudes towards guidelines are a determining factor in physicians' compliance with guidelines. More research is needed to develop valid scales in a more rigorous procedure, involving qualitative and quantitative steps.
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Affiliation(s)
- E Touzé
- Medexact Company, Boulogne-Billancourt, France.
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23
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Botlon K, Scheimann A, Lee P. 10 DETERMINANTS OF LONG-TERM EFFICACY FOR GROWTH HORMONE THERAPY IN PRADER-WILLI SYNDROME. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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25
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Abstract
Nicotinamide which is an inhibitor of poly (ADPR) synthetase and precursor of NAD has been observed to prevent diabetes in some experimental models possibly by protecting beta cells. To determine whether nicotinamide could cure or prevent type 1 diabetes, we administered large doses (0.5 g/Kg/d) to BB rats. When used in the 45 days following diagnosis nicotinamide failed to bring remission. As a preventive treatment, nicotinamide administered between the 40th and 90th day of age, alone or in association with desferrioxamine did not significantly lower the incidence of diabetes (23% and 30.8% respectively vs. 56.6%). When used earlier, immediately after weaning, nicotinamide did not affect the incidence of diabetes in this model (62.5%). The degree of protection was not comparable with that obtained with cyclosporin A (15% of diabetic animals). Histology study of the pancreas from the animals killed either immediately or 1 year after treatment revealed no endocrine tumor. These findings suggest that in BB rats nicotinamide has little or no effect on the course of autoimmune diabetes mellitus thus dampening the high hopes for this drug in the treatment of human diabetes.
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Affiliation(s)
- L Hermitte
- Laboratory of Diabetology, La Timone Hospital, University of Marseille, France
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