Prenatal Coffin-Siris Syndrome: Expanding the Phenotypic and Genotypic Spectrum of the Disease

Coffin-Siris syndrome is an autosomal dominant disorder with neurological, cardiovascular, and gastrointestinal symptoms. Patients with Coffin-Siris syndrome typically have variable degree of developmental delay or intellectual disability, muscular hypotonia, dysmorphic facial features, sparse scalp hair, but otherwise hirsutism and fifth digit nail or distal phalanx hypoplasia or aplasia. Coffin-Siris syndrome is caused by pathogenic variants in 12 different genes including SMARCB1 and ARID1A. Pathogenic SMARCB1 gene variants cause Coffin-Siris syndrome 3 whereas pathogenic ARID1A gene variants cause Coffin-Siris syndrome 2. Here, we present two prenatal Coffin-Siris syndrome cases with autosomal dominant pathogenic variants: SMARCB1 gene c.1066_1067del, p.(Leu356AspfsTer4) variant, and a novel ARID1A gene c.1920+3_1920+6del variant. The prenatal phenotype in Coffin-Siris syndrome has been rarely described. This article widens the phenotypic spectrum of prenatal Coffin-Siris syndrome with severely hypoplastic right ventricle with VSD and truncus arteriosus type III, persisting left superior and inferior caval vein, bilateral olfactory nerve aplasia, and hypoplastic thymus. A detailed clinical description of the patients with ultrasound, MRI, and post mortem pictures of the affected fetuses showing the wide phenotypic spectrum of the disease is presented.

Impact of nutrition counselling on nutrition knowledge and nutrient intake of 7- to 9-y-old children in an atherosclerosis prevention project

OBJECTIVE

To assess the impact of nutrition counselling given to 7.5- to 9-y-old children and their parents on children's nutrition knowledge and nutrient intakes.

DESIGN AND SUBJECTS

The study children are participants in a prospective, randomised STRIP study (Special Turku Coronary Risk Factor Intervention Project for Children), whose aim was to decrease the intakes of saturated fat and cholesterol while increasing the intake of unsaturated fat in the intervention children from the age of 7 months onwards. Nutrition counselling was given only to the parents until the child's age of 7 y. Nutrition knowledge and nutrient intakes (total energy, total fat, saturated fat, unsaturated fat and sodium) were studied in a time-restricted cohort of 47, 7-y-old intervention and 51 control children. Thereafter, nutrition counselling was given both to the children and parents. Children's nutrition knowledge and nutrient intakes were measured again at the age of 9 y.

RESULTS

Biannual nutrition counselling given to the intervention children and the parents maintained the differences in saturated fatty acid intake attained during the intervention given to the parents alone (11.5 vs 13.3 E% (percent of energy intake), at the age of 7 y, P<0.01; 11.1 vs 13.4 E% at the age of 9 y, respectively; P<0.01). The intervention children used more polyunsaturated fatty acids at the age of 9 y than the control children (5.7 vs 5.1 E%, P=0.05). At 7 y, the intervention and control children had similar nutrition knowledge scores (total knowledge score 12.9 vs 12.0, respectively, P=0.13). After 1.5 y of nutrition intervention, at 9 y, the intervention children's nutrition knowledge was higher than that of the controls (total nutrition score 16.5 vs 13.2, respectively, P<0.001) and the ability to explain the reasons for their picture choices in the nutrition knowledge test had increased.

CONCLUSION

This study showed that only a relatively short period of counselling with low input is needed to increase in children's nutrition knowledge and ability to explain nutrition-related subjects if advice has first been given to the parents and if the parents have received reinforcement and concrete help with parent-child communication after their children have been involved in the counselling. The differences attained in nutrient intake could also be maintained.

Parental nutrition knowledge and nutrient intake in an atherosclerosis prevention project: the impact of child-targeted nutrition counselling

Most of the counselling in health care targeted at child nutrition is delivered via the parents, but little is known about the effects of such counselling on the nutrition knowledge and dietary habits of the parents. In the Special Turku Coronary Risk Factor Intervention Project for Children (STRIP), we studied how 6.5 years of child-targeted nutrition counselling affected the knowledge, attitudes and dietary habits of the parent mainly responsible for food purchase and preparation. We used a questionnaire and a 24-h recall interview in a time-restricted cohort of 98 families belonging to the intervention group and 89 families belonging to the control group in the STRIP project. After controlling for background variables, the intervention parents had better knowledge than the control parents of causal relationships between food choices and coronary heart disease and of the nutritional composition of foods. Knowledge of nutrition concepts did not differ between the two groups. The quality of fat was better in the diet of the intervention parents, they consumed less salt and they also had more knowledge concerning these subjects compared to the control parents (higher behavioural capability scores). The behavioural capability scores of the total group correlated poorly with their nutrient intakes. Thus, child-targeted nutrition intervention delivered to the parents increased parental nutrition knowledge and improved the quality of the parents' diet. However, as nutrition knowledge of the parents correlated poorly with their nutrient intakes, other factors than knowledge appear to influence parental dietary decisions.

Nutrition knowledge and food intake of seven-year-old children in an atherosclerosis prevention project with onset in infancy: the impact of child-targeted nutrition counselling given to the parents

OBJECTIVE

To compare nutrition knowledge and food intake in 7-y-old intervention and control children in an atherosclerosis risk factor intervention trial after 6.5 y of nutrition counselling given to the parents.

DESIGN, SUBJECTS AND METHODS

Intervention families in the Special Turku Coronary Risk Factor Intervention Project received child-oriented nutritional counselling one to three times a year since child's age of 7 months, aimed at reduced saturated fat and cholesterol intake. Children's nutrition knowledge was analysed in a time-restricted cohort of 70 seven-y-old (34 boys) intervention children and 70 control children (40 boys) with a picture identification test. For comparison, children's food intake was evaluated using scores developed for the project that reflected quality and quantity of fat and quantity of salt in children's two or three 4-day food diaries recorded between 5.5 and 7 y of age.

RESULTS

Child-targeted nutrition counselling of the intervention families only slightly increased intervention children's knowledge of heart-healthy foods (42.6% vs 34.9% correct answers by the intervention and control children, P = 0.057). Only < or = 20% of the children were able to adequately justify their answers in the test. The food diaries of the intervention children comprised more foods low in saturated fat and high in unsaturated fat than those of the control children (57.1% vs 41.7% of the maximum score for low fat foods, P = 0.0001; 48.9% vs 37.7% for high unsaturated fat foods, P = 0.0009, respectively), but the intervention and control children consumed similar amounts of low-salt foods (P = 0.23). Nutrition knowledge and food use scores correlated poorly (r = -0.20-0.35).

CONCLUSIONS

Child-targeted nutrition counselling repeatedly given to the parents during and after child's infancy strongly influenced food choice scores of the 5.5-7-y-old children but failed to influence children's salt intake or scores in a nutrition knowledge picture test.

Connections between parental eating attitudes and children's meagre eating: questionnaire findings

This study investigated whether young children's problematic, meagre eating is associated with the eating habits and attitudes of the parents. The subjects, 397 children, their mothers (n = 397) and fathers (n = 375) participated in a prospective atherosclerosis risk-factor intervention trial. The parents evaluated their own eating behaviour in questionnaires when their child was 13 mo old. The children's eating problems were recorded by the mothers when the child was 13 mo old, and by both parents when the child was 5 y old. At both ages, the weight and height of the children were measured. Problematic or maladaptive eating habits of the children were found to be connected to those of their parents. The mother's poor ability to enjoy eating, high tendency to snack and low tendency to eat only when hungry, as well as the father's difficulty in maintaining ideal weight significantly predicted persistent problems of meagre eating in their children.

CONCLUSION

The study suggests that the eating habits and attitudes of parents may be reflected in the eating behaviour of young children.

Behavior of 3-year old children in a prospective randomized trial of reduced saturated fat and cholesterol diet since infancy: the STRIP baby project

Interventions aimed at decreased exposure of children to known atherosclerosis risk factors may have untoward behavioral side effects. We examined how children's behavior or parent's perception of the behavior of the children at 3 years of age was influenced by the intervention in a prospective randomized trial that began in infancy and effectively decreased serum cholesterol concentration. This Special Turku coronary Risk factor Intervention Project for babies (STRIP) began when the infant was 7 months old. Half of 1,062 children received individualized dietary counseling at 1 to 3-month intervals during the first 2 years of age and then half-yearly; the other half had an unrestricted diet. At 3 years of age a standardized questionnaire of the child's behavior was sent to 791 families (76% returned the questionnaire). At the onset of the trial the sociodemographic data of the families and serum lipid values of the intervention and control children were similar. Later, mean serum cholesterol values of the intervention children remained constantly at a level 6% to 10% below the values of the control children. At 3 years of age the parental perceptions of the child's behavior suggested minimal differences between the intervention and control children. The intervention children were slightly less jealous and more active and creative but showed slightly more negative signs of behavior (bed-wetting, problems in falling asleep, fears) than the controls. We conclude that long-term, individualized dietary and lifestyle intervention that begins in infancy slightly influences children's behavior or parent's recognition of the behavior of the children at the age of 3 years.

Outcome at six and twelve months post inpatient treatment for cocaine and alcohol dependence

This study presents outcome rates for inpatient treatment for alcohol, cocaine and other drug dependence. The abstinence rates at six and twelve months post discharge and other demographic information are compiled on 1,627 patients admitted to an inpatient treatment unit for the rehabilitation of cocaine, alcohol and other drug dependence. The percent of the 1,627 patients with the diagnosis of alcohol dependence only was 42%, cocaine, alcohol and other drug dependence 25%, and alcohol and other drugs, 28%. The abstinence rate at six months for patients with alcohol dependence only was 75%, alcohol and other drug dependence 82%, cocaine dependence 76%; at twelve months, the abstinence rates were 71%, 66%, and 62% respectively.

The diagnosis of alcohol, cocaine, and other drug dependence in an inpatient treatment population

The diagnosis of alcohol, cocaine, and other drug dependence in inpatient treatment populations is important to identify for clinical prognosis, treatment, and genetic research. The use of alcohol by cocaine addicts is a common cause for relapse to cocaine. The treatment of cocaine addiction is simplified if alcohol dependence is also present because the same methods can be used for both. In this study, 94% of those patients who qualified for the diagnosis of cocaine dependence were also diagnosed as having alcohol and other drug dependence. The demographic characteristics of these cocaine addicts (n = 413) compared to those patients with the diagnosis of alcohol dependence only (n = 677) and alcohol dependence and drug dependence other than cocaine (n = 453).