Gliadin antibodies for diagnosis of celiac disease.
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Biomedical subjects
Publications and source records attributed to V Khoshoo.
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Children with acute diarrhea and moderate dehydration between 3 months and 5 years of age were randomly assigned to receive treatment with standard WHO oral rehydration solution (ORS) (n = 33) and two other solutions in which the 20 g/L glucose was substituted by 50 g/L of pop rice (n = 31) and 60 g/L of mung bean (lentil) powder (n = 29). Satisfactory oral rehydration, as assessed clinically and by changes in PCV and total serum solids (TSS), was achieved in 90.9% with WHO ORS, 96.8% with pop rice, and 96.6% in the mung bean ORS treated group (p greater than 0.05). The purging rates (ml/kg/h) until recovery were 2.49 +/- 1.5 (pop rice); 2.91 +/- 2.0 (WHO), and 3.41 +/- 1.7 in the mung bean group (p greater than 0.05). The percentage of patients recovering from diarrhea within the 72 h study period was 58.0 (pop rice), 48.4 (WHO), and 44.8 for mung bean group (p greater than 0.05). Though differences in stool volumes and duration in the three groups were not statistically different, there was a trend toward improvement in efficacy with the pop rice ORS in several parameters: greater weight gain, higher percentage decline in TSS, higher urine output despite lower ORS intake, and lower purging rates. The intake of semisolids in the 24-72 h study period was also higher in the pop rice group as compared to the other two groups (p less than 0.05). The number of breast feeds and intake of artificial milk was however similar in all groups (p greater than 0.05).
Sixty children less than 2 years of age suffering from mild acute gastroenteritis with less than 5% dehydration were randomly assigned to two different isocaloric feeding regimens, viz., a locally prepared milk-free formulation (group A) of rice, lentil, sugar, and coconut oil and a spray dried commercial cow's milk formula (group B). There were two treatment failures in group A and one in group B. The postintervention duration of diarrhea (days) in group A (11.0 +/- 10.0) was higher than in group B (7.6 +/- 10.8), but these differences were not significant (p greater than 0.05). The energy intake (kcal/kg/24 h) on postintervention day 4 was 78.7 +/- 31.7 in group A and 101.3 +/- 41.1 in group B (p greater than 0.05). The corresponding values for day 7 were 74.2 +/- 29.1 and 110.0 +/- 41.1, respectively (p less than 0.05). The mean weight gain (g/kg/24 h) between admission and the day of recovery in group A (2.0 +/- 4.2) was significantly lower (p less than 0.05) than in group B (5.8 +/- 7.8). Similar trends in weight gain were observed at days 4 and 7. These findings suggest that a cow's milk-based formula is well tolerated by majority of the infants with mild acute gastroenteritis after initial rehydration with ORS. The infants who were fed the milk-free cereal-based diet showed significantly less energy intake and gained weight less rapidly than those who were fed the cow's milk-based formula.
BACKGROUND: The effect of nasogastric feeding with high- and low-fat, peptide-based diets on body composition and disease activity was studied in adolescents with active Crohn's disease. METHODS: Fourteen patients with active Crohn's disease (12 to 17 years) were fed exclusively through nasogastric feedings with two isocaloric, isonitrogenous, peptide-based diets, either with low- or high-fat content, for 3 weeks each in a randomized manner then were "crossed over" to the other diet for another 3 weeks of feeding. At the end of each 3-week period, urine and stools were collected for 72 hours for measuring energy absorption and nitrogen utilization (n = 6). Weight, height, triceps skin folds, fat free body mass, and disease activity were also monitored (n = 14). RESULTS: There was no difference in any parameter of energy absorption or nitrogen utilization between the two formulas irrespective of the order in which they were administered. The changes in nutritional parameters were also comparable with both formulas. There was a significant increase in weight, fat free body mass and triceps skinfold thickness during both the 3-week periods of feeding (p < .05). This was accompanied by a significant reduction in the pediatric Crohn's disease activity index (p < .05). CONCLUSIONS: Peptide-based diets may be useful in restoring the fat free body mass and improving the disease activity in patients with Crohn's disease. A high fat (high medium-chain triglycerides) diet did not offer any nutritional advantage over a similar but low-fat diet. The improvement in disease activity during feeding with a low-fat diet was comparable to that with a high-fat diet. The improvement in disease activity seems to be associated with improvement in lean body mass irrespective of the type of diet used to achieve it.
Oral intake following a high density oral supplement (preload) is lower than that after a low density preload. We studied a similar effect of parenteral nutrition on oral intake. Twelve neurologically intact children (8-16 yr) with orthopedic problems and no concurrent illness were included in the study. As part of the inclusion criteria, all patients had documented energy intake for breakfast of +/- 10% on 3 consecutive days. On the fourth day parenteral nutrition equal to 50% of the mean energy intake for breakfast was provided for 4 hours before breakfast and energy intake measured. The composition of the parenteral energy was matched with that of the oral intake. The mean oral energy intake without (470 +/- 90 kcal) and with (458 +/- 64 kcal) parenteral nutrition preload was comparable (p > 0.05). Our conclusion is that parenteral nutrition does not affect oral intake in patients without underlying gastrointestinal disease.
R-1 anti-reticulin antibodies (ARA) were present in sera of 10 of the 12 children who subsequently fulfilled the ESPGAN diagnostic criteria for celiac disease (CD), but was not found in any children in the age-matched control groups, viz., severely malnourished (n = 20), acute gastroenteritis (n = 23), normally nourished asymptomatic (n = 38), and 42 children with protracted diarrhoea and failure to thrive due to nonceliac causes. ARA was a highly specific (100%) and sensitive (83%) assay for the early diagnosis of CD. A positive ARA assay with an initial subtotal villous atrophy was seen to always suggest CD, and these together would provide a useful basis for instituting gluten-free diets in suspected cases of CD rather than histological findings alone, which may be often present in children in the third world with protracted diarrhoea and associated severe malnutrition.