Prevalence and dietetic management of mild gastrointestinal disorders in milk-fed infants

AIM: To assess the prevalence of mild gastrointestinal disorders in milk-fed infants in paediatric practice, and to evaluate the effectiveness and satisfaction with dietetic treatment.METHODS: A cross-sectional epidemiological study was first carried out. A total of 285 paediatricians included 3487 children seen during a period of one week. In a second phase an observational, prospective and multicentre study was conducted and 2069 milk-fed infants with mild gastrointestinal disorders (colic, constipation, regurgitation and diarrhoea) were included. There was a baseline visit (start of treatment) and a final visit four weeks later. The effectiveness of the various Novalac formulas, as well as the satisfaction of the parents/tutors and paediatricians with the dietetic treatment were assessed at the final visit.RESULTS: The prevalence of mild gastrointestinal disorders was 27.8% of all paediatrician consultations (9.2%, 7.8%, 6.1% and 4.6% in relation to colic, constipation, regurgitation and diarrhoea, respectively). The several Novalac adapted milk formulas resolved 88.4% of the mild gastrointestinal disorders. Depending on the type of disorder, differences in response rate were observed. The highest effectiveness was recorded with respect to diarrhoea (92.6%), followed by constipation (91.6%), colic (87.6%) and regurgitation (81%). Overall, 91% of the paediatricians and 88.8% of the parents/tutors were satisfied or very satisfied with the Novalac adapted milk formulas.CONCLUSION: Mild gastrointestinal disorders show a high prevalence in paediatric practice. The Novalac adapted milk formulas have been shown to be effective in treating mild gastrointestinal disorders in milk-fed infants in the context of routine clinical practice.

Epidemiology of functional gastrointestinal disorders in infants and toddlers: A systematic review

AIM: To assess the functional gastrointestinal disorders(FGID) prevalence in infants and toddlers. METHODS: Pub Med, EMBASE, and Scopus were searched for original articles from inception to February 2016. The literature search was made in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA). For inclusion, each study had to report epidemiological data of FGID on children up to 4 years old and contain standardized outcome Rome Ⅱ or Ⅲ criteria. The overall quality of included epidemiological studies was evaluated in accordance to Loney's proposal for prevalence studies of health literature. Two reviewers assessed each study for inclusion and extracted data. Discrepancies were reconciled through discussion.RESULTS: It was identified a total of 101 articles through the databases and two through the manual search. A total of 28 articles fulfilled the eligibility criteria. After reading the full articles, 13 of them were included in the present review. Twelve studies were written in English and one in Chinese, and published between 2004 and 2015. Eight articles(61.5%) were performed in Europe, three(23.1%) in America and two(15.4%) in Asia. Sample size varied between 45 and 9660 subjects. Cross-sectional frequency was reported in majority of studies(k = 9) and four studies prospectively followed the subjects. 27.1% to 38% of participants have met any of Rome's criteria for gastrointestinal syndromes, of those 20.8% presented two or more FGID. Infant regurgitation and functional constipation were the most common FGID, ranging from less than 1% to 25.9% and less than 1% to 31%, respectively. Most included studies were of moderate to poor data quality with respect to absence of confidential interval for prevalence rate and inadequate sampling methods.CONCLUSION: The scarcity and heterogeneity of FGID data call for the necessity of well-designed epidemiological research in different levels of pediatric practice and refinement of diagnostic.

Hypothesis on supine sleep,sudden infant death syndrome reduction and association with increasing autism incidence

AIM:To identify a hypothesis on:Supine sleep,sudden infant death syndrome(SIDS) reduction and association with increasing autism incidence.METHODS:Literature was searched for autism spectrum disorder incidence time trends,with correlation of change-points matching supine sleep campaigns.A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism.RESULTS:In five countries(Denmark,United Kingdom,Australia,Israel,United States) with published time trends of autism,change-points coinciding with supine sleep campaigns were identified.The model proposes that supine sleep does not directly cause autism,but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility,thereby specifically increasing the incidence of autism without intellectual disability.CONCLUSION:Supine sleep is likely a physiological stressor,that does reduce SIDS,but at the cost of impact on emotional and social development in the population,a portion of which will be susceptible to,and consequently express autism.A re-evaluation of all benefits and harms of supine sleep is warranted.If the SIDS mechanism proposed and autism model presented can be verified,the research agenda may be better directed,in order to further decrease SIDS,and reduce autism incidence.

北京市中学生进食障碍检出率研究的结构式会谈结果报告

目的 :初步调查进食障碍在北京市女中学生中的发病情况。方法 :在对 2 61名女中学生的问卷筛查的基础上 ,对 3 8名在节食状况测查表和进食障碍症状调查问卷中得高分的被试 (占总数 15 % )进行了结构式的会谈调查。会谈问题由进食障碍的诊断标准及有关资料编制而成。结果 :在面谈中发现 3例与贪食症有关的非典型性进食障碍的个案 ,即非典型性进食障碍的检出率为 1 1%

小儿厌食症临床试验设计与评价技术要点的文献研究

[目的]系统评估、提炼小儿厌食症临床试验设计与评价技术要点,为试验设计的标准化和试验结果的相互比较提供可行性。[方法]检索国内外权威数据库中的小儿厌食症/厌食及其相关疾病随机对照临床试验(RCT)文献,纳入文献要求符合厌食症及其相关疾病诊断标准,干预措施为中医药、化学药、行为疗法,语种为中英文。[结果]共检索出文献1321篇,最终纳入21篇。其临床定位,14项国内研究中,均以改善食欲不振症状或和增加食量为主,同时探讨改善生长和营养状况3项;7项国外研究中,以改善摄食行为、食欲不振症状、摄食量、小儿生长和营养状况为主,分别为4、1、1、1项。试验总体设计,选择阳性药、安慰剂、行为疗法和空白对照,分别为14、4、1、2项;采用双盲法10项,多中心试验9项,有样本量估算1项;采用差异性检验19项,非劣效检验、优效性检验各1项。中、西医诊断标准,主要参考或符合世界卫生组织(WHO)国际疾病分类、国内外专业学会或权威书籍,以及中国高等院校统编教材标准。受试者选择,具有纳入标准、排除标准、脱落剔除标准设计,分别为21、18、7项。干预措施,采用中医药、化学药、行为干预治疗分别为11项、4项、3项,联合治疗3项;疗程在10 d^8周,以2~4周居多。有效性评价,14项国内研究中,以食欲食量症状改善综合评价为主8项,以中医症状整体评价为主6项;7项国外研究中,以摄食行为量表评价为主4项,食欲不振改善、管饲喂养与口服卡路里的比例、体质量为主要指标各1项。安全性观察,有明确指标设计12项。此外,全部21项研究中,有伦理审批表达仅1项。[结论]文章纳入的RCT文献信息完善、质量较高,研究结果涵盖了小儿厌食症中药临床试验设计的基本要素,具有一定的借鉴和参考价值。

6～36月龄婴幼儿喂养困难现状研究

目的了解婴幼儿喂养困难现状。方法 2009年4月至2010年12月采用定点抽样的方法,对全国69个市（县、区）4017名6-36月龄婴幼儿进行调查,由医务人员和主要抚养人填写婴幼儿喂养困难评分量表,进行婴幼儿喂养困难发生情况统计。结果抽样地区婴幼儿喂养困难860例,发生率为21.4%,男女发生率分别为21.1%和21.8%。城市与农村婴幼儿不同程度喂养困难发生率差异有统计学意义（P〈0.01）;不同类别农村婴幼儿喂养困难发生率差异有统计学意义（P〈0.01）;不同类别主要抚养人喂养困难发生率差异有统计学意义（P〈0.01）;抚养人不同文化程度婴幼儿喂养困难发生率差异有统计学意义（P〈0.01）;不同家庭收入婴幼儿喂养困难发生率差异有统计学意义（P〈0.01）。婴幼儿不同程度喂养困难差异均有统计学意义（P均〈0.01）。结论婴幼儿喂养困难存在地区、抚养人及家庭经济收入差异。

成都市区1486名女性大、中学生进食障碍的现况调查

目的探讨女性大、中学生进食障碍的患病率及其相关因素。方法采用最优分配分层整群随机抽样法从成都市区抽取大学6所、普通高中1所、普通中专1所、成人中专2所、职业高中1所、初中3所，共1486名女性大、中学生，采用进食障碍问卷、体像障碍量表、抑郁自评量表、贝克焦虑自评量表、自编调查问卷进行现场调查。采用t检验和logistic回归分析数据。结果成都市女性大、中学生进食障碍估计患病率3．32％；各年龄组中17岁组估计患病率最高（7．16％）；各学龄阶段中高中组最高（5．21％）。进食障碍倾向组在认识偏差（P=0．009）、期望偏差（P=0．000）方面均比非进食障碍倾向组得分高。关注减肥相关媒体宣传、童年时父母关系紧张、童年时受虐待、进食障碍问卷的不满体型因子、内感受意识因子及焦虑是进食障碍倾向的相关危险因素。结论进食障碍在女性大、中学生中估计患病率较高，应积极干预。

合肥市幼师女生进食障碍状况及其与睡眠关系

目的探讨14～21岁幼师女生进食障碍现况及其相关因素,为实施幼师女生进食障碍的早期筛检和有针对性的干预提供科学依据。方法于2010年10月采用随机整群抽样方法抽取安徽省合肥市幼儿师范学院2 371名女生,运用进食障碍问卷、匹兹堡睡眠质量指数量表、焦虑自评量表、抑郁自评量表、自编一般情况问卷进行调查。结果合肥市幼师女生进食障碍估计患病率为7.09%(168/2 371);各年龄组中1,8岁组估计患病率最高,为10.6%(41/388);各年级中,五年级估计患病率最高,为10.5%(43/411);过瘦、偏瘦、正常体重、和超重女生的进食障碍得分分别为(26.49±18.83)(、27.62±17.67)(、34.40±19.96)(、32.33±22.19)分,差异有统计学意义(F=26.79,P<0.01);不同父母关系、不同经济状况、不同媒体关注度、不同亲属及朋友节食情况的女生在进食障碍得分方面差异均有统计学意义(P<0.01);多元线性逐步回归结果表明,焦虑、对减肥相关媒体的关注度、抑郁、体质指数、睡眠、年龄、朋友是否节食是进食障碍的相关危险因素。结论进食障碍在幼师女生中估计患病率较高,正确的健康教育,合理膳食,规律睡眠是降低进食障碍发生的关键。

1型糖尿病青少年饮食行为紊乱患病率及影响因素的系统评价

目的系统评价1型糖尿病(T1DM)青少年饮食行为紊乱(DEB)的患病率及影响因素。方法计算机检索美国国立医学图书馆数据库(PubMed)、Cochrane循证医学数据库(Cochrane Library)、医学文摘数据库(EMbase)、美国医学会杂志(JAMA)、护理学文献资料库(CINAHL)、心理学文摘数据库(PsycINFO)、中国期刊全文数据库(CNKI)、中国生物医学文献数据库、万方数据库和维普数据库(VIP)等10个中英文数据库,纳入评价T1DM青少年DEB患病率及影响因素的文献,检索时间为建库至2021年11月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 14.0软件计算合并患病率,并对影响因素进行描述性分析。结果共纳入16篇文献,包括4652例T1DM青少年,发表时间为2010—2021年。Meta分析结果显示,T1DM青少年DEB患病率为34%(95%CI 25%~46%)。亚组分析显示,女性(51%,95%CI 38%~69%)、亚洲(45%,95%CI 22%~89%)、发表时间为2015—2018年(45%,95%CI 21%~96%)T1DM青少年DEB患病率更高。描述性分析显示,T1DM青少年DEB发生的影响因素包括个体内部因素(女性、身体不满等)、心理社会因素(抑郁、低自尊等)和家庭因素(父母文化程度低)。结论T1DM青少年DEB患病率较高,女性、身体不满、抑郁、低自尊和父母文化程度较低等可增加T1DM青少年DEB患病的风险。