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Rising Burden of Psychiatric and Behavioral Disorders and Their Adverse Impact on Health Care Expenditure in Hospitalized Pediatric Patients with Inflammatory Bowel Disease

  • Aravind Thavamani;Jasmine Khatana;Krishna Kishore Umapathi;Senthilkumar Sankararaman
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.26 no.1
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    • pp.23-33
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    • 2023
  • Purpose: The incidence and prevalence of inflammatory bowel disease (IBD) are increasing along with an increasing number of patients with comorbid conditions like psychiatric and behavioral disorders, which are independent predictors of quality of life. Methods: Non-overlapping years (2003-2016) of National Inpatient Sample and Kids Inpatient Database were analyzed to include all IBD-related hospitalizations of patients less than 21 years of age. Patients were analyzed for a concomitant diagnosis of psychiatric/ behavioral disorders and were compared with IBD patients without psychiatric/behavioral disorder diagnoses for outcome variables: IBD severity, length of stay and inflation-adjusted hospitalization charges. Results: Total of 161,294 IBD-related hospitalizations were analyzed and the overall prevalence rate of any psychiatric and behavioral disorders was 15.7%. Prevalence rate increased from 11.3% (2003) to 20.6% (2016), p<0.001. Depression, substance use, and anxiety were the predominant psychiatric disorders. Regression analysis showed patients with severe IBD (odds ratio [OR], 1.57; confidence interval [CI], 1.47-1.67; p<0.001) and intermediate IBD (OR, 1.14; CI, 1.10-1.28, p<0.001) had increased risk of associated psychiatric and behavioral disorders than patients with a low severity IBD. Multivariate analysis showed that psychiatric and behavioral disorders had 1.17 (CI, 1.07-1.28; p<0.001) mean additional days of hospitalization and incurred additional $8473 (CI, 7,520-9,425; p<0.001) of mean hospitalization charges, independent of IBD severity. Conclusion: Prevalence of psychiatric and behavioral disorders in hospitalized pediatric IBD patients has been significantly increasing over the last two decades, and these disorders were independently associated with prolonged hospital stay, and higher total hospitalization charges.

Nutritional Intervention Through Ketogenic Diet in GLUT1 Deficiency Syndrome

  • Young-Sun Kim;Woojeong Kim;Ji-Hoon Na;Young-Mock Lee
    • Clinical Nutrition Research
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    • v.12 no.3
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    • pp.169-176
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    • 2023
  • Glucose transporter type 1 (GLUT1) deficiency syndrome (DS) is a metabolic brain disorder caused by a deficiency resulting from SLC2A1 gene mutation and is characterized by abnormal brain metabolism and associated metabolic encephalopathy. Reduced glucose supply to the brain leads to brain damage, resulting in delayed neurodevelopment in infancy and symptoms such as eye abnormalities, microcephaly, ataxia, and rigidity. Treatment options for GLUT1 DS include ketogenic diet (KD), pharmacotherapy, and rehabilitation therapy. Of these, KD is an essential and the most important treatment method as it promotes brain neurodevelopment by generating ketone bodies to produce energy. This case is a focused study on intensive KD nutritional intervention for an infant diagnosed with GLUT1 DS at Gangnam Severance Hospital from May 2022 to January 2023. During the initial hospitalization, nutritional intervention was performed to address poor intake via the use of concentrated formula and an attempt was made to introduce complementary feeding. After the second hospitalization and diagnosis of GLUT1 DS, positive effects on the infant's growth and development, nutritional status, and seizure control were achieved with minimal side effects by implementing KD nutritional intervention and adjusting the type and dosage of anticonvulsant medications. In conclusion, for patients with GLUT1 DS, it is important to implement a KD with an appropriate ratio of ketogenic to nonketogenic components to supply adequate energy. Furthermore, individualized and intensive nutritional management is necessary to improve growth, development, and nutritional status.

The Study on the Weight, Food Group Intake and Tendency of Eating Disorder of Adolescents in Osan GyeongGi Province (경기 오산지역 중.고등학생의 체중과 식품섭취 및 섭식장애 경향 조사)

  • Rhie, Seung-Gyo;Jung, Eun-Hee;Won, Hyang-Rye;Kang, Heui-Yun
    • The Korean Journal of Community Living Science
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    • v.20 no.2
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    • pp.157-168
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    • 2009
  • This study was carried out to investigate the effect of eating behavior, physical status and tendency of eating disorder on the right eating habit. The subjects of this study were 324 middle school students and 340 high school students in Osan city GyeongGi province. The average of weight and height in the middle and high school students were 48.7kg, 160.0cm and 56.8kg, 164.8cm respectively. In PIBW values, 92.9% of middle school students and 99.1% of high school students were almost close to the average. The 28.5% of high school and 21.5% of middle school students were aware of themselves as overweight. The risk of eating disorders in high school students(16.4%) were higher than that in middle school students(4.9%). Moreover, the risk of eating disorders in girls high school students(19.3%) was significantly higher than those of middle school students(5.2%) (p<0.001). The thought of food problems were realized in 57.4% of in high school students and in 39.9% of in middle school students. The intake of food group frequency, middle school students ate more fruit than high school students(p<0.01). Boys ate more frequently soy beans (p<0.05) and algae(p<0.1) than girls in high school students. The meat intake was more frequent in high school students, but the eggs and milk were more in middle school students. The boys' intakes of fish and milk were more often than the girls' in high school students. Eating disorders and food intake frequency scores were closely correlated with weights(PIBW and the gap of ideal. weight with real weight). In conclusion, the education about realizing exact healthy body shape and how to modify behavior to prevent eating disorders should be planned since junior high school. Especially in high school girls, the variety food intake education would be needed. Proper recognition of the weight is required for good food intake and for prevent eating disorders.

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Benign Recurrent Intrahepatic Cholestasis with a Single Heterozygote Mutation in the ATP8B1 Gene

  • Lee, Yun Seok;Kim, Mi Jin;Ki, Chang Seok;Lee, Yoo Min;Lee, Yoon;Choe, Yon Ho
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.15 no.2
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    • pp.122-126
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    • 2012
  • Benign recurrent intrahepatic cholestasis (BRIC) is a rare autosomal recessive inherited disorder characterized by multiple recurrent episodes of severe cholestatic jaundice without obstruction of extrahepatic bile duct. We present the case of a 7-year-old boy with BRIC confirmed by mutation analysis in the ATP8B1 gene and typical clinical manifestation. Despite inheritance of BRIC, we detected a mutation on only one allele. To our knowledge, this is the first report of BRIC with a confirmed single heterozygote novel mutation in the ATP8B1 gene in Korea.

Effects of probiotics on the prevention of atopic dermatitis

  • Kim, Nam Yeun;Ji, Geun Eog
    • Clinical and Experimental Pediatrics
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    • v.55 no.6
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    • pp.193-201
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    • 2012
  • Atopic dermatitis (AD) is an immune disorder that is becoming increasingly prevalent throughout the world. The exact etiology of AD remains unknown, and a cure for AD is not currently available. The hypothesis that appropriate early microbial stimulation contributes to the establishment of a balanced immune system in terms of T helper type Th1, Th2, and regulatory T cell (Treg) responses has led to the use of probiotics for the prevention and treatment of AD in light of various human clinical studies and animal experiments. Meta-analysis data suggests that probiotics can alleviate the symptoms of AD in infants. The effects of balancing Th1/Th2 immunity and enhancing Treg activity via the interaction of probiotics with dendritic cells have been described in vitro and in animal models, although such an effect has not been demonstrated in human studies. In this review, we present some highlights of the immunomodulatory effects of probiotics in humans and animal studies with regard to their effects on the prevention of AD.

A Case of Primary Intestinal Lymphangiectasia (원발성 장 림프관 확장증 1례)

  • Hwang, Dae Hwan;Han, Jung Woo;Kim, Ji Hong;Han, Seok Joo;Hong, Soon Won
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.7 no.2
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    • pp.253-259
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    • 2004
  • Primary intestinal lymphangiectasia is a congenital lymphatic disorder in which intestinal lymphatic channels are dilated and ruptured resulting in loss of protein, lipid, and lymphocyte into the intestine or peritoneum. As a result, hypoalbuminemia, generalized edema, diarrhea are clinically manifested. We report a case of primary intestinal lymphangiectasia with generalized edema which occurred in a 7-year old boy who was treated with lipid restriction diet with medium chain triglyceride oil supplement.

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Dietitians' Perceptions of Safety Supervision in Institutional Foodservices (I) - Status of Accidents and Assessment of Hazards - (단체급식 안전관리에 대한 영양사 인식 조사(I) - 사고 현황 및 위해 평가 -)

  • Park, Hye-Ran;Moon, Hye-Kyung
    • Journal of the Korean Dietetic Association
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    • v.16 no.4
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    • pp.318-331
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    • 2010
  • The objectives of this study were to investigate the status of accidents and to assess hazards in institutional foodservices in the Changwon and Masan areas. A survey was conducted from February 1 to March 31, 2009 using questionnaires, and 142 dietitians participated. The dietitians' perception of accident risks in workplace averaged 3.11 points. Forty-five percent of the respondents responded that accidents had occurred more than once between 2006 and 2008. In addition, 28.2% of the respondents experienced employee absences or turnover due to accidents during Year 2008. 'Musculoskelectal injuries or disorders (65.5%)', 'slips or falls (64.8%)', 'burns (57.7%)', and 'cuts and punctures (48.6%)' were the predominant accidents in foodservice. 'Knives (76 points)', 'steam kettles (41 points)', 'vegetable cutters (34 points)' and 'turn kettles (26 points)' were the equipment with severe accidents, such as burns or cut injuries. Among foodservice processes, 'carpal tunnel syndrome while washing (2.83 points)', 'burned by frying oil (2.64 points)', 'cut by sharp tools (2.55 points)', 'musculoskelectal injury by moving heavy weight food materials (2.41 points)', and 'injury by slipping on wet workplace floors and trenches (2.19 points)' were the most frequently occurring accidents at foodservice sites. To prevent safety accidents, dietitians' perceptions of safety supervision should be improved, and therefore, it is necessary they receive safety education.

Multiple Intestinal Perforations in a Child with Behcet's Disease (소아 베체트 병에서 발생된 복부 천공 1예)

  • Choi, Kum-Ok;Koh, Hong;Chung, Ki-Sup
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.11 no.1
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    • pp.80-83
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    • 2008
  • Behcet's disease (BD) is a multisystem inflammatory disorder dominated clinically by recurrent oral and genital ulceration, uveitis and erythema nodosum. BD is very rare in children, especially those less than 10 years of age, who account for only an estimated 5% of all cases. Gastrointestinal ulcers, in patients with Behcet's disease with intestinal involvement are rare and have been reported in only 1-2% of all cases. The intestinal ulcers of Behcet's disease are usually multiple and scattered and tend to cause perforations associated with significant morbidity. Patients with BD and abdominal symptoms must be evaluated thoroughly for potential perforation of the gastrointestinal tract. Here we report the case of a 4 year 9 month old child with multiple perforations of the gastrointestinal tract associated with BD.

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Presentation of Progressive Familial Intrahepatic Cholestasis Type 3 Mimicking Wilson Disease: Molecular Genetic Diagnosis and Response to Treatment

  • Boga, Salih;Jain, Dhanpat;Schilsky, Michael L.
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.18 no.3
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    • pp.202-208
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    • 2015
  • Progressive familial intrahepatic cholestasis type 3 (PFIC3) is an autosomal recessive disorder of cholestasis of hepatocellular origin, typically seen in infancy or childhood caused by a defect in the ABCB4 located on chromosome 7. Here we report on an older patient, aged 15, who presented with biochemical testing that led to an initial consideration of a diagnosis of Wilson disease (WD) resulting in a delayed diagnosis of PFIC3. Diagnosis of PFIC3 was later confirmed by molecular studies that identified novel mutations in the ABCB4 gene. Cholestasis due to PFIC3 can cause elevated hepatic copper and increased urine copper excretion that overlap with current diagnostic criteria for WD. Molecular diagnostics are very useful for establishing the diagnosis of PFIC3. Ursodeoxycholic acid ameliorates cholestasis in PFIC3, and may help mediate a reduction in hepatic copper content in response to treatment.

A Case of Glycogen Storage Disease IV with Rare Homozygous Mutations in the Glycogen Branching Enzyme Gene

  • Choi, So Yoon;Kang, Ben;Choe, Jae Young;Lee, Yoon;Jang, Hyo Jeong;Park, Hyung-Doo;Lee, Suk-Koo;Choe, Yon Ho
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.21 no.4
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    • pp.365-368
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    • 2018
  • Glycogen storage disease (GSD) IV is a rare autosomal recessive inherited disorder caused by mutations in the gene coding for glycogen branching enzyme leading to progressive liver disease. GSD IV is associated with mutations in GBE1, which encodes the glycogen branching enzyme. We report a case of GSD IV with rare homozygous mutations in the GBE1 gene (c.791G>A (p.Gly264Glu), which was successfully treated by liver transplantation.