Human milk composition is variable. The identification of influencing factors and interdependencies of components may help to understand the physiology of lactation. In this study, we analyzed... Show moreHuman milk composition is variable. The identification of influencing factors and interdependencies of components may help to understand the physiology of lactation. In this study, we analyzed linear trends in human milk composition over time, the variation across different European countries and the influence of maternal celiac disease. Within a multicenter European study exploring potential prevention of celiac disease in a high-risk population (PreventCD), 569 human milk samples were donated by women from five European countries between 16 and 163 days postpartum. Some 202 mothers provided two samples at different time points. Protein, carbohydrates, fat and fatty acids, insulin, adiponectin, and insulin-like growth factor II (IGF-II) were analyzed. Milk protein and n-6 long chain polyunsaturated fatty acids decreased during the first three months of lactation. Fatty acid composition was significantly influenced by the country of residence. IGF-II and adiponectin concentrations correlated with protein content (r = 0.24 and r = 0.35), and IGF-II also correlated with fat content (r = 0.36), suggesting a possible regulatory role of IGF in milk macronutrient synthesis. Regarding the impact of celiac disease, only the level in palmitic acid was influenced by this disease, suggesting that breastfeeding by celiac disease mothers should not be discouraged. Show less
Roca, M.; Vriezinga, S.L.; Crespo-Escobar, P.; Auricchio, R.; Hervas, D.; Castillejo, G.; ... ; PREVENT CD Study Grp 2018
BACKGROUND & AIMS: Compliance to a gluten free diet (GFD) in celiac disease (CD) is ideally assessed by dietary interviews, albeit time-consuming. Short dietary questionnaires have been... Show moreBACKGROUND & AIMS: Compliance to a gluten free diet (GFD) in celiac disease (CD) is ideally assessed by dietary interviews, albeit time-consuming. Short dietary questionnaires have been developed for adults but not for children. Primary aim was to compare GFD compliance in celiac children, measured by a short dietary questionnaire against a dietary interview. Secondary aims were correlation between both questionnaires and celiac antibodies and identifying variables predicting noncompliance.METHODS: Between 2012 and 2014, participants in the E-health CoelKids study, completed a short dietary questionnaire and standardized dietary interview together with measurement of anti-tissue transglutaminase antibodies (TG2A). Results of the questionnaires were assigned under similar categories. Factors possibly influencing dietary compliance were recorded. Where appropriate, Pearson's Chi-square test for trend, unpaired t-test, Cohen's kappa and one-way ANOVA were used.RESULTS: 151 of 165 participating patients were studied, 66% were female. Mean age was 11.3 years (2-26, SD 5.4), mean age at CD diagnosis was 4.9 years (1-23, SD 4.0). The short questionnaire and dietary interview correlated poorly, detecting problems in dietary adherence in 14% and 52% of the patients, respectively (Cohen's kappa 0.034). Only the short questionnaire correlated with TG2A (p = 0.003). Only older age was associated with noncompliance, the mean age of completely nonadherent, adherent but committing errors, and strictly adherent patients were 15.5, 11.5 and 10.1 years, respectively (p < 0.001).CONCLUSIONS: Compared to the dietary interview, short dietary questionnaires and TG2A serology failed to detect dietary transgressions in CD children, wherein adolescents were shown to be at highest risk. Show less
Coeliac disease (CD) is an immune-mediated systemic disorder elicited by gluten in genetically susceptible individuals. The aim of this thesis was to investigate the influence of infant feeding on... Show moreCoeliac disease (CD) is an immune-mediated systemic disorder elicited by gluten in genetically susceptible individuals. The aim of this thesis was to investigate the influence of infant feeding on prevention and development of childhood CD (part 1) and to explore new strategies for improvement of care for CD children and young adults (part 2). In part 1, the European multi-centre randomized double-blind placebo-controlled dietary intervention-study in high-risk children (www.preventcd.com) is presented. Based on retrospective studies suggesting a ‘window of opportunity’ for primary prevention of CD, parents were advised to introduce gluten between 4–6 months of age. Our results show that this did not reduce the risk of CD by 3 years of age and contributed to a new European guideline stating that gluten may be introduced between age 4-12 months. Part 2 shows that physicians overestimate the CD specific health-related quality-of-life (HRQOL) of CD patients, supporting implementation of self-reported CD-specific HRQOL measurements during follow-up. Compared to traditional hospital visits for treated CD, E-health was cost-saving, satisfactory, and significantly improved the CD-specific HRQOL. As E-health requires a point-of-care test suitable for follow-up of treated CD, three different tests were compared with conventional ELISA and one was found to be suitable. Show less
