Effectiveness of nutritional supplementation for children with coeliac disease who are on a gluten-free diet

Patients on a gluten-free diet are at risk of developing polyhypoavitaminosis and deficiency states, which requires the supplementation of their diet to prevent nutrient deficiencies. The aim of the study: to analyze the dynamics of anthropometric and laboratory parameters, components of the quality of life in children with coeliac disease on the background of a month-long course of administration of hypercaloric mixture for enteric nutrition. Materials and methods: 45 children with coeliac disease aged 2-10 years (mean age 6.3 ± 0.3 years) on a strict gluten-free diet for more than one year. All patients received additional enteric nutrition with a hypercaloric mixture in the volume of 200 ml/day (300 kcal/day) for 1 month as a supplement to the main food ration. Two groups of patients receiving the supplement in 2012-2013 and 2017-2018 were identified. Physical development was assessed under the WHO AnthroPlus programme. The quality of life indicators were assessed using the PedQL 4.0 questionnaire. Results: the total frequency of protein-сalorie deficiency (PCD) before the course of nutritional supplementation was 13 (28.9%) cases, while acute PCD was diagnosed in 6 (13.3%) and chronic PCD in 7 (15.6%) patients. Against the background of the course of nutritious supplementation in children with coeliac disease, there was a significant reduction in weight, height and BMI in both groups. Patients in 2012-2013 initially had a greater gap in weight and height compared to children in 2017-2018. There was an improvement in the sum of the quality of life indicators by 6.3% for children in the first group and by 4.3% for children in the second group against the background of nutritional supplementation. Conclusions: Enrichment of children’s diets with a hypercaloric blend of dietary fiber helps to accelerate the pace of physical development, reduce the number of children with diabetes mellitus, improve hemogram rates and most components of quality of life.

The interesting case of a woman who gets eating satisfaction through a gastrostomy tube

Aim of this study is to show how people are getting accustomed to alternative ways of eating in cases of illness and eating disability. Case report presentation: A 60-year-old woman was admitted in the Intensive Care Unit due to an acute upper airway obstruction. The woman was tracheostomized before entering the ICU and presented a large goiter and thus she was operated two days later and a thyroidectomy was executed. Post-operatively, it was diagnosed that a tracheo-esophageal fistula was present and the patient was obliged to live with a gastrostomy for months. During the first attempts for eating via a nasogastric tube at first and later via a gastrostomy, she had various problems with enteric nutrition, most prominent of which was osmotic diarrhea. The patient asked soon to stop eating enteral nutrition and preferred to eat food of her choice according to her appetite. She insisted that she was able to receive eating satisfaction, even by eating through a gastrostomy, because her bowels gave to her a positive feedback with the form of abdominal comfort after lunches. She said that the only food that would not harm her was real food and she chose food on her own with the help of her sister. This woman never presented any kind of psychiatric disorder in the past, neither she lost her courage inside hospital, although she was forced to live with a tracheostomy and a gastrostomy for more than 6 months.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The approaches to early diagnostic and correction of nutritive disorders under arterial hypertension combined with chronic obstructive lungs disease

The complex evaluation of food status of patients with arterial hypertension and chronic obstructive disease of lungs was implemented. The patients with combination of arterial hypertension and chronic obstructive disease of lungs are characterized by expressed anomalies of body composition (visceral obesity, surplus of total and extracellular fluid, protein-energy deficiency), dyslipidemia (increasing of level of cholesterol of low density lipoproteins, index of atherogenicity and hypertriglycer-inemia), disorders of protein metabolism (decreasing of total protein and pre-albumin) and adipocytokine status (increasing of concentration of leptin and resistin of blood against the background of decreasing of content of adiponeсtin). The mentioned alterations can promote increasing of cardiovascular risk in patients of this phenotype. The patients received protein formula for enteric nutrition during 21 day in combination with standard therapy. Whereupon, the indices of food status were re-evaluated. In dynamics, amelioration of indices of protein and fat metabolism was established. Hence, it appropriates to prescribe to patients with combination of arterial hypertension and chronic obstructive disease of lungs nutritive support with higher protein products for enteric nutrition.