Food allergy has become a significant public health problem affecting a large number of people worldwide.Maternal obesity causes inflammation and alters the immune system of offspring,which may exacerbate their food a...Food allergy has become a significant public health problem affecting a large number of people worldwide.Maternal obesity causes inflammation and alters the immune system of offspring,which may exacerbate their food allergy.The aim of this study was to determine whether offspring mice born to obese mothers would have more serve reactions to cow's milk protein-induced food allergy,and further investigate the underlying mechanisms.Female offspring BALB/c mice of mothers with normal and high-fat diets were sensitized withβ-lactoglobulin(BLG),respectively.Maternal obesity increased the serum immunoglobulin E and mouse mast cell protease levels,though did not have significant influence on anaphylactic symptom score,core temperature and diarrhea rate of offspring mice after BLG sensitization.Furthermore,maternal obesity led to a lower level of occludin mRNA expression in BLG-sensitized mice.The mice born to obese mothers exhibited increased mRNA expression levels of GATA-3,interleukin(IL)-4 and IL-10 in jejunum after BLG sensitization,indicating maternal obesity intensified Th2-type biased immune responses.In conclusion,maternal obesity exerted exacerbating effects on the responsiveness of their offspring to cow's milk protein sensitization.展开更多
Delayed passage of meconium or constipation during the perinatal period is traditionally regarded as a signal to initiate further work up to evaluate for serious diagnoses such as Hirschsprung’s disease(HD),meconium ...Delayed passage of meconium or constipation during the perinatal period is traditionally regarded as a signal to initiate further work up to evaluate for serious diagnoses such as Hirschsprung’s disease(HD),meconium ileus due to Cystic Fibrosis,etc.The diagnosis of HD particularly warrants invasive testing to confirm the diagnosis,such as anorectal manometry or rectal suction biopsy.What if there was another etiology of perinatal constipation,that is far lesser known?Cow’s milk protein allergy(CMPA)is often diagnosed in infants within the first few weeks of life,however,there are studies that show that the CMPA allergen can be passed from mother to an infant in-utero,therefore allowing symptoms to show as early as day one of life.The presentation is more atypical,with perinatal constipation rather than with bloody stools,diarrhea,and vomiting.The diagnosis and management would be avoidance of cow's milk protein within the diet,with results and symptom improvement in patients immediately.Therefore,we discuss whether an alternative pathway to address perinatal constipation should be further discussed and implemented to potentially avoid invasive techniques in patients.This entails first ruling out CMPA with safe,noninvasive techniques with diet modification,and if unsuccessful,then moving forward with further diagnostic modalities.展开更多
Background This study aimed to develop an expert consensus regarding the epidemiology,diagnosis,and management of cow’s milk protein allergy(CMPA)in the Middle East.Methods A three-step modified Delphi method was uti...Background This study aimed to develop an expert consensus regarding the epidemiology,diagnosis,and management of cow’s milk protein allergy(CMPA)in the Middle East.Methods A three-step modified Delphi method was utilized to develop the consensus.Fifteen specialized pediatricians participated in the development of this consensus.Each statement was considered a consensus if it achieved an agreement level of>80%.Results The experts agreed that the double-blind placebo-controlled oral challenge test(OCT)should be performed for 2-A weeks using an amino acid formula(AAF)in formula-fed infants or children with suspected CMPA.Formula-fed infants with confirmed CMPA should be offered a therapeutic formula.The panel stated that an extensively hydrolyzed formula(eHF)is indicated in the absence of red flag signs.At the same time,the AAF is offered for infants with red flag signs,such as severe anaphylactic reactions.The panel agreed that infants on an eHF with resolved symptoms within 2-4 weeks should continue the eHF with particular attention to the growth and nutritional status.On the other hand,an AAF should be considered for infants with persistent symptoms;the AAF should be continued if the symptoms resolve within 2-4 weeks,with particular attention to the growth and nutritional status.In cases with no symptomatic improvements after the introduction of an AAF.other measures should be followed.The panel developed a management algorithm,which achieved an agreement level of 90.9%.Conclusion This consensus document combined the best available evidence and clinical experience to optimize the management of CMPA in the Middle East.展开更多
Background There are few approved biomarkers for diagnosis and monitoring of cow's milk protein allergy(CMPA),thus the oral food challenge remains to be the golden diagnostic standard.A potential biomarker is feca...Background There are few approved biomarkers for diagnosis and monitoring of cow's milk protein allergy(CMPA),thus the oral food challenge remains to be the golden diagnostic standard.A potential biomarker is fecal calprotectin,a cytosolic protein,elevating in the presence of intestinal mucosal inflammation.We aimed to undertake a scoping review of the evi-dence pertaining to the current status of fecal calprotectin used for diagnosis and monitoring CMPA in children,and tried to indicate the aspects needed to be concerned in the future investigations and researches.Methods A scoping review was performed using the literature searched from PUBMED,EMBASE,and Web of Science Databases until July 2019 on the studies about the application of fecal calprotectin as a biomarker of CMPA in children.Studies were examined according to the inclusion and exclusion criteria.Data were extracted,and a narrative synthesis was conducted to summarize and analyze.Results Thirteen studies with different study design embracing 1238 children were included.The age range was from infants to adolescents.Most children with CMPA presented gastrointestinal symptoms,among which hematochezia was most com-mon.Amount of data suggested that infants with CMPA represented elevated levels of fecal calprotectin,particularly with distinct significance in non-IgE-mediated CMPA groups.Decreases of fecal calprotectin after elimination diet were demon-strated in enrolled studies.However,no matter in the CMPA positive or negative groups,the changes of fecal calprotectin before or after challenge showed no significance.Contradictory results were generated from studies on the role of fecal calprotectin in predicting allergic disease.Conclusions Available evidence is not sufficient to confirm the utilization of fecal calprotectin both in diagnosis and moni-toring of CMPA and predicting for allergic disease.More clinical and bench researches with elaborate design should be conducted and the exact cut-off values of fecal calprotectin in different groups remain to be determined.展开更多
BACKGROUND Allergy to cow’s milk is the most frequent allergy occurring in infants and young children.The dietary management of these patients consists of the elimination of any cow’s milk proteins from the diet,and...BACKGROUND Allergy to cow’s milk is the most frequent allergy occurring in infants and young children.The dietary management of these patients consists of the elimination of any cow’s milk proteins from the diet,and for formula-fed infants,the substitution of the usual infant formula with an adapted formula that is generally based on extensively hydrolyzed cow’s milk proteins.The American Academy of Pediatrics has established specific criteria to confirm the hypoallergenicity of a formula intended for these children.AIM To assess the hypoallergenicity of a new thickened extensively hydrolyzed casein-based formula (TeHCF) in children with cow’s milk allergy (CMA).METHODS Children diagnosed with CMA through a double-blind placebo-controlled food challenge (DBPCFC) were randomly administered increased doses of a placebo formula or the TeHCF [Allernova,new thickener including fibres (Novalac)] under double-blind conditions and medical surveillance on two separate days.Otherwise,both of these formulas and a cow’s milk-based formula were randomly introduced to children who were highly suspected of having CMA on three separate days.Immediate and late reactions occurring after the introduction of any of these formulas were thoroughly recorded by the physician at the hospital and reported by parents to the physician after hospital discharge,respectively.If the children tolerated the TeHCF during the DBPCFC,they were exclusively fed this formula during a 3-mo period where potential allergic symptoms,anthropometric parameters,as secondary outcomes,and adverse events were registered.The Cow’s Milk-related Symptoms Score (CoMiSSTM) was assessed and anthropometric parameters were compared to World Health Organization (WHO) reference data.RESULTS Of the 30 children included in the study,the CMA diagnosis of 29 (mean age: 8.03 ± 7.43 mo) patients was confirmed by a DBPCFC.The children all tolerated the TeHCF during both the challenge and the subsequent 3-mo feeding period,which they all completed.During the latter period,the CoMiSSTM remained at a very low level,never exceeding its baseline value (1.4 ± 2.0),growth parameters were within WHO reference standards and no adverse event related to the TeHCF was reported.Over the first week of this period,the proportion of patients with digestive discomfort significantly decreased from 20.7%(6/29) to 3.4%(1/29),P = 0.025.The proportion of satisfaction with the overall effect of the formula reported by the parents and investigator was high,as was the formula acceptability by the child.CONCLUSION The new TeHCF meets the hypoallergenicity criteria according to the American Academy of Pediatrics standards,confirming that the tested TeHCF is adapted to the dietary management of children with CMA.Moreover,growth was adequate in the included population.展开更多
新生儿牛奶蛋白过敏(cow's milk protein allergy,CMPA)临床表现不典型,可导致多器官和系统受累,并且可能影响新生儿体格生长和中枢神经系统发育,造成机体功能障碍,还会增加其他家庭成员的焦虑和压力。由于缺乏特异性临床表现和诊...新生儿牛奶蛋白过敏(cow's milk protein allergy,CMPA)临床表现不典型,可导致多器官和系统受累,并且可能影响新生儿体格生长和中枢神经系统发育,造成机体功能障碍,还会增加其他家庭成员的焦虑和压力。由于缺乏特异性临床表现和诊断方法,新生儿CMPA的诊断和管理仍然是目前非常重要的临床挑战。为促进新生儿CMPA规范化诊治,由中华医学会儿科学分会新生儿学组、中华儿科杂志编辑委员会组织制定了《新生儿牛奶蛋白过敏诊断与管理专家共识(2023)》,该文对该共识新生儿CMPA饮食和营养管理部分重点内容进行介绍和解读。展开更多
目的探讨个体化营养干预对牛奶蛋白过敏(cow milk protein allergy,CMPA)患儿营养状况及生长发育的影响。方法选取2022年2月—2023年2月惠州市中心人民医院儿科收治的60例CMPA患儿作为研究对象。其中30例作为对照组给予游离氨基酸奶粉...目的探讨个体化营养干预对牛奶蛋白过敏(cow milk protein allergy,CMPA)患儿营养状况及生长发育的影响。方法选取2022年2月—2023年2月惠州市中心人民医院儿科收治的60例CMPA患儿作为研究对象。其中30例作为对照组给予游离氨基酸奶粉进行喂养,另外30例作为研究组给予个体化营养干预(包括游离氨基酸奶粉喂养、辅食回避、微量元素及维生素的合理补充)。干预6个月后,对比2组患儿生长发育指标(身高、体质量、头围)、营养指标(血红蛋白、白蛋白、转铁蛋白)、血清维生素D、钙、锌水平及干预疗效。结果干预后,研究组患儿的生长发育指标优于对照组,营养状况优于对照组,血清维生素D、钙、锌水平高于对照组(P<0.05)。研究组患儿的总有效率为100%,高于对照组的83.33%,差异有统计学意义(P<0.05)。结论对CMPA患儿给予个体化营养干预可以有效促进患儿生长发育,提升患儿营养状况,临床效果显著。展开更多
目的探索牛奶蛋白过敏(cow's milk protein allergy,CMPA)患儿肠道菌群及短链脂肪酸水平的变化,明确其在CMPA中的作用。方法纳入2019年8月—2020年8月在郑州大学附属儿童医院就诊的25例CMPA婴儿作为CMPA组,同时选取25例正常婴儿作...目的探索牛奶蛋白过敏(cow's milk protein allergy,CMPA)患儿肠道菌群及短链脂肪酸水平的变化,明确其在CMPA中的作用。方法纳入2019年8月—2020年8月在郑州大学附属儿童医院就诊的25例CMPA婴儿作为CMPA组,同时选取25例正常婴儿作为对照组。收集两组婴儿粪便200mg,采用16SrDNA高通量检测技术和液相色谱质谱联用技术分别检测肠道微生物组成及其代谢产物的变化,并将微生物多样性与代谢产物进行联合分析。结果与对照组相比,CMPA组患儿肠道菌群结构发生变化,且α-多样性显著增加(P<0.001)。与对照组相比,CMPA组患儿肠道内厚壁菌门、梭状芽孢杆菌目、拟杆菌丰度显著降低,而梭菌科、支原体科、鞘脂单胞菌科丰度显著增加(P<0.001)。代谢组学检测发现,与对照组相比,CMPA组菌群代谢产物乙酸、丁酸和异戊酸水平显著下降,并与短链脂肪酸产生菌粪杆菌属、罗氏菌属等丰度呈正相关(P<0.05)。结论CMPA患儿肠道内菌群结构发生改变,微生物多样性增加,短链脂肪酸水平降低,可能导致肠道炎症反应增加。展开更多
Milk is related to many gastrointestinal disorders from the cradle to the grave due to the many milk ingredients that can trigger gastrointestinal discomfort and disorders.Cow’s milk protein allergy(CMPA)is the most ...Milk is related to many gastrointestinal disorders from the cradle to the grave due to the many milk ingredients that can trigger gastrointestinal discomfort and disorders.Cow’s milk protein allergy(CMPA)is the most common food allergy,especially in infancy and childhood,which may persist into adulthood.There are three main types of CMPA;immunoglobulin E(IgE)-mediated CMPA,non-IgEmediated CMPA,and mixed type.CMPA appears before the first birthday in almost all cases.Symptoms may start even during the neonatal period and can be severe enough to simulate neonatal sepsis.CMPA(often non-IgE mediated)can present with symptoms of gastroesophageal reflux,eosinophilic esophagitis,hemorrhagic gastritis,food protein-induced protein-losing enteropathy,and food protein-induced enterocolitis syndrome.Most CMPAs are benign and outgrown during childhood.CMPA is not as common in adults as in children,but when present,it is usually severe with a protracted course.Lactose intolerance is a prevalent condition characterized by the development of many symptoms related to the consumption of foods containing lactose.Lactose intolerance has four typical types:Developmental,congenital,primary,and secondary.Lactose intolerance and CMPA may be the underlying pathophysiologic mechanisms for many functional gastrointestinal disorders in children and adults.They are also common in inflammatory bowel diseases.Milk consumption may have preventive or promoter effects on cancer development.Milk may also become a source of microbial infection in humans,causing a wide array of diseases,and may help increase the prevalence of antimicrobial resistance.This editorial summarizes the common milk-related disorders and their symptoms from childhood to adulthood.展开更多
基金supported by the National Key Research and Development Program of China(2019YFC1605000)the Beijing Dairy Industry Innovation Team(BAIC06-2021)。
文摘Food allergy has become a significant public health problem affecting a large number of people worldwide.Maternal obesity causes inflammation and alters the immune system of offspring,which may exacerbate their food allergy.The aim of this study was to determine whether offspring mice born to obese mothers would have more serve reactions to cow's milk protein-induced food allergy,and further investigate the underlying mechanisms.Female offspring BALB/c mice of mothers with normal and high-fat diets were sensitized withβ-lactoglobulin(BLG),respectively.Maternal obesity increased the serum immunoglobulin E and mouse mast cell protease levels,though did not have significant influence on anaphylactic symptom score,core temperature and diarrhea rate of offspring mice after BLG sensitization.Furthermore,maternal obesity led to a lower level of occludin mRNA expression in BLG-sensitized mice.The mice born to obese mothers exhibited increased mRNA expression levels of GATA-3,interleukin(IL)-4 and IL-10 in jejunum after BLG sensitization,indicating maternal obesity intensified Th2-type biased immune responses.In conclusion,maternal obesity exerted exacerbating effects on the responsiveness of their offspring to cow's milk protein sensitization.
文摘Delayed passage of meconium or constipation during the perinatal period is traditionally regarded as a signal to initiate further work up to evaluate for serious diagnoses such as Hirschsprung’s disease(HD),meconium ileus due to Cystic Fibrosis,etc.The diagnosis of HD particularly warrants invasive testing to confirm the diagnosis,such as anorectal manometry or rectal suction biopsy.What if there was another etiology of perinatal constipation,that is far lesser known?Cow’s milk protein allergy(CMPA)is often diagnosed in infants within the first few weeks of life,however,there are studies that show that the CMPA allergen can be passed from mother to an infant in-utero,therefore allowing symptoms to show as early as day one of life.The presentation is more atypical,with perinatal constipation rather than with bloody stools,diarrhea,and vomiting.The diagnosis and management would be avoidance of cow's milk protein within the diet,with results and symptom improvement in patients immediately.Therefore,we discuss whether an alternative pathway to address perinatal constipation should be further discussed and implemented to potentially avoid invasive techniques in patients.This entails first ruling out CMPA with safe,noninvasive techniques with diet modification,and if unsuccessful,then moving forward with further diagnostic modalities.
基金Medical writing support in the development of this manuscript was provided by Dr.Ahmed Elgebaly of Clinart MENA and funded by Nutricia Middle East.
文摘Background This study aimed to develop an expert consensus regarding the epidemiology,diagnosis,and management of cow’s milk protein allergy(CMPA)in the Middle East.Methods A three-step modified Delphi method was utilized to develop the consensus.Fifteen specialized pediatricians participated in the development of this consensus.Each statement was considered a consensus if it achieved an agreement level of>80%.Results The experts agreed that the double-blind placebo-controlled oral challenge test(OCT)should be performed for 2-A weeks using an amino acid formula(AAF)in formula-fed infants or children with suspected CMPA.Formula-fed infants with confirmed CMPA should be offered a therapeutic formula.The panel stated that an extensively hydrolyzed formula(eHF)is indicated in the absence of red flag signs.At the same time,the AAF is offered for infants with red flag signs,such as severe anaphylactic reactions.The panel agreed that infants on an eHF with resolved symptoms within 2-4 weeks should continue the eHF with particular attention to the growth and nutritional status.On the other hand,an AAF should be considered for infants with persistent symptoms;the AAF should be continued if the symptoms resolve within 2-4 weeks,with particular attention to the growth and nutritional status.In cases with no symptomatic improvements after the introduction of an AAF.other measures should be followed.The panel developed a management algorithm,which achieved an agreement level of 90.9%.Conclusion This consensus document combined the best available evidence and clinical experience to optimize the management of CMPA in the Middle East.
基金supported by Science and Technology Project of the Health Planning Committee of Sichuan Province,China(17PJ278).
文摘Background There are few approved biomarkers for diagnosis and monitoring of cow's milk protein allergy(CMPA),thus the oral food challenge remains to be the golden diagnostic standard.A potential biomarker is fecal calprotectin,a cytosolic protein,elevating in the presence of intestinal mucosal inflammation.We aimed to undertake a scoping review of the evi-dence pertaining to the current status of fecal calprotectin used for diagnosis and monitoring CMPA in children,and tried to indicate the aspects needed to be concerned in the future investigations and researches.Methods A scoping review was performed using the literature searched from PUBMED,EMBASE,and Web of Science Databases until July 2019 on the studies about the application of fecal calprotectin as a biomarker of CMPA in children.Studies were examined according to the inclusion and exclusion criteria.Data were extracted,and a narrative synthesis was conducted to summarize and analyze.Results Thirteen studies with different study design embracing 1238 children were included.The age range was from infants to adolescents.Most children with CMPA presented gastrointestinal symptoms,among which hematochezia was most com-mon.Amount of data suggested that infants with CMPA represented elevated levels of fecal calprotectin,particularly with distinct significance in non-IgE-mediated CMPA groups.Decreases of fecal calprotectin after elimination diet were demon-strated in enrolled studies.However,no matter in the CMPA positive or negative groups,the changes of fecal calprotectin before or after challenge showed no significance.Contradictory results were generated from studies on the role of fecal calprotectin in predicting allergic disease.Conclusions Available evidence is not sufficient to confirm the utilization of fecal calprotectin both in diagnosis and moni-toring of CMPA and predicting for allergic disease.More clinical and bench researches with elaborate design should be conducted and the exact cut-off values of fecal calprotectin in different groups remain to be determined.
文摘BACKGROUND Allergy to cow’s milk is the most frequent allergy occurring in infants and young children.The dietary management of these patients consists of the elimination of any cow’s milk proteins from the diet,and for formula-fed infants,the substitution of the usual infant formula with an adapted formula that is generally based on extensively hydrolyzed cow’s milk proteins.The American Academy of Pediatrics has established specific criteria to confirm the hypoallergenicity of a formula intended for these children.AIM To assess the hypoallergenicity of a new thickened extensively hydrolyzed casein-based formula (TeHCF) in children with cow’s milk allergy (CMA).METHODS Children diagnosed with CMA through a double-blind placebo-controlled food challenge (DBPCFC) were randomly administered increased doses of a placebo formula or the TeHCF [Allernova,new thickener including fibres (Novalac)] under double-blind conditions and medical surveillance on two separate days.Otherwise,both of these formulas and a cow’s milk-based formula were randomly introduced to children who were highly suspected of having CMA on three separate days.Immediate and late reactions occurring after the introduction of any of these formulas were thoroughly recorded by the physician at the hospital and reported by parents to the physician after hospital discharge,respectively.If the children tolerated the TeHCF during the DBPCFC,they were exclusively fed this formula during a 3-mo period where potential allergic symptoms,anthropometric parameters,as secondary outcomes,and adverse events were registered.The Cow’s Milk-related Symptoms Score (CoMiSSTM) was assessed and anthropometric parameters were compared to World Health Organization (WHO) reference data.RESULTS Of the 30 children included in the study,the CMA diagnosis of 29 (mean age: 8.03 ± 7.43 mo) patients was confirmed by a DBPCFC.The children all tolerated the TeHCF during both the challenge and the subsequent 3-mo feeding period,which they all completed.During the latter period,the CoMiSSTM remained at a very low level,never exceeding its baseline value (1.4 ± 2.0),growth parameters were within WHO reference standards and no adverse event related to the TeHCF was reported.Over the first week of this period,the proportion of patients with digestive discomfort significantly decreased from 20.7%(6/29) to 3.4%(1/29),P = 0.025.The proportion of satisfaction with the overall effect of the formula reported by the parents and investigator was high,as was the formula acceptability by the child.CONCLUSION The new TeHCF meets the hypoallergenicity criteria according to the American Academy of Pediatrics standards,confirming that the tested TeHCF is adapted to the dietary management of children with CMA.Moreover,growth was adequate in the included population.
文摘目的:初步探讨孕期因素与婴儿牛奶蛋白过敏的关系。方法:数据来自一项“中国儿童对牛奶蛋白过敏的遗传易感性研究”的子队列,包括2020年3月1日至12月31日在北京大学人民医院出生的婴儿,根据随访至1岁时有无牛奶蛋白过敏(cow’s milk protein allergy,CMPA),分为病例组(CMPA组)和对照组。回顾性收集婴儿及其母亲孕前和孕期的临床资料,分析孕期多因素与婴儿牛奶蛋白过敏的相关性。结果:共纳入278例婴儿,CMPA患儿52例,对照组226例;男性婴儿143例,女性婴儿135例,其中男性婴儿在CMPA组比例(69.2%)高于对照组(47.3%),差异有统计学意义(P=0.004);CMPA患儿和对照组在出生体质量、出生胎龄、低出生体重儿、早产、脐带绕颈、新生儿窒息分布上差异无统计学意义(P>0.05)。母亲孕期合并免疫性疾病、贫血者以及孕期存在抗生素暴露者在CMPA组比例均高于对照组,两组之间差异有统计学意义(P<0.05);其他妊娠期合并症,如子痫/子痫前期、慢性高血压/妊娠期高血压、糖尿病/妊娠期糖尿病、甲状腺疾病等在两组分布差异无统计学意义(P>0.05)。CMPA组与对照组孕期多项血常规指标总体分布差异无统计学意义(P>0.05)。多因素Logistic回归分析发现男性婴儿、母亲妊娠合并免疫性疾病、妊娠合并贫血以及孕期抗生素暴露是CMPA发生的独立危险因素。结论:男性婴儿、母亲妊娠合并免疫性疾病、妊娠合并贫血以及孕期抗生素暴露是CMPA发生的独立危险因素。
文摘新生儿牛奶蛋白过敏(cow's milk protein allergy,CMPA)临床表现不典型,可导致多器官和系统受累,并且可能影响新生儿体格生长和中枢神经系统发育,造成机体功能障碍,还会增加其他家庭成员的焦虑和压力。由于缺乏特异性临床表现和诊断方法,新生儿CMPA的诊断和管理仍然是目前非常重要的临床挑战。为促进新生儿CMPA规范化诊治,由中华医学会儿科学分会新生儿学组、中华儿科杂志编辑委员会组织制定了《新生儿牛奶蛋白过敏诊断与管理专家共识(2023)》,该文对该共识新生儿CMPA饮食和营养管理部分重点内容进行介绍和解读。
文摘目的探讨个体化营养干预对牛奶蛋白过敏(cow milk protein allergy,CMPA)患儿营养状况及生长发育的影响。方法选取2022年2月—2023年2月惠州市中心人民医院儿科收治的60例CMPA患儿作为研究对象。其中30例作为对照组给予游离氨基酸奶粉进行喂养,另外30例作为研究组给予个体化营养干预(包括游离氨基酸奶粉喂养、辅食回避、微量元素及维生素的合理补充)。干预6个月后,对比2组患儿生长发育指标(身高、体质量、头围)、营养指标(血红蛋白、白蛋白、转铁蛋白)、血清维生素D、钙、锌水平及干预疗效。结果干预后,研究组患儿的生长发育指标优于对照组,营养状况优于对照组,血清维生素D、钙、锌水平高于对照组(P<0.05)。研究组患儿的总有效率为100%,高于对照组的83.33%,差异有统计学意义(P<0.05)。结论对CMPA患儿给予个体化营养干预可以有效促进患儿生长发育,提升患儿营养状况,临床效果显著。
文摘目的探索牛奶蛋白过敏(cow's milk protein allergy,CMPA)患儿肠道菌群及短链脂肪酸水平的变化,明确其在CMPA中的作用。方法纳入2019年8月—2020年8月在郑州大学附属儿童医院就诊的25例CMPA婴儿作为CMPA组,同时选取25例正常婴儿作为对照组。收集两组婴儿粪便200mg,采用16SrDNA高通量检测技术和液相色谱质谱联用技术分别检测肠道微生物组成及其代谢产物的变化,并将微生物多样性与代谢产物进行联合分析。结果与对照组相比,CMPA组患儿肠道菌群结构发生变化,且α-多样性显著增加(P<0.001)。与对照组相比,CMPA组患儿肠道内厚壁菌门、梭状芽孢杆菌目、拟杆菌丰度显著降低,而梭菌科、支原体科、鞘脂单胞菌科丰度显著增加(P<0.001)。代谢组学检测发现,与对照组相比,CMPA组菌群代谢产物乙酸、丁酸和异戊酸水平显著下降,并与短链脂肪酸产生菌粪杆菌属、罗氏菌属等丰度呈正相关(P<0.05)。结论CMPA患儿肠道内菌群结构发生改变,微生物多样性增加,短链脂肪酸水平降低,可能导致肠道炎症反应增加。
文摘Milk is related to many gastrointestinal disorders from the cradle to the grave due to the many milk ingredients that can trigger gastrointestinal discomfort and disorders.Cow’s milk protein allergy(CMPA)is the most common food allergy,especially in infancy and childhood,which may persist into adulthood.There are three main types of CMPA;immunoglobulin E(IgE)-mediated CMPA,non-IgEmediated CMPA,and mixed type.CMPA appears before the first birthday in almost all cases.Symptoms may start even during the neonatal period and can be severe enough to simulate neonatal sepsis.CMPA(often non-IgE mediated)can present with symptoms of gastroesophageal reflux,eosinophilic esophagitis,hemorrhagic gastritis,food protein-induced protein-losing enteropathy,and food protein-induced enterocolitis syndrome.Most CMPAs are benign and outgrown during childhood.CMPA is not as common in adults as in children,but when present,it is usually severe with a protracted course.Lactose intolerance is a prevalent condition characterized by the development of many symptoms related to the consumption of foods containing lactose.Lactose intolerance has four typical types:Developmental,congenital,primary,and secondary.Lactose intolerance and CMPA may be the underlying pathophysiologic mechanisms for many functional gastrointestinal disorders in children and adults.They are also common in inflammatory bowel diseases.Milk consumption may have preventive or promoter effects on cancer development.Milk may also become a source of microbial infection in humans,causing a wide array of diseases,and may help increase the prevalence of antimicrobial resistance.This editorial summarizes the common milk-related disorders and their symptoms from childhood to adulthood.
