A systematic review and meta-analysis of the nutrient content of preterm and term breast milk

BACKGROUND: Breast milk nutrient content varies with prematurity and postnatal age. Our aims were to conduct a meta-analysis of preterm and term breast milk nutrient content (energy, protein, lactose, oligosaccharides, fat, calcium, and phosphorus); and to assess the influence of gestational and postnatal age. Additionally we assessed for differences by laboratory methods for: energy (measured vs. calculated estimates) and protein (true protein measurement vs. the total nitrogen estimates). METHODS: Systematic review results were summarized graphically to illustrate the changes in composition over time for term and preterm milk. Since breast milk fat content varies within feeds and diurnally, to obtain accurate estimates we limited the meta-analyses for fat and energy to 24-hour breast milk collections. RESULTS: Forty-one studies met the inclusion criteria: 26 (843 mothers) preterm studies and 30 (2299 mothers) term studies of breast milk composition. Preterm milk was higher in true protein than term milk, with differences up to 35% (0.7 g/dL) in colostrum, however, after postnatal day 3, most of the differences in true protein between preterm and term milk were within 0.2 g/dL, and the week 10–12 estimates suggested that term milk may be the same as preterm milk by that age. Colostrum was higher than mature milk for protein, and lower than mature milk for energy, fat and lactose for both preterm and term milk. Breast milk composition was relatively stable between 2 and 12 weeks. With milk maturation, there was a narrowing of the protein variance. Energy estimates differed whether measured or calculated, from −9 to 13%; true protein measurement vs. the total nitrogen estimates differed by 1 to 37%. CONCLUSIONS: Although breast milk is highly variable between individuals, postnatal age and gestational stage (preterm versus term) were found to be important predictors of breast milk content. Energy content of breast milk calculated from the macronutrients provides poor estimates of measured energy, and protein estimated from the nitrogen over-estimates the protein milk content. When breast milk energy, macronutrient and mineral content cannot be directly measured the average values from these meta-analyses may provide useful estimates of mother’s milk energy and nutrient content

Serology-based criteria for adult coeliac disease have excellent accuracy across the range of pre-test probabilities

Background The revised paediatric criteria for coeliac disease allow omission of duodenal biopsies in symptomatic children who have specific serology and coeliac disease-associated genetics. It remains unclear whether this approach is also applicable for adults with various clinical presentations. Aim To evaluate the accuracy of serology-based criteria in adults with variable pre-test probabilities for coeliac disease. Methods Three study cohorts comprised adults with high-risk clinical coeliac disease suspicion (n = 421), moderate-risk family members of coeliac disease patients (n = 2357), and low-risk subjects from the general population (n = 2722). Serological and clinical data were collected, and "triple criteria" for coeliac disease comprised transglutaminase 2 antibodies >10x the upper limit of normal, positive endomysium antibodies, and appropriate genetics without requirement of symptoms. The diagnosis was based on intestinal biopsy. Results The diagnosis of coeliac disease was established in 274 subjects. Of these, 59 high-risk subjects, 17 moderate-risk subjects, and 14 low-risk subjects fulfilled the "triple criteria". All had histologically proven coeliac disease, giving the criteria a positive predictive value of 100%. Altogether, 90 (33%) of all 274 newly diagnosed patients could have avoided biopsy, including 37% among high-risk, 20% among moderate-risk, and 48% among low-risk patients. No histological findings other than coeliac disease were found in the biopsies of "triple positive" subjects. Conclusions Coeliac disease can reliably and safely be diagnosed without biopsy in adults fulfilling the "triple criteria" regardless of the pre-test probability. Revised criteria would enable the number of endoscopies to be reduced by one-third.Peer reviewe

Growth and Nutritional Biomarkers of Preterm Infants Fed a New Powdered Human Milk Fortifier: A Randomized Trial.

The aim of this study was to assess growth and nutritional biomarkers of preterm infants fed human milk (HM) supplemented with a new powdered HM fortifier (nHMF) or a control HM fortifier (cHMF). The nHMF provides similar energy content, 16% more protein (partially hydrolyzed whey), and higher micronutrient levels than the cHMF, along with medium-chain triglycerides and docosahexaenoic acid. In this controlled, multicenter, double-blind study, a sample of preterm infants ≤32 weeks or ≤1500 g were randomized to receive nHMF (n = 77) or cHMF (n = 76) for a minimum of 21 days. Weight gain was evaluated for noninferiority (margin = -1 g/day) and superiority (margin = 0 g/day). Nutritional status and gut inflammation were assessed by blood, urine, and fecal biochemistries. Adverse events were monitored. Adjusted mean weight gain (analysis of covariance) was 2.3 g/day greater in nHMF versus cHMF; the lower limit of the 95% CI (0.4 g/day) exceeded both noninferiority (P < 0.001) and superiority margins (P = 0.01). Weight gain rate (unadjusted) was 18.3 (nHMF) and 16.8 g · kg · day (cHMF) between study days 1 and 21 (D1-D21). Length and head circumference (HC) gains between D1 and D21 were not different. Adjusted weight-for-age z score at D21 and HC-for-age z score at week 40 corrected age were greater in nHMF versus cHMF (P = 0.013, P = 0.003 respectively). nHMF had higher serum blood urea nitrogen, pre-albumin, alkaline phosphatase, and calcium (all within normal ranges; all P ≤ 0.019) at D21 versus cHMF. Both HMFs were well tolerated with similar incidence of gastrointestinal adverse events. nHMF providing more protein and fat compared to a control fortifier is safe, well-tolerated, and improves the weight gain of preterm infants

Biopharmaceutical considerations in paediatrics with a view to the evaluation of orally administered drug products – a PEARRL review.

Objectives: In this review, the current biopharmaceutical approaches for evaluation of oral formulation performance in paediatrics are discussed. Key findings: The paediatric gastrointestinal (GI) tract undergoes numerous morphological and physiological changes throughout its development and growth. Some physiological parameters are yet to be investigated, limiting the use of the existing in vitro biopharmaceutical tools to predict the in vivo performance of paediatric formulations. Meals and frequencies of their administration evolve during childhood and affect oral drug absorption. Furthermore, the establishment of a paediatric Biopharmaceutics Classification System (pBCS), based on the adult Biopharmaceutics Classification System (BCS), requires criteria adjustments. The usefulness of computational simulation and modeling for extrapolation of adult data to paediatrics has been confirmed as a tool for predicting drug formulation performance. Despite the great number of successful physiologically based pharmacokinetic models to simulate drug disposition, the simulation of drug absorption from the GI tract is a complicating issue in paediatric populations. Summary: The biopharmaceutics tools for investigation of oral drug absorption in paediatrics need further development, refinement and validation. A combination of in vitro and in silico methods could compensate for the uncertainties accompanying each method on its own

Appropriate age range for introduction of complementary feeding into an infant’s diet

Peer reviewedPublisher PD

Modulation of myocyte contractility by transient outward K+ current and P13K[gamma] in the rodent heart

Action potential (AP) prolongation, due to reductions in repolarizing transient outward K+ currents (Ito), modulates contractility by affecting L-type calcium current (ICa,L). To examine how repolarization rate modulates SR Ca2+ release, rat myocytes were stimulated in whole-cell voltage clamp mode with ramps or modeled APs with decreasing levels of Ito conductance. We measured ICa,L as well as calcium transients and Ca2+ spikes using confocal microscopy. AP prolongation via Ito reductions resulted in a biphasic relationship with SR Ca2+ release despite increased integrated ICa,L. We then investigated how calcium handling modulates myocyte contractility by examining a hypercontractile mouse model—PI3Kγ(−/−) mice. PI3Kγ(−/−) mice had increased calcium transients and SR Ca2+ content with prolonged APs at 90% repolarization. However, no differences in ICa,L or K+ current densities were detected. In conclusion, myocyte contractility is strongly modulated by SR Ca2+ release via reductions in Ito and PI3Kγ via changes in Ca2+ handling.M.Sc

The role of the Voluntary Fire Brigade in the life of local community on example Wola Drzewiecka

Celem pracy jest charakterystyka i ocena podejmowanych przez Ochotniczą Straż Pożarną działań, jakie przyczyniają się do rozwoju lokalnego i wspierają integrację mieszkańców wsi Wola Drzewiecka. Praca składa się z 3 rozdziałów. W rozdziale pierwszym omówiono organizacje pozarządowe, ich obszary działań i funkcje. Rozdział drugi stanowią: historia, cele statutowe oraz opis działalności Ochotniczej Straży Pożarnej w Woli Drzewieckiej na rzecz rozwoju lokalnego. Trzeci rozdział prezentuje ocenę działań stowarzyszenia, wskazuje na bariery z jakimi boryka się Ochotnicza Straż Pożarna w Woli Drzewieckiej w spełnianiu swoich funkcji, jak również prezentuje działania, które mogłyby usprawnić działalność organizacji w obszarze integracji mieszkańców i poprawić jakość i poziom życia w Woli Drzewieckiej.The purpose of this thesis is to characterise and evaluate actions taken by the Voluntary Fire Brigade. These activities contribute to a local community development and support integration of the Wola Drzewiecka village inhabitants. In the first chapter non-governmental organisations were discussed as well as their functions and areas of action. The second chapter contains: description of the history, statutory objectives and activities description of the Voluntary Fire Brigade in Wola Drzewiecka which support a local community growth. In the third chapter actions undertaken by the assocation were evaluated. It was pointed out that there is many obstacles the Voluntary Fire Brigade in Wola Drzewiecka has to deal with while fulfilling its duties. A number of actions were presented how to improve organization's operation to increase the quality of life in Wola Drzewiecka

SOURCES OF FINANCING NON - GOVERNMENTAL ORGANIZATIONS

Celem pracy jest charakterystyka źródeł z jakich organizacje pozarządowe mogą pozyskiwać fundusze unijne oraz jakim zasadom rachunkowym podlegają te organizacje. Praca składa się z 4 rozdziałów. W rozdziale pierwszym omówiono podstawy prawne oraz rodzaje działalności organizacji pozarządowych. Rozdział drugi stanowi polityka rachunkowości i formy zatrudnienia w organizacjach pozarządowych oraz charakterystyka organizacji pożytku publicznego. Trzeci rozdział prezentuje ocenę wykorzystania środków unijnych, fundusze dostępne dla organizacji pozarządowych oraz źródła środków unijnych wykorzystywane przez Ochotnicze Straże Pożarne. Czwarty rozdział zawiera sprawozdawczość, działalność statutową i gospodarczą prowadzoną przez OSP w Woli Drzewieckiej oraz opis zrealizowanych bądź zaczętych projektów.The aim of this dissertation is to characterize the sources from which non-governmental organizations can obtain funds from Eurepean Union Programs and the accounting rules which these organizations are obliged to follow. The paper consists of four chapters. The first chapter discusses legal basis and types of NGOs’ activities. The second chapter outlines a general characteristics of public-benefit organizations, accounting policies utilized in this sector, and forms of employment in NGOs. The third chapter presents a broad assessment of the use of EU funds, the funds available for NGOs and the EU funding sources used by the Voluntary Fire Brigades. The fourth chapter describes a case study of business conducted by the Voluntary Fire Brigade in Wola Drzewiecka with regards to economic activity and financial reporting of completed and ongoing projects

A67 ABC, EASY AS 123, SIMPLE AS GLUTEN-FREE? KNOWLEDGE AND ADHERENCE IN ADOLESCENTS WITH CELIAC DISEASE

Abstract Background Research shows that adolescents with celiac disease (CeD) are at great risk for non-adherence to the gluten-free diet (GFD), and that knowledge of the GFD may play a role in adherence. Aims The primary objective of this study was to examine the relationship between patient knowledge and adherence to the GFD in a local population of adolescents with CeD. Secondary objectives were to identify information sources used to learn about the GFD, and compare adolescent and parent knowledge of the GFD. Methods Adolescents with CeD (12–17 years) were recruited at pediatric gastroenterology clinics in Calgary, Alberta. Preliminary data was collected October 2020 to August 2021. Both the adolescent and a parent were asked to complete a 5 minute online survey received via email. Survey measures included a validated adherence scale (Biagi score) and a unique knowledge assessment (GFD-Q), adapted from a previously published questionnaire. GFD-Q scores were categorized as “sufficient knowledge” based on correctly identifying 3/3 gluten-containing foods, at least 4/7 of gluten-free foods, and at least 4/7 foods that may contain gluten. Respondents submitted demographic and clinical information, as well as reviewed information sources used to learn about the GFD. Results Initial data were reviewed for 25 participant pairs (adolescent with respective parent), with a planned sample size of 40 participant pairs. Most adolescents (96%) reported adherence to the GFD (Biagi score of 3 or 4). Eleven (44%) adolescents had sufficient knowledge of the GFD. About 90% of adolescents correctly identified which foods to question, however, 20% did not correctly identify a gluten-containing food (namely malt), and 36% did not identify most gluten-free foods (such as maltodextrin and balsamic vinegar). Parents scored higher on the GFD-Q with 17/25 (68%) demonstrating sufficient knowledge. Interestingly, of the 11 adolescents with sufficient knowledge, 10/11 (91%) respective parents also had sufficient knowledge. Most adolescents and parents identified the gastroenterologist, another individual with CeD, and Google as helpful information sources. Adolescents also indicated their parents were a helpful information source. Conclusions While the study is still enrolling to reach sample size, we acknowledge that most adolescents in our study report being adherent to the GFD. However, their reported knowledge is variable, especially in knowing which foods are safe to eat. Thus, education should also focus as much on which foods to avoid, as well as safe foods to consume. Parent knowledge of the GFD may have a role in adolescent knowledge. At study completion, descriptive statistics will be used to examine participant characteristics and identify trends to assist in the development of future health education for adolescents with CeD. Funding Agencies Canadian Celiac Association - James A.Campbell Research Fund </jats:sec