Background Eosinophilic esophagitis is a chronic, immune-mediated inflammatory disorder that responds to dietary therapy; however, data evaluating the effectiveness of dietary therapeutic strategies is limited. Objective This study compared the effectiveness of three frequently prescribed dietary therapies [elemental, six-food elimination, and skin prick and atopy patch-directed elimination] and assessed the remission predictability of skin tests and their utility in directing dietary planning. Methods A retrospective cohort of proton-pump inhibitor-unresponsive, non-glucocorticoid-treated eosinophilic esophagitis patients who had two consecutive endoscopic biopsies associated with dietary intervention was identified. Biopsy histology and remissions (< 15 eosinophils/high-power field) following dietary therapy and food reintroductions were evaluated. Results Ninety-eight of 513 patients met eligibility criteria. Of these 98, 50% (49), 27% (26), and 23% (23) received elemental, six-food elimination, and directed diets, respectively. Remission occurred in 96%, 81%, and 65% of patients on elemental, six-food elimination, and directed diets, respectively. The odds of post-diet remission vs. non-remission were 5.6-fold higher (P=0.05) on elemental vs. six-food elimination, 12.5-fold higher (P=0.003) on elemental vs. directed, and were not significantly different (P=0.22) on six-food elimination vs. directed diets. Following 116 single-food reintroductions, the negative predictive value of skin testing for remission was 40%–67% (milk 40%, egg 56%, soy 64%, and wheat 67%). Conclusion All three dietary therapies are effective; however, an elemental diet is superior at inducing histologic remission compared with six-food elimination and skin test-directed diets. Notably, an empiric six-food elimination diet is as effective as a skin test-directed diet. The negative predictive values of foods most commonly reintroduced in single-food challenges are not sufficient to support the development of dietary advancement plans solely based on skin tests.

Objective To determine the prevalence of specific micronutrient (iron, zinc, magnesium, phosphorus, selenium, copper, folate, vitamins A, D, E and B12) deficiencies in children with intestinal failure (IF), and identify risk factors associated with developing these deficiencies. Study design A retrospective review of prospectively collected data from 178 children with IF managed by the intestinal rehabilitation program at Cincinnati Children’s Hospital Medical Center, Ohio, USA between August1st 2007 and July 31st 2012. Transition to full enteral nutrition (FEN) was defined as the period during which the patient received between 20%–100% of estimated required nutrition enterally. FEN was defined as the patient tolerating all of the estimated required nutrition (100%) enterally for > 2 weeks. Results Necrotizing enterocolitis (NEC) was the most common cause of IF (27.5 %). Iron was the most common micronutrient deficiency identified during (83.9%) and after (61%) successful transition to FEN with significant reduction in the percentage of patients with iron deficiency between the two periods (P=0.003). Predictors of micronutrient deficiency after successful transition to FEN include birth weight (P=0.03), weight percentiles (P=0.02), height percentiles (P=0.04) and PN duration (P=0.013). After multivariate adjustments, only PN duration remained statistically significant (P=0.03). Conclusions Micronutrient deficiencies persist in patients with IF during and after transition to enteral nutrition. These data support the need for routine monitoring and supplementation of these patients especially those on prolonged PN.

Objective. To measure daily physical activity in patients with juvenile rheumatoid arthritis (IRA] and in healthy controls, and to identify variables that may influence physical activity in IRA patients.Methods. Twenty-three prepubertal children, ages 5-11 years, with mild to moderate IRA and no prior exposure to systemic glucocorticosteroids, were compared to 23 healthy children of similar age. Physical activity was measured for 3 days (minimum of one weekend day] using 3 standardized methods simultaneously. Total body movement was assessed by the Caltrac accelerometer and the University of Cincinnati Motion Sensor (UCMS]. The Caltrac measured movement in the vertical plane; the UCMS measured movement of 10" or more from the horizontal plane. The type and intensity of daily physical activity was measured by the %day activity record, which also recorded the number of hours of daily sleep. Participation and duration of involvement in organized sports was ascertained by questionnaire. 114Results. The mean physical activity was significantly lower in JRA patients than in controls for the activity diary {P = 0.05). However, daily body movement measured by the Caltrac and UCMS were similar for both groups. Differences were seen in the number of hours of sleep per day (P = 0.02) and participation in strenuous activities (P < 0.01). IRA patients had significantly less participation in organized sports [P = 0.011.Conclusion. There was less daily physical activity by this group of JRA patients than for healthy ageand sex-matched control subjects.

Objectives To determine the prevalence and predisposing factors for vitamin D deficiency and low bone mineral density (BMD) in patients with intestinal failure (IF). Methods A retrospective review of patients with IF managed at the Cincinnati Children’s Hospital Medical Center. IF was defined as history of parenteral nutrition (PN) >30 days. Vitamin D deficiency was defined as serum 25-OH vitamin D [25(OH) D] < 20ng/dL. Reduced bone mineral density (BMD) was defined using dual x-ray absorptiometry (DXA) Z-score ≤− 2. A binary logistic regression model was used to test for association of significant risk factors and the outcome variables after univariate analyses. Results One hundred and twenty three patients with median age of 4 years (range 3–22 years) were evaluated. Forty-nine (39.8%) patients had at least a documented serum 25 (OH) D deficiency during the study interval while 10 out of 80 patients (12.5%) with DXA scans done had a low BMD Z-score. Age at study entry was associated with both 25 (OH) D deficiency (P= 0. 01) and low BMD Z-score (P = 0. 03). Exclusive PN at study entry was associated with reduced bone mass (P=0.03). There was no significant association between vitamin D deficiency and low BMD Z-score (P=0.31). Conclusion The risk of 25 (OH) D deficiency and low BMD Z-score increases with age among patients with IF. Strategies for monitoring and preventing abnormal bone health in older children receiving exclusive PN need to be developed and evaluated.