Background Survival of patients with short‐bowel syndrome (SBS) receiving home parenteral nutrition (HPN) and associated factors have not been reported recently in North America. The objective of this study was to determine the long‐term survival of adult patients with SBS as the primary indication for HPN and assess factors that may affect survival by using the Canadian HPN Registry. Methods This is a retrospective analysis of prospectively collected data extracted from the HPN registry, prior to approval of teduglutide in Canada. Using only incident cases, survival probabilities were estimated by using the Kaplan‐Meier method for both full‐cohort and nonmalignant SBS. Log‐rank test was also used to test the differences in survival distributions between subgroups in the univariate analysis. To identify potential variables that are affecting survival distribution of patients for the multivariable analysis, Least Absolute Shrinkage and Selection Operator and stepwise selection procedure were used. Results There were 321 patients with a known duration receiving HPN (total, 2287 years), of whom 218 were entered into the registry within 1 year of initiation of HPN. Of 218 incident cases, 22 had active malignancy, along with SBS, and their survival time was significantly lower than those with nonmalignant SBS (P‐value < .0001). The 5‐year survival of nonmalignant‐SBS patients was 81.9%. In this subgroup, there was no significant association between patients’ survival and known intestinal anatomy, age, or sex. Conclusion Patients with nonmalignant SBS who receive HPN have a 5‐year survival of >80%. Known intestinal anatomical factors did not affect survival.
Background There is a demographic shift toward older patients receiving home parenteral nutrition (HPN), but data on clinical outcomes are limited. The objective of this study was to determine differences between older and younger HPN patients in regard to HPN indications, prescriptions, and outcomes over the first 2 years receiving HPN. Methods This was a retrospective analysis of prospectively collected data from HPN adult patients entered in the Canadian HPN Registry. New HPN patients enrolled between 2003 and 2017 and receiving HPN for at least 2 years were selected. Data included demographics, PN prescriptions, catheter‐related bloodstream infections (CRBSIs) over the past year, survival, and quality of life based on Karnofsky Performance Status (KPS). Results Four hundred two patients were included: 184 patients were ≥60 years old, and 219 patients were between 18 and 59 years old. There were no differences in the main indications for HPN, body mass index (BMI), and PN prescriptions at baseline. At 2 years, younger patients received more energy from PN than older patients (27.9 vs 19.6 kcal/kg; P < .001), but BMI remained comparable. There were fewer CRBSIs in the older group (20% vs 36%, P = .0023), but 78% of younger patients remained alive vs 69% in the older group (P = .0401). In those alive, the proportion of patients continuing to receive HPN was comparable and the proportion of patients with a KPS ≥60. Conclusions Older HPN patients have similar clinical characteristics as younger patients but have fewer CRBSIs and higher 2‐year mortality.
Objectives Unhealthy food marketing to children adversely affects their diet quality and health. The negative impacts of this marketing may be amplified on digital media, which allows industry to use artificial intelligence (AI) to market unhealthy food to children in covert ways. Health Canada is developing regulations to prohibit digital marketing of unhealthy food that appeals to children <13 years. However, reliance on adults to manually assess food marketing to children on digital media has limited understanding of key targets for policy and capacity to monitor policy adherence. To address these gaps, we are developing an AI system to monitor marketing of unhealthy food to children on digital media, including websites, YouTube, social media and mobile gaming apps. Methods Our web and mobile scrapers continuously collect marketing instances that may be viewed by individuals in Canada on websites and social media applications popular with children. This has allowed us to accumulate a database of > 615,000 marketing instances. The AI system extracts features from each marketing instance to determine whether foods are present, and if so, whether they are unhealthy according to Health Canada's standards (based on the presence of added saturated fat, added sodium and/or free sugars). Next, the AI system uses a supervised machine learning model to assess whether child appealing marketing techniques are present. In the final step, the system integrates all of the data collected to determine whether a given marketing instance features unhealthy foods and appeals to children. The system can be applied to monitor the extent and nature of digital food marketing to children internationally. It can also be retrained to monitor adherence to country-specific policy. Results This is a protocol paper so there are no results. Conclusions The AI system provides a scalable, objective and reproducible manner to identify digital marketing of unhealthy food that appeals to children across the digital marketing landscape. The system can assist researchers and policy makers to study children's exposure to digital marketing of unhealthy food and its impacts, and to monitor adherence to policy that restricts this marketing. Funding Sources Canadian Institutes of Health Research.
Background Crohn’s disease (CD) is characterized by intestinal inflammation due to the interplay between immunity, genetics, and environmental factors such as diet. Selenium (Se) deficiency is common in patients with CD due to malabsorption or high enteric losses. Selenium is used in the synthesis of selenoproteins that have antioxidant properties (e.g. glutathione peroxidases (GPx)) and are highly expressed in macrophages. However, how Se deficiency affects immune system function in patients with CD is unknown. We hypothesize that characterizing Se status, selenoprotein expression and subsequently macrophage function will advance knowledge of mucosal immunity and provide novel insight into CD. Purpose To determine if patients with active CD and healthy controls differ in Se dietary intake and status, oxidative stress, and macrophage cytotoxicity in response to oxidative stress. Method Blood was collected from healthy volunteers and patients diagnosed with ileal, ileocolonic or colonic CD (age ≥18 years, with mild or moderate endoscopic disease activity or fecal calprotectin ≥250 µg/g, and Harvey Bradshaw index <16, stable medications including biologics for at least 8-weeks prior to recruitment). Serum was analyzed for GPx activity, malondialdehyde (MDA) and C-reactive protein (CRP) concentrations. Monocytes were isolated by plastic adherence and treated with M-CSF (10 ng/ml, 7d) to derive macrophages. mRNA expression of GPx1, GPx4 and SelenoP was determined by qPCR. Lactate dehydrogenase release was measured in macrophages treated with 500 µM H2O2 for 2h. Result(s) Samples and/or dietary intake data were collected from 9 patients with CD (3 female, 6 male, mean age=36.8 years) and 13 controls (7 female, 6 male, mean age=27.7 years). Dietary Se intake did not differ between patients with CD and controls (126.1 ± 23.2 vs. 123.3 ± 19.8 µg/day). GPx activity was greater in the serum of patients with CD compared to controls (369 ± 49 vs. 169 ± 27 mU/mL, n=6-8, p<0.005). Patients with CD and controls did not differ in serum MDA concentration (7.80 ± 0.57 vs. 6.53 ± 1.1 µM). CRP levels correlated with serum MDA concentration in patients with CD (r=0.95, n=5, p<0.05) but not GPx activity. Macrophages from patients with CD (n=6) and controls (n=7) did not differ in expression of GPx1 and GPx4 mRNA, whereas SelenoP mRNA was ~200-fold lower in macrophages from patients with CD. Macrophages derived from patients with CD were more susceptible to H2O2-evoked cell death (10.3 ± 1.1 vs. 4.7 ± 0.7 % n=2-3 p<0.05). Conclusion(s) Despite adequate dietary Se intake our findings suggest altered Se metabolism in patients with active CD, with increases in serum GPx potentially indicative of the need for antioxidant activity to counter oxidative stress. The increased sensitivity of macrophages from patients with CD to H2O2 emphasizes the role of oxidative stress and redox balance in IBD. Defining how micronutrients, in this instance Se, impacts innate immunity may provide new approaches to the management of CD. Disclosure of Interest None Declared
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