Journal of Comprehensive Pediatrics
Volume:14 Issue: 1, Feb 2023

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in children, with an increased incidence of overweight and obesity. Currently, no food and drug administration is approved for treating NAFLD in children; however, antioxidants such as vitamins are the safest options for managing this disease. Regarding the unknown aspects of managing NAFLD, this review provides an overview of the latest evidence on the association of vitamins A, B, C, D, and E with NAFLD in children and adolescents.

In this narrative review, we searched and extracted relevant English publications from the Web of Science, PubMed, Scopus, and Google Scholar using keywords such as non-alcoholic fatty liver disease, NAFLD, children, pediatric, Vitamin A, Vitamin B, Vitamin C, Vitamin D, and Vitamin E.

The level of vitamins A, B, C, D, and E in children with NAFLD has been linked to the disease’s prognosis and severity.

Regarding previous studies on this issue, measuring vitamins in children with NAFLD seems logical.

Nephrotic syndrome (NS) is a common glomerular disease in children, for which there are currently no noninvasive markers for predicting responsiveness to steroid treatment.

This study aimed to analyze the relationship between clinical-laboratory presentations and subsequent response to steroid therapy and to evaluate the role of urinary vitamin D binding protein (uVDBP) as a predictor of steroid resistance (SR).

This was a prospective longitudinal study on 60 children with active NS (30 patients with newly diagnosed NS and 30 with relapsed NS). In addition, 30 control subjects served as a reference group for uVDBP values. The patients were evaluated before starting steroid therapy, and response to steroid therapy was monitored 4 - 8 weeks later.

The levels of uVDBP were elevated in patients with NS (33.33 ± 15.6 ng/mL) compared to control subjects (17.35 ± 5.5 ng/mL, P < 0.001). Also, the levels of uVDBP were significantly higher in patients with relapsed NS (37.93 ± 16.2 ng/mL) than in newly diagnosed NS patients (28.73 ± 13.67 ng/mL, P = 0.014). The level of uVDBP on presentation did not significantly differ between patients who had steroid-sensitive nephrotic syndrome (SSNS) (34.91 ± 15.01 ng/mL) and patients who had steroid-resistant nephrotic syndrome (SRNS) after 4 - 8 weeks of steroid treatment (32.60 ± 15.94 ng/mL, P = 0.417). Steroid resistance was significantly associated with a younger age of onset, specifically below 2.1 years (P = 0.023), a longer duration of the illness (P = 0.007), having more relapses (P = 0.002), total leucocytic count on presentation > 8.05 × 103/mm3 (P = 0.031), and platelet counts on presentation > 516.5 × 103/mm3 (P = 0.044).

In this study, we found that uVDBP levels could reflect disease severity rather than predict the pattern of steroid responsiveness. Younger age of onset, longer duration of illness, previous relapses, and increased total leukocyte and platelet counts on presentation were associated with SRNS.

Cystic fibrosis (CF) is a multisystem disease presenting different manifestations, including the involvement of the respiratory and gastrointestinal tract. Patients may be at risk for micronutrient depletion, particularly during illness and infection. However, the relationship between micronutrient depletion and pulmonary involvement is not established well.

This study aimed to determine the relationship between serum levels of calcium, phosphorus, magnesium, zinc, copper, selenium, and vitamin D with the severity of pulmonary involvement in patients with CF.

This cross-sectional study was performed on 84 patients with CF referred to Mofid Children’s Hospital, Tehran, Iran, in 2017. The collected data included demographic and anthropometric information. Laboratory evaluations included magnesium, copper, zinc, selenium, complete blood cell count (CBC), and vitamin D levels. The severity of pulmonary involvement was determined based on the Brasfield scoring system (BSS). Pearson correlation coefficient, t test, χ2 test, or Fisher exact test was used for analyses.

The mean age of the children was 6.8 ± 3.5 years, and 36 patients (43%) were female. Based on the z score, 53 patients (63%) were malnourished. The severity of pulmonary involvement was mild in 25 patients (30%), moderate in 39 patients (46%), and severe in 20 patients (24%). The percentages of deficiency related to vitamin D, zinc, copper, and selenium were 56%, 38%, 32.1%, and 21.4%, respectively. Among trace elements, there was a statistically significant relationship between the severity of pulmonary involvement according to BSS and serum copper (P = 0.007 and r = -0.229) and selenium deficiency (P < 0.001 and r = -0.418). There was a significant relationship between malnutrition and vitamin D deficiency in patients (P = 0.034, r = 0.231).

Serum copper concentration might affect respiratory function in CF patients. Selenium supplements should be added to patients’ diets. However, further interventional studies are required to investigate the possible causal relationships.

The close relatives of patients with celiac disease (CD), particularly their siblings, are known to be at a higher risk for CD development.

Our aim was to determine the prevalence of CD in siblings of confirmed CD patients in Lorestan province, Iran, in 2020.

In this cross-sectional study, anti-tissue transglutaminase (tTG) antibody levels were measured in 140 siblings of children with CD. Duodenal biopsies were taken to confirm the diagnosis in those with positive serological tests. The subjects’ demographic and clinical data were recorded into a pre-designed questionnaire, and the collected data were analyzed by SPSS software version 22 at a significance level of 0.05.

Twelve out of 140 subjects (8.6%) tested positive for tTG IgA, eight of them (66.7%) were girls, and most of them (75%) were ≤ 15 years old. Half of the newly diagnosed patients were in the Marsh IIIc category. The Marsh grading had no significant relationship with the serum levels of tTG IgA antibodies (P = 0.319). The most common gastrointestinal symptom was bloating (66.7%), and the most common extraintestinal symptoms were anemia (58.3%) and dental and oral diseases (58.3%).

We found a high prevalence (8.6%) of CD among the siblings of children with confirmed CD. Since the early diagnosis of CD can lead to better management, particularly in pediatrics, it is recommended screen patients’ family members as soon as the diagnosis of CD is confirmed.

Developmental delay (DD) in children is a crucial issue in pediatric health. The most practical evaluation way for early detection of developmental delay is parent-completed tool by the Ages and Stages Questionnaire (ASQ).

The aim of this study was to estimate the prevalence of developmental delay in 12-month-old infants.

In this cross-sectional study, 5,025 ASQs of 12-month-old children who presented in urban health centers of Shahid Beheshti University of Medical Sciences from 23 August 2018 to 23 August 2019, were evaluated. Total scores in five main domains and six final questions were extracted.

Fifty-one-point-five percent were boys. Also, 243 cases (4.8%) had problem in at least one out of the five domains, 68 cases (1.35%) had DD in two domains, five cases (0.09%) in three domains, four cases (0.07%) in four domains, and two cases (0.03%) had an essential delay in all five domains. Developmental delay was seen more in gross motor (1.6%), followed by communication (1.5%), problem-solving (1%), fine motor (0.4%), and personal-social (0.3%), respectively. There were significant statistical differences in personal-social and problem-solving in boys. Among six questions in ASQ, the most common problem was in question 4 (1.4%), which is related to auditory problems.

Developmental screening is a basic tool for developmental delay detection. Developmental delay diagnosis and early intervention may be possible through cost-effective screening tools.

Low birth weight among preterm neonates is a crucial public health problem worldwide.

The study aimed to assess if massage therapy and coconut oil application could affect weight gain in premature neonates.

A double-blind, randomized controlled trial (RCT) was conducted in neonatal intensive care units (NICU) of 2 educational hospitals affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Iran, from September 2019 to April 2021. Massage therapy, alongside applying coconut oil to the skin for 5 days, versus massage therapy with tepid water, was considered an intervention. Demographic data, weight gain, and serum triglycerides (TG) levels were the outcomes. First, oil was tested on the baby’s wrist skin. If there was no skin reaction or side effects, massage therapy was started using fingertips in 3 steps, and each step lasted for 5 minutes.

The study included 94 neonates with a gestational age of fewer than 37 weeks who were randomly assigned to 3 groups: body massage with coconut oil group (n = 33), body massage without oil (n = 30), and control group (n = 31) who did not receive any intervention. Fifty-one cases (54.3%) were male. The mean gestational age of all patients was 32.5 ± 2.24 weeks (range of 27 to 36.6), birth weight was 1769.04 ± 472.8 grams (range of 800 to 2780 grams), serum triglycerides levels before and after intervention in all patients were 0.87 ± 0.43 and 1.14 ± 0.50 mmol/L respectively (or 77.04 ± 39.7 and 100.94 ± 44.7 mg/dL respectively) (P = 0.44). The 5-day average weight gains based on the groups included: coconut oil: 49.24 ± 94.32 grams, tepid water: 27.16 ± 65.79 grams, control: 26.29 ± 77.09 grams, P = 0.49. There were no statistically significant differences among all groups for weight gain and change in serum TG levels.

Massage therapy, alongside applying coconut oil to the skin for 5 days, could not increase weight and serum TG levels in premature neonates. Further studies with long-term intervention and a larger sample size are recommended.

Celiac disease is a hereditary digestive disease in children associated with an autoimmune disorder of the small intestine. This study aimed to study aortic stiffness in children with celiac disease compared with controls and assess the effects of a gluten-free diet on aortic stiffness parameters.

This case-control study was conducted on 114 children with celiac disease and 57 healthy volunteers. Children with celiac disease comprised three groups: Gluten-free diet (GFD)-responsive, GFD-nonresponsive, and newly diagnosed. Systolic and diastolic diameters of the ascending aorta were recorded by M-mode echocardiography. Data were analyzed using SPSS 20. Study data had free distribution and nonparametric tests were applied for the analysis. The tests were Mann-Whitney U and Kruskal-Wallis with P value < 0.05as the significance level.

Aortic strain (11.15 ± 7.47 vs. 13.78 ± 6.95, P = 0.002) and aortic distensibility (6.98 ± 5.03 vs. 8.33 ± 5.13, P = 0.037) were lower in celiac disease (CD) while pressure strain elastic modulus (410.60 ± 247.45 vs. 330.71 ± 216.94, P = 0.012) and aortic strain β index (1.79 ± 0.62 vs. 1.44 ± 0.51, P < 0.001) were higher. The aortic strain significantly differed between control and response to GFD (P = 0.026), control and new diagnosis (P < 0.001), response to GFD and new diagnosis (P = 0.003), and no response to GFD and new diagnosis (P < 0.001) groups. The aortic strain β index differed significantly between control and response to GFD (P ≤ 0.001), control and new diagnosis (P < 0.001), response to GFD and no response to GFD (P = 0.035), response to GFD and new diagnosis (P = 0.002), and no response to GFD and new diagnosis (P < 0.001) groups. Aortic distensibility significantly differed between control and new diagnosis (P < 0.001), response to GFD and new diagnosis (P = 0.037), and no response to GFD and new diagnosis (P = 0.021) groups. Pressure strain elastic modulus significantly differed between control and new diagnosis (P < 0.001), response to GFD and new diagnosis (P = 0.037), and no response to GFD and new diagnosis (P = 0.021) groups.

The present study concluded that the elasticity parameters will change due to celiac disease. Gluten-free diet had no significant effect on aortic stiffing measures except the ASβ index.

Functional constipation (FC) is a common disease in children. This disease can cause many behavioral and mental problems and ultimately reduce the quality of life. Reciprocally, psychological factors can play a role in the development and persistence of FC.

In this study, we aimed to determine the prevalence of social anxiety in children with chronic FC in Arak city, Iran.

In this cross-sectional study, 200 children between 10 - 17 years with chronic FC referred to Amirkabir Hospital in Arak, Iran, which is a specialized center, were enrolled. This study was done in 2022, and the participants' disease was diagnosed based on Rome ΙV criteria. The Social Anxiety Scale for Adolescents (SASA) was completed by children under the guidance and supervision of their parents. Statistical analyses were performed in SPSS 22 using the Chi-square test and independent sample T-test.

The participants’ mean age (SD) was 13.43 ± 1.54 years. The prevalence of social anxiety was estimated at 67.5% (95%CI: 60.6 - 73.4), of whom 70% had moderate anxiety, and 30% had severe anxiety. There was no significant difference in the prevalence of social anxiety between the age groups (P = 0.167). The prevalence of social anxiety was significantly higher in girls (74.8%) than in boys (59.8%) (P = 0.034). Also, girls showed a significantly higher prevalence of severe social anxiety than boys (P = 0.023).

In this study, the prevalence of social anxiety was found to be considerably high in children with chronic FC. There was no significant difference between different age groups in terms of the prevalence of social anxiety; however, the prevalence and severity of this disease were significantly higher in girls than in boys.