RESUMEN
BACKGROUND: Outcomes in pediatric ulcerative colitis (UC) are heterogeneous and predictors of disease course eagerly sought. Mucosal atrophy (MA) is characterized by histological abnormalities of colonic intestinal glands. OBJECTIVE: To determine the prevalence of MA in a national inception cohort of pediatric UC and its impact on outcomes. METHODS: Irish children < 16 years old with UC are diagnosed at a single referral center. At diagnosis, patients underwent phenotyping by Paris classification and activity assessment by Pediatric Ulcerative Colitis Activity Index. Biopsies from all colonic segments were evaluated for MA. Patients were followed prospectively. The primary outcome was corticosteroid-free remission at 1 year. Secondary outcomes included relapse, treatment escalation, and colectomy by 2 years. RESULTS: Of 251 pediatric patients with UC (mean age 11.8 years, 55% male), 38 (15%) had MA on diagnostic biopsy. Baseline characteristics were similar between groups with/without MA and there was no difference in steroid-free remission or rates of moderate-severe UC at 1 year. Patients with MA had higher use of steroids (29% vs 15%, P = 0.04) and immunomodulators (40% vs 21%, P = 0.04) at 6 months, higher biologic use at 1 year (34% vs 16%, P = 0.03), earlier first relapse (mean ± SD 29.4 ± 26.1 vs 46.7 ± 43.4 weeks after diagnosis, P = 0.02), and higher colectomy rates by 2 years (21% vs 8%, P = 0.01). CONCLUSIONS: Children with MA at diagnosis had higher colectomy rates despite earlier treatment escalation and similar baseline severity scores. We identify MA as a promising new prognostic marker in children with newly diagnosed UC.
Asunto(s)
Colitis Ulcerosa , Humanos , Masculino , Niño , Adolescente , Femenino , Estudios de Cohortes , Resultado del Tratamiento , Colitis Ulcerosa/cirugía , Colitis Ulcerosa/diagnóstico , Colectomía , RecurrenciaRESUMEN
PURPOSE: This study examined the body composition, nutritional knowledge, behaviors, attitudes, and educational needs of senior schoolboy rugby players in Ireland. METHODS: Participants included 203 male rugby players age 15-18 yr competing at Senior School's Cup level in Leinster, Ireland. Estimation of body composition included measurement of height, weight, and percentage body fat (PBF; using bioelectrical impedance analysis, Tanita BC-418). Nutritional knowledge, behaviors, attitudes, and education needs were assessed by questionnaire. RESULTS: The range of PBF was 5.1-25.3%. Sixty-eight percent of the players in this study had a healthy PBF (10-20%), 32 (22%) were classified as underweight (<10% body fat), and 9.7% (n = 14) were overweight. Assessment of nutritional knowledge demonstrated poor knowledge of the foods required for refueling, appropriate use of sports drinks, and the role of protein in muscle formation. Alcohol consumption and dietary supplement use were reported by 87.7% and 64.5%, respectively. A perception that greater body size enhances sport performance did not predict dietary supplement use. Nutritional advice had been previously sought by 121 players from coaches (66.9%), magazines (42.1%), Web sites (38.8%), peers (35.5%), family (28.1%), sport organizations (16.5%), and health professionals (8.2%). Nutritional knowledge was no better in these players, nor did better nutritional knowledge correlate with positive dietary behaviors or attitudes. CONCLUSIONS: Most players had a healthy PBF. Despite a positive attitude toward nutrition, poor nutritional knowledge and dietary practices were observed in many players. Young athletes' nutritional knowledge and dietary practices may benefit from appropriate nutritional education.