N ¼ 87 N ¼ 60 6.98 2.58 5.26 2.4 P < 0.0001 P < 0.0001
N ¼ 50 4.86 2.6 N ¼ 66 5.8 2.6 N ¼ 81 3.8 2.2
CD families Non-CD families CD families Non-CD families CD families
Results are expressed as grams of gluten per day standard deviation. N ¼ number of food frequency questionnaires.
Joaquim Calvo Lerma, Paula Crespo Escobar, yEtna Masip Simo, y Ester Donat Aliaga, yBegon˜a Polo Miguel, and Carmen Ribes-Koninckx Instituto de Investigacio´n Sanitaria La Fe y Pediatric Gastroenterology, Hospital Universitari i Polite`cnic La Fe, Valencia, Spain
N ¼ 78 4.9 3.07 P < 0.0001
Non-CD families
o the Editor: We suspected children belonging to families with a history of coeliac disease (CD) had a lower gluten intake than children from the general population (GP), provided that families with a member with CD tend to adapt their meals to the patients’ needs. To assess this hypothesis, we compared in a prospective study the mean daily gluten intake (MDGI) in Spanish children ages 12 to 36 months from families with a history of CD and from GP. A validated food frequency questionnaire was used to calculate the MDGI: 231 from children from the GP and 214 from families with a history of CD participating in PreventCD (www. preventcd.com). Three age ranges were considered for both groups: 12 to 18 (G1), 19 to 24 (G2), and 25 to 36 months (G3). MDGI was statistically significantly lower (Student t test) in the families with a history of CD for each age range (Table 1). We found that MDGI increased with age for both groups, the highest intake, that is, 6.98 g/day, corresponding to G3 of the GP. After 18 months, the introduction of new food products, mainly bread and pasta, led to a sharp increase in the MDGI only in families with a history of CD, thus suggesting these families are cautious with early gluten introduction in their infants’ diet. No statistical differences were observed regarding the index case, parent or sibling, in the families with a history of CD. Although PreventCD participants received specific gluten introduction instructions only up to 11 months, we cannot exclude that this may have some impact on later gluten consumption habits. Provided that a low daily gluten intake may account for a milder disease expression (clinical and biological), this must be especially taken into account when screening programs are implemented in this at-risk group.
G3 25–36 mo
T
G2 19–24 mo
Low Gluten Consumption by Young Children From Families With a History of Coeliac Disease
EDITOR
G1 12–18 mo
TO THE
TABLE 1. Mean daily gluten intake of at-risk children (CD families) and children from the GP (non-CD families), for different age groups
LETTERS
e50 JPGN Volume 58, Number 5, May 2014 Copyright 2014 by ESPGHAN and NASPGHAN. Unauthorized reproduction of this article is prohibited.
JPGN
Volume 58, Number 5, May 2014
Relation Between Sleep and Disease Activity in Depressed Pediatric Patients With Crohn Disease
T
o the Editor: Benhayon et al (1) presented an association between sleep and disease activity in 96 depressed pediatric patients with Crohn disease (CD). I have some concerns regarding their study. First, the number of control subjects was limited (n ¼ 19), so the authors could not use them to predict sleep by matching the data. Second, factor analysis was performed on subscales of the Pittsburgh Sleep Quality Index (PSQI), extracting 2 factors termed qualitative and quantitative sleep. Although sleep latency was classified as factor 1 (qualitative), sleep latency regulates sleep duration and also relates to sleep efficiency. This means that sleep latency is a quantitative indicator, and 2 subscales of PSQI by factor analysis should be handled with caution. Finally, multivariate regression analysis proposed that qualitative and quantitative sleep by PSQI were both predicted by CD activity, but the square values of multiple regression coefficients were
N ¼ 50 4.86 2.6 N ¼ 66 5.8 2.6 N ¼ 81 3.8 2.2
CD families Non-CD families CD families Non-CD families CD families
Results are expressed as grams of gluten per day standard deviation. N ¼ number of food frequency questionnaires.
Joaquim Calvo Lerma, Paula Crespo Escobar, yEtna Masip Simo, y Ester Donat Aliaga, yBegon˜a Polo Miguel, and Carmen Ribes-Koninckx Instituto de Investigacio´n Sanitaria La Fe y Pediatric Gastroenterology, Hospital Universitari i Polite`cnic La Fe, Valencia, Spain
N ¼ 78 4.9 3.07 P < 0.0001
Non-CD families
o the Editor: We suspected children belonging to families with a history of coeliac disease (CD) had a lower gluten intake than children from the general population (GP), provided that families with a member with CD tend to adapt their meals to the patients’ needs. To assess this hypothesis, we compared in a prospective study the mean daily gluten intake (MDGI) in Spanish children ages 12 to 36 months from families with a history of CD and from GP. A validated food frequency questionnaire was used to calculate the MDGI: 231 from children from the GP and 214 from families with a history of CD participating in PreventCD (www. preventcd.com). Three age ranges were considered for both groups: 12 to 18 (G1), 19 to 24 (G2), and 25 to 36 months (G3). MDGI was statistically significantly lower (Student t test) in the families with a history of CD for each age range (Table 1). We found that MDGI increased with age for both groups, the highest intake, that is, 6.98 g/day, corresponding to G3 of the GP. After 18 months, the introduction of new food products, mainly bread and pasta, led to a sharp increase in the MDGI only in families with a history of CD, thus suggesting these families are cautious with early gluten introduction in their infants’ diet. No statistical differences were observed regarding the index case, parent or sibling, in the families with a history of CD. Although PreventCD participants received specific gluten introduction instructions only up to 11 months, we cannot exclude that this may have some impact on later gluten consumption habits. Provided that a low daily gluten intake may account for a milder disease expression (clinical and biological), this must be especially taken into account when screening programs are implemented in this at-risk group.
G3 25–36 mo
T
G2 19–24 mo
Low Gluten Consumption by Young Children From Families With a History of Coeliac Disease
EDITOR
G1 12–18 mo
TO THE
TABLE 1. Mean daily gluten intake of at-risk children (CD families) and children from the GP (non-CD families), for different age groups
LETTERS
e50 JPGN Volume 58, Number 5, May 2014 Copyright 2014 by ESPGHAN and NASPGHAN. Unauthorized reproduction of this article is prohibited.
JPGN
Volume 58, Number 5, May 2014
Relation Between Sleep and Disease Activity in Depressed Pediatric Patients With Crohn Disease
T
o the Editor: Benhayon et al (1) presented an association between sleep and disease activity in 96 depressed pediatric patients with Crohn disease (CD). I have some concerns regarding their study. First, the number of control subjects was limited (n ¼ 19), so the authors could not use them to predict sleep by matching the data. Second, factor analysis was performed on subscales of the Pittsburgh Sleep Quality Index (PSQI), extracting 2 factors termed qualitative and quantitative sleep. Although sleep latency was classified as factor 1 (qualitative), sleep latency regulates sleep duration and also relates to sleep efficiency. This means that sleep latency is a quantitative indicator, and 2 subscales of PSQI by factor analysis should be handled with caution. Finally, multivariate regression analysis proposed that qualitative and quantitative sleep by PSQI were both predicted by CD activity, but the square values of multiple regression coefficients were
