Very high intakes of foods rich in soluble fiber lower blood cholesterol levels even when the main dietary modifiers of blood lipids--namely, saturated fat and cholesterol--are greatly reduced.

No abstract

Presently, undernutrition still goes undetected in pediatric hospitals despite its association with poor clinical outcomes and increased annual hospital costs, thus affecting both the patient and the health care system. The reported prevalence of undernutrition in pediatric patients seeking care or hospitalized varies considerably, ranging from 2.5 to 51%. This disparity is mostly due to the diversity of the origin of populations studied, methods used to detect and assess nutritional status, as well as the lack of consensus for defining pediatric undernutrition. The prevalence among inpatients is likely to be higher than that observed for the community at large, since malnourished children are likely to have a pre-existent disease or to develop medical complications. Meanwhile, growing evidence indicates that the nutritional status of sick children deteriorates during the course of hospitalization. Moreover, the absence of systematic nutritional screening in this environment may lead to an underestimation of this condition. The present review aims to critically discuss studies documenting the prevalence of malnutrition in pediatric hospitals in developed and in-transition countries and identifying hospital practices that may jeopardize the nutritional status of hospitalized children.

Purpose To determine the frequency of biochemical cholestasis (direct bilirubin (DB) ≥ 2mg/dL) in children with short bowel syndrome and biopsy proven parenteral nutrition (PN) associated liver disease and to define predictive factors for the occurrence and degree of hepatic fibrosis. Methods Following IRB approval, a retrospective review was conducted of patients followed by two multidisciplinary intestinal rehabilitation programs between January 1st, 2000, and September 30th, 2008. Inclusion criteria were exposure to parenteral nutrition (>30 days) and having undergone a liver biopsy. Liver biopsies were graded from 0–3 based upon degree of fibrosis in the pathology report. The most recent DB within 10 days prior to biopsy was recorded. Results A total of 66 children underwent 83 liver biopsies. The most common diagnoses included necrotizing enterocolitis (NEC) (36.4%), gastroschisis (22.7%) and intestinal atresia (15.1%). Median age at biopsy was 6.1 months with a median duration of PN of 4.7 months. 70.3% of patients had a history of exposure to parenteral omega-3 lipid emulsion. 89% (74/83) of liver biopsies demonstrated some degree of fibrosis (fibrosis scale 1–3), while 9.6% (8/83) had evidence of cirrhosis. 83% of biopsies without fibrosis and 55% of biopsies with fibrosis were obtained in patients without evidence of biochemical cholestasis (P=0.20). 3 of the 8 patients with cirrhosis on liver biopsy (37%) had no evidence of biochemical cholestasis. Univariate analysis identified only gestational age at birth (GA) as significantly associated with the degree of liver fibrosis (P=0.03). A multivariate logistic regression model accounting for multiple biopsies in patients revealed that GA was a predictor of fibrosis only in patients with a diagnosis other than NEC (P <0.01). Conclusions In children with short bowel syndrome, biochemical cholestasis does not reflect the presence or degree of histologically confirmed parenteral nutrition-associated liver fibrosis. Careful follow-up, combined with further refinement of diagnostic and hepatoprotective strategies, may be warranted in this patient population.