Petah Tikva, Israel
Petah Tikva, Israel

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Davidson S.,Helen Schneider Hospital for Women | Davidson S.,Tel Aviv University | Natan D.,Maccabi Healthcare Services | Novikov I.,Gertner Institute for Epidemiology | And 5 more authors.
Clinical Nutrition | Year: 2011

Background & aims: The risk of childhood obesity, an increasingly prevalent problem worldwide, might be predictable by early body mass index measurements. This study sought to develop body mass index and weight-for-length ratio references for infants born at 33-42 weeks gestation and to validate these data against the growth curves of the World Health Organization Multicenter Growth Reference Study. Methods: Data were collected from the Neonatal Registry of Rabin Medical Center for all healthy singleton babies born live at 33-42 weeks gestation. Crude and smoothed reference tables and graphs for body mass index and weight-for-length ratio by gestational age were created for males and females, separately. Results: Birth weight, length, and body mass index percentiles for full-term neonates were similar to the World Health Organization study, reinforcing the generalizability of our reference charts for infants born at 33-42 weeks. Cutoff values for small for date (<5th, <10th percentile) and large for date (>85th, >95th percentile) infants differed across gestational ages in both pre-term and full-term infants. Conclusions: As body proportionality indexes provide an assessment of body mass and fatness relative to length, we suggest that BMI and Wt/L ratio percentiles be added to weight and length growth curves as a routine intrauterine growth assessment at birth. © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.


Waisbourd-Zinman O.,Institute for Gastroenterology | Rosenbach Y.,Institute for Gastroenterology | Rosenbach Y.,Tel Aviv University | Shalitin S.,Tel Aviv University | And 8 more authors.
Digestive Diseases and Sciences | Year: 2012

Background The prevalence of celiac disease among type 1 diabetes mellitus (T1DM) patients is 5-10 times higher than in the general population. Thus, evaluation of celiac serology is indicated at diagnosis of T1DM and on follow up. Aim This study was prompted by the observation that elevated anti-TTG antibody levels in diabetic children may spontaneously normalize despite continued consumption of gluten. The objective of the study was to investigate the prevalence of this phenomenon and associated factors. Materials and Methods The files of all children diagnosed with type 1 diabetes mellitus from 2003-2009 at a tertiary pediatric medical center were reviewed for those with elevated serum levels of anti-TTG antibody. Clinical, medical, laboratory, and treatment data were collected. Findings were compared between patients diagnosed with celiac disease and patients with initially elevated anti-TTG antibody levels that spontaneously normalized. Results Forty-eight of the 738 patients with type 1 diabetes attending our center (6.5%) had elevated anti-TTG antibody blood levels. Celiac disease was diagnosed in 23, and anti-TTG antibody levels normalized in 17 (35.4%), all of whom consumed gluten. At one-year follow-up, there was no significant difference between the groups in HbA1c level or change in anthropometric measurements. Conclusion Physicians treating children with type 1 diabetes and mildly elevated anti-TTG antibody levels might consider 12-month serologic follow-up on a gluten-containing diet rather than immediate duodenal biopsy. © 2012 Springer Science+Business Media, LLC.


Yanai H.,Inflammatory Bowel Disease Center | Yanai H.,Tel Aviv University | Lichtenstein L.,Tel Aviv University | Lichtenstein L.,Rabin Medical Center | And 28 more authors.
Clinical Gastroenterology and Hepatology | Year: 2015

Background & Aims: There is controversy about whether levels of anti-tumor necrosis factor (TNF) and antidrug antibodies (ADAs) are accurate determinants of loss of response to therapy. We analyzed the association between trough levels of anti-TNF agents or ADAs and outcomes of interventions for patients with loss of response to infliximab or adalimumab. Methods: We performed a retrospective study of pediatric and adult patients with inflammatory bowel disease and suspected loss of response to anti-TNF agents treated at medical centers throughout Israel from October 2009 through February 2013. We examined the correlation between outcomes of different interventions and trough levels of drug or ADAs during loss of response. An additional subanalysis was performed including only patients with a definite inflammatory loss of response (clinical worsening associated with increased levels of C-reactive protein or fecal calprotectin, or detection of inflammation by endoscopy, fistula discharge, or imaging studies). Results: Among 247 patients (42 with ulcerative colitis), there were 330 loss-of-response events (188 to infliximab and 142 to adalimumab). Trough levels of adalimumab greater than 4.5 mcg/mL and infliximab greater than 3.8 mcg/mL identified patients who failed to respond to an increase in drug dosage or a switch to another anti-TNF agent with 90% specificity; these were set as adequate trough levels. Adequate trough levels identified patients who responded to expectant management or out-of-class interventions with more than 75% specificity. Levels of antibodies against adalimumab >4 microgram per mL equivalent (mcg/mL-eq) or antibodies against infliximab >9 mcg/mL-eq identified patients who did not respond to an increased drug dosage with 90% specificity. Patients with high titers of ADAs had longer durations of response when anti-TNF agents were switched than when dosage was increased (P= .03; log-rank test), although dosage increases were more effective for patients with no or low titers of ADAs (P = .02). An analysis of definite inflammatory loss-of-response events (n= 244) produced similar results; patients with adequate trough levels had a longer duration of response when they switched to a different class of agent than when anti-TNF was optimized by either a dosage increase or by a switch within the anti-TNF class (P= .002; log-rank test). Conclusions: The results of this retrospective analysis suggest that trough levels of drug or ADAs may guide therapeutic decisions for more than two-thirds of inflammatory bowel disease patients with either clinically suspected or definite inflammatory loss of response to therapy. © 2015 AGA Institute.


Heymann A.D.,Maccabi Healthcare Services | Heymann A.D.,Tel Aviv University | Leshno M.,Tel Aviv University | Endevelt R.,Maccabi Healthcare Services | And 3 more authors.
Health Economics Review | Year: 2013

Background: The aim of this study was to identify costs in patients diagnosed with Celiac disease. Methods: This retrospective case control study covered the period 2003-2006 and was conducted in a large Israeli Health Maintenance Organization insuring over two million members. Our cohort comprised 1,754 patients with Celiac disease with a control group of 15,040. Costs were aggregated according to main cost-branches and computed individually for each member. A linear step wise regression was performed with costs being the dependent variable and the independent variables; age, gender and the presence of celiac disease. Costs were compared with patients suffering from other chronic diseases. Results: The total costs of the patients with celiac disease were significantly higher than that of the control group for hospital admission, medications, laboratory and imaging. Hospital admission rate was 7.98% as opposed to 7.1% for the control group (p = 0.06). When compared with other chronic illnesses, the costs of patients with celiac disease were similar to those of patients with diabetes and hypertension. Conclusions: Patients with Celiac disease utilize medical services more than the general population. This research suggests that the use of medical resources by patients with Celiac disease may be higher than previously thought. © Heymann et al.


Shamir R.,Institute for Gastroenterology | Shamir R.,Tel Aviv University | Shehadeh N.,Meyer Childrens Hospital of Haifa | Shehadeh N.,Technion - Israel Institute of Technology
Nestle Nutrition Institute Workshop Series | Year: 2013

Human milk contains a substantial number of hormones and growth factors. Studies in animal models show that some of these peptides (e.g. insulin, insulin-like growth factor 1, IGF-1, epidermal growth factors) have an effect on the small intestine after orogastric administration. Recently, two efforts were made to incorporate growth factors into infant formulas. One of these efforts included the incorporation of IGF-1, and the second is an ongoing effort to evaluate the safety and efficacy of incorporating insulin into infant formulas. The rational and current evidence for adding insulin to infant formulas (presence in human milk, effects of orally administrated insulin on gut maturation, intestinal permeability, systemic effects and preliminary encouraging results of supplementing insulin to a preterm infant formula) is detailed in this review. If the addition of insulin to preterm infant formulas indeed results in better growth and accelerated intestinal maturation, future studies will need to address the supplementation of insulin in term infants and assess the efficacy of such supplementation in enhancing gut maturation and prevention of later noncommunicable diseases such as allergy, autoimmune diseases and obesity. Copyright © 2013 Nestec Ltd., Vevey/S. Karger AG, Basel.


Masarwi M.,Tel Aviv University | Masarwi M.,Felsenstein Medical Research Center | Gabet Y.,Tel Aviv University | Dolkart O.,Tel Aviv University | And 11 more authors.
British Journal of Nutrition | Year: 2016

The aim of the present study was to determine whether the type of protein ingested influences the efficiency of catch-up (CU) growth and bone quality in fast-growing male rats. Young male Sprague-Dawley rats were either fed ad libitum (controls) or subjected to 36 d of 40 % food restriction followed by 24 or 40 d of re-feeding with either standard rat chow or iso-energetic, iso-protein diets containing milk proteins - casein or whey. In terms of body weight, CU growth was incomplete in all study groups. Despite their similar food consumption, casein-re-fed rats had a significantly higher body weight and longer humerus than whey-re-fed rats in the long term. The height of the epiphyseal growth plate (EGP) in both casein and whey groups was greater than that of rats re-fed normal chow. Microcomputed tomography yielded significant differences in bone microstructure between the casein and whey groups, with the casein-re-fed animals having greater cortical thickness in both the short and long term in addition to a higher trabecular bone fraction in the short term, although this difference disappeared in the long term. Mechanical testing confirmed the greater bone strength in rats re-fed casein. Bone quality during CU growth significantly depends on the type of protein ingested. The higher EGP in the casein- and whey-re-fed rats suggests a better growth potential with milk-based diets. These results suggest that whey may lead to slower bone growth with reduced weight gain and, as such, may serve to circumvent long-term complications of CU growth. Copyright © The Authors 2016.


Zevit N.,Institute for Gastroenterology | Zevit N.,Tel Aviv University | Niv Y.,Tel Aviv University | Niv Y.,Rabin Medical Center | And 4 more authors.
European Journal of Clinical Investigation | Year: 2011

Background 13C urea breath test (UBT) results, used for the diagnosis of Helicobacter pylori infection, fluctuate in different age groups. We characterized both the age- and gender-based trends of UBT results, from early childhood through late adulthood. Methods A national H. pylori referral laboratory was screened for all positive UBTs during 2007-2008, determined as a delta over baseline (DOB)≥3·5. Data were analysed with respect to both age and gender. Results In the studied period, 61060 UBTs were performed and 24 237 were positive. After excluding multiple testing for an individual, a total of 21767 positive results were analysed. The male/female ratio for positive UBTs was 1:1·77. DOB results decreased as age increased from a maximum of 38·6±21 at age 3-5years to 21·1±12 at age 19-30 in females (P<0·001) and from 30·0±16 at age 6-10years to 14·7±8 at age 19-30years in males (P<0·0001). At this point, the values reached a nadir for both genders. In patients older than 60years, old test results increased moderately (P<0·003). In all age groups, except 6-10years old, females had significantly higher UBT results than males. Conclusions The decrease in mean UBT values already occurs during the first decade of life, and results increase following the sixth decade. Females have significantly higher results than males even in early childhood and throughout old age. © 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation.


PubMed | Institute for Gastroenterology
Type: Journal Article | Journal: Journal of clinical gastroenterology | Year: 2010

It is suggested that for celiac disease (CD) diagnosis, biopsies should also be taken from the duodenal bulb. Whether bulb biopsies suggestive of CD can be found on upper gastrointestinal endoscopy (EGD) done for reasons other than CD diagnosis is not clear. The aim of our study was to evaluate the contribution of routine bulb biopsies to the diagnosis of CD, when taken regardless of prior suspicion of CD.The study included 96 children who underwent EGD for suspected CD and a control group of 69 children who underwent EGD for reasons other than CD. The mucosal changes were evaluated using the Marsh-Oberhuber classification.Among the 87 children diagnosed with CD, we identified 6 patients (7%) with typical histologic findings only in the bulb (Marsh 3), but also 1 patient (1.1%) with findings only in the distal duodenum (Marsh 2). In 20 patients (23%) the histological changes were more severe in the bulb. One patient had more prominent findings in the second part of the duodenum. None of the control patients had histological changes compatible with CD in the bulb or the second part of the duodenum.Our findings suggest that when CD is suspected, biopsies should be taken from both locations (bulb and second part) as mucosal changes may emerge only at one site. Nevertheless, the presence of characteristic histology on duodenal bulb biopsies might be sufficient for the diagnosis of CD.


PubMed | Institute for Gastroenterology
Type: Journal Article | Journal: European journal of clinical investigation | Year: 2011

(13) C urea breath test (UBT) results, used for the diagnosis of Helicobacter pylori infection, fluctuate in different age groups. We characterized both the age- and gender-based trends of UBT results, from early childhood through late adulthood.A national H. pylori referral laboratory was screened for all positive UBTs during 2007-2008, determined as a delta over baseline (DOB) 35. Data were analysed with respect to both age and gender.In the studied period, 61,060 UBTs were performed and 24,237 were positive. After excluding multiple testing for an individual, a total of 21,767 positive results were analysed. The male/female ratio for positive UBTs was 1 : 177. DOB results decreased as age increased from a maximum of 386 21 at age 3-5 years to 211 12 at age 19-30 in females (P < 0001) and from 300 16 at age 6-10 years to 147 8 at age 19-30 years in males (P < 00001). At this point, the values reached a nadir for both genders. In patients older than 60 years, old test results increased moderately (P < 0003). In all age groups, except 6-10 years old, females had significantly higher UBT results than males.The decrease in mean UBT values already occurs during the first decade of life, and results increase following the sixth decade. Females have significantly higher results than males even in early childhood and throughout old age.


PubMed | Institute for Gastroenterology
Type: | Journal: Nestle Nutrition Institute workshop series | Year: 2013

Human milk contains a substantial number of hormones and growth factors. Studies in animal models show that some of these peptides (e.g. insulin, insulin-like growth factor 1, IGF-1, epidermal growth factors) have an effect on the small intestine after orogastric administration. Recently, two efforts were made to incorporate growth factors into infant formulas. One of these efforts included the incorporation of IGF-1, and the second is an ongoing effort to evaluate the safety and efficacy of incorporating insulin into infant formulas. The rational and current evidence for adding insulin to infant formulas (presence in human milk, effects of orally administrated insulin on gut maturation, intestinal permeability, systemic effects and preliminary encouraging results of supplementing insulin to a preterm infant formula) is detailed in this review. If the addition of insulin to preterm infant formulas indeed results in better growth and accelerated intestinal maturation, future studies will need to address the supplementation of insulin in term infants and assess the efficacy of such supplementation in enhancing gut maturation and prevention of later noncommunicable diseases such as allergy, autoimmune diseases and obesity.

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