S304- Emerging Treatments of Nutritional Disorders

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1 S304- Emerging Treatments of Nutritional Disorders Erick Hernandez, MD Division of Pediatric Gastroenterology Miami Children s Hospital Miami, Florida

2 Disclosure of Relevant Relationship Dr. Hernandez(or spouse/partner) has not had (in the past 12 months) any conflicts of interest to resolve or relevant financial relationship with the manufacturers of products or services that will be discussed in this CME activity or in his presentation. Dr. Hernandez will support this presentation and clinical recommendations with the best available evidence from medical literature. Dr. Hernandez does not intend to discuss an unapproved/investigative use of a commercial product/device in this presentation.

3 Milestones in the history of pediatric nutrition 1850s Analysis of nutrient content of human and cow s milk 1880s Estimates of daily caloric requirements of infants 1893 Value of cod liver to prevent rickets 1915 Development of infant formula from cow s milk Synthesis of vitamins Pediatric Research (2003) 54. R. E Kleinman, L. A Barness and L. Finberg

4 Milestones in the history of pediatric nutrition 1940s Long term consequences of malnutrition in children 1956 F. Gomez-malnutrition based on weight for height 1960s Endocrinology of Vitamin D First use of total parenteral nutrition 1990s Genes and genes products related to energy expenditure Resurgence of breast-feeding Pediatric Research (2003) 54. R. E Kleinman, L. A Barness and L. Finberg

5 Percentage World undernourished population 2007/2008 UN Human Development Report

6 Percentage stunting of children under the age of five 2007/2008 UN Human Development Report

Iron deficiency and iron deficiency anemia impair neurocognitive development 1. Iron deficiency is the most common form of nutrient deficiency worldwide 2.

7 Iron deficiency and iron deficiency anemia impair neurocognitive development 1. Iron deficiency is the most common form of nutrient deficiency worldwide 2. Iron deficiency inhibits learning as well as motor and emotional development 3. Individuals exposed to perinatal iron deficiency are at high risk for failing to reach educational milestones later in life Front. Hum. Neurosci., 23 September. E. C. Radlowski and R. W. Johnson

8 Nano-iron supplement to treat iron-deficiency anemia Iron Oxide MRC Human Nutrition Research. July, D Pereira

10 Emerging therapeutic options for celiac disease Engineering gluten-free grains Gastroenterol Hepatol (N Y) Sep; 8(9): A Bakshi, S Stephen, M L. Borum, and D B. Doman

11 Blockage of the epithelial zonulin receptor decreases intestinal permeability in celiac patients Celiac patient Non-celiac control patient Gastroenterol Hepatol (N Y) Sep; 8(9): A Bakshi, S Stephen, M L. Borum, and D B. Doman

12 ImmusanT raises $12 million to enable advancement of immunotherapy for celiac disease Boston Business Journal (blog)-dec 22, 2014 Gastroenterol Hepatol (N Y) Sep; 8(9): A Bakshi, S Stephen, M L. Borum

13 Prevention of rickets and Vitamin D Deficiency 1. Breastfed and partially breastfed infants should be supplemented with 400 IU/day 2. All non breastfed infants and older childrenand adolescents who are ingesting <1000 ml/day of vitamin D should receive 400 IU/day 3. Serum 25-OH-D concentrations in all pediatric patients should be > 50 nmol/l Pediatrics Volume 122, Number 5, November 2008Carol L. Wagner and F. R Greer

14 The DEXA scan provides a highly accurate measurements of body composition for fat and bone mass

15 Standard treatments of dyslipidemias in childhood 1. Diet and exercise 2. Niacin 3. Statins (FDA approved for familial hypercholesterolemia over 8 years of age) 4. Bile acid-binding resins (Questran) Front. Hum. Neurosci., 23 September. E. C. Radlowski and R. W. Johnson

16 Bile acid receptors as targets for the treatment of dyslipidemia and cardiovascular disease Nuclear receptor Journal of Lipid Research Volume 53, G. Porez

17 Hepatocyte couple as a model of bile flow E. Hernandez et al, J Biol Chem Frontiers in Bioscience 14, , June 1, 2009

18 BLOOD BLOOD Nuclear receptors an emerging treatment in dyslipidemia FXR-farsenoid X receptor NTCP BSEP Bile CAR-constitutive androstane receptor

19 Milestones in the history total parenteral nutrition (TPN) 1650s First used of IV solution (opium and beer) 1960s First used of TPN and first pediatric death First and last TPN modification

20 Emerging changes in total parenteral nutrition (TPN). Glucagon- like-peptide-2 (GLP-2). Omega-3-fatty acids (fish oil). Short Chain Fatty Acids(Butyrate) Bartholome et al., 2014

21 Butyrate ameliorates T-cell-dependent experimental colitis Nature 504, (19 December 2013). Yukihiro Furusawa et al

22 Importance of genes in human development

23 Diet + Genome= Phenotype

24 Diet + Genome(Nutrigenomics)= Phenotype

25 We are what we eat

26 The human body carries about 100 trillion microorganisms in the intestines 10 times more than the total number of human cells 100 times more genes than the human genome

27 Diet is the most influential environmental factor associated to Crohn disease Butyrate

28 The first supper

29 The Potato Eaters is an oil painting by Dutch artist Vincent van Gogh painted in April 1885 in Nuenen, Netherlands The Great Famine

31 Diet + Genome= Phenotype Genes Diet Individual Differences

32 The rise of the hominids as an adaptive shift in fallback foods: Plant underground storage organs (USOs)and australopith origins Journal of Human Evolution G. Laden and R. Wrangham

March 30, ASN Comments and Additions to Select, Proposed Topics and Questions are in Red Below

March 30, ASN Comments and Additions to Select, Proposed Topics and Questions are in Red Below March 30, 2018 The American Society for Nutrition (ASN) appreciates the opportunity to comment on the proposed topics and supporting scientific questions that will be considered during the development