Background Hepatitis B virus (HBV) infection is a major cause of hepatocellular carcinoma. This population-based study aimed to investigate whether prevention of hepatocellular carcinoma by the ...universal Taiwanese HBV vaccine program, launched in July 1984, has extended beyond childhood and to identify the predictors of hepatocellular carcinoma for vaccinated birth cohorts. Methods Data on 1958 patients with hepatocellular carcinoma who were aged 6–29 years at diagnosis in Taiwan between 1983 and 2004 were collected from two national hepatocellular carcinoma registries. Age- and sex-specific incidence among vaccinated and unvaccinated birth cohorts were analyzed by using Poisson regression models. All statistical tests were two-sided. Records of 64 hepatocellular carcinoma patients and 5 524 435 HBV vaccinees who were born after the initiation of the vaccination program were compared for HBV immunization characteristics during infancy and prenatal maternal hepatitis B surface antigen (HBsAg) and e antigen (HBeAg) serostatus. Results Hepatocellular carcinoma incidence was statistically significantly lower among children aged 6–19 years in vaccinated compared with unvaccinated birth cohorts (64 hepatocellular cancers among vaccinees in 37 709 304 person-years vs 444 cancers in unvaccinated subjects in 78 496 406 person-years, showing an age- and sex-adjusted relative risk of 0.31, P < .001, for persons vaccinated at birth). The risk of developing hepatocellular carcinoma for vaccinated cohorts was statistically significantly associated with incomplete HBV vaccination (for those who received fewer than three doses of HBV vaccine, odds ratio OR = 4.32, 95% confidence interval CI = 2.34 to 7.91); with prenatal maternal HBsAg seropositivity (OR = 29.50, 95% CI = 13.98 to 62.60); with prenatal maternal HBeAg seropositivity (with administration of hepatitis B immunoglobulin at birth, OR = 5.13, 95% CI = 2.24 to 11.71; and without it, OR = 9.43, 95% CI = 3.54 to 25.11). Conclusion The prevention of hepatocellular carcinoma by this HBV vaccine extends from childhood to early adulthood. Failure to prevent hepatocellular carcinoma results mostly from unsuccessful control of HBV infection by highly infectious mothers.
Background
Non‐alcoholic fatty liver disease (NAFLD) is the leading cause of pediatric chronic liver disease, which is strongly associated with obesity. Transient elastography, together with ...anthropometric values including waist‐to‐height ratio (WHtR) and body mass index (BMI) z‐scores are a more precise diagnostic method of NAFLD than ultrasonography. Through transient elastography, we investigate the principal anthropometric values associated with pediatric NAFLD.
Methods
Healthy children between the ages of 6–18 years whose BMIs were ≥85% of normal were recruited as the overweight‐and‐obese group, and children whose BMIs ranged between 5%–85% were recruited as the control group. Non‐alcoholic fatty liver disease was evaluated via transient elastography. BMI z‐score and WHtR were measured.
Results
A total of 107 (58 overweight‐and‐obese, 49 control) children were recruited. As evaluated by transient elastography, children in the overweight‐and‐obese group had significantly higher controlled attenuation parameter and liver stiffness measurement values than the control group. To detect fatty liver, WHtR with a cut‐off point of 0.481 and BMI z‐score with cut‐off point of 1.075 had the best sensitivity and specificity. To identify liver stiffness or inflammation, WHtR with cut‐off point of 0.514 and BMI z‐score with cut‐off point of 1.62 had the best sensitivity and specificity. Controlled attenuation parameter demonstrated a fair correlation with WHtR and BMI z‐scores, even in the normal range of these parameters.
Conclusions
Transient elastography together with anthropometric measurements demonstrate that pediatric NAFLD may develop earlier than expected. We present principal anthropometric values associated with pediatric NAFLD.
In Taiwan, a screening system using an infant stool color card to promote the early diagnosis of biliary atresia (BA) was established in 2002. This study aimed to investigate the 5‐year outcome of BA ...before and after using the screening program. BA patients were divided into three cohorts according to their birth dates. The patients in cohort A (n = 89) were born before the stool card screening program (1990‐2000); those in cohort B (n = 28) were screened by the stool card regional screening program (2002‐2003); and those in cohort C (n = 74) were screened by the stool card universal screening program (2004‐2005). The relative odds ratios were computed using logistic regression to compare the different factors affecting survival time. The rate of age at Kasai operation <60 days was 49.4% and 65.7% in cohorts A and B+C, respectively (P = 0.02). The jaundice‐free (total serum bilirubin <2.0 mg/dL) rate 3 months after surgery was 34.8% and 60.8% in cohorts A and B+C, respectively (P < 0.001). The 3‐year jaundice‐free survival rate with native liver was 31.5% in cohort A and 56.9% in cohort B+C (P < 0.001), whereas the 3‐year overall survival rates were 64.0% and 89.2%, respectively (P < 0.001). The 5‐year jaundice‐free survival rate with native liver was 27.3% in cohort A and 64.3% in cohort B (P < 0.001), and the 5‐year overall survival rates were 55.7% and 89.3%, respectively (P < 0.001). Conclusion: The stool color card screening program for BA allows for earlier Kasai operation, which increases the jaundice‐free rate at 3 months postsurgery. With higher surgical success rates, the 3‐ and 5‐year outcome of BA patients in Taiwan improves remarkably. (HEPATOLOGY 2011.)
Objectives To investigate the characteristics of biliary atresia (BA) in preterm infants. Study design Nationwide screening for BA in Taiwan using an infant stool color card was launched in 2004. We ...investigated the characteristics of BA in preterm infants using the national stool card registry center database. Results We identified 197 cases of BA from January 2004 to June 2010. The overall incidence of BA was 1.51 cases per 10 000 live births. The annual incidence of BA per 10 000 live births in term and preterm infants was 1.43 and 2.37 ( P < .05), respectively. The sensitivity of detecting BA using stool cards before 60 days of age was 92.8% in term, and 96.3% in preterm infants. The Kasai operation before 60 days of age was 68.7% in term, and 44.4% in preterm infants. The jaundice-free rate at 3 months after the Kasai operation among infants with BA was 62.0% in term, and 37.0% in preterm infants ( P = .015). The 18-month survival rate with native liver was higher in the term infants (72.7%) than that in the preterm infants (50.0%) ( P = .043). Conclusion The incidence of BA in preterm infants is more frequent than in term infants. The stool color card is sensitive to detecting BA in preterm infants. Preterm infants with BA were more prone to delayed Kasai operation and had poorer outcome.
Coffee is a complex chemical mixture, with caffeine being the most well-known bioactive substance. The immunomodulatory and anti-inflammatory properties of coffee and caffeine impact health in ...various aspects, including the respiratory system. The objective is to investigate the effects of coffee and caffeine on airway hyperresponsiveness and allergic reactions, as well as to analyze and compare associated cytokine profiles.
BALB/c mice were intraperitoneally sensitized with ovalbumin (OVA) and given OVA inhalation to induce airway hypersensitivity. Two weeks after sensitization, they were intragastrically gavaged with coffee or caffeine, both containing 0.3125 mg caffeine, daily for 4 weeks. Control mice were fed with double-distilled water. Serum OVA-specific antibody levels were measured beforehand and 5 weeks after the first gavage. Airway hyperresponsiveness was detected by whole body plethysmography after gavage. Cytokine levels of bronchoalveolar lavage and cultured splenocytes were analyzed.
Coffee effectively suppressed T helper 2-mediated specific antibody response. Airway responsiveness was reduced in mice treated with either coffee or caffeine. Compared to the control, coffee significantly reduced OVA-specific immunoglobulin (Ig) G, IgG1 and IgE antibody responses (
< 0.05). Caffeine also attenuated specific IgG and IgG1 levels, though IgE level was unaffected. Coffee significantly reduced interleukin (IL)-4 and increased IL-10 concentration in spleen cells and bronchoalveolar lavage fluid (
< 0.05).
Coffee effectively attenuated airway hyperresponsiveness and systemic allergic responses induced by OVA food allergen in mice. As a complex composition of bioactive substances, coffee displayed enhanced immunomodulatory and anti-inflammatory effects than caffeine.
Transient elastography is a non-invasive assessment of steatosis (measured as the controlled attenuation parameter, CAP) and fibrosis (measured as liver stiffness measurement, LSM) in patients with ...pediatric non-alcoholic fatty liver disease (NAFLD). Abdominal adiposity is considered the most important factor for metabolic dysregulation including NAFLD. However, there is lack of a correlation between transient elastography measurements and abdominal adiposity. Accordingly, this study aimed to assess the correlation between transient elastography measurements and abdominal adiposity in children.
This cross-sectional study included 137 children who visited the Taipei Veterans General Hospital. Hepatic steatosis (CAP) and fibrosis (LSM), were assessed by transient elastography. Abdominal adiposity including subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and preperitoneal adipose tissue (PPT) was assessed using abdominal sonography. The correlation between transient elastography measurements and abdominal adiposity was assessed using multiple linear regression.
In total, 137 children were included in this study. SAT and VAT were significantly associated with CAP, whereas SAT was significantly associated with LSM. An increment of 1 mm in SAT increased CAP and LSM by 5.56 dB/m and 0.06 kPa, respectively.
Certain abdominal adiposities, especially SAT, are significantly associated with CAP and LSM, as determined by transient elastography. Simple abdominal adiposity measured using sonography may be useful for the early detection of pediatric NAFLD.
Biliary atresia is the most common cause of death from liver disease in children. Although the Kasai operation before 60 days of age can significantly improve prognosis, delay in referral and surgery ...remains a formidable problem worldwide because of difficulties in differentiating it from benign prolonged neonatal jaundice. We established a universal screening system using an infant stool color card to promote the early diagnosis and treatment of biliary atresia. After a pilot regional study in 2002–2003, a national stool color screening system was established by integrating the infant stool color card into the child health booklet given to every neonate in Taiwan since 2004. Within 24 hours of the discovery of an abnormal stool color, this event is reported to the registry center. The annual incidence of biliary atresia per 10,000 live births in 2004 and 2005 was 1.85 (40/216,419) and 1.70 (35/205,854), respectively. The sensitivity of detecting biliary atresia using stool cards before 60 days of age was 72.5% in 2004, which improved to 97.1% in 2005. The national rate of the Kasai operation before 60 days of age increased from 60% in 2004 to 74.3% in 2005. The jaundice‐free rate (<2 mg/dL) at 3 months after the Kasai operation among infants with biliary atresia in 2004–2005 was 59.5% (44 of 74), significantly higher than the historical data of 37.0% in 1976–2000 before the stool card screening program (P = 0.002). Conclusion: Universal screening using the stool color cards can enhance earlier referral, which may ultimately lead to timely performance of the Kasai operation and better postoperative outcome in infants with biliary atresia. (HEPATOLOGY 2008.)
Background and Objectives: Fast-food consumption has greatly increased in Taiwan. Frequent fast food intake is associated with both allergy and obesity. The aim of this study was to describe fast ...food habit changes, and to assess the relationship between fast food intake and the risk of functional gastrointestinal disorders (FGIDs) among Taiwanese adolescents. Methods and Study Design: This analysis used data from the Nutrition and Health Survey in Taiwan (NAHSIT) of high school students conducted in 2011. A total of 2,042 adolescents (12- 19 years) completed the questionnaire. The survey included the Rome III criteria for FGIDs, translated into Chinese for adolescents. Respondents with previously diagnosed chronic organic gastrointestinal diseases were excluded from the study. Results: In total, 2,034 children were enrolled. 545 subjects (26.8%) had history of at least one FGID. 88.1% of the subjects reported fast foods consumption. A significantly higher prevalence of FGIDs was noted in adolescents with a history of fast foods consumption, compared with those reported not to have ingested fast foods in the past 30 days (27.6% vs 20.6%, p=0.024). An increased risk of FGIDs in children and adolescents was associated with fast food intake (OR 1.8, 95% CI: 1.78-1.83). Conclusions: FGIDs were common among Taiwanese adolescents. Fast-food consumption may contribute to a positive association with the development of functional gastrointestinal disorders. Lower fiber intake and more frozen desserts in the diet may be complicit in FGIDs. The findings have public health relevance in regard to the global increase in fast food consumption.
Functional gastrointestinal disorders (FGID) are a group of disorders of the digestive system in which the chronic or recurrent symptoms cannot be explained by the presence of structural or tissue ...abnormality. This survey used a modified Rome III questionnaire on the health and nutrition status of a general population in Taiwan during 2005-2008. A total of 4,275 responders completed the questionnaire. The sample was evenly distributed for men (n=2,137) and women (n=2,138). The prevalence of FGID was 26.2%. Unspecified functional bowel disorder was the most prevalent (8.9%). The second was functional dyspepsia (5.3%), and the third were irritable bowel syndrome (4.4%) and functional constipation (4.4%). Women had a greater prevalence than males (33.2% compared to 22.4%, p<0.05) with regards to total FGID. Most categories of FGID were significantly prominent in women, except functional diarrhea. The FGID groups took fewer servings of vegetables and fruits than the non- FGID group each day (vegetables 2.51 vs 2.70, p<0.001; fruits 0.82 vs 0.91, p<0.001). Smoking, alcohol consumption, and betel nut chewing had no significant impaction on prevalence of FGID. The mean BSRS (briefsymptom rating scale) for screening depression and suicide ideation was higher in the FGID group (2.86 vs 1.63, p<0.001). In conclusion, FGID diagnosed with Rome III criteria are not uncommon in Taiwan's general population. Subjects who met the Rome III criteria for FGID in Taiwan were younger, had less vegetables and fruits intake, higher BSRS scores and were of greater female predominance.
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