New Constellations 2019 | Page 26

DIABETES & ENDOCRINOLOGY CONTINUED FROM PREVIOUS PAGE “We’ll need longer-term research to sort this out,” says Dr. Inge. For the time being, though, surgery was Mona’s best option, and she ultimately decided to do it. It’s not quite what she thought it would be. She knew she wouldn’t be able to eat like she did anymore, but the change is drastic. She can’t eat two bites of a hamburger. Even drinking too much water at once makes her feel full. And she can’t eat spicy foods at all. “Hot Cheetos were my hardest breakup,” she jokes. But she lost 10 lbs. just following the surgery prep recommendations, and she’s been losing about 10 lbs. a month ever since. Dr. Inge thinks she’ll lose 85 lbs. before she’s done. And that hope makes the difference. She’s back to hiking. She hits the gym every day. Last month, she even did the Manitou Incline, a grueling gain of 2,000 feet in less than a mile along an old washed out funicular track on a mountainside just west of Colorado Springs. “I was tired, but I did it,” she says. “That felt really good. I know if I didn’t have the surgery, I wouldn’t be able to do half the things I’m doing now.” ● (Very) early intervention GASTROENTEROLOGY & GI SURGERY #7 Department of Pediatric Endocrinology in the nation as ranked by U.S. News & World Report 70+ 430+ Annual type 1 diabetes diagnoses * LEAD “We’ve been looking at risk factors transmitted across generations,” she says. Site for the only multicenter, NIH-sponsored research study defining adolescent bariatric surgery outcomes Their findings so far: Breastfed babies of overweight women corrected their heavy birth weight by 2 weeks old and seemed to stay that way, suggesting breastfeeding plays a crucial role in setting the right course. Dr. Krebs’s group published that in Pediatric Obesity last year. And when they start solids, babies on a meat-based diet were longer and leaner at 1 year old than babies on a diary-based diet, the group found. They published that in the American Journal of Clinical Nutrition, and a follow-up in the Journal of Pediatrics showing that those height differences persisted at 24 months old — even with no dietary restrictions in their second year. 24 Intravenous nutrition saves lives. Used long-term, though, it’s also connected to cirrhosis and eventual liver failure. “We didn’t know what caused it, how to treat it, or how to prevent the disease from progressing,” says Ronald Sokol, MD, Chief of Pediatric Gastroenterology, Hepatology and Nutrition at Children’s Colorado. “Without a way to chronicle the pathogenesis of the disease, we were stuck.” Active endocrinology clinical trials * If the upshot of Teen-LABS is that the earlier you treat childhood obesity the better, pediatric nutritionist Nancy Krebs, MD, MS, is taking that idea all the way. Babies born to overweight or obese mothers arrive heavier and gain weight faster — which sets up more of the same. Dr. Krebs’s group is looking at how early nutrition choices impact that vicious cycle. UNSTUCK * Combined data for Children’s Colorado and the Barbara Davis Center for Childhood Diabetes. LEADERSHIP: Philip Zeitler, MD, PhD Chief, Pediatric Endocrinology Thomas Inge, MD, PhD Associate Surgeon-in-Chief, Center for Children’s Surgery, Dr. David R. and Kiku Akers Chair in Pediatric Surgery Nancy Krebs, MD, MS Chief, Pediatric Medical Nutrition Until the advent of total parenteral nutrition, or TPN, half a century ago, patients with necrotizing enterocolitis, short bowel syndrome and other gastrointestinal malformations would not survive. While TPN increased survival and quality of life for many, physicians soon realized that long-term treatment came with grave side effects for infants and children with bowel problems, the most serious among them rapidly-progressing cirrhosis and liver failure. Often fatal without a liver or multivisceral transplant, this TPN-associated cholestasis (PNAC), was a major stumbling block for the field. Seeing the toll it took on these young patients, Dr. Sokol, gut macrophage expert Karim El Kasmi, MD, PhD, and a team of researchers from Children’s Colorado and the University of Colorado School of Medicine set out to develop an animal model, one that would replicate the human pathophysiology of this mysterious liver disease. Forming a hypothesis “We hypothesized that intestinal injury was just as important as the application of TPN,” says Dr. Sokol. “We speculated that the lack of enteral feeding may significantly reduce intestinal motility and favor bacterial overgrowth, subsequently aggravating underlying inflammation. This, together with the presumed increased intestinal permeability of infants, could compromise the intestinal barrier function.” With a poorly-functioning intestinal barrier, bacterial proteins, lipids or nucleic acids could be entering the portal vein, they surmised, initiating If we can prove efficacy of one of these drugs in preventing PNAC, it will dramatically alter the course of treatment for these infants and children.” R O N A L D S O KO L , M D Chief, Pediatric Gastroenterology, Hepatology and Nutrition For endocrinology healthcare professional resources, visit childrenscolorado.org/EndoHCP. NEW CONSTELLATIONS 25