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.
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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
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