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The prevalence of food and skin allergies increased in children aged 0a€“17 years from 1997a€“2011. Younger children were more likely to have skin allergies, while older children were more likely to have respiratory allergies. Hispanic children had lower rates of all three types of allergies compared with children of other race or ethnicities. The prevalence of food and respiratory allergy, but not skin allergy, increased with higher income levels. The prevalence of food and skin allergies increased in children under age 18 years from 1997a€“2011. Hispanic children had a lower prevalence of food allergy, skin allergy, and respiratory allergy compared with children of other race or ethnicities.
Allergic conditions are among the most common medical conditions affecting children in the United States (1a€“5). The prevalence of both food allergy and respiratory allergy increased with the increase of income level.
Among children under age 18 years in the United States, the prevalence of food and skin allergies increased from 1997a€“1999 to 2009a€“2011. NHIS data are collected continuously throughout the year for the Centers for Disease Control and Prevention's National Center for Health Statistics by interviewers from the U.S.
NHIS is designed to yield a sample that is representative of the civilian noninstitutionalized population of the United States, and the survey uses weighting to produce national estimates.
Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
Are there racial or ethnic differences in the percentage of total dietary kilocalories consumed from sugar drinks? Are there income differences in the percentage of total dietary kilocalories consumed from sugar drinks?
Non-Hispanic black children and adolescents consume more sugar drinks in relation to their overall diet than their Mexican-American counterparts. Low-income persons consume more sugar drinks in relation to their overall diet than those with higher income. Most of the sugar drinks consumed away from home are obtained from stores and not restaurants or schools. Consumption of sugar drinks in the United States has increased over the last 30 years among both children and adults (1a€“3). Overall, males consume an average of 178 kcal from sugar drinks on any given day, while females consume 103 kcal. Approximately one-half of the population aged 2 and older consumes sugar drinks on any given day. Higher-income persons consume fewer kilocalories from sugar drinks as a percentage of total daily kilocalories than do lower-income individuals. Sugar drinks: For these analyses, sugar drinks include fruit drinks, sodas, energy drinks, sports drinks, and sweetened bottled waters, consistent with definitions reported by the National Cancer Institute (8). Location of sugar-drink consumption: Respondents to the 24-hour dietary recall interview were asked if each reported food was consumed at home or away from home. Source of sugar drinks: Respondents to the 24-hour dietary recall interview were asked where they obtained each food consumed.
Poverty income ratio (PIR): A measure representing the ratio of household income to the poverty threshold after accounting for inflation and family size. Data from the National Health and Nutrition Examination Survey (NHANES) were used for these analyses.
The NHANES sample is selected through a complex, multistage design that includes selection of primary sampling units (counties), household segments within the counties, households within segments, and, finally, sample persons from selected households.
Sample weights, which account for the differential probabilities of selection, nonresponse, and noncoverage, were incorporated into the estimation process. Despite being described anatomically almost 2,000 years ago the physiological function of the pancreas and its role in diseases remained more or less unknown until the 19th century. Later on, when indirect function tests became available, fecal chymotrypsin activity and fecal elastase 1 concentrations (FEC) were used to measure exocrine pancreatic function. Several national and international associations have discussed and published special considerations concerning exocrine insufficiency in diabetes mellitus and type 3c diabetes mellitus (1, 13, 33, 40). Fat digestion in patients with diabetes mellitus and low fecal elastase 1 levels have been studied by at least two different centers.
This neglect might be explained by the fact that most diabetic patients do not report classical symptoms of exocrine insufficiency – unless they are asked about it.
When taking into consideration that in most studies the finding of PEI did not depend on the duration of diabetes mellitus, it seems rather unlikely that PEI is a complication of diabetes mellitus.
The maldigestion due to PEI can lead to a relevant qualitative malnutrition concerning e.g. Since the secretion of incretins (regarded as a major factor regulating insulin secretion and action) largely depends on normal fat and protein digestion, PEI might play a critical role in quite a number of patients. Since the incretin axis has become a major target in modern diabetology, it is of utmost importance to learn about the clinical implications of exocrine pancreatic insufficiency in diabetic patients.
However, there are hardly any studies addressing the impact of PEI on glycemic control in diabetes mellitus. Most studies address glycemic control in patients with type 3c diabetes mellitus due to chronic pancreatitis or cystic fibrosis (11, 27, 29, 30). Several studies describe a major impact of an adequately restored fat digestion on incretin action and therefore on glycemic control (2, 6, 20, 21).
It is evident that there is a frequent comorbidity of endocrine and exocrine pancreatic pathology.
The relevance of the finding of a frequent comorbidity of exocrine and endocrine pancreatic disease is still under controversial debate.
Cavalot F, Bonomo K, Fiora E, Bacillo E, Salacone P, Chirio M, Gaia E, Trovati M.  Does pancreatic elastase-1 in stools predict steatorrhea in type 1 diabetes? Hardt P, Hammer H, Abrahamian H, Ebenbichler C, Hummel M, Matthaei S, Schnell O, Spinas G, Weitgasser R, Wiesli P, Philippe J. Hardt PD, Krauss A, Bretz L, Porsch-Oezcueruemez M, Schnell-Kretschmer H, Maser E, Bretzel RG, Zekorn T, Klor HU. Kuo P, Stevens JE, Russo A, Maddox A, Wishart JM, Jones KL, Greville H, Hetzel D, Chapman I, Horowitz M, Rayner CK.
Mancilla AC, Hurtado HC, Tobar AE, Orellana NI, Pineda BP, Castillo MI, Ledezma RR, Berger FZ.
Rickels MR, Bellin M, Toledo FGS, Robertson RP, Andersen DK, Chari ST, Brand R, Frulloni L, Anderson MA, Whitcomb DC for the PancreasFest Recommendation Conference Participant. Semakula C, Vandewalle CL, Van Schravendijk CF, Sodoyez JC, Schuit FC, Foriers A, Falorni A, Craen M, Decraene P, Pipeleers DG, Gorus FK. Terzin V, Varkonyi T, Szabolcs A, Lengyel C, Takacs T, Zsori G, Stajer A, Palko A, Wittmann T, Palinkas A, Czako L. Vujasinovic M, Zaletel J, Tepes B, Popic B, Makuc J, Epsek Lenart M, Predikaka M, Rudolf S.
Non-Hispanic black children were more likely to have skin allergies and less likely to have respiratory allergies compared with non-Hispanic white children.
Children with family income equal to or greater than 200% of the poverty level had the highest prevalence rates. An allergic condition is a hypersensitivity disorder in which the immune system reacts to substances in the environment that are normally considered harmless (6,7).
The prevalence of respiratory allergy, which is the most prevalent type of allergy among children, did not change during this period. The poverty level is based on a set of income thresholds that vary by family size and composition.
Food allergy knowledge, attitudes, and beliefs of parents with food-allergic children in the United States.


Prevalence and risk factors for allergic contact dermatitis to topical treatment in atopic dermatitis: A study in 641 children. The management of anaphylaxis in childhood: Position paper of the European Academy of Allergology and Clinical Immunology. Health-related quality of life among adolescents with allergy-like conditionsa€”with emphasis on food hypersensitivity. Multiple imputation of family income and personal earnings in the National Health Interview Survey: Methods and examples. Non-Hispanic black and Mexican-American adults consume more than non-Hispanic white adults.
Sugar drinks have been linked to poor diet quality, weight gain, obesity, and, in adults, type 2 diabetes (4,5). Mean consumption of sugar drinks is higher in males than females at all ages except among 2- to 5-year-olds. Among adult women, the percentage is lower, with 40% consuming sugar drinks on any given day, while among boys aged 2a€“19, 70% consume sugar drinks on any given day (Figure 2).
Of these sugar-drink kilocalories, the vast majority is purchased in stores (92%), and just over 6% is purchased in restaurants or fast-food establishments. For example, males consume more than females, and teenagers and young adults consume more than other age groups.
Most sugar drinks consumed away from home are obtained from stores, but more than one-third are obtained in restaurants or fast-food establishments. Sugar drinks do not include diet drinks, 100% fruit juice, sweetened teas, and flavored milks. To determine source of food, respondents were offered 26 options, categorized for this brief as store, restaurant (including fast-food), school or child care, and other.
In 2008, a PIR of 350% was equivalent to approximately $77,000 for a family of four; a PIR of 130% was equivalent to approximately $29,000 for a family of four. NHANES is a cross-sectional survey designed to monitor the health and nutritional status of the civilian, noninstitutionalized U.S. The sample design includes oversampling to obtain reliable estimates of health and nutritional measures for population subgroups.
The standard errors of the percentages were estimated using Taylor Series Linearization, a method that incorporates the sample weights and sample design. Trends in food and nutrient intakes by adults: NFCS 1977a€“78, CSFII 1989-91, and CSFII 1994-95. Effects of soft drink consumption on nutrition and health: A systematic review and meta-analysis. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association's strategic impact goal through 2020 and beyond. Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States.
Performing pancreatectomies in dogs, von Mehring and Minkowski realised that the animals developed diabetes that could be cured by pancreas transplantation (26).
Despite being rather invasive and complicated, these tests remained the gold standard for scientific evaluation of exocrine pancreatic function until today.
Since these tests did not depend on specialized centers, it was possible to involve larger series of patients with diabetes mellitus. If asked, they report a slightly increased number of stools, bloating and loose stools as compared to patients without PEI.
Nevertheless, the high prevalence of coexisting pathological findings in endocrine and exocrine pancreas has stimulated several national and international expert committees to discuss and publish guidelines on PEI in diabetes mellitus and diagnosis and management of diabetes mellitus in pancreatic diseases. As early as in 1980, exocrine pancreatic insufficiency has been shown to prevent the normal release of GIP in response to oral feeding and that this effect can be abolished by enzyme replacement therapy (6).
This is rather astonishing considering the fact, that due to the above described reasons one would expect a rather important impact of restoring proper fat digestion in those patients. Thus, a well-designed randomized controlled trial on pancreatic enzyme replacement therapy in patients with diabetes mellitus and PEI is urgently needed.
Alterations in exocrine pancreatic function in diabetes mellitus can be found quite frequently.
Second Giessen International Workshop on Interactions of Exocrine and Endocrine Pancreatic Diseases.
Reversal of impaired GIP and insulin secretion in patients with pancreatogenic steatorrhea following enzyme substitution.
Impaired exocrine pancreatic function in diabetics with diarrhoea and peripheral neuropathy. Pancreatin therapy in patients with insulin-treated diabetes mellitus and exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations. High prevalence of steatorrhea in 101 diabetic patients likely to suffer from exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations: a prospective multicenter study. Vitamin D status and per-oral vitamin D supplementation in patients suffering from chronic pancreatitis and pancreatic cancer disease. Increased postprandial responses of GLP-1 and GIP in patients with chronic pancreatitis and steatorrhea following pancreatic enzyme substitution.
Gastric emptying, incretin hormone secretion, and postprandial glycemia in cystic fibrosis--effects of pancreatic enzyme supplementation. Oral pancreatic enzyme therapy in the control of diabetes mellitus in tropical calculous pancreatitis. The exacerbation of pancreatic endocrine dysfunction by potent pancreatic exocrine supplements in patients with chronic pancreatitis. Pancreatic enzyme supplementation improves the incretin hormone response and attenuates postprandial glycemia in adolescents with cystic fibrosis: a randomized crossover trial. Detection, evaluation and treatment of diabetes mellitus in chronic pancreatitis: Recommendations from PancreasFest 2012. Abnormal circulating pancreatic enzyme activities in more than twenty-five percent of recent-onset insulin-dependent diabetic patients: association of hyperlipasemia with high-titer islet cell antibodies.
Alterations of vitamin D3 metabolism in young women with various grades of chronic pancreatitis.
Prevalence of exocrine pancreatic insufficiency in type 2 diabetes mellitus with poor glycemic control. Food or digestive allergies, skin allergies (such as eczema), and respiratory allergies (such as hay fever) are the most common allergies among children. There was no significant trend in respiratory allergies from 1997a€“1999 to 2009a€“2011, yet respiratory allergy remained the most common type of allergy among children throughout this period (17.0% in 2009a€“2011). Families or individuals with income below their appropriate thresholds are classified as below the poverty level.
NHIS collects information about the health and the health care of the civilian noninstitutionalized U.S. Point estimates and estimates of corresponding variances for the HDI estimates were calculated using SUDAAN software (15) to account for the complex sample design of NHIS. Consumption of sugar drinks increases until ages 12a€“19 years and then decreases with age. Among adults, non-Hispanic black and Mexican-American persons consume more than non-Hispanic white persons, and low-income individuals consume more sugar drinks in relation to their total diet than higher-income individuals.
Percentage of daily kilocalories from sugar drinks is the percentage of total daily energy obtained from sugar drinks.
Population estimates of sugar-drink kilocalories are based on data from one in-person, 24-hour dietary recall interview.
Ever since these studies it has been accepted that pancreatic diseases or diseases involving the exocrine pancreas can induce diabetes mellitus. The largest trial was carried out as a multi-center trial in Germany and included 323 patients classified as “type 1 diabetes mellitus” and 697 patients classified as “type 2” diabetes mellitus.
A significant correlation of low fecal elastase 1 levels and low vitamin D levels has been demonstrated e.g. Other recent studies emphasize the important role of unimpaired fat hydrolysis in regulating GLP-1 secretion (2) and document a reversal of impaired GLP-1 secretion by pancreatic enzyme supplementation in patients with exocrine pancreatic insufficiency due to cystic fibrosis (21).


Some report more stable glucose control, some less stable control, and some no impact of enzyme replacement therapy on glycemic control. One might speculate that pancreatic enzyme replacement therapy would be a beneficial therapeutic option concerning glucose control.
Although there are many interesting pathophysiological concepts trying to explain those consistent findings, none of the raised hypotheses have been proven so far. Allergies can affect a child's physical and emotional health and can interfere with daily activities, such as sleep, play, and attending school (8,9). Skin allergy prevalence was also higher than food allergy prevalence for each period from 1997a€“2011 (Figure 1).
However, skin allergy decreased with the increase of age, and respiratory allergy increased with the increase of age. Lack of comment regarding the difference between any two statistics does not necessarily suggest that the difference was tested and found to be not significant.
Akinbami are with the Centers for Disease Control and Prevention's National Center for Health Statistics, Office of Analysis and Epidemiology. Consumption of sugar drinks is lowest among the oldest females (42 kcal per day) and highest among males aged 12a€“19 (273 kcal per day) (Figure 1). Over 20% of sugar-drink kilocalories consumed away from home are obtained in other places such as vending machines, cafeterias, street vendors, and community food programs, among others (Figure 6). Census Bureau data (9).The cut point for participation in the Supplemental Nutrition Assistance Program is 130% of the poverty level. The survey consists of interviews conducted in participants' homes, standardized physical examinations in mobile examination centers, and laboratory tests utilizing blood and urine specimens provided by participants during the physical examination. In 2007a€“2008, African-American and overall Latino subgroups were oversampled, with sufficient sample sizes for separate analysis of the Mexican-American subgroup.
Carroll are with the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics, Division of Health and Nutrition Examination Surveys.
The American Diabetes Association (ADA) diabetes classification published in 1998 therefore includes pancreatic diabetes as “type 3c” that can be caused by pancreatic neoplasms, acute or chronic pancreatitis, hemochromatosis, cystic fibrosis or pancreatic surgery (37). So far, they have proposed the evaluation of exocrine function in patients with known diabetes mellitus and symptoms suggestive of PEI. To our knowledge there is only one study so far addressing the impact of pancreatic enzyme replacement therapy on glycemic control in patients with diabetes mellitus and PEI. Probably several of the described pathophysiological hypotheses contribute to the phenomenon to a certain degree.
There was no significant difference in the prevalence of skin allergy by poverty status (Figure 4).
The prevalence of allergies varies by race and ethnicity, with Hispanic children having the lowest prevalence of food, skin, and respiratory allergies compared with non-Hispanic white and non-Hispanic black children. Interviews are conducted in respondents' homes, but follow-ups to complete the interviews may be conducted over the telephone. All estimates shown in this report have a relative standard error less than or equal to 30%. Moreover, the American Heart Association has recommended a consumption goal of no more than 450 kilocalories (kcal) of sugar-sweetened beveragesa€”or fewer than three 12-oz cans of carbonated colaa€”per week (7). The age patterns of percentage of total daily kilocalories from sugar drinks (not shown) are similar to those for kilocalories from sugar drinks. Dietary information for this analysis was obtained via an in-person, 24-hour dietary recall interview in the mobile examination center.
Sohyun Park is with CDC's National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity. When the role of insulin was established in the early 20st century, physicians were aware that patients with diabetes mellitus – most of them having type 1 diabetes at the time – also suffered from malnutrition.
Other studies reported very similar results – an overview of the available studies is given in Table 2. In this study there was a significant inverse correlation between FEC and the amount of fat excretion (4). In this multicenter study no positive effect on HbA1c, C-peptide levels or blood glucose levels could be found. Furthermore the impact of fat and protein maldigestion (and therefore impaired incretin secretion) on glycemic control is unclear due to the lack of larger clinical studies. Foods represent the most common cause of anaphylaxis among children and adolescents (10,11). Estimates by poverty status from NHIS are based on both reported and imputed family income (13). The Sample Child component collects detailed data on health conditions for a randomly selected child in households with at least one child. The significance of trends was tested using weighted least squares regression models of the log of each outcome and Joinpoint software (16) to determine whether an apparent change over time was statistically significant, taking into account the standard error for each data point. This brief presents the most recent national data on sugar-drink consumption in the United States. Each year of data collection is based on a representative sample covering all ages of the civilian, noninstitutionalized population. While prior to the discovery of insulin this malnutrition was a consequence of failure of nutrient storage rather than digestion, physicians nonetheless suspected that the digestive function of the pancreas might be reduced in patients with diabetes mellitus and several groups started to investigate exocrine pancreatic function in diabetes mellitus once pancreatic function tests became available. On average, pancreatic exocrine insufficiency (PEI) was described in 67% of the patients investigated with direct function tests, most of them being classified as insulin dependent diabetes mellitus (“IDDM”) or type 1 diabetes where absolute insulin deficiency leads to pancreas gland atrophy. While the relevance of these findings is still under debate, it can be summarized that the coincidence of exocrine and endocrine pancreatic insufficiency has been accepted to be very frequent. Despite this surprising finding (steatorrhea is believed to exist only if pancreatic lipase secretion is below 10% of normal activity) it did not receive much attention.
However, before reasonable advice can be given, there is still need for prospective trials to determine the true prevalence of type 3c diabetes mellitus and its clinical relevance. There was a slight trend towards fewer hypoglycemic episodes in the pancreatic enzyme treated group, yet it was not statistically significant (8).
Early detection and appropriate interventions can help to decrease the negative impact of allergies on quality of life (6). All of the data in the Sample Child component are obtained from a proxy respondent and not from medical records.
Because there were limited data points over the period, linear regression (zero joinpoints) was specified for all models. Supplementation with high doses of vitamin D resulted in normalization of serum concentrations (19).
This report presents recent trends in the prevalence of allergies and differences by selected sociodemographic characteristics for children under age 18 years. Food allergy and respiratory allergy increased with the increase of income level, but there was no difference in the prevalence of skin allergy by poverty status. A responsible adult, usually a parent, responds to the survey questions as proxy for the sample child.
Considering the important role of vitamin D in the regulation of the immune system, the possible role of vitamin D deficiency in the pathogenesis of type 1 diabetes and the highly interesting association of low vitamin D levels and poor glycemic control, qualitative malnutrition of vitamin D in patients with PEI and diabetes mellitus may be of great clinical importance. The study included insulin dependent diabetes mellitus patients and did not differentiate between type 1, type 2 or type 3c diabetes mellitus.
Measuring serum 25-hydroxyvitamin D levels and supplementing patients with low levels should therefore be considered in these patients. However, up to date randomized, controlled trials are still missing and are strongly encouraged.



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