Gaeta F.: Ethics of “Healthy” Claims and Labels: From Enrichment to Sugar Manipulation?

Hello, listeners! Today's guest on the ESPGHAN podcast is Prof Dr Jean-Frédéric Colombel, whose special interest is inflammatory bowel disease (IBD), and with whom today we discuss three articles titled: "Neutralizing anti-granulocyte macrophage-colony stimulating factor autoantibodies recognize post-translational glycosylations on granulocyte macrophage-colony stimulating factor years before diagnosis and predict complicated Crohn's disease"; "Prediction and prevention of inflammatory bowel disease"; and "Prediction and prevention of inflammatory bowel disease: A call to action", listed in order of their publication. (A précis of this podcast, posted at the ESPGHAN website, has full bibliographic detail.) Before taking up those articles, though, perhaps a bit of information on Prof Colombel is in order. Born in 1956 in Boulogne-sur-Mer, on the English Channel, he studied medicine in Amiens and climbed the academic ladder in Lille, where at the Centre Hospitalier Universitaire de Lille, Lille University Hospital, he rose to lead the department of hepatogastroenterology. Then, after only two years in that post, came a caesura: In 2013 he emigrated to New York, to the Upper East Side of Manhattan, where since then at Mount Sinai Medical Center he has led an IBD research-and-treatment group. Nearly sixty years of loyalty to the Hauts-de-France – what can have happened to prompt him to turn his back on his native soil? Well, people lead complicated lives, and Prof Colombel will have had his reasons to abandon moules frites, carbonade, and Maroilles. For today, however, we might set that aside and instead pose the questions: What in his analyses of mucosal immunity in IBD led to the conclusion that IBD can be predicted? If IBD can be predicted, can IBD be prevented? Prof Colombel has those answers for us, and we need only listen to learn. Literature Lee S-H et al. Prediction and prevention of inflammatory bowel disease: A call to action. Gastroenterology. 2026 Feb;170(2):233–239. doi:10.1053/j.gastro.2025.09.042. Epub 2025 Dec 18. PMID: 41410638. PMCID: PMC12862785. Lopes EW et al. Prediction and prevention of inflammatory bowel disease. Clin Gastroenterol Hepatol. 2025 Feb;23(3):396–405.e1. doi:10.1016/j.cgh.2024.05.047. Epub 2024 Jul 10. PMID: 38996831. Mortha A et al. Neutralizing anti-granulocyte macrophage-colony stimulating factor autoantibodies recognize post-translational glycosylations on granulocyte macrophage-colony stimulating factor years before diagnosis and predict complicated Crohn's disease. Gastroenterology. 2022 Sep;163(3):659–670. doi:10.1053/j.gastro.2022.05.029. Epub 2022 May 24. PMID: 35623454. PMCID: PMC10127946. Prof. Jean-Frédéric Colombel favourite song: Mistral gagnant” – Renaud ESPGHAN favourite Songs can be found on Spotify: https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo

Greetings – what child of the 1960s can use that word without becoming a space alien, alighting from an interstellar craft? – "Greetings, Earthlings!" But today, of course, it's greetings to ESPGHAN podcast listeners, those logging in from other planets as well as on this one. The guest today is Prof Dr Raoul Furlano, a wearer of many hats. Most important among them is perhaps that of a member of the Guild of the Golden Star, the Zunft zum goldenen Stern, active since 1398 as the brotherhood of barber-surgeons in the city and canton of Basel. He also has sat since 2014 as member for Gross-Basel Ost in the Grand Council of the city and canton of Basel, representing the Liberal Democratic Party there. (I've visited the party's website: They seem decent sorts, if to my tastes "liberal" misrepresents their stances... but any published political programme has as its central principle, of course, only Pro bono, contra malum.) Finally, in accord with the Milizprinzip of Swiss direct participatory democracy and very much as a side-job, he is head of paediatric gastroenterology and paediatrician-in-chief at the University Hospital of Basel. For consideration today, Prof Furlano proposes three articles on aspects of endoscopy to address foreign-body ingestion: Thomson M et al., "Paediatric gastrointestinal endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy guidelines"; Tringali A et al., "Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guideline executive summary"; and Mubarak A et al., "Diagnosis, management, and prevention of button battery ingestion in childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper." Before the listeners pause the podcast to dig out the original articles and to read along, what is the difference between the first two articles? They were published simultaneously in 2017, their author lists are largely the same: Why both of these two? These two articles include recommendations for dealing with ingestion of a variety of foreign bodies, whilst the third, from 2021, addresses only button-battery ingestion. Scuttlebutt has it that ESPGHAN has commissioned an assessment of endoscopy in foreign-body ingestion. Well, at this point listeners don't have access to a publication of the findings of that assessment. What is Prof Furlano in a position to say about those findings and about how the stances taken by ESPGHAN differ from those in the articles that he has set before us? (A quick note, listeners: Bibliographic information on the three articles is included in the précis of this podcast that can be found on the ESPGHAN website.) With that, it's off to the races! Foreign-body ingestion: What, where, how, and when! And maybe, as lagniappe, more about Swiss politics and guild Carnival parades.. Prof Furlano´s favourite song: Andrea" – Fabrizio De André ESPGHAN favourite Songs can be found on Spotify: https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo Literature Mubarak A et al. Diagnosis, management, and prevention of button battery ingestion in childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper. J Pediatr Gastroenterol Nutr. 2021 Jul 1;73(1):129–136. doi:10.1097/MPG.0000000000003048. PMID: 33555169. Thomson M et al. Paediatric gastrointestinal endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy guidelines. J Pediatr Gastroenterol Nutr. 2017 Jan;64(1):133–153. doi:10.1097/MPG.0000000000001408. PMID: 27622898. Tringali A et al. Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelin

So many links between liver and brain! Today’s guest on the ESPGHAN podcast is Prof Dr Valérie McLin, a Scots Bruxelloise living and working in Geneva, where at the University Hospital she heads the department of paediatric gastroenterology, hepatology, and nutrition. There she has pursued a particular interest, that of blood flow through the liver and the effects that disorders of hepatic perfusion have on both intellection and the physiology of intellection, or cerebration. Manifest dysfunction of cerebration and thus of intellection resulting from liver disease is termed hepatic encephalopathy. It can occur with or without primarily disordered intermediary metabolism; congenital portosystemic shunts underlie some instances of hepatic encephalopathy without primary hepatocellular metabolic dysfunction. (Portosystemic shunting that results from vascular malformation rather than from hepatic scarring also may secondarily perturb intermediary metabolism.) Dr McLin has substantially contributed to recognition that a spectrum exists of neurocognitive dysfunction in children with chronic liver disease or portosystemic shunting – berry-picking among initial letters has given the abbreviation SLiPS for such dysfunction. Hepatic encephalopathy in children, unlike in adults, may alter brain development as well as function. In consequence, successful palliation of liver disease in children – as with liver transplantation – may not entirely ameliorate cognitive deficits such as impaired attention, executive function, processing speed, and school performance. Structured neuropsychological assessment and interventional support thus are important for children with liver disease in all phases of their journey. Dr McLin today offers three articles – bibliographic details are in the online précis of this session – as a basis for discussion. They are titled “Minimal hepatic encephalopathy in children with chronic liver disease: Prevalence, pathogenesis and magnetic resonance-based diagnosis”, by Srivastava et al.; “The current pediatric perspective on type B and C hepatic encephalopathy”, by McLin and D’Antiga; and “Neurometabolism and brain morphometry in an adolescent female with an extra-hepatic congenital portosystemic shunt”, by Chabbey et al. Her perspectives on SLiPS follow, with her proposals for diagnosis of what can be subtle, easy-to-miss problems and suggestions on patient management. Literature Chabbey I et al. Neurometabolism and brain morphometry in an adolescent female with an extra-hepatic congenital portosystemic shunt. JPGN Rep. 2023 Dec 28;5(1):35–42. doi:10.1002/jpr3.12035. eCollection 2024 Feb. PMID: 38545268. PMCID: PMC10964341. McLin VA, D’Antiga L. The current pediatric perspective on type B and C hepatic encephalopathy. Anal Biochem. 2022 Apr 15;643:114576. doi:10.1016/j.ab.2022.114576. Epub 2022 Jan 29. PMID: 35104444. Srivastava A et al. Minimal hepatic encephalopathy in children with chronic liver disease: Prevalence, pathogenesis and magnetic resonance-based diagnosis. J Hepatol. 2017 Mar;66(3):528–536. doi:10.1016/j.jhep.2016.10.026. Epub 2016 Nov 1. PMID: 27815224. Dr McLin´s favourite song: “Mon p’tit gars” – Drôles de Dames ESPGHAN favourite Songs can be found on Spotify: https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo

Jake has chosen for today’s session two studies in metabolic dysfunction-associated steatotic liver disease – for convenience, henceforward “MASLD”. I’ve added three. Jake’s choices . . . Well. One addresses the question: Can MASLD scoring identify children at high risk of developing Type II diabetes? (Spoiler alert: Yes. Kinda sorta.) The other presents the ESPGHAN consensus on MASLD: What, who, when, where, and why. (Authorial alert: Jake’s implicated as, Lord preserve us, senior author, although all co-authors are eminently respectable.) And my additions? The MASLD-scoring article depends heavily on a system presented to the world only last year. To understand that system may be important if one is to understand the conclusions drawn from its use. I’d like, with listeners, to ask Jake to take apart the article introducing the system. I’d also like, with listeners, to review an earlier article that reported a correlation between fibrosis in steatohepatitis and susceptibility to the development of Type II diabetes. What does Jake say: Has the use of MASLD scoring, as set out in Jake’s choice, brought matters beyond where they stood at publication of that earlier article? Finally, yet a third scoring system for paediatric MASLD has been developed. Jake, are there reasons to preferentially use any of the three? But let’s dive in. Jake, your consensus statement doesn’t draw substantially on that scoring system, which just last autumn pulled into the ESPGHAN station. Leaving that aside, then, what do you and ESPGHAN have to share with us? We’ll take on the scoring system later, with how to use it and how it’s been used, if you don’t take up all the time. And listeners: Fasten your seat belts. This may be a bumpy flight. LiteratureLefere S et al. Development and validation of pFIB scores for exclusion of significant liver fibrosis in pediatric MASLD. Hepatology 2025 Apr 1;81(4):1276-1287. Doi: 10.1097/HEP.0000000000001016. Epub 2024 Jul 19. PMID: 39028885 Lefere S et al. pFIB scores for paediatric MASLD fibrosis are associated with risk of youth-onset type 2 diabetes in children with obesity. Diabetologia 2026 Jul 22. Doi: 10.1007/s00125-026-06804-4. PMID: 42486926 Mann JP et al. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) position paper on screening, diagnosis and investigation of paediatric metabolic dysfunction-associated steatotic liver disease. J Pediatr Gastroenterol Nutr 2026 Jun 30. Doi: 10.1002/jpn3.70490. Online ahead of print. PMID: 42374900 Newton KP et al. Incidence of type 2 diabetes in children with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2023 May;21(5):1261-1270. Doi: 10.1016/j.cgh.2022.05.028. Epub 2022 Jun 13. PMID: 35709934. PMCID: PMC19151072 Wang A et al. Development of Fibro-PeN, a clinical prediction model for moderate-to-severe fibrosis in children with nonalcoholic fatty liver disease. Hepatology 2024 Jun 1;79(6):1381-1392. Doi: 10.1097/HEP.0000000000000644. Epub 2023 Oct 23. PMID: 37870272. PMCID: PMC11035485

Hello, and welcome to another ESPGHAN podcast! Let’s start by asking if you know a particular German idiom: What does "Leben wie Gott in Frankreich" mean? Literally, "to live like God in France"—but the French themselves describe those deliciously well set up as comme un coq en pâte, a rooster in dough... go figure. Living like God in France, as anyone knows who has eaten at a French table, can be improved, however, with one substitution: Leben wie Gott in Lyon. Yes, Lyon. This city, once named Lugdunum, was the capital of omnia Gallia (all three parts!). She has happily ceded that rôle to Paris. Instead, she enjoys the status of the capital of French cooking, and thus of gastronomy worldwide. Our guest today can vouch for the truth of this, as he lives in Lyon, where he is, very appropriately, a professor of both paediatrics and nutrition: Dr Noël Peretti. Prof Peretti clinically addresses many aspects of paediatric nutrition and malnutrition, but his research concentrates on lipids and their handling—only natural in Lyon. In Lyon, where, as in Hungary, many recipes begin, "Take something that used to be a pig," in Lyon, home of the celebration of the lardon that is the salade Lyonnaise... But revenons à nos moutons, or rather à nos porcs. Lipids, and their handling, and its disorders: Prof Peretti has chosen for discussion an article by Wiegman et al., from the European Heart Journal—"Familial Hypercholesterolaemia in Children and Adolescents: A European Atherosclerosis Society Consensus Statement." Let’s begin by defining the problem. One in 300 of us has familial hypercholesterolaemia (FH)—yes, that many, counting heterozygotes; biallelic FH affects perhaps one in 300,000. Overall, perhaps 500,000 children in Europe have FH. Biallelic FH can manifest with fatal atherosclerosis in adolescence or childhood. Heterozygous FH speeds the progression of atherosclerosis somewhat, but less severely. The challenge for public health is to achieve diagnosis of FH, with intervention, in childhood; of those 500,000 European children, fewer than 50,000 (10%) are identified. Guidelines for diagnosis and for intervention were published in 2015. Those diagnostic criteria accurately identified FH—but in too few children. In the years since those guidelines appeared, understanding of FH and choices among therapies have increased, as has the weight given to chronic hyperlipidaemia. Algorithms for diagnosis and for treatment thus have been revisited. The work by Wiegman et al. presents state-of-the-art recommendations for FH, which Prof Peretti helped to formulate and which he sets out now for ESPGHAN listeners. Literature Wiegman A et al. Familial Hypercholesterolaemia in Children and Adolescents: A European Atherosclerosis Society Consensus Statement. Eur Heart J. 2026 May 25:ehag382. doi: 10.1093/eurheartj/ehag382. Online ahead of print. PMID: 42179051. Prof. Peretti´s favourite song: Le Poinçonneur des Lilas – Serge Gainsbourg ESPGHAN favourite Songs can be found on Spotify: https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo