Search

The SWAP IT program aims to improve the nutritional quality of school lunchboxes via a multicomponent m-health intervention, involving: weekly support messages to parents, physical resources, school nutrition guidelines and lunchbox lessons. SWAP IT has been reported to be effective. This study aims to determine the cost and cost effectiveness of the SWAP IT m-health intervention. The retrospective trial-based economic evaluation was conducted in 12 Catholic primary schools in New South Wales, Australia. Schools were randomised to intervention or usual care. The costs (AUD, 2019) were evaluated from societal perspectives. The direct cost to uptake the intervention and the incremental cost-effectiveness ratios (ICER) were calculated. ICERS were calculated for two outcomes: reduction in total kJ and reduction in discretionary kJ from the lunchbox. The total cost was calculated to be AUD 55, 467. The mean incremental cost per student to receive the intervention was calculated to be AUD 31/student. The cost per reduction in total lunchbox energy was AUD 0.54. The ICER for the reduction in energy from discretionary foods in the lunchbox was AUD 0.24. These findings suggest that this m-health intervention has potential to be cost effective in reducing the kilojoules from discretionary foods packed in school lunchboxes.

Daily routines may influence children and adolescents’ eating patterns, however the influence of days of the week on dietary intake has rarely been explored. This study aimed to examine discretionary choices intake in the context of diet quality on weekdays versus weekends. A secondary analysis was conducted using the Australian National Nutrition and Physical Activity Survey 2011–2012. Differences in discretionary choices intake and diet quality on weekdays versus weekends, were examined using ANCOVA analyses. Associations between child and parent-proxy characteristics and weekday/weekend discretionary choices intake were examined using multivariable regression models. Primary analyses included 2584 Australian 2–17-year-olds. There were small differences in discretionary choices intake and diet quality between weekdays and weekends in all age subgroups. Compared to weekdays, intakes on weekends were characterized by a higher intake of discretionary choices, and lower total Dietary Guidelines Index for Children and Adolescents (DGI-CA) scores across the age subgroups (all p &lt, 0.01). Parent-proxy discretionary choices intake and child age were predictors of weekday and weekend discretionary choices intake. Parent-proxy obesity weight status compared with healthy weight status was a predictor of weekend intake, while parent-proxy education level was a predictor of weekday discretionary choices intake. Future intervention strategies should target discretionary choices intake on both weekdays and weekends.

Acute diarrhea is a major cause of morbidity and mortality in children under five. Probiotics are beneficial for treating acute diarrhea in children, but unclear which specific probiotic is the most effective. We performed a Bayesian network meta-analysis to examine the comparative effectiveness of probiotics. By searching EMBASE, PubMed, and the Cochrane Library up to 31 March 2021, randomized clinical trials (RCTs) on probiotics for treating acute diarrhea in children were included. Primary outcomes included the duration of diarrhea and diarrhea lasting ≥2 days, and secondary outcomes included the mean stool frequency on day 2 and duration of hospitalization, fever, and vomiting. We assessed the certainty of the evidence of outcomes according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline. Eighty-four studies with twenty-one different interventions in 13,443 children were included. For the primary outcomes, moderate evidence indicated that, Lactobacillus reuteri [mean difference (MD) = −0.84 day; 95% confidence interval (CI), −1.39, −0.29], Bifidobacterium lactis (MD = −0.98 day; 95%CI, −1.82, −0.14), Saccharomyces boulardii (MD = −1.25 day; 95%CI, −1.59, −0.91), Lactobacillus species (spp.) plus Bifidobacterium spp. plus Saccharomyces spp. (MD = −1.19 day; 95%CI, −1.81, −0.58), and Bacillus spp. plus Enterococcus spp. plus Clostridium spp. (MD = −1.1 day; 95%CI, −1.84, −0.35) significantly reduced the duration of diarrhea when compared with placebo. Saccharomyces boulardii [Odds ratio (OR) = 0.22; 95%CI, 0.11, 0.41] and Lactobacillus reuteri (OR = 0.23; 95%CI, 0.090, 0.60) significantly reduced the risk of diarrhea lasting ≥2 days when compared with placebo or no treatment, with moderate evidence. Among all probiotics, Saccharomyces boulardii may be the most effective in reducing both duration of diarrhea (compared with placebo) and risk of diarrhea lasting ≥2 days (compared with placebo or no treatment), with moderate evidence. To be conclusive, Saccharomyces boulardii may be the most effective probiotic for treating acute diarrhea in children, followed by several other single-strain and multi-strain probiotics.

Lockdown caused by the COVID-19 pandemic may have influenced feeding behaviour and lifestyle in children and adolescents. The purpose of this study was to analyse feeding behaviour and lifestyle in children and adolescents one year after lockdown by the COVID-19 pandemic in Chile. In this cross-sectional study an online survey was implemented in 1083 parents and caregivers regarding their children’s feeding behaviour and lifestyle and sociodemographic background. The results showed that “eat breakfast daily” (89.2%), “not overnight food intake” (69.9%) and “not fast-food intake” (66.0%) were the most frequent reported feeding behaviours, particularly in pre-school children. Respondents declaring healthy feeding behaviours and lifestyle were 23.4 and 23.7%, respectively, with no significant differences by sex. In pre-school children, families with three or fewer members and parents or caregivers with an undergraduate or postgraduate degree reported a significantly better feeding behaviour and lifestyle compared to families with more than three members and parents or caregivers without an undergraduate or postgraduate degree. In conclusion, the pandemic lockdown had a negative impact in lifestyle in children and particularly in adolescents. Healthier feeding behaviour was associated with fewer family members and parents or caregivers with at least an undergraduate degree.

Julio Plaza-Diaz is part of the “UGR Plan Propio de Investigación 2016” and the “Excellence actions: Unit of Excellence on Exercise and Health (UCEES), University of Granada”. Patricio Solis-Urra was supported by a fellowship from the National Agency for Research and Development (ANID) BECAS Chile/72180543. Julio Plaza-Diaz is supported by a fellowship awarded to postdoctoral researchers at foreign universities and research centers from the “Fundación Ramón Areces”, Madrid, Spain. Jerónimo Aragón-Vela was funded by a Postdoctoral fellowship from the ‘Fundación Alfonso Martín Escudero’ (Spain). Francisco Javier Ruiz-Ojeda is supported by a fellowship from Spanish Government “Agencia Estatal de Investigación-Juan de la Cierva-Incorporación” program (IJC2020-042739-I). We are grateful to Belén Vázquez-González for her assistance with the illustration service., Physical activity, exercise, or physical fitness are being studied as helpful nonpharmacological therapies to reduce signaling pathways related to inflammation. Studies describing changes in intestinal microbiota have stated that physical activity could increase the microbial variance and enhance the ratio of Firmicutes/Bacteroidetes, and both actions could neutralize the obesity progression and diminish body weight. The aim of this review is to provide an overview of the literature describing the relationship between physical activity profiles and gut microbiota and in obesity and some associated comorbidities. Promoting physical activity could support as a treatment to maintain the gut microbiota composition or to restore the balance toward an improvement of dysbiosis in obesity; however, these mechanisms need to be studied in more detail. The opportunity to control the microbiota by physical activity to improve health results and decrease obesity and related comorbidities is very attractive. Nevertheless, several incompletely answered questions need to be addressed before this strategy can be implemented., ANID BECAS Chile/72180543, Agencia Estatal de Investigación-Juan de la Cierva-Incorporación, National Agency for Research and Development, University of Granada, Fundación Alfonso Martín Escudero, Fundación Ramón Areces, Agencia Estatal de Investigación IJC2020-042739-I

Characteristics of chronic milk-dependent food protein-induced enterocolitis syndrome (FPIES) in children from the region of Western Pomerania were studied. Prospectively, 55 children were diagnosed at a median of 2.2 months. The open food challenges (OFC), morphologies, milk-specific IgE (sIgE) (FEIA method, CAP system), and skin prick tests (SPTs) were examined. Vomiting and diarrhea escalated gradually but quickly led to growth retardation. Of the infants, 49% had BMI &lt, 10 c, 20% BMI &lt, 3 c, 25% had anemia, and 15% had hypoalbuminemia. During the OFCs we observed acute symptoms that appeared after 2–3 h: vomiting diarrhea and pallor. A total of 42% children required intravenous hydration. Casein hydrolysates or amino acids formulae (20%) were used in treatment. In 25% of children, SPT and milk sIgE were found, in 18%—other food SPTs, and in 14% allergy to other foods. A transition to IgE-dependent milk allergy was seen in 3 children. In the twelfth month of life, 62% of children had tolerance to milk, and in the twenty-fifth month—87%. Conclusions. Chronic milk-dependent FPIES resolves in most children. By the age of 2 children are at risk of multiple food sensitization, and those who have milk sIgE are at risk to transition to IgE-mediated milk allergy. Every OFC needs to be supervised due to possible severe reactions.

Reduced Glycemic Index (GI) of breakfast has been linked to improved cognitive performance in both children and adult populations across the morning. However, few studies have profiled the post-prandial glycemic response (PPGR) in younger children. The aim of this study was to assess PPGR to breakfast interventions differing in GI in healthy children aged 5–7 years. Eleven subjects completed an open-label, randomized, cross-over trial, receiving three equicaloric test beverages (260 kcal) consisting of 125 mL semi-skimmed milk and 50 g sugar (either glucose, sucrose, or isomaltulose). On a fourth occasion, the sucrose beverage was delivered as intermittent supply. PPGR was measured over 180 min using Continuous Glucose Monitoring (CGM). The incremental area under the curve (3h-iAUC) was highest for the glucose beverage, followed by intermittent sucrose (−21%, p = 0.288), sucrose (−27%, p = 0.139), and isomaltulose (−48%, p = 0.018). The isomaltulose beverage induced the smallest Cmax (7.8 mmol/L vs. >9.2 mmol/L for others) and the longest duration with moderate glucose level, between baseline value and 7.8 mmol/L (150 vs.

Background: This study aimed to describe the epidemiology of malnutrition among children with cerebral palsy (CP) in low- and middle-income countries (LMICs). Methods: Data from children with confirmed CP aged &lt, 18 years registered into the Global LMIC CP Register (GLM CPR) from Bangladesh, Indonesia, Nepal, and Ghana were included. Anthropometric measurements were collected, and nutritional status was determined following the WHO guidelines. Descriptive statistics and adjusted logistic regression were used to describe the nutritional status and identify predictors of malnutrition. Results: Between January 2015 and December 2020, 3619 children with CP were registered into the GLM CPR (median age at assessment: 7.0 years, 39% female). Overall, 72–98% of children from Bangladesh, Indonesia, Nepal, and Ghana had at least one form of undernutrition. The adjusted analysis showed, older age, low maternal education, spastic tri/quadriplegia, and Gross Motor Functional Classification System (GMFCS) levels III–V were significant predictors of underweight and stunting among children with CP in Bangladesh. In Nepal, female children, GMFCS III–V had higher odds of underweight and stunting. In Ghana, low maternal education was significantly associated with underweight, whereas older age and the presence of associated impairments were the significant predictors of stunting among children with CP. Having a GMFCS of III–V increased the odds of being underweight among children in Indonesia, however, no predictors were identified for stunting, as nearly all children with CP registered from Indonesia were stunted. Conclusion: Most children with CP in GLM CPR had undernutrition. Maternal education and moderate-to-severe motor impairment (GMFCS III–V) were significant predictors. Practical nutrition education to mothers/caregivers and management guidelines according to the motor severity using local resources could improve the nutritional outcome of children with CP in LMICs.

The persistent coexistence of stress and paediatric obesity involves interrelated psychophysiological mechanisms, which are believed to function as a vicious circle. Here, a key mechanistic role is assumed for stress responsiveness and eating behaviour. After a stress induction by the Trier Social Stress Test in youngsters (n = 137, 50.4% boys, 6–18 years), specifically those high in chronic stress level and overweight (partial η2 = 0.03–0.07) exhibited increased stress vulnerability (stronger relative salivary cortisol reactivity and weaker happiness recovery) and higher fat/sweet snack intake, compared to the normal-weight and low-stress reference group. Stress responsiveness seems to stimulate unhealthy and emotional eating, i.e., strong cortisol reactivity was linked to higher fat/sweet snack intake (β = 0.22) and weak autonomic system recovery was linked to high total and fat/sweet snack intake (β = 0.2–0.3). Additionally, stress responsiveness acted as a moderator. As a result, stress responsiveness and emotional eating might be targets to prevent stress-induced overweight.

Background: Children and adolescents affected by type 1 diabetes have an increased risk of being overweight or obese and of suffering from cardiometabolic symptoms. Aims: To retrospectively evaluate the effects of a new complex of polysaccharide macromolecules, Policaptil Gel Retard® (PGR), on auxological and metabolic parameters, glycaemic variability and control parameters in paediatric patients with type 1 diabetes and metabolic syndrome (MetS). Patients and Methods: Data for 27 paediatric patients with a diagnosis of type 1 diabetes in conjunction with obesity and MetS of at least 5 years’ standing were collected and retrospectively studied. Of these, 16 (median age 12.9, range 9.5–15.8 years) had been adjunctively treated with PGR and 11 (median age 12.6, range 9.4–15.6 years) had not been treated with PGR. Auxological, metabolic and glycaemic control and variability parameters and insulin dosing were compared after 6 months in the two groups. Results: PGR significantly reduced BMI standard deviation score (SDS) (p &lt, 0.005), waist SDS (p &lt, 0.005), HbA1c (p &lt, 0.05) and daily mean insulin dose requirement (p &lt, 0.005). A significant improvement was also observed in the metabolic and glycaemic variability parameters of mean daily blood glucose (BG) levels (p &lt, 0.005), SD of daily BG levels (p &lt, 0.0001), mean coefficient of variation (p &lt, 0.05), LBGI (p &lt, 0.0001), HBGI (p &lt, 0.0001), J-index (p &lt, 0.005), total cholesterol (p &lt, 0.005), HDL-cholesterol (p &lt, 0.005) and LDL-cholesterol (p &lt, 0.005) and triglycerides (p &lt, 0.05). Conclusions: PGR produces a good auxological and metabolic response in obese patients with MetS who are affected by type 1 diabetes. It led to a significant reduction in BMI SDS, waist SDS and an improvement in glucose control and variability as well as in other MetS parameters. The use of polysaccharide compounds, especially if associated with appropriate dietary changes, may help achieve treatment targets in type 1 diabetes and reduce the risk that patients develop metabolic syndrome.

The COVID-19 pandemic has led to the implementation of policies that mandate various restrictions on daily life, including social distancing, the closure of public services and schools, and movement limitations. Even though these restrictive measures decreased the COVID-19 spread, they may have detrimental effects on various lifestyle components such as physical inactivity, sedentary behavior, and dietary habits, influencing the maintenance of weight and contributing to obesity among children and adolescents. The coexistence of childhood obesity and COVID-19 and changes in the bioecological environment have put children and adolescents at increased risk for developing obesity and exacerbating the severity of this disorder. The use of telehealth technology is a modern approach useful for the delivery of health care services by health care professionals, where distance is a critical factor. Telehealth is effective in promoting increased self-monitoring and behavioral change, and provides the opportunity to perform online nutritional support and exercise training programs to promote a healthy lifestyle and reduce sedentary behaviors in children and adolescents. Telehealth, including tele-exercise and tele-nutrition, has the potential to address many of the key challenges in providing health services, including in patients with obesity during the COVID-19 outbreak. This narrative review aims to describe the role of telehealth as an opportunity in the management of pediatric obesity in the COVID-19 era, and to deliver nutrition and exercise programs for the maintenance of health.

Milk is widely considered as a beneficial product for growing children. This study was designed to describe the milk consumption status of Korean children aged 30–36 months and to investigate its association with the risk of obesity and iron deficiency anemia (IDA). This nationwide administrative study used data from the Korean national health insurance system and child health screening examinations for children born in 2008 and 2009. In total, 425,583 children were included, and they were divided into three groups based on daily milk consumption: low milk group (do not drink or drink &lt, 200 mL milk per day, n = 139,659), reference group (drink 200–499 mL milk per day, n = 255,670), and high milk group (drink ≥500 mL milk per day, n = 30,254). After adjusting variable confounding factors, the consumption of a large amount of milk of ≥500 mL per day at the age of 30–36 months was associated with an increased risk of obesity at the age of 42–72 months and IDA after the age of 30 months. These results may provide partial evidence for dietary guidelines for milk consumption in children that are conducive to health.

Zinc deficiency (ZnD) has adverse health consequences such as stunted growth. Since young children have an increased risk of developing ZnD, it is important to determine its prevalence and associated factors in this population. However, only a few studies have reported on ZnD prevalence in young children from Western high-income countries. This study evaluated ZnD prevalence and associated factors, including dietary Zn intake, in healthy 1–3-year-old children from Western European, high-income countries. ZnD was defined as serum Zn concentration &lt, 9.9 µmol/L. A total of 278 children were included with a median age of 1.7 years (Q1–Q3: 1.2–2.3). The median Zn concentration was 11.0 µmol/L (Q1–Q3: 9.0–12.2), and ZnD prevalence was 31.3%. No significant differences were observed in the socio-economic characteristics between children with and without ZnD. Dietary Zn intake was not associated with ZnD. ZnD is common in healthy 1–3-year-old children from Western European countries. However, the use of currently available cut-off values defining ZnD in young children has its limitations since these are largely based on reference values in older children. Moreover, these values were not evaluated in relation to health consequences, warranting further research.

Tourette syndrome results from a complex interaction between social–environmental factors, multiple genetic abnormalities, and neurotransmitter disturbances. This study is a double-blinded, randomized controlled trial using probiotics Lactobacillus plantarum PS128 as an intervention to examine if probiotics improve symptoms of children with Tourette syndrome. This study enrolled children aged 5 to 18 years old who fulfilled DSM-V diagnostic criteria for Tourette syndrome. Patients were assessed before initiating the trial, at one month, and at two months after randomization. The primary outcome was evaluated by Yale Global Tic Severity Scale (YGTSS), and the secondary outcome studied the possible comorbidities in these children. The results revealed no significant difference in improvement in YGTSS between the control group and the PS128 group. As for secondary endpoints, an analysis of Conners’ Continuous Performance Test (CPT) showed improvement in commission and detectability in the PS128 group. In conclusion, although probiotics may not have tic-reducing effects in children with Tourette syndrome, it may have benefits on comorbidities such as attention deficit and hyperactivity disorder (ADHD). Further studies are needed to clarify the effects of probiotics on the comorbidities of Tourette syndrome children.

Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on prolonged postprandial hyperglycaemia have become more evident to patients and health-care professionals alike. However, there is no unified recommendation on how to calculate and best administer additional bolus insulin for these two macronutrients. The aim of this review is to investigate: the scientific evidence of how dietary fat and protein influence postprandial glucose levels; current recommendations on the adjustment of bolus insulin; and algorithms for insulin application in children with T1DM. A PubMed search for all articles addressing the role of fat and protein in paediatric (sub-)populations (

Behavioural weight management interventions are recommended for the treatment of obesity in children. However, the evidence for these is limited and often generated under trial conditions with White, middle-class populations. Healthy Eagles is a behavioural weight management intervention designed to treat excess weight in children. It ran in the London Borough of Croydon from 2017 to 2020 and was delivered in both school and community settings, providing a natural experiment to compare outcomes. A total of 1560 participants started the Healthy Eagles programme, 347 were in the community setting and 703 in the school setting. Data were analysed for those who completed 70% of the programme. In the school setting, there was a small but significant reduction in BMI z-score (M = −0.04, 95% CI = −0.08, −0.01) for participants above a healthy weight, especially in those with severe obesity (M = −0.09, 95% CI = −0.15, −0.03), there was no significant change in any subgroup in the community setting. Linear regression analysis showed the school setting was associated with a 0.26 (95% CI = 0.13, 0.49) greater reduction in BMI z-score than the community setting after adjusting for ethnicity, deprivation, age and gender. Across both programmes, the effect was somewhat greater in participants from a Black (African/Caribbean/Other) ethnic background (M = −0.06, 95% CI = −0.09, −0.02) and from the two most deprived quintiles (M = −0.06, 95% CI = −0.11, −0.01). Data were limited, but minimal changes were measured in nutrition and physical activity behaviours regardless of setting. This evaluation provides indirect evidence of a small but significant benefit to running weight management interventions in a school versus community setting.

Few studies have investigated food security, dietary quality, or unfavorable food intake through self-reports among children and adolescents in Asia. This study assessed the association of perceived food insecurity with dietary quality and unfavorable food intake among 1111 children and 538 adolescents from economically disadvantaged families in Taiwan. Food security status was collected by a validated questionnaire. Dietary quality was examined using a dietary diversity score (DDS). Unfavorable food intake was defined as fried food, bread/cake/pastries, sugar-sweetened beverages, and biscuits/chips. Food-insecure participants had lower DDS, whole grains and protein-rich food intake than food-secure participants. Furthermore, food-insecure children had a higher frequency of unfavorable food consumption. The level of children’s food insecurity was inversely associated with DDS (β: −0.047, 95% CI: −0.085 to −0.009) but positively with bread/pastry (β: 0.103, 95% CI: 0.022–0.184) and sugar-sweetened beverages (β: 0.117, 95% CI: 0.018–0.215) intake. Adolescents who reported food insecurity and not enough money for household expenses had an odds ratio of 2.85 (95% CI: 1.15–7.10) for poor DDS relative to their food-secure and financially able counterparts. We recommended that health policy needs to include diversifying food and nutrition education for vulnerable children and adolescents to improve dietary quality.

The problem of poor nutrition with impaired growth persists in young children worldwide, including in India, where wasting occurs in 20% of urban children (&lt, 5 years). Exacerbating this problem, some children are described by their parent as a picky eater with behaviors such as eating limited food and unwillingness to try new foods. Timely intervention can help prevent nutritional decline and promote growth recovery, oral nutritional supplements (ONS) and dietary counseling (DC) are commonly used. The present study aimed to determine the effects of ONS along with DC on growth in comparison with the effects of DC only. Enrolled children (N = 321) were &gt, 24 to ≤48 months old, at malnutrition risk (weight-for-height percentile 3rd to 15th), and described as a picky eater by their parent. Enrollees were randomized to one of the three groups (N = 107 per group): ONS1 + DC, ONS2 + DC, and DC only. From day 1 to day 90, study findings showed significant increases in weight-for-height percentile for ONS1 + DC and for ONS2 + DC interventions, as compared to DC only (p = 0.0086 for both). There was no significant difference between the two ONS groups. Anthropometric measurements (weight and body mass index) also increased significantly over time for the two ONS groups (versus DC only, p &lt, 0.05), while ONS1 + DC significantly improved mid-upper-arm circumference (p &lt, 0.05 versus DC only), as well. ONS groups showed a trend toward greater height gain when compared to DC only group, but the differences were not significant within the study interval. For young Indian children with nutritional risk and picky eating behaviors, our findings showed that a 90-day nutritional intervention with either ONS1 or ONS2, along with DC, promoted catch-up growth more effectively than did DC alone.

Background: Lockdown is an effective nonpharmaceutical intervention to reduce coronavirus disease 2019 (COVID-19) transmission, but it restricts daily activity. We aimed to investigate the impact of lockdown on pediatric body weight and body mass index (BMI). Methods: The systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Four online databases (EMBASE, Medline, the Cochrane Library and CINAHL) were searched. Results: The pooled results showed that lockdown was associated with significant body weight gain (MD 2.67, 95% CI 2.12–3.23, p &lt, 0.00001). The BMI of children with comorbidities or obesity did not change significantly. The BMI of general population was significantly higher during lockdown than before the pandemic (MD 0.94, 95% CI 0.32–1.56, p = 0.003). However, heterogeneity was high (I2 = 84%). Among changes in weight classification, increases in the rates of obesity (OR 1.23, 95% CI 1.10–1.37, p = 0.0002) and overweight (OR 1.17, 95% CI 1.06–1.29, p = 0.001) were reported. Conclusions: Our meta-analysis showed significant increases in body weight and BMI during lockdown among school-age children and adolescents. The prevalence of obesity and overweight also increased. The COVID-19 pandemic worsened the burden of childhood obesity.

Regular medical supervision represents a fundamental component of the clinical management of obesity. In fact, when frequently supplied it reduces the risk of failure associated with any body weight reduction program (BWRP), resulting in body weight gain. The aim of the present study was to establish the potential beneficial effects of increasing medical supervision on weight loss and other auxometric and cardiometabolic parameters in a population of children and adolescents with obesity (n = 158, F/M = 94/64, age range 9.7–17.3 years, body mass index, BMI = 37.8 ± 6.9 kg/m2), followed up for one year in a real-world setting, after and before a 3-week in-hospital BWRP. Weight loss was significantly associated with medical supervision and changes in several auxometric and cardiometabolic parameters such as fat mass, fat-free mass, waist and hip circumferences, total and LDL cholesterols, triglycerides, glucose, insulin, HOMA-IR, systolic blood pressure and IDF criteria for the diagnosis of metabolic syndrome. As expected, weight loss and, congruently, medical supervision, were significantly higher in responsive and stable subjects than in those belonging to the non-responsive group and in responsive subjects than those belonging to the stable group. While weight loss was significantly higher in subjects having class 2 and 3 obesity than those belonging to class 1 obesity group, medical supervision was significantly higher in subjects having class 3 than those having class 1 obesity. Weight loss was significantly higher in subjects suffering from metabolic syndrome than those without, nevertheless, no significant difference was found in medical supervision between these groups. Finally, sex was associated with no differences in weight loss and medical supervision. In conclusion, based on the results of a real-world experience, frequent medical supervision increases the weight loss associated with a longitudinal multidisciplinary BWRP, with a parallel improvement of a set of auxometric and cardiometabolic parameters. Prospectively, incentivising regular medical supervision should reduce the risk of BWRP failure and body weight gain, thus contributing to counteract the detrimental transition from simple obesity to metabolic syndrome in pediatric patients.

With rapid urbanization and the Indian nutrition transition, Indian adolescents face a high risk of developing an energy imbalance. This study aims to assess the prevalence of excessive weight, underweight, and associated knowledge and lifestyle behaviors among private school-going adolescents in Delhi. A cross-sectional study was conducted in students (6th–7th grades) of eight randomly selected private schools in Delhi, India in 2019. A self-administered survey was used to assess students’ dietary-and-physical-activity-related knowledge and behavior. Anthropometric measurements (height, weight, and waist circumference) were also conducted. Out of 1567 participants, 7.2% were underweight, 61.3% normal, and 31.5% excess in weight. Underweight was associated with significantly more eating whilst studying for exams (relative risk ratio (RRR) 1.7 (1.0–2.9)). Excessive weight was associated with less incorrect knowledge on behaviors causing overweight (RRR 0.7 (0.5–0.9)), more often reading nutritional labels of packed food items (RRR 0.6 (0.4–0.9)), and less frequent vegetable-intake (RRR 0.7 (0.4–0.9)). Underweight students showed more suboptimal knowledge and unhealthy behaviors, whilst students with excessive weight showed more correct knowledge and healthy behaviors. This study highlights the immediate need for effective health-promoting interventions focused on the importance of healthy lifestyle at least in underweight adolescents.

Breakfast skipping increases with age, and an association with a high risk of being overweight (OW) and of obesity (OB), cardiometabolic risk, and unhealthy diet regimen has been demonstrated in observational studies with children and adults. Short-term intervention trials in adults reported conflicting results. The purpose of this systematic review was to summarize the association of breakfast skipping with body weight, metabolic features, and nutrition quality in the groups of young people that underwent randomized controlled (RCT) or intervention longitudinal trials lasting more than two months. We searched relevant databases (2000–2021) and identified 584 articles, of which 16 were suitable for inclusion. Overall, 50,066 children and adolescents were included. No studies analyzed cardiometabolic features. Interventions were efficacious in reducing breakfast skipping prevalence when multi-level approaches were used. Two longitudinal studies reported a high prevalence of OW/OB in breakfast skippers, whereas RCTs had negligible effects. Ten studies reported a lower-quality dietary intake in breakfast skippers. This review provides insight into the fact that breakfast skipping is a modifiable marker of the risk of OW/OB and unhealthy nutritional habits in children and adolescents. Further long-term multi-level intervention studies are needed to investigate the relationship between breakfast, nutrition quality, chronotypes, and cardiometabolic risk in youths.

This article belongs to the Section Pediatric Nutrition. Cereal-based foods, including breakfast (BC) and infant cereals (IC), are among the first solid foods introduced to infants. BC and IC are sources of macro and micronutrients that have bene ficial effects on health, but can also be sources of harmful chemical and microbiological contaminants and nutrients that may lead to adverse health effects at high consumption levels. This study was performed under the RiskBenefit4EU project with the aim of assessing the health impact associated with consumption of BC and IC by Portuguese children under 35 months. Adverse effects associated with the presence of aflatoxins, Bacillus cereus, sodium and free sugars were assessed against the benefits of fiber intake. We applied a risk–benefit assessment approach, and quantified the health impact of changes in consumption of BC and IC from current to various alternative consumption scenarios. Health impact was assessed in terms of disability-adjusted life years. Results showed that moving from the current consumption scenario to considered alternative scenarios results in a gain of healthy life years. Portuguese children can benefit from exchanging intake of IC to BC, if the BC consumed has an adequate nutritional profile in terms of fiber, sodium and free sugars, with levels of aflatoxins reduced as much as possible. This research was funded by European Food Safety Authority (EFSA) (Grant Agreement Number–GA/EFSA/AFSCO/2017/01–GA02) (The authors declare that this manuscript reflects only the authors’ view and EFSA is not responsible for any use that may be made of the information it contains.). R.A., P.A. and C.M. also thanks FCT/MCTES for the financial support to CESAM (UIDP/50017/2020 + UIDB/50017/2020), through national funds. R.A. was supported by FCT Individual CEEC 2018 Assistant Researcher Grant CEECIND/01570/2018. info:eu-repo/semantics/publishedVersion

School gardens have become common school-based health promotion strategies to enhance dietary behaviors in the United States. The goal of this study was to examine the effects of TX Sprouts, a one-year school-based gardening, cooking, and nutrition cluster randomized controlled trial, on students’ dietary intake and quality. Eight schools were randomly assigned to the TX Sprouts intervention and eight schools to control (i.e., delayed intervention) over three years (2016–2019). The intervention arm received: formation and training of Garden Leadership Committees, a 0.25-acre outdoor teaching garden, 18 student lessons including gardening, nutrition, and cooking activities, taught weekly in the teaching garden during school hours, and nine parent lessons, taught monthly. Dietary intake data via two 24 h dietary recalls (24 hDR) were collected on a random subsample (n = 468). Dietary quality was calculated using the Healthy Eating Index 2015 (HEI-2015). The intervention group compared to control resulted in a modest increase in protein intake as a percentage of total energy (0.4% vs. −0.3%, p = 0.021) and in HEI-2015 total vegetables component scores (+4% vs. −2%, p = 0.003). When stratified by ethnicity/race, non-Hispanic children had a significant increase in HEI-2015 total vegetable scores in the intervention group compared to the control group (+4% vs. −8%, p = 0.026). Both the intervention and control groups increased added sugar intake, however, to a lesser extent within the intervention group (0.3 vs. 2.6 g/day, p = 0.050). School-based gardening, cooking, and nutrition interventions can result in significant improvements in dietary intake. Further research on ways to scale and sustain nutrition education programs in schools is warranted. The trial is registered at ClinicalTrials.gov (NCT02668744).

Background: Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental conditions whose etiopathogenesis derives from a complex interaction between genetic liability and environmental factors. In this framework, mounting evidence suggests that immune system dysfunction could be a risk factor contributing to the development of ASD in at least a subpopulation of individuals. In particular, some studies suggest an association between celiac disease (CD)—a long-term autoimmune disorder that primarily affects the small intestine triggered by the ingestion of gluten—and ASD, while others hypothesized a random link. This investigation aimed to evaluate the prevalence of CD in a large sample of school-aged children with ASD and to characterize their clinical profile. Methods: Medical records of 405 children with ASD aged 5–11 years (mean age: 7.2 years, SD: 1.8 years) consecutively referred to a tertiary-care university hospital between January 2014 and December 2018 were reviewed, among them, 362 had carried out serological testing for CD. Results: Nine patients with positive CD serology were identified, eight of which satisfied the criteria for CD diagnosis. The estimated CD prevalence in ASD children was 2.18% (95% CI, 0.8–3.7), which was not statistically different (1.58%, p = 0.36) from that of an Italian population, matched for age range, considered as a control group (95% CI, 1.26–1.90). Three out of the eight ASD patients with CD did not have any symptoms suggestive of CD. Conclusions: Our findings did not show a higher prevalence of CD in ASD children than in the control population, but could suggest the utility of routine CD screening, given its frequent atypical clinical presentation in this population.

This work reviews available data on dietary intakes of total fat, saturated fatty acids (SFA) and individual polyunsaturated fatty acids (PUFA) in children in different countries worldwide and for the first time, compares them with recent international recommendations. Studies published before June 2021 reporting total fat, total SFA and individual PUFA intakes in children aged 1–7 y were included. Observed intakes were evaluated against FAO/WHO and EFSA recommendations. 65 studies from 33 countries were included. Fat intake was too low in 88% of studies in young children (1–3 y). SFA intake was >10%E in 69–73% of children, especially in Europe. Linoleic acid intake was

Celiac disease (CD) is an immune-mediated enteropathy caused by gluten ingestion, affecting approximately 1% of the worldwide population. Extraintestinal symptoms may be present as the first signs of CD, years before the CD diagnosis is made. A great variety of extraintestinal manifestations may be associated with CD. Cutaneous manifestations represent the main extraintestinal manifestations, with dermatitis herpetiformis being the most common in patients with CD. In adults, it has been demonstrated that the role of a gluten-free diet is crucial not only for the recovery of signs and symptoms associated with CD but also for cutaneous manifestations, which often improve after gluten avoidance. In children with CD, the association with skin disorders is well documented regarding dermatitis herpetiformis, but studies considering other dermatological conditions, such as psoriasis and atopic dermatitis, are few. The prevalence and manifestations of dermatological disorders in celiac children are often different from those in adults, explaining the gap between these populations. In addition, the therapeutic role of a gluten-free diet in the improvement in skin alterations is not fully understood in children and in adult population except for dermatitis herpetiformis. Therefore, cutaneous CD symptoms need to be known and recognized by physicians despite their specialties to improve early CD diagnosis, which is critical for a better prognosis. This review describes the current scientific evidence on skin manifestations associated with CD in the pediatric population.

Malnutrition is a major public health concern in Niger. The stunting rate in children in Niger is over 50%, one of the highest in the world. The purpose of this cross-sectional study was to examine children’s dietary diversity (CDD) and the maternal factors that impact CDD. A total of 1265 mother–child pairs were analyzed. Descriptive analysis was conducted to present maternal and child characteristics. To compare the mean scores of CDD in relation to the region, an independent sample t-test was conducted. A one-way ANOVA test was conducted to evaluate the CDD score by different age groups. A linear regression model was estimated to identify household, maternal and child factors that affect the CDD score. Our results indicate that most of the participants of our survey resided in rural areas and the majority (80.7%) of the mothers had no education. Factors such as region, children’s age, woman’s empowerment, vitamin A intake and wealth index were significant predictors of CDD (p &lt, 0.05). The children residing in rural areas were more likely to have lower CDD scores (p &lt, 0.05) than the children in urban areas, therefore becoming more susceptible to malnutrition.

Children with obesity are at higher risk for developing cardiometabolic diseases that once were considered health conditions of adults. Obesity is commonly associated with cardiometabolic risk factors such as dyslipidemia, hyperglycemia, hyperinsulinemia and hypertension that contribute to the development of endothelial dysfunction. Endothelial dysfunction, characterized by reduced nitric oxide (NO) production, precedes vascular abnormalities including atherosclerosis and arterial stiffness. Thus, early detection and treatment of cardiometabolic risk factors are necessary to prevent deleterious vascular consequences of obesity at an early age. Non-pharmacological interventions including L-Citrulline (L-Cit) supplementation and aerobic training stimulate endothelial NO mediated vasodilation, leading to improvements in organ perfusion, blood pressure, arterial stiffness, atherosclerosis and metabolic health (glucose control and lipid profile). Few studies suggest that the combination of L-Cit supplementation and exercise training can be an effective strategy to counteract the adverse effects of obesity on vascular function in older adults. Therefore, this review examined the efficacy of L-Cit supplementation and aerobic training interventions on vascular and metabolic parameters in obese individuals.

Malnutrition continues to threaten the lives of millions across the world, with children being hardest hit. Although inadequate access to food and infectious disease are the primary causes of childhood malnutrition, the gut microbiota may also contribute. This review considers the evidence on the role of diet in modifying the gut microbiota, and how the microbiota impacts childhood malnutrition. It is widely understood that the gut microbiota of children is influenced by diet, which, in turn, can impact child nutritional status. Additionally, diarrhoea, a major contributor to malnutrition, is induced by pathogenic elements of the gut microbiota. Diarrhoea leads to malabsorption of essential nutrients and reduced energy availability resulting in weight loss, which can lead to malnutrition. Alterations in gut microbiota of severe acute malnourished (SAM) children include increased Proteobacteria and decreased Bacteroides levels. Additionally, the gut microbiota of SAM children exhibits lower relative diversity compared with healthy children. Thus, the data indicate a link between gut microbiota and malnutrition in children, suggesting that treatment of childhood malnutrition should include measures that support a healthy gut microbiota. This could be of particular relevance in sub-Saharan Africa and Asia where prevalence of malnutrition remains a major threat to the lives of millions.

Background: We aimed to estimate the burden and underlying risk factors of malnutrition among children and adolescents with cerebral palsy in Arabic-speaking countries. Methods: OVID Medline, OVID Embase, CINAHL via EBSCO, Cochrane Library, and SCOPUS databases were searched up to 3 July 2021. Publications were reviewed to identify relevant papers following pre-defined inclusion/exclusion criteria. Two reviewers independently assessed the studies for inclusion. Data extraction was independently completed by two reviewers. Descriptive and pooled analysis has been reported. Results: From a total of 79 records screened, nine full-text articles were assessed for eligibility, of which seven studies met the inclusion criteria. Study characteristics, anthropometric measurements used, and nutritional outcome reported varied between the studies. The included studies contained data of total 400 participants aged 1–18 years. Overall, (mean: 71.46%, 95% confidence interval: 55.52–85.04) of children with cerebral palsy had at least one form of malnutrition. Severe gross motor function limitation, feeding difficulties, cognitive impairment and inadequate energy intake were the commonly reported underlying risk factors for malnutrition among children with cerebral palsy. Conclusions: The burden of malnutrition is high among children with cerebral palsy in Arabic-speaking countries. More research is needed for better understanding of this public health issue in these countries.

Background: vitamin D (VD) may be a protective factor for retinoblastoma, though no temporal association has been reported during pregnancy or the child’s first year of life. Serum VD concentrations are determined by both distal (DF) and proximal factors (PF). Objective: To identify if DF and PF can predict VD insufficiency (VDI) and VD deficiency (VDD) in women of childbearing age, and to test whether maternal exposure to DF and PF during pregnancy and a child’s exposure during the first 11.9 months postpartum are associated with sporadic retinoblastoma (SRb) in children. Methods: This is a secondary analysis of data from the Epidemiology of SRb in Mexico (EpiRbMx) study and the National Health and Nutrition Survey 2018–2019 (ENSANUT 2018–2019, for its acronym in Spanish). The association of DF and PF with VDD or VDI was estimated using ENSANUT 2018–2019, and the association of DF and PF with SRb using EpiRbMx. All were estimated using logistic regression, with comparable samples selected from ENSANUT 2018–2019 and EpiRbMx. Results: Altitude, latitude and obesity predicted VDI and VDD in ENSANUT women. In EpiRbMx, residence in a rural location during pregnancy increased the risk of SRb. For children, rural residence and latitude increased the risk of SRb, while the number of days exposed to the spring–summer season during months 6 to 11.9 of life was protective. Conclusions: risk of VDI and VDD in women (ENSANUT 2018–2019) increased with altitude, urban dwelling, overweight and obesity. The child and mother’s place of residence, including altitude, latitude and rural classification were important predictors of SRb in EpiRbMx.

Children exhibiting picky eating behavior often demonstrate strong food preferences and rejection of particular foods or food texture, which may lead to limited dietary variety and possibly inadequate or unhealthy diet. Yet, the relationship between picky eating and nutrient intake in school-aged children has not been established previously. This study aimed to investigate the sociodemographic determinants of picky eating and the associations between picky eating and dietary intake in children. Data of 424 healthy Saudi children aged 6–12 years were collected from their mothers. A child’s picky eating habits were captured using a validated questionnaire. Sociodemographic characteristics of the children were assessed. Dietary data, including 24 h dietary recalls and frequency of fruit, vegetable, and milk consumption, were collected by dietetic professionals using phone-administered interviews. Compared to those of normal-weight mothers, children of mothers with obesity had higher odds of being in the highest tertile of picky eating (OR = 1.93, 95% CI 1.02, 3.63). Children exhibiting higher levels of picky eating consumed less fruits (B = −0.03, 95% CI −0.06, −0.01), vegetables (B = −0.05, 95% CI −0.07, −0.02), and protein (B = −0.21, 95% CI −0.33, −0.09), and had higher consumption of trans fatty acid intake (B = 1.10, 95% CI 0.06, 2.15). Children with higher levels of picky eating presented unhealthy dietary behaviors. Future studies are needed to examine the long-term effect of picky eating on cardiovascular health. Dietary behaviors of mothers with obesity must be taken into consideration when designing intervention programs aiming to improve eating behaviors of children.

Limited access to fresh foods is a barrier to adequate consumption of fruits and vegetables among youth, particularly in low-income communities. The current study sought to examine preliminary effectiveness of a fruit and vegetable prescription program (FVPP), which provided one USD 15 prescription to pediatric patients during office visits. The central hypothesis was that exposure to this FVPP is associated with improvements in dietary patterns and food security. This non-controlled longitudinal intervention trial included a sample of caregiver–child dyads at one urban pediatric clinic who were exposed to the FVPP for 1 year. Patients received one USD 15 prescription for fresh produce during appointments. A consecutive sample of caregivers whose children were 8–18 years of age were invited to participate in the study. Dyads separately completed surveys that evaluated food security and dietary behaviors prior to receipt of their first prescription and again at 12 months. A total of 122 dyads completed surveys at baseline and 12-month follow-up. Approximately half of youth were female (52%), and most were African American (63%). Mean caregiver-reported household food security improved from baseline to 12 months (p &lt, 0.001), as did mean child-reported food security (p = 0.01). Additionally, child-reported intake of vegetables (p = 0.001), whole grains (p = 0.001), fiber (p = 0.008), and dairy (p &lt, 0.001) improved after 12 months of exposure to the FVPP. This study provides evidence that pediatric FVPPs may positively influence food security and the dietary patterns of children.

This cross-sectional study aimed to assess 24-h urinary sodium and potassium excretion in children and the relationships with their family excretion. Using the baseline data of a randomized trial conducted in three cities of China in 2018, a total of 590 children (mean age 8.6 ± 0.4 years) and 1180 adults (mean age 45.8 ± 12.9 years) from 592 families had one or two complete 24-h urine collections. The average sodium, potassium excretion and sodium-to-potassium molar ratio of children were 2180.9 ± 787.1 mg/d (equivalent to 5.5 ± 2.0 g/d of salt), 955.6 ± 310.1 mg/d and 4.2 ± 1.7 respectively, with 77.1% of the participants exceeding the sodium recommendation and 100% below the proposed potassium intake. In mixed models adjusting for confounders, every 1 mg/d increase in sodium excretion of adult family members was associated with a 0.11 mg/d (95% CI: 0.06 to 0.16, p &lt, 0.0001) increase in sodium excretion of children. The family-child regression coefficient corresponds to 0.20 mg/d (95% CI: 0.15 to 0.26, p &lt, 0.0001) per 1 mg/d in potassium and to 0.36 (95% CI: 0.26 to 0.45, p &lt, 0.0001) in sodium-to-potassium molar ratio. Children in China are consuming too much sodium and significantly inadequate potassium. The sodium, potassium excretion and sodium-to-potassium ratio of children are associated with their family excretions in small to moderate extent. Efforts are warranted to support salt reduction and potassium enhancement in children through comprehensive strategies engaging with families, schools and food environments.

Obesity prevention interventions generally have either not worked or had effects inadequate to mitigate the problem. They have been predicated on the simple energy balance model, which has been severely questioned by biological scientists. Numerous other etiological mechanisms have been proposed, including the intestinal microbiome, which has been related to childhood obesity in numerous ways. Public health research is needed in regard to diet and the microbiome, which hopefully will lead to effective child obesity prevention.

Nutrition during childhood and adolescence is very important for growth and can have long-term health implications. The COVID-19 lockdown caused significant changes in everyday life, including in children and adolescents. This study evaluated the effects of the first COVID-19 lockdown on eating habits and body weight in children and adolescents. An online cross-sectional survey was carried out among the parents of children (5–9 years) and adolescents (10–14 years) living in Italy. The online self-administered questionnaire included demographic and anthropometric data (reported weight and height) weight and dietary habit changes during the COVID-19 lockdown in Italy (March to June 2020). A total of 439 participants were included. We found a change in eating habits with an increase in consumption of sweet packaged snacks (34%) and processed meat (25%), as well as bread, pizza and bakery products (47%). We also found an increase in vegetable, fresh fruit and legume intake (19%), and a reduction in sweet beverage and candy intake. A total of 59.7% of the participants reported body weight gain, with adolescents gaining more than children (67% vs. 55%, p = 0.010, respectively). In children, body weight gain was associated with a change in body height and increased consumption of dairy products and sweet packaged snacks, while in adolescents it was associated with an increased intake of comfort foods and processed meat. Our data highlighted the need to carefully monitor eating behaviors to avoid the establishment of unhealthy eating habits and prevent obesity in children and adolescents during periods of self-isolation.

The prevalence of primary hypertension in pediatric patients is increasing, especially as a result of the increased prevalence of obesity in children. New diagnostic guidelines for blood pressure were published by the American Academy of Pediatrics (AAP) in 2017 to better define classes of hypertension in children. The aim of our study is to evaluate the impact of new guidelines on diagnosis of hypertension in pediatrics and their capacity to identify the presence of cardiovascular and metabolic risk. Methods: Retrospective clinical and laboratory data from 489 overweight and obese children and adolescents were reviewed. Children were classified according to the 2004 and 2017 AAP guidelines for systolic and diastolic blood pressure. Lipid profile and glucose metabolism data were recorded, triglyceride/HDL ratio (TG/HDL) was calculated as an index of endothelial dysfunction. Hepatic steatosis was detected using the ultrasonographic steatosis score. Results: Children with elevated blood pressure increased from 12.5% with the 2004 AAP to 23.1% with the 2017 AAP criteria (p &lt, 0.001). There was a statistically significant increase in children with high blood pressure in all age groups according to the new cut-off values. Notably, the diagnosis of hypertension according to 2017 AAP criteria had a greater positive association with Hepatic Steatosis (rho 0.2, p &lt, 0.001) and TG/HDL ratio (rho 0.125, p = 0.025). Conclusions: The 2017 AAP tables offer the opportunity to better identify overweight and obese children at risk for organ damage, allowing an earlier and more impactful prevention strategy to be designed.

Food allergy (FA) is a pathological immune response, potentially deadly, induced by exposure to an innocuous and specific food allergen. To date, there is no specific treatment for FAs; thus, dietary avoidance and symptomatic medications represent the standard treatment for managing them. Recently, several therapeutic strategies for FAs, such as sublingual and epicutaneous immunotherapy and monoclonal antibodies, have shown long-term safety and benefits in clinical practice. This review summarizes the current evidence on changes in treating FA, focusing on monoclonal antibodies, which have recently provided encouraging data as therapeutic weapons modifying the disease course.

The purpose of this cross-cultural study was to determine the association between the sociodemographic background of a child’s parents (i.e., their socioeconomic level, marital status, and educational level) with the child’s lifestyle (i.e., Mediterranean diet (MD), physical activity (PA) and screen time (ST)), and health markers. Material: This cross-sectional study included 1273 children, from Chile (n = 496), Colombia (n = 340), and Spain (n = 437). The sociodemographic information together with the lifestyle and health markers of the children were measured. There was an inverse association between a low or medium-low socioeconomic level for the parents of Chilean children and handgrip strength (β −0.61, p &lt, 0.001), meanwhile, for Spanish children, an inverse association between a low or medium-low socioeconomic level and PA after school (β −0.58, p = 0.016), lifestyle (β −0.74, p = 0.015), and with MD adherence (β −0.86, p = 0.004) was found. The risk (i.e., by odd ratios (OR)) of being divorced/separated parents marital status showed an inverse association with abdominal obesity (OR 0.21, p = 0.045) in Spanish children, however, the parent’s marital status and a low educational level were risk factors for the suffering of a low nutritional level in Colombian children (OR 2.02, p = 0.048, OR 2.49, p &lt, 0.001, respectively). On the other hand, a low educational level for parents reported for Chilean children had a positive association with ST of ≥4 h per day (OR 1.82, p = 0.020). In conclusion, in Spanish-speaking children, the lifestyle and health markers of the children are affected by the sociodemographic background of their parents, however, these effects could be moderated by the socio-cultural and economic status of their countries as members of the OCDE, therefore, it is essential to develop policies that decrease these gaps, so that children who are under-resourced can reach their full potential.

Adolescence is a time in life when lifestyle behaviours are acquired. One indicator of poor diet quality is the intake of foods and beverages with a relatively low nutritional value. Using the Australian classification of such foods, termed “discretionary”, we classified the intakes of Swedish adolescents who participated in the Riksmaten Adolescent 2016–17 national dietary survey. From selected schools, 3099 adolescents in age groups 11–12, 14–15 and 17–18 years provided two 24-h recalls. Intakes and healthy dietary scores were calculated. Plasma ferritin, folate and 25(OH)D were available for a third. Almost 40% of total energy came from discretionary foods/beverages. Adolescents with higher intakes were more likely to be female, older, from a low socioeconomic position-household and born in Sweden. Most discretionary foods/beverages were consumed on weekend days and during in-between meals, outside of the home and at school. Percent energy from discretionary intake was associated with healthy dietary scores but not nutritional status. A substantial amount of energy was obtained from discretionary foods/beverages, and we found that consumption is pervasive across sociodemographic factors, time and place. Addressing this pattern will require a comprehensive approach to food environments and behaviours to reach all adolescents in an equitable manner.

The identification of sodium and potassium intake in youths is an important step to preventing the increase of blood pressure in childhood. We examined food intake and estimated mineral intake using a brief-type self-administered diet history questionnaire (BDHQ) to test its validity as a comparison with urinary excretion in Japanese youths. The subjects were 5th and 8th graders (n = 2377), who completed the BDHQ and permitted the use of their overnight urine specimens. Sodium intake was poorly associated with sodium excretion (Rho = 0.048), and the coefficients of dietary potassium and a sodium-to-potassium molar ratio were 0.091–0.130. Higher soybean paste (miso) intake and pickles were significantly associated with higher sodium excretion (p ≤ 0.005). However, these foods were positively associated with potassium excretion (p = 0.002–0.012), and not associated with an excreted sodium-to-potassium ratio. Fruits and dairy products were positively associated (p ≤ 0.048), whereas beverages were negatively associated with potassium excretion (p ≤ 0.004). The association of the sodium-to-potassium ratio was opposite to that of potassium (p ≤ 0.001). The choice of foods, potassium, and the sodium-to-potassium ratio assessed using the BDHQ are available as part of health education for youths, but the assessment of sodium intake in population levels should be carefully conducted.

This scoping review examined intervention and sample characteristics of family-based obesity prevention interventions among Hispanic youth. This review also examined the degree to which existing interventions were culturally-adapted, acknowledged social determinants of health (SDoH), and collaborated with community stakeholders. A comprehensive search across Medline Ovid, Embase, Scopus, PsycInfo, and Pubmed was used to identify 13 studies primarily based in the U.S. (92.3%). Data was extracted by two independent reviewers. Most used a randomized control trial design (69.2%), a behavior change theory (84.6%), and reported moderate to high (≥70%) retention (69.2%). Studies targeted improvements in physical activity (69.2%) and fruit and vegetable intake (92.3%) through nutrition education, cooking demonstrations, and tastings. Younger children from low socioeconomic backgrounds (61.5%) were well represented. Most interventions were culturally-adapted (69.2%), all studies reported collaboration with stakeholders, yet only half used strategies that acknowledged SDoH (46.2%). To increase our understanding of the underlying mechanisms by which family-based approaches can reach and engage Hispanic youth and families, future studies should rigorously evaluate theoretical constructs, family processes, and SDoH that influence program participation and health behaviors. This information will guide the design and development of future interventions aimed at reducing obesity disparities among Hispanic youth.

International audience; Background: The main source of vitamin D is skin synthesis, which depends on sunlight exposure. During the pandemic, COVID-19 children were obliged to home confinement, which potentially limiting sunlight exposure. The aim of this study was to evaluate whether home confinement led to decreased vitamin D serum levels in children in Warsaw, Poland. Methods: The study included 1472 children who were divided into two groups, based on the date of 25(OH)D level blood sampling: before and during the pandemic. Children under 1 year of age (infants) were analysed separately. Results: A statistically significant decrease in the average level of vitamin D was observed between groups of children over 1 year of age (35 ng/mL +/- 18 vs. 31 ng/mL +/- 14). In infants from both groups, the mean vitamin D levels were within the normal range (Group 1 inf 54 ng/mL +/- 21 vs. Group 2 inf 47 ng/mL +/- 15). The characteristic seasonal variability was observed before the pandemic, with maximal vitamin D levels in summer (40 ng/mL +/- 17) and minimal levels in winter (30 ng/mL +/- 14). During the pandemic, no seasonal variability was observed (summer 30 ng/mL +/- 11 vs. winter 30 ng/mL +/- 19). Conclusions: The COVID-19 pandemic restrictions led to a significant decrease in vitamin D serum levels in children.

Autism Spectrum Disorder is a neurodevelopmental disorder. Recent data suggest that probiotics can reduce some symptoms of this disorder and Lactobacillus plantarum PS128 has been reported to be especially useful. We recruited a sample of 131 autistic children and adolescents (M:F = 122:19; age: 86.1 ± 41.1 months) and evaluated their changes after use of probiotics by mean of CGI. We found some significant improvements with very few side effects; these positive effects were more evident in younger children. Patients taking Lactobacillus plantarum PS128 had greater improvements and fewer side effects than those taking other probiotics. Our real-life data are consistent with existing literature showing a specific effect of Lactobacillus plantarum PS128 in Autism Spectrum Disorder.

A probiotic formulation combining Lactobacillus helveticus Rosell®-52, Bifidobacterium infantis Rosell®-33, and Bifidobacterium bifidum Rosell®-71 with fructooligosaccharides, first commercialized in China, has been sold in over 28 countries since 2002. Clinical studies with this blend of strains were conducted mainly in pediatric populations, and most were published in non-English journals. This comprehensive review summarizes the clinical studies in infants and children to evaluate the efficacy of this probiotic for pediatric indications. Literature searches for pediatric studies on Biostime® or Probiokid® (non-commercial name) in 6 international and Chinese databases identified 28 studies, which were classified by indications. Twelve studies show that the probiotic significantly increases the efficacy of standard diarrhea treatment regardless of etiology, reducing the risk of unresolved diarrhea (RR 0.31 [0.23; 0.42]; p < 0.0001) by 69%. In eight studies, the probiotic enhanced immune defenses, assessed by levels of various immune competence and mucosal immunity markers (six studies), and reduced the incidence of common infections (two studies). The probiotic improved iron deficiency anemia treatment efficacy (three studies), reducing the risk of unresolved anemia by 49% (RR 0.51 [0.28; 0.92]; p = 0.0263) and significantly reducing treatment side effects by 47% (RR 0.53 [0.37; 0.77]; p = 0.0009). Other studies support further investigation into this probiotic for oral candidiasis, eczema, feeding intolerance in premature babies, or hyperbilirubinemia in newborns.

We aimed to investigate the association between caregiver social status and health-related quality of life (HRQoL) in children with neurological impairment (NI) on home enteral nutrition (HEN). This was an ancillary study of a multicenter, cross-sectional study which explored HRQoL in 75 NI children on HEN. All the caregivers from the original cohort were contacted, and data on education level, occupation and marital status were collected. The association between social status and HRQoL was investigated using a multiple Poisson Generalized Linear Model. In total, 93 caregivers were included, responsible for the care of 71 children. The caregivers of four children of the original cohort did not answer the questionnaire. Mothers with high-level education presented lower HRQoL in comparison to mothers with low-level (β: −5.97, 95% CI −11.51, −0.10, p = 0.027) or medium-level education (β: 4.85, 95% CI −9.87, 0.53, p = 0.044). The analysis of the subgroup of cases in which the main caregiver was represented by both parents gave similar findings, with education level of the father being negatively correlated with HRQoL. Our data showed that higher education level may negatively affect quality of life of caregivers of NI children. This could be helpful in identifying at-risk families and addressing supportive efforts.

Maternal feeding practices have been shown to have a powerful influence on shaping dietary behaviors of children. Nonetheless, the association with the nutrient intake of children has not been previously explored. This study aimed to investigate the associations of maternal use of pressure to eat (PE) and a healthy home food environment (HHFE) with nutrient intakes in children (6–12 years old). Data of 424 mother–child dyads were included. Maternal use of PE and a HHFE were assessed using a validated questionnaire. Child food intake was collected using telephone-administered 24 h recalls. Multivariate linear regression analyses were conducted to investigate the associations of maternal feeding practices with energy and nutrient intakes of children. Maternal use of PE predicted higher children’s intake of carbohydrate (B = 0.90, 95% confidence interval (CI) 0.19 to 1.62) and dietary fiber (B = 1.25, 95% CI 0.32 to 2.18) and lower fat intake (B = −0.74, 95% CI −1.37 to −0.11). Maternal use of a HHFE was significantly positively associated with protein intake (B = 0.99, 95% CI 0.53 to 1.46) and negatively associated with free sugar intake in children (B = −3.56, 95% CI −5.03 to −2.09). Our findings indicate that nutrient intakes of children are linked to feeding practices employed by mothers. Further studies are warranted to gain a more contextualized understanding of mother–child feeding interactions and to develop effective interventions.

Fortification with multiple micronutrient powder has been proposed as a public health intervention able to reduce micronutrient deficiencies in children. Our objective was to compare the effectiveness of fortification with multiple micronutrient powder with drug supplementation in the prevention and treatment of iron deficiency and anaemia. This was a cluster trial with anemic and non-anaemic children between six and 42 months old, in randomization data. Non anaemic children received fortification with multiple micronutrient powder or standard drug supplementation of ferrous sulfate associated with folic acid in a prevention dose. Anaemic children who were randomized to receive multiple micronutrient powder also received the recommended iron complementation for anaemia treatment. A total of 162 children were evaluated. The prevalence of anaemia decreased from 13.58 to 1.85%. Iron deficiency decreased from 21.74% to 7.89% (by serum ferritin) and iron deficiency decreased from 66.81 to 38.27% (by soluble transferrin receptor). No difference was identified between interventions for hemoglobin (p = 0.142), serum ferritin (p = 0.288), and soluble transferrin receptor (p = 0.156). Fortification with multiple micronutrient powder was effective in preventing iron deficiency and anaemia in children aged six to 48 months. In anaemic children, it was necessary to supplement the dose of multiple micronutrient powder with ferrous sulfate.

Lipoprotein subclasses possess crucial cardiometabolic information. Due to strong multicollinearity among variables, little is known about the strength of influence of physical activity (PA) and adiposity upon this cardiometabolic pattern. Using a novel approach to adjust for covariates, we aimed at determining the “net” patterns and strength for PA and adiposity to the lipoprotein profile. Principal component and multivariate pattern analysis were used for the analysis of 841 prepubertal children characterized by 26 lipoprotein features determined by proton nuclear magnetic resonance spectroscopy, a high-resolution PA descriptor derived from accelerometry, and three adiposity measures: body mass index, waist circumference to height, and skinfold thickness. Our approach focuses on revealing and validating the underlying predictive association patterns in the metabolic, anthropologic, and PA data to acknowledge the inherent multicollinear nature of such data. PA associates to a favorable cardiometabolic pattern of increased high-density lipoproteins (HDL), very large and large HDL particles, and large size of HDL particles, and decreasedtriglyceride, chylomicrons, very low-density lipoproteins (VLDL), and their subclasses, and to low size of VLDL particles. Although weakened in strength, this pattern resists adjustment for adiposity. Adiposity is inversely associated to this pattern and exhibits unfavorable associations to low-density lipoprotein (LDL) features, including atherogenic small and very small LDL particles. The observed associations are still strong after adjustment for PA. Thus, lipoproteins explain 26.0% in adiposity after adjustment for PA compared to 2.3% in PA after adjustment for adiposity.