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Guidelines for Parenteral Nutrition were prepared by the German Society for Nutritional Medicine (http://www.dgem.de/), in collaboration with other medical associations to provide guidance for quality assurance for parenteral nutrition (PN) practice, and to promoting health and quality of life of patients concerned. A coordination team proposed topics, working group leaders who along with working group members performed systematic literatur searches and drafted recommendations in a nominal group process. Recommendations were discussed and agreed upon in a structured consensus conference process, followed by a Delphi consensus. The current English version of the guidelines was written and updated during the period between the last quarter of 2007 and the first quarter of 2009. The recommendations of the guidelines should be reviewed, and if necessary updated five years after publication.

There are special challenges in implementing parenteral nutrition (PN) in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants

In patients with Crohn's disease and ulcerative colitis parenteral nutrition (PN) is indicated when enteral nutrition is not possible or should be avoided for medical reasons. In Crohn's patients PN is indicated when there are signs/symptoms of ileus or subileus in the small intestine, scars or intestinal fistulae. PN requires no specific compounding for chronic inflammatory bowel diseases. In both diseases it should be composed of 55–60% carbohydrates, 25–30% lipids and 10–15% amino acids. PN helps in the correction of malnutrition, particularly the intake of energy, minerals, trace elements, deficiency of calcium, vitamin D, folic acid, vitamin B12, and zinc. Enteral nutrition is clearly superior to PN in severe, acute pancreatitis. An intolerance to enteral nutrition results in an indication for total PN in complications such as pseudocysts, intestinal and pancreatic fistulae, and pancreatic abscesses or pancreatic ascites. If enteral nutrition is not possible, PN is recommended, at the earliest, 5 days after admission to the hospital. TPN should not be routinely administered in mild acute pancreatitis or nil by moth status

The infusion of lipid emulsions allows a high energy supply, facilitates the prevention of high glucose infusion rates and is indispensable for the supply with essential fatty acids. The administration of lipid emulsions is recommended within ≤7 days after starting PN (parenteral nutrition) to avoid deficiency of essential fatty acids. Low-fat PN with a high glucose intake increases the risk of hyperglycaemia. In parenterally fed patients with a tendency to hyperglycaemia, an increase in the lipid-glucose ratio should be considered. In critically ill patients the glucose infusion should not exceed 50% of energy intake. The use of lipid emulsions with a low phospholipid/triglyceride ratio is recommended and should be provided with the usual PN to prevent depletion of essential fatty acids, lower the risk of hyperglycaemia, and prevent hepatic steatosis. Biologically active vitamin E (α-tocopherol) should continuously be administered along with lipid emulsions to reduce lipid peroxidation. Parenteral lipids should provide about 25–40% of the parenteral non-protein energy supply. In certain situations (i.e. critically ill, respiratory insufficiency) a lipid intake of up to 50 or 60% of non-protein energy may be reasonable. The recommended daily dose for parenteral lipids in adults is 0.7–1.3 g triglycerides/kg body weight. Serum triglyceride concentrations should be monitored regularly with dosage reduction at levels >400 mg/dl (>4.6 mmol/l) and interruption of lipid infusion at levels >1000 mg/dl (>11.4 mmol/l). There is little evidence at this time that the choice of different available lipid emulsions affects clinical endpoints.

ObjectiveTo assess the separate and combined associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain with the risks of pregnancy complications and their population impact.DesignIndividual participant data meta-analysis of 39 cohorts.SettingEurope, North America, and Oceania.Population265 270 births.MethodsInformation on maternal pre-pregnancy BMI, gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used.Main outcome measuresGestational hypertension, pre-eclampsia, gestational diabetes, preterm birth, small and large for gestational age at birth.ResultsHigher maternal pre-pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes, and large for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared with normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (odds ratio 2.51, 95% CI 2.31- 2.74). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large for gestational age infants was attributable to excessive gestational weight gain.ConclusionsMaternal pre-pregnancy BMI and gestational weight gain are, across their full ranges, associated with risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre-pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity.Tweetable abstractPromoting a healthy body mass index and gestational weight gain might reduce the population burden of pregnancy complications.

Background/Objectives: Assessing fatty acid (FA) composition in relation to inflammatory markers can shed light on the role of different FA and their metabolism in low-grade inflammation. Existing exploratory studies in children are scarce, and findings inconsistent. We hence aim to analyse associations of FA with common inflammatory markers, high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6), in 10-year-old children. Subjects/Methods: Complete data were available for 958 participants from the 10-year follow-up of the LISAplus (Influence of Lifestyle-Related Factors on the Immune System and the Development of Allergies in Childhood plus the Influence of Traffic Emissions and Genetics) birth cohort study. FA composition was assessed in serum glycerophospholipids. Hs-CRP and IL-6 were categorised into three levels. Associations of FA with inflammatory markers were assessed using multinomial logistic regression, adjusting for potential confounders. Additionally, sex-stratified analyses were carried out. Results: FA exposures associated with significantly higher low-grade inflammation, as indicated by higher hs-CRP or IL-6 levels, included: palmitic acid (PA) (IL-6: P Conclusions: These findings suggest that higher SFA and minor n-6 HUFA, namely PA and AA, are associated with increased low-grade inflammation in children, whereas the major dietary n-6 PUFA and total PUFA are associated with reduced inflammation. Elevated desaturase activity, estimated by the ratio AA/LA, may be associated with higher inflammation, particularly in boys., Author(s): C Harris [sup.1] , H Demmelmair [sup.2] , A von Berg [sup.3] , I Lehmann [sup.4] [sup.5] , C Flexeder [sup.1] , B Koletzko [sup.2] , J Heinrich [sup.1] [...]

Background Maternal postpartum depression (PPD) could affect children's emotional development, increasing later risk of child psychological problems. The aim of our study was to assess the association between child's emotional and behavioural problems and mother's PPD, considering maternal current mental health problems (CMP). Methods This is a secondary analysis from the EU-Childhood Obesity Project (NCT00338689). Women completed the Edinburgh Postnatal Depression Scale (EPDS) at, 2, 3 and 6 months after delivery and the General Health Questionnaire (GHQ-12) to assess CMP once the children reached the age of 8 years. EPDS scores > 10 were defined as PPD and GHQ-12 scores > 2 were defined as CMP. The psychological problems of the children at the age of eight were collected by mothers through the Child's Behaviour Checklist (CBCL). Results 473, 474 and 459 mothers filled in GHQ-12 and CBCL tests at 8 years and EPDS at 2, 3 and 6 months, respectively. Anxiety and depression was significantly increased by maternal EPDS. Children whose mothers had both PPD and CMP exhibited the highest levels of psychological problems, followed by those whose mothers who had only CMP and only PPD. PPD and CMP had a significant effect on child's total psychological problems (p = 0.033, p < 0.001, respectively). Children whose mothers had PPD did not differ from children whose mothers did not have any depression. Conclusions Maternal postpartum depression and current mental health problems, separately and synergistically, increase children's psychological problems at 8 years., Author(s): R. Closa-Monasterolo [sup.1] , M. Gispert-Llaurado [sup.1] , J. Canals [sup.2] , V. Luque [sup.1] , M. Zaragoza-Jordana [sup.1] , B. Koletzko [sup.3] , V. Grote [sup.3] , M. [...]

Background/Objectives: The World Health Organization recommends to limit intake of free sugars to 5% of total energy per day because of the great impact of high sugar intake on body fat deposition, adiposity and dental caries. However, little data exist about total intake and sources of sugar in European children. Therefore, this paper aims to describe sugar intake and dietary sugar sources and associated factors. Subjects/Methods: Three-day weighed dietary records were obtained at eight time points from children 1 to 8 years of age (n=995) in five European countries. Food items were classified into subgroups according to food composition. Linear mixed models were used to examine associated factors. Results: Total sugar intake increased from 65 g/day (30.0% of energy intake (E%)) at 12 months of age to 83 g/day (20.9 E%) at 96 months of age. Around 80% of children's sugar intake was derived from the following sources: milk and dairy products, fruits and fruit products, confectionary and sugar sweetened beverages (SSB). Total sugar intake and dietary sugar sources varied significantly by country of residence. Boys had a significantly (P=0.003) higher total sugar consumption than girls. SSB consumption was significantly higher in children from young mothers while sugar intake from fruit products was lower in children from mothers with lower educational status and those with higher birth order. Conclusions: Sugar intake in our population was lower than in other studies. Total sugar intake was associated with country of residence and gender, while dietary sugar sources varied by country of residence, maternal age, education and birth order., Author(s): I Pawellek [sup.1] , V Grote [sup.1] , M Theurich [sup.1] , R Closa-Monasterolo [sup.2] , A Stolarczyk [sup.3] , E Verduci [sup.4] , A Xhonneux [sup.5] , B [...]