Search

International audience; Reducing the burden of non-communicable diseases (NCDs) is one of the top priorities of public health policies worldwide. One of the recognized means of achieving this objective is to improve the diet quality. The Nutri-Score (N-S) is a [five-color - A, B, C, D, E letters] front-of-pack labelling logo intended to help consumers quickly identify the healthier prepackaged foods within a food category. Available studies have shown that the N-S is an efficient tool to achieve this aim in terms of consumers' awareness, perception, understanding and purchasing and that its use may help to reduce the prevalence of NCDs. The N-S is currently implemented on a voluntary basis in seven European countries and a discussion is underway within the European Commission to achieve a harmonized mandatory label. However, no study on the putative impact of the N-S on children's dietary patterns and health is available. The N-S is not applicable to infants' and young children's formulas and to specific baby foods, the compositions of which are already laid down in European Union regulations. The N-S does not replace age-appropriate dietary guidelines. As children consume an increasing number of adult type and processed foods, the relevance of the N-S for children should be evaluated considering the children's high specific requirements, especially in younger children. This is especially necessary for fitting fat and iron requirements, whereas protein-rich foods should be better framed. Moreover, efforts should be made to inform on how to use the N-S and in education on healthy diets.

Pregnant and lactating women are continuously and ubiquitously exposed to numerous environmental pollutants from various sources including air, food, water, and occupational and household environments. The available evidence shows that pollutants are present in human milk and one of the emerging questions is what happens when the nursing infant is involuntarily exposed to contaminants through breastfeeding.The available literature does not currently provide a conclusive evidence of any consistent or clinically relevant health consequences in infants exposed to environment chemicals through breast milk. The available data strongly suggest that the benefits of breastfeeding outweigh the potential harmful effects of pollutants contained in human milk. The committee of nutrition of the French Pediatric Society strongly supports breastfeeding but also calls for public health actions to reduce the overall contamination level in the environment, to continue promoting breastfeeding, and to support research in this area.

International audience

BackgroundThe vast majority of the world population declares affiliation to a religion, predominantly Christianity and Islam. Many religions have special dietary rules, which may be more or less strictly adhered to.MethodsReligious food rules were collected from holy books and religious websites as well as their translation into dietary practices. The literature was searched for potential associations between these rules and potential nutritional consequences.ResultsJewish, Islamic and Indian religions support prolonged breastfeeding. Religious avoidance of alcohol is probably beneficial to health. When strictly applied, a few rules may lead to nutritional inadequacies, mainly in populations living in unfavourable socio-economic or environmental conditions. In Jewish and Muslim observants, animal slaughtering procedures may increase the risk of iron deficiency. Jews may be at risk of excess sodium intake related to home-prepared foods. A vegan diet, as observed by some believers, often by drifting from original precepts, or by some Hindus or Buddhists, may result in vitamin B12, calcium, iron, zinc, selenium and n-3 fatty acids deficiencies.ConclusionWhen implemented in accordance with the rules, most religious food precepts are not detrimental to health, as suggested by the fact that they have more or less been followed for millennia. Nevertheless, some practices may lead to nutritional inadequacies, such as iron, calcium, vitamin D and vitamin B12 deficiencies. Patients with low socio-economic status, children and women of childbearing age are of particular risk of such deficiencies. Being aware of them should help health professionals to take an individualized approach to decide whether to supplement or not.

International audience; Background & aims: Iron deficiency (ID) is considered the most frequent micronutrient deficiency in industrialized countries where strategies for its primary prevention vary widely and are insufficiently evaluated. We aimed to study the effectiveness for iron status of a national iron deficiency prevention strategy based on recommendations for young-child formula (YCF) use after age 12 months, taking into consideration other sources of iron and the family's socio-economic status.Methods: In a cross-sectional observational study conducted in primary care pediatrician offices throughout France from 2016 to 2017, infants aged 24 months were consecutively included for a food survey and blood sampling. Associations between YCF consumption and serum ferritin (SF) level were studied by multivariable regression after adjustment on sociodemographic, perinatal and dietary characteristics, notably other intakes of iron.Results: Among the 561 infants analyzed, the ID prevalence was 6.6% (37/561; 95% confidence interval [CI] 4.7-9.0). Daily iron intake excluding YCF and total daily iron intake including YCF were below the 5-mg/day recommended average requirements for 63% and 18% of children, respectively. ID frequency was significantly decreased (or SF level was independently higher) with any YCF consumption after age 10 months (odds ratio 0.15, 95% CI 0.07-0.31), current YCF consumption at age 24 months (median SF level 29 vs 21 μg/L if none), prolonged YCF consumption (28 μg/L if >12 months vs 17 μg/L if none), and increasing daily volume of YCF consumed at age 24 months from a small volume (e.g., 29 μg/L if

To assess the diagnostic accuracy of existing clinical criteria and to develop prediction tools for iron deficiency in 2-year-old children.In a national cross-sectional study conducted in primary care pediatricians' practices throughout France, 2-year-old children were consecutively included (2016-2017). Multivariable logistic regression modeling and bootstrapping were used to develop several clinical models to predict iron deficiency (serum ferritin12 μg/L). These models used the best criteria and combinations among the American Academy of Pediatrics' (AAP) criteria adapted to the European context (n = 10), then all potential predictors (n = 19). One model was then simplified into a simple prediction tool.Among 568 included infants, 38 had iron deficiency (6.7%). In univariable analyses, no significant association with iron deficiency was observed for 8 of the 10 adapted AAP criteria. Three criteria (both parents born outside the European Union, low weight at 1 year old, and weaning to cow's milk without supplemental iron) were retained in the AAP model, which area under the receiver operating characteristic curve, sensitivity, and specificity were 0.62 (95% CI, 0.58-0.67), 30% (95% CI, 22%-39%), and 95% (95% CI, 92%-97%), respectively. Four criteria were retained in a newly derived simple prediction tool (≥1 criterion among the 3 previous plus duration of iron-rich formula consumption12 months), which area under the receiver operating characteristic curve, sensitivity, and specificity were 0.72 (95% CI, 0.65-0.79), 63% (95% CI, 47%-80%), and 81% (95% CI, 70%-91%), respectively.All prediction tools achieved acceptable diagnostic accuracy. The newly derived simple prediction tool offered potential ease of use.ClinicalTrials.gov NCT02484274.

Formulas adapted to infant feeding, although most of the time made from cow’s milk proteins, can be made from hydrolyzed rice protein but they must be classified as “formulas for specific medical needs”, according to European regulations. The nutritional quality of rice proteins is thus suitable to be used in infant formulas giving that it is supplemented by certain amino acids which can be lacking. Besides, hydrolysis is required to facilitate their water solubility and digestibility. Owing to a low allergenicity of rice and to the absence of the cross-allergy between milk proteins and rice proteins, these formulas are adapted to the diet of children with cow’s milk protein allergy (CMPA), which explains their growing use in some countries. However, CMPA, an expanding disorder, has consequences for growth, bone mineralization, and often has an association with allergy to other foods, including cow’s milk extensive hydrolysate, so that a surveillance of the adaption of hydrolyzed rice protein formulas (HRPF) to CMPA, the absence of unexpected side effects, and the appropriate response to its various health hazards seems mandatory. This paper analyses the health problem deriving from CMPA, the industrial development of hydrolyzed rice protein formulas, and the limited number of clinical studies, which confirms, at the moment, a good allergic tolerance and safety. The goal is to better advise heath care professionals on their use of HRPFs during CMPA.

Resume Des aliments dietetiques destines a des fins medicales speciales (ADDFMS) contenant une fraction proteique a base de proteines de riz hydrolysees (PRH) sont commercialises en Europe depuis les annees 2000 pour le traitement de l’allergie aux proteines de lait de vache (APLV). Les formules a base de PRH (FPRH) sont proposees comme une alternative vegetale aux formules a base de proteines de lait de vache extensivement hydrolysees (FPLV-eH) a cote des formules de proteines de soja dont l’utilisation dans l’APLV est controversee. Les FPRH ne contiennent pas de phyto-estrogenes et sont produites a partir de riz non genetiquement modifie. Les FPRH sont d’origine vegetale, a l’exception de l’ajout de vitamine D3 (cholecalciferol). Comme la teneur en acides amines des proteines de riz differe de celle des proteines du lait de femme, la qualite proteique de ces formules est amelioree par addition de lysine, threonine et tryptophane libres. La consommation de FPRH a augmente : par exemple, en France, elle represente 4,9 %, en volume, de toutes les formules destinees aux enfants de 0 a 3 ans. Plusieurs etudes ont montre l’efficacite des FPRH dans le traitement de l’APLV. Elles assurent une croissance satisfaisante des les 1res semaines de vie des nourrissons et des enfants en bas âge, tant chez les enfants en bonne sante que chez ceux atteints d’APLV. Les FPRH peuvent etre utilisees pour traiter les enfants atteints d’APLV soit d’emblee, soit en deuxieme intention en cas de mauvaise tolerance aux FPLV-eH pour des raisons organoleptiques ou par manque d’efficacite. En France, le cout des FPRH est proche de celui des preparations standard premium pour nourrissons ou de suite.

International audience; Due to transient gut immaturity, most very preterm infants receive parenteral nutrition (PN) in the first few weeks of life. Yet providing enough protein and energy to sustain optimal growth in such infants remains a challenge. Extrauterine growth restriction is frequently observed in very preterm infants at the time of discharge from hospital, and has been found to be associated with later impaired neurodevelopment. A few recent randomized trials suggest that intensified PN can improve early growth; whether or not such early PN improves long-term neurological outcome is still unclear. Several other questions regarding what is optimal PN for very preterm infants remain unanswered. Amino acid mixtures designed for infants contain large amounts of branched-chain amino acids and taurine, but there is no consensus on the need for some nonessential amino acids such as glutamine, arginine, and cysteine. Whether excess growth in the first few weeks of life, at a time when very preterm infants receive PN, has an imprinting effect, increasing the risk of metabolic or vascular disease at adulthood continues to be debated. Even though uncertainty remains regarding the long-term effect of early PN, it appears reasonable to propose intensified initial PN. The aim of the current position paper is to review the evidence supporting such a strategy with regards to the early phase of nutrition, which is mainly covered by parenteral nutrition. More randomized trials are, however, needed to further support this type of approach and to demonstrate that this strategy improves short- and long-term outcome.

Cow's milk is one of the most common foods responsible for allergic reactions in children. Cow's milk allergy (CMA) involves immunoglobulin E (IgE)- and non-IgE-mediated reactions, the latter being both variable and nonspecific. Guidelines thus emphasize the need for physicians to recognize the specific syndromes of CMA and to respect strict diagnostic modalities. Whatever the clinical pattern of CMA, the mainstay of treatment is the elimination from the diet of cow's milk proteins. The challenge is that both the disease and the elimination diet may result in insufficient height and weight gain and bone mineralization. If, during CMA, the mother is not able or willing to breastfeed, the child must be fed a formula adapted to CMA dietary management, during infancy and later, if the disease persists. This type of formula must be adequate in terms of allergic efficacy and nutritional safety. In older children, when CMA persists, the use of cow's milk baked or heated at a sufficient temperature, frequently tolerated by children with CMA, may help alleviate the stringency of the elimination diet. Guidance on the implementation of the elimination diet by qualified healthcare professionals is always necessary. This guidance should also include advice to ensure adequate bone growth, especially relating to calcium intake. Specific attention should be given to children presenting with several risk factors for weak bone mineral density, i.e., multiple food allergies, vitamin D deficiency, poor sun exposure, steroid use, or severe eczema. When CMA is outgrown, a prolonged elimination diet may negatively impact the quality of the diet over the long term.

International audience; No abstract available

National audience; ’ARFID (trouble d’alimentation sélective et/ou d’évitement) a été récemment ajouté au DSM V dans la classification des troubles du comportement alimentaire (TCA). L’ARFID se caractérise par un manque d’intérêt pour l’alimentation ou un évitement de certains aliments, en raison de leurs caractéristiques sensorielles se traduisant par un déficit d’apports nutritionnels. Ce comportement peut entraîner des carences nutritionnelles importantes et peut, dans les cas graves, générer une dépendance aux suppléments nutritionnels oraux et interférer avec le fonctionnement psychosocial. La prévalence de l’ARFID peut atteindre 3 % dans la population générale. L’ARFID est souvent associée à des symptômes gastro-intestinaux et apparaît principalement chez les enfants souffrant de troubles anxieux. Compte tenu de la forte prévalence de ce trouble alimentaire, une enquête nutritionnelle systématique rapide devrait être réalisée à chaque consultation pédiatrique. Le traitement doit être adapté à la gravité du problème nutritionnel et peut nécessiter une hospitalisation avec une prise en charge multidisciplinaire (pédiatre, nutritionniste, diététicien, psychologues et orthophonistes).

International audience; Avoidant/restrictive food intake disorder (ARFID) has recently been added to the DSM V (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) as a new class of eating disorders (EDs). ARFID is characterized by a lack of interest in eating or avoiding specific types of foods because of their sensory characteristics. This avoidance results in decreased nutritional intake, eventually causing nutritional deficiencies. In severe cases, ARFID can lead to dependence on oral nutritional supplements, which interferes with psychosocial functioning. The prevalence of ARFID can be as high as 3% in the general population, and it is often associated with gastrointestinal symptoms and mainly appears in children with anxiety disorders. Given the high prevalence of ARFID, a rapid and systematic nutrition survey should be conducted during every pediatric consultation. Its treatment should also be adapted depending on the severity of the nutritional problem and may involve hospitalization with multidisciplinary care (pediatrician, nutritional therapist, dietitian, psychologists, and speech therapists).

Resume Il existe des le jeune âge une relation entre la consommation de sodium et le niveau de la pression arterielle, ce qui justifie de controler les apports sodes chez les enfants. Cependant, les besoins en sodium a cet âge ne sont pas connus de facon precise. Cet article fait le point sur les apports souhaitables de sodium en fonction de l’âge selon differents groupes d’experts, sur les niveaux d’apport observes dans les enquetes de consommation et sur les strategies de sante publique mises en place pour reduire la consommation de sel dans la population pediatrique. Des recommandations pratiques sont proposees par le Comite de nutrition de la Societe francaise de pediatrie pour limiter la consommation de sel chez les enfants.

Background: Adequate evaluation of iron status in young children is of paramount importance given the frequency of iron deficiency (ID) and its potential short- and long-term neurocognitive adverse effects when occurs early. Iron metabolism is complex and the correct evaluation of iron status may be difficult, notably when inflammation is present. Soluble transferrin receptor (sTfR) is not modified by inflammation but lacks specificity in ID, and its combination with serum ferritin (SF) by the TfR-F index (TfR/logSF) has been proposed to improve diagnosis performances [Punnonen Blood 1997]. Hepcidin has been identified in the two last decades has the key regulator of iron homeostasis mainly by controlling iron release from macrophages via ferroportin degradation, as well as enterocytes absorption [Ganz Blood 2011]. Scarce studies have been published on hepcidin in healthy children in industrialized countries [Uijterschout Pediatr Res 2014]. The distribution of sTfR and hepcidin in healthy young children is unknown, including according to gender. Aims: Our objective was to describe hepcidin, sTfR and other iron status biomarkers (serum ferritin [SF], hemoglobin (Hb), transferrin saturation, zinc protoporphyrin [ZnPP]) distributions in a population of healthy infants aged 2 years old. Methods: In a cross-sectional observational study conducted in primary care pediatricians' offices throughout France from 2016 to 2017, infants aged 2 years old were consecutively included to undergo a blood sampling in the morning fasting. They were excluded if they were affected by a chronical disease involving iron metabolism, had fever in the last 15 days or biological inflammation defined as a CRP≥10 mg/L, and had no measurement for hepcidin. Hepcidin and ZnPP in erythrocytes were measured after a Results: Among the 539 included children, the mean age was 24 months (SD 0.6), 49% were girls. Prevalence of ID (SF 0.3). Distributions of other iron biomarkers were closed to those reported in the literature. Conclusion: We described for the first time in a nationwide ambulatory study hepcidin and TfR/logSF distributions in a population of 2 year-old healthy infants with a low ID prevalence. Hepcidin had a right-skewed distribution and its normalisation was not obtained by usual transformations. Low values, partly corresponding to the limit of detection, were over-represented despite the low proportion of ID defined by SF level. High values were also observed despite the exclusion of infants with CRP>10 mg/L. We did not find significant variations according to gender. Our results will help define normal values at this age to better interpret iron status. Disclosures Sacri: Secteur Francais des Aliments de l Enfance: Research Funding; French Ministry of Health DGOS PHRC regional 2014 no. AOR14053: Research Funding. De Montalembert:Bluebird Bio: Membership on an entity's Board of Directors or advisory committees; Addmedica: Consultancy, Honoraria; Novartis: Consultancy, Honoraria. Chalumeau:French Ministry of Health DGOS PHRC regional 2014 no. AOR14053: Research Funding; Secteur Francais des Aliments de l Enfance: Research Funding.

The prevalence of breastfeeding in France is one of the lowest in Europe: 65% of infants born in France in 2010 were breastfed when leaving the maternity ward. Exclusive breastfeeding allows normal growth until at least 6 months of age, and can be prolonged until the age of 2 years or more, provided that complementary feeding is started after 6 months. Breast milk contains hormones, growth factors, cytokines, immunocompetent cells, etc., and has many biological properties. The composition of breast milk is influenced by gestational and postnatal age, as well as by the moment of the feed. Breastfeeding is associated with slightly enhanced performance on tests of cognitive development. Exclusive breastfeeding for at least 3 months is associated with a lower incidence and severity of diarrhoea, otitis media and respiratory infection. Exclusive breastfeeding for at least 4 months is associated with a lower incidence of allergic disease (asthma, atopic dermatitis) during the first 2 to 3 years of life in at-risk infants (infants with at least one first-degree relative presenting with allergy). Breastfeeding is also associated with a lower incidence of obesity during childhood and adolescence, as well as with a lower blood pressure and cholesterolemia in adulthood. However, no beneficial effect of breastfeeding on cardiovascular morbidity and mortality has been shown. Maternal infection with hepatitis B and C virus is not a contraindication to breastfeeding, as opposed to HIV infection and galactosemia. A supplementation with vitamin D and K is necessary in the breastfed infant. Very few medications contraindicate breastfeeding. Premature babies can be breastfed and/or receive mother's milk and/or bank milk, provided they receive energy, protein and mineral supplements. Return to prepregnancy weight is earlier in breastfeeding mothers during the 6 months following delivery. Breastfeeding is also associated with a decreased risk of breast and ovarian cancer in the premenopausal period, and of osteoporosis in the postmenopausal period.

Resume Les recommandations sur la prise en charge des gastro-enterites aigues (GEA) de l’enfant reposent sur la prise systematique de solution de rehydratation orale, une realimentation precoce avec le regime anterieurement suivi, et une absence de traitement medicamenteux systematique. L’objectif principal de cette etude etait d’evaluer les modalites de l’application de ces recommandations par les pediatres liberaux en cas de GEA legere ou moderee. L’objectif secondaire etait d’interroger les pediatres sur leur pratique de la vaccination contre les rotavirus. Methodes Un questionnaire anonyme a ete envoye par voie electronique en juin 2012, a 1187 pediatres liberaux. Resultats Les reponses de 641 pediatres (54 %) ont ete analysees. La quasi-totalite preconisait une realimentation precoce apres la prise de solution de rehydratation. Selon l’âge de l’enfant, 16 a 23 % d’entre eux proposaient un lait sans lactose, et 80 % conseillaient un regime anti-diarrheique apres l’âge de 6 mois. Seuls 18 % des medecins declaraient prescrire jamais ou rarement un medicament. Les medicaments les plus prescrits etaient, par ordre decroissant, le racecadotril, le diosmectite, et les probiotiques. Prescrite parfois ou systematiquement par 90 % des pediatres, la vaccination anti-rotavirus etait en realite moins pratiquee, puisque seulement 65 % des pediatres pensaient vacciner plus de la moitie des enfants. Conclusion Cette etude montre une adhesion variable des pediatres liberaux aux recommandations. Comparativement a une etude similaire faite 10 ans plus tot, un lait sans lactose et des medicaments etaient moins souvent prescrits ; cependant, les modalites de la realimentation diversifiee, apres une prise de solution de rehydratation, etaient souvent eloignees des recommandations. Le vaccin contre les rotavirus, bien que largement prescrit, restait en pratique moins souvent administre.

Resume La denutrition proteino-energetique est l’etat pathologique resultant d’une inadequation entre les besoins et les apports proteino-energetiques. Elle peut entrainer une augmentation de la morbidite voire de la mortalite d’une eventuelle pathologie sous-jacente. Le Comite de nutrition de la Societe francaise de pediatrie recommande de peser et de mesurer tout enfant quel que soit le contexte de visite ou d’hospitalisation. En l’absence d’information sur la cinetique de la croissance, l’indice de masse corporelle (IMC) doit etre calcule et interprete en fonction des courbes de reference figurant dans le carnet de sante. Pour tout IMC inferieur au troisieme percentile pour l’âge et le sexe, il est recommande d’examiner l’enfant a la recherche de signes cliniques de denutrition ou de signes orientant vers son origine et de noter dans le dossier l’evolution de la croissance staturo-ponderale (IMC et taille). Une strategie nutritionnelle integree a la prise en charge globale de l’enfant sera alors etablie. Elle suppose de definir le poids cible et d’adapter les apports proteino-energetiques en termes qualitatif, quantitatif, et de modalites d’administration (orale, enterale, parenterale). Dans tous les cas, cette attitude sera evaluee et adaptee selon l’effet obtenu.

International audience; Vitamin A (retinol) fulfills multiple functions in vision, cell growth and differentiation, embryogenesis, the maintenance of epithelial barriers and immunity. A large number of enzymes, binding proteins and receptors facilitate its intestinal absorption, hepatic storage, secretion, and distribution to target cells. In addition to the preformed retinol of animal origin, some fruits and vegetables are rich in carotenoids with provitamin A precursors such as β-carotene: 6 μg of β-carotene corresponds to 1 μg retinol equivalent (RE). Carotenoids never cause hypervitaminosis A. Determination of liver retinol concentration, the most reliable marker of vitamin A status, cannot be used in practice. Despite its lack of sensitivity and specificity, the concentration of retinol in blood is used to assess vitamin A status. A blood vitamin A concentration below 0.70 μmol/L (200 μg/L) indicates insufficient intake. Levels above 1.05 μmol/L (300 μg/L) indicate an adequate vitamin A status. The recommended dietary intake increases from 250 μg RE/day between 7 and 36 months of age to 750 μg RE/day between 15 and 17 years of age, which is usually adequate in industrialized countries. However, intakes often exceed the recommended intake, or even the upper limit (600 μg/day), in some non-breastfed infants. The new European regulation on infant and follow-on formulas (2015) will likely limit this excessive intake. In some developing countries, vitamin A deficiency is one of the main causes of blindness and remains a major public health problem. The impact of vitamin A deficiency on mortality was not confirmed by the most recent studies. Periodic supplementation with high doses of vitamin A is currently questioned and food diversification, fortification or low-dose regular supplementation seem preferable.; La vitamine A (rétinol) a de multiples fonctions dans la vision, la croissance et la différenciation cellulaires, l’embryogenèse, l’entretien des barrières épithéliales, l’immunité, etc. De nombreux enzymes, protéines de liaison et récepteurs facilitent l’absorption digestive, le stockage hépatique, la sécrétion hépatocytaire et la distribution du rétinol aux cellules cibles. Hors le rétinol préformé d’origine animale, certains légumes et fruits sont riches en caroténoïdes à activité provitaminique A, comme le ß-carotène, dont 6 μg correspondent à 1 équivalent rétinol (ER). Les caroténoïdes n’entraînent jamais d’hypervitaminose A. La concentration hépatique, marqueur fiable du statut, étant, en pratique, inaccessible, on a recours, malgré son manque de sensibilité et de spécificité, à la rétinolémie. Une concentration inférieure à 0,7 μmole/L (200 μg/L) est un indicateur d’apports insuffisants. Une rétinolémie supérieure à 1,05 μmole/L (300 μg/L) reflète un statut satisfaisant. Les apports journaliers conseillés en ER vont de 250 μg à 7–36 mois jusqu’à 750 μg à 15–17 ans et sont satisfaits dans les pays industrialisés. Les apports dépassent les apports conseillés, voire les limites de sécurité (600 μg/j) chez certains nourrissons non allaités. La nouvelle réglementation européenne (2015) sur les préparations pour nourrissons et de suite, et la suppression des suppléments en rétinol non justifiés devraient en principe limiter cet excès d’apport. Dans certains pays en développement, la carence vitaminique A, cause majeure de cécité, reste d’actualité. Son impact sur la mortalité préscolaire n’apparaît plus dans des études récentes ; le recours aux charges semestrielles jusque-là recommandées est controversé, au profit d’une meilleure diversification alimentaire, voire d’aliments enrichis ou d’une supplémentation régulière à faible dose.

Although iron deficiency (ID) is considered the most frequent micronutrient deficiency in industrialized countries and is associated with impaired neurodevelopment when occurring in early years, accurate recent estimations of its prevalence are lacking. Our objective was to estimate ID prevalence and associated sociodemographic markers in young children in France. The Saturn-Inf national cross-sectional hospital-based survey recruited 3,831 French children

New data on food allergy has recently changed the management of children with cow's milk protein allergy (CMPA). The diagnosis of CMPA first requires the elimination of cow's milk proteins and then an oral provocation test following a standard diagnostic procedure for food allergy, without which the elimination diet is unjustified and sometimes harmful. Once the diagnosis is made, the elimination diet is strict, at least until the age of 9-12 months. If the child is not breastfed or the mother cannot or no longer wishes to breastfeed, the first choice is a formula based on extensive hydrolyzate of cow's milk (eHF), provided that its effectiveness has been demonstrated. When eHF fails, a formula based on amino acids is warranted. eHF based on rice protein hydrolysates is an alternative to cow's milk eHF. Infant formulas based on soy protein can be used after the age of 6 months, after verification of good clinical tolerance to soy. Most commonly, CMPA disappears within 2 or 3 years of life. However, the age of recovery varies depending on the child and the type of CMPA, and whether or not it is IgE-mediated, the first being more sustainable. When the child grows, a hospital oral provocation test evaluates the development of tolerance and, if possible, authorizes continuing the reintroduction of milk proteins at home. Some children with CMPA will tolerate only a limited daily amount of cow's milk proteins. The current therapeutic options are designed to accelerate the acquisition of tolerance, which seems facilitated by regular exposure to cow's milk proteins.

Between 1981 and 1996, several interventional studies proved the efficacy of periconceptional folic acid supplementation in the prevention of neural tube closure defects (NTCD), first in women at risk (with a previous case of NTCD) and also in women of the general population in age to become pregnant. The poor observance of this supplementation led several countries (USA, Canada, Chile...) to decide mandatory folic acid fortification of cereals, which permitted a 30% (USA) to 46% (Canada) reduction in the incidence of NTCD. Moreover, this benefit was accompanied by a diminished incidence of several other malformations and of stroke and coronary accidents in elderly people. However, several papers drew attention to an increased risk of colorectal and breast cancer in relation with high blood folate levels and the use of folic acid supplements. A controlled interventional study showed a higher rate of recurrence of colic adenomas and a higher percentage of advanced adenomas in subjects receiving 1mg/day of folic acid. A recent study demonstrated an abrupt reversal of the downward trend in colorectal cancer 1 year after the beginning of cereal folic acid fortification in the USA and Canada. Two studies also reported impaired cognitive functions in elder persons with defective vitamin B(12) status. Taken in aggregate, these studies question the wisdom of a nationwide, mandatory, folic acid fortification of cereals. As of today, despite their limited preventive efficacy, a safe approach is to keep our current French recommendations and to increase the awareness of all caregivers, so as to improve the observance of these recommendations.

Allergic diseases depend on a complex interaction between genetic factors, environmental exposure to allergens and gut microbiota. Allergy results from immune reactions triggered by allergens in the digestive or in the respiratory tract. The frequency and severity of allergy are increasing. Preventive measures derive from mechanisms implicated in the development of allergy. The easiest intervention process is the reduction of the allergenic load. Following birth, the primary prevention strategy relies first on the detection of at-risk newborns, that is, with allergic first degree relatives. In this targeted population, as well as for the general population, exclusive breastfeeding is recommended for 4–6 months. In the absence of breastfeeding, an hydrolyzed formula is suggested for which foods without allergenicity can be used for feeding at-risk newborns. Complementary feeding should not be started before the age of 4–6 months, which seems partially efficacious on early allergy. Probiotics, prebiotics as well as n-3 fatty acids have not yet demonstrated any definitive protective effect.

National audience

Resume Dans le cadre de la declinaison regionale du Programme National Nutrition Sante (PNNS), la Franche-Comte a initie, entre 2002 et 2005, un cycle de conferences pedagogiques destinees a modifier (dans un departement) ou a supprimer (dans les 3 autres) la collation matinale au sein des ecoles maternelles suivant en cela les recommandations nationales. Trente conferences ont ete organisees et pres de 4 000 enseignants ont ete rejoints. Organisee par 99 % des ecoles en 2002, cette collation n’est plus proposee en 2005 que par 59 % d’entre elles avec des differences departementales fortes. Dans les situations de maintien de la collation, le contenu propose a evolue favorablement dans plus de trois ecoles sur quatre. Cette action montre que les modifications de pratiques professionnelles, pourtant tres fortement ancrees, sont possibles et que la « desinstitutionalisation » de ce repas est en cours en Franche-Comte. Cette initiative permet aussi d’insister sur le role majeur de certains plans de sante publique globaux (decline en region) comme le PNNS et sur l’importance d’accompagner la mise en œuvre des textes officiels par un travail d’explication de proximite.

This paper presents practical guidelines for nutrition and feeding of infants and toddlers including vitamin D, vitamin K and fluoride supplementations and preventive measures at risk for food allergy based on family history.

Objective The aim of the present study was to compare the effect of Bifidobacterium animalis subspecies lactis (B lactis) alone or with 90% galacto-oligosaccharide (GOS) and 10% fructo-oligosaccharide (FOS) on infections in infants. Methods In a multicenter trial, healthy, term, newborn infants ages 42 days or younger whose mothers had decided not to breast-feed beyond this age received infant and follow-on formulas containing B lactis (10 colony-forming units/g) + GOS/FOS (0.4 g/100 mL, intention-to-treat, n = 261) or B lactis alone (10⁷ colony-forming units/g, intention-to-treat, n = 267). Investigators accessed computer-generated randomization sequences via a remote server. Infants were exclusively fed formulas until 4 to 6 months of age and along with complementary feeding thereafter up to 12 months. The primary outcome was the mean number of annual infections reported by the investigators. Secondary outcomes were mean gains in anthropometric measurements, frequency of antibiotic use, and occurrence of adverse events based on investigators' records at each visit and gastrointestinal tolerance (daily stool frequency and consistency) and volume of formula intake recorded in 6-day diaries by parents. Results Mean ± standard deviation infection rates in infants followed up to 12 months (full analysis set) were 4.9 ± 3.2 per infant per year in the B lactis + GOS/FOS group (n = 219) and 4.5 ± 3.0 per infant per year in the B lactis group (n = 220; analysis of variance, P = 0.18). Mean daily weight gain was slightly lower in the B lactis + GOS/FOS than the B lactis group (16.1 ± 2.9 vs 16.6 ± 2.6 g/day, P = 0.046), but was not clinically significant. Other outcomes were not significantly different between groups. Conclusions Formulas containing B lactis + GOS/FOS did not reduce infection rates beyond those containing only B lactis.

The diagnosis of cows' milk protein allergy (CMPA) requires first the suspicion of diagnosis based on symptoms described in the medical history, and, second, the elimination of cows' milk proteins (CMP) from the infant's diet. Without such rigorous analysis, the elimination of CMP is unjustified, and sometimes harmful. The elimination diet should be strictly followed, at least until 9–12 months of age. If the child is not breast fed or the mother cannot or no longer wishes to breast feed, the first choice is an extensively hydrolysed formula (eHF) of CMP, the efficacy of which has been demonstrated by scientifically sound studies. If it is not tolerated, an amino acid-based formula is warranted. A rice protein-based eHF can be an alternative to a CMP-based eHF. Soya protein-based infant formulae are also a suitable alternative for infants >6 months, after establishing tolerance to soya protein by clinical challenge. CMPA usually resolves during the first 2–3 years. However, the age of recovery varies depending on the child and the type of CMPA, especially whether it is IgE-mediated or not, with the former being more persistent. Once the child reaches the age of 9–12 months, an oral food challenge is carried out in the hospital ward to assess the development of tolerance and, if possible, to allow for the continued reintroduction of CMP at home. Some children with CMPA will tolerate only a limited daily amount of CMP. The current therapeutic options are designed to accelerate the acquisition of tolerance thereof, which seems to be facilitated by repeated exposure to CMP.

The aims of the present position paper by the Committee on Nutrition of the French Society of Paediatrics were to summarize the recently published data on vitamin D in infants, children and adolescents, i.e., on metabolism, physiological effects, and requirements and to make recommendations on supplementation after careful review of the evidence. Scientific evidence indicates that calcium and vitamin D play key roles in bone health. The current evidence, limited to observational studies, however, does not support other benefits for vitamin D. More targeted research should continue, especially interventional studies. In the absence of any underlying risk of vitamin D deficiency, the recommendations are as follows: pregnant women: a single dose of 80,000 to 100,000 IU at the beginning of the 7th month of pregnancy; breastfed infants: 1000 to 1200 IU/day; children less than 18 months of age, receiving milk supplemented with vitamin D: an additional daily dose of 600 to 800 IU; children less than 18 months of age receiving milk not supplemented with vitamin D: daily dose of 1000 to 1200 IU; children from 18 months to 5 years of age: 2 doses of 80,000 to 100,000 IU every winter (November and February). In the presence of an underlying risk of vitamin D deficiency (dark skin; lack of exposure of the skin to ultraviolet B [UVB] radiation from sunshine in summer; skin disease responsible for decreased exposure of the skin to UVB radiation from sunshine in summer; wearing skin-covering clothes in summer; intestinal malabsorption or maldigestion; cholestasis; renal insufficiency; nephrotic syndrome; drugs [rifampicin; antiepileptic treatment: phenobarbital, phenytoin]; obesity; vegan diet), it may be justified to start vitamin D supplementation in winter in children 5 to 10 years of age as well as to maintain supplementation of vitamin D every 3 months all year long in children 1 to 10 years of age and in adolescents. In some pathological conditions, doses of vitamin D can be increased. If necessary, the determination of 25(OH) vitamin D serum concentration will help determine the level of vitamin D supplementation.

Atherosclerosis begins during childhood. From childhood, a strong relation has been shown between the prevalence and extent of the asymptomatic atherosclerosis lesions and cardiovascular risk factors such as elevation in body mass index, blood pressure and plasma lipid concentrations. These risk factors depend not only on the subjects' genetic predisposition, but also on environmental parameters, particularly diet. The Committee on Nutrition reviewed the scientific basis of dietary recommendations for children that could reduce the risk factors and thereby, reduce the risk of coronary heart disease in later life: the effects of prenatal nutrition; the beneficial consequences of breast-feeding on later levels of cholesterolemia, blood pressure and corpulence; the role of dietary lipids on plasma lipid concentration, of salt and potassium on blood pressure, and of lifestyle on corpulence.

Background: Upper gastrointestinal endoscopy (UGIE) is appropriate in many situations in adults and children. Recommendations for UGIE use in children were published recently by the French-language Paediatric Hepatology, Gastroenterology, and Nutrition Group (GFHGNP). Patients and Methods: We retrospectively reviewed the 293 UGIE procedures undertaken in 251 children between January 1, 2001 and June 30, 2003 by 2 senior endoscopists. The UGIE procedures were categorized as appropriate or inappropriate based on GFHGNP recommendations, and diagnostic efficiency was compared in the 2 groups with the X 2 test followed by multivariate logistic regression analysis. Results: Of the 293 UGIE procedures, 52 (17.7%) were considered inappropriate. Diagnostic efficiency was 51% in the appropriate group versus 17.3% in the inappropriate group (odds ratio, 4.2; 95% CI, 2-8.7; P

Les coliques infantiles sont un probleme courant mais souvent inexplique et multifactoriel. Le but de ce travail etait de determiner les caracteristiques a la naissance des enfants qui presentaient des coliques (Rome III). Les parametres : anthropometriques, terme, rang de fratrie, allaitement, tabagisme, IMC et profession des parents ont ete compares entre 2 populations de nourrissons : 422 controles vs 100 avec coliques. Une regression logistique multiple et une analyse factorielle de correspondance multiple ont ete realisees pour rechercher les caracteristiques liees a la survenue de coliques entre 2 semaines et 3 mois d’âge. Cinq variables (p Ces 5 facteurs n’expliquent cependant que 9% de la variance totale (aire sous la courbe ROC =0,71). Les parametres recueillis a la naissance ne suffisent pas a predire le risque ulterieur de coliques.

Objectifs Evaluer l’effet d’un lait infantile symbiotique par rapport a un lait infantile probiotique sur le nombre d’infections jusqu’a l’âge d’un an, chez le nourrisson ne a terme. Population et Methodes Des nouveau-nes a terme, en bonne sante et non allaites (âge Bifidobacterium lactis (groupe P), soit un lait infantile enrichi en Bifidobacterium lactis et contenant egalement des fructo/galacto-oligosaccharides (FOS/GOS: 10/90, 4 g/L, groupe S). On a denombre les infections dans les deux groupes jusqu’a l’âge d’un an (critere principal). Resultats 568 enfants ont ete inclus (ITT=528 ; 267=groupe P, 261=groupe S). Pendant la 1 re annee de vie, chaque enfant a presente en moyenne 4,4 ± 3,4 infections (NS) dans chacun des 2 groupes dont 0,5 ± 1,0 (groupe P) et 0,6 ± 0,8 (groupe S) infections digestives (NS). Conclusion L’addition de FOS/GOS a un lait infantile enrichi en Bifidobacterium lactis n’a pas d’influence sur la survenue des infections et notamment sur celle des infections digestives au cours de la 1ere annee de vie.

Suite de Sans Domicile Fisc.; International audience