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International audience; In hospitals through Europe and worldwide, the practices regarding hospital diets are very heterogeneous. Hospital diets are rarely prescribed by physicians, and sometimes the choices of diets are based on arbitrary reasons. Often prescriptions are made independently from the evaluation of nutritional status, and without taking into account the nutritional status. Therapeutic diets (low salt, gluten-free, texture and consistency modified, …) are associated with decreased energy delivery (i.e. underfeeding) and increased risk of malnutrition. The European Society for Clinical Nutrition and Metabolism (ESPEN) proposes here evidence-based recommendations regarding the organization of food catering, the prescriptions and indications of diets, as well as monitoring of food intake at hospital, rehabilitation center, and nursing home, all of these by taking into account the patient perspectives. We propose a systematic approach to adapt the hospital food to the nutritional status and potential food allergy or intolerances. Particular conditions such as patients with dysphagia, older patients, gastrointestinal diseases, abdominal surgery, diabetes, and obesity, are discussed to guide the practitioner toward the best evidence based therapy. The terminology of the different useful diets is defined. The general objectives are to increase the awareness of physicians, dietitians, nurses, kitchen managers, and stakeholders towards the pivotal role of hospital food in hospital care, to contribute to patient safety within nutritional care, to improve coverage of nutritional needs by hospital food, and reduce the risk of malnutrition and its related complications.

The aim of this work was to identify dietary patterns based on reduced rank regression (RRR) and principal component analysis (PCA) and to evaluate the association of these patterns with the prevalence of childhood obesity.A sample of 2317 toddlers and preschoolers from Greece (Growth, Exercise and Nutrition Epidemiological Study In preSchoolers) was used. In total, 12 food groups were used as predictors of RRR and PCA. Nutrients such as total fat, simple carbohydrate and fiber intake were used as response variables to apply RRR.One factor/pattern was retained from RRR and PCA in order to ensure the comparability of the methods. The pattern derived from PCA was mainly characterized by consumption of fruits, vegetables, legumes, fish and seafood, grains and oils. This pattern explained 12.5% of the total variation in food groups. On the other hand, the pattern extracted from RRR was mainly characterized by reduced consumption of fruits, vegetables and legumes, and by increased consumption of sweets and red meat. The pattern derived from RRR explained 8.2% of the total variation in food groups. Simple and multiple logistic regression revealed that the pattern extracted from RRR is significantly associated with the prevalence of childhood obesity (OR=1.11, 95% CI: 1.00-1.28 for each unit increase of dietary pattern) as opposed to the pattern derived from PCA.The preferable technique to derive dietary patterns related to childhood obesity seems to be RRR compared with PCA.

Objectives: To investigate the relationship between the angiotensin I-converting enzyme 1 (ACE) I/D polymorphism and adiposity-related phenotypes in a large cohort of toddlers and preschoolers. Methods: Body composition measurements and DNA samples were obtained from 2102 Greek children aged 1–6 years, as part of a large-scale epidemiological study (GENESIS). All children were genotyped for the ACE I/D polymorphism and gender- and age-stratified statistical analyses were performed. Results: In girls aged 4–6 years, the D-allele was associated with higher measurements of body mass index (BMI) (P=0.018), waist (P=0.001) and upper arm (P=0.013) circumferences, genotype accounting for 2.5, 4 and 3% of the phenotypic variance, respectively. In boys, the D-allele showed strong associations with lower BMI (P=0.001) at the age of 1–2 years that explained 17% of the phenotypic variance and with larger suprailiac skinfold (P=0.008) at 3–4 years old that explained 2% of the variance. No other significant associations between the ACE I/D polymorphism and adiposity-related phenotypes were found. In girls, the age at which significant associations were revealed coincided with the age at which BMI was observed to increase after its developmental nadir, but this feature of the association was not observed in boys. Conclusions: The ACE I/D polymorphism is associated with developmental and physiological changes in adiposity-related traits during early childhood in a gender- and age-specific manner.

Objective The current paper aims to describe the characteristics of mothers failing to initiate breast-feeding, provide information on the factors contributing to longer duration of breast-feeding and identify the association of maternal obesity with both initiation and duration of breast-feeding in the Greek population. Design Data from the cross-sectional GENESIS (Growth, Exercise and Nutrition Epidemiological Study In preSchoolers) study were used. Mothers were categorized by their pre-pregnancy BMI and their gestational weight gain according to guidelines from the Institute of Medicine. Setting Preschool children aged 1-5 years in five counties in Greece. Subjects Preschoolers (n 2374) with full maternal anthropometric data before and during pregnancy and breast-feeding data. Results A higher percentage of mothers with increased pre-pregnancy BMI or high gestational weight gain failed to initiate breast-feeding compared with their normal-weight counterparts. Obese mothers were 2.86 times more likely to fail in initiating breast-feeding in a multiple logistic regression model. Multiple linear regression analysis showed that among women initiating breast-feeding, those who were either underweight before pregnancy or smoked at the third trimester of pregnancy breast-fed their children for about 1.5 weeks less than their normal-weight or non-smoking counterparts, respectively. Similarly, multiparous women breast-fed their children for about 7 weeks less than uniparous women. In women who initiated breast-feeding, no significant differences in breast-feeding duration were found between women of different gestational weight gains. Conclusions Mothers with high pre-pregnancy BMI are less likely to initiate breast-feeding while high gestational weight gain has no effect on either the initiation or duration of breast-feeding in Greece.