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International audience; Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent chronic liver disease that occurs mostly in the context of insulin resistance and obesity. It has rapidly evolved into the most common cause of liver disease among children. The incidence is high in obese children and a greater risk of disease progression is associated with severe obesity, highlighting the role of nutrition. To date, there is no consensus on NAFLD management. This is a narrative review of clinical studies on the potential benefit of nutritional interventions, including lifestyle modifications, vitamins, docosahexaenoic acid, and probiotics in children with NAFLD. The Comit e de nutrition de la Soci et e Française de P ediatrie (CN-SFP) emphasizes the effect of limiting added sugar intake, i.e., fructose or sucrose-containing beverages, and promoting physical activity in the care of NAFLD.

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.

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

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.

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.

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.

Resume Objectifs L’objectif de cette etude etait d’evaluer les symptomes emotionnels (anxieux et depressifs) et de decrire les conduites alimentaires dans une population d’enfants et d’adolescents consultant en pediatrie pour une obesite. L’objectif secondaire etait d’etudier les interactions entre les composantes emotionnelles et alimentaires. Populations et methodes Il s’est agit d’une etude exploratoire transversale a partir de 5 autoquestionnaires evaluant la depression (Child Depression Inventory), l’anxiete (State-Trait Anxiety Inventory for Children), l’hyperphagie boulimique (Child Binge Eating Scale), l’alimentation en reponse a des emotions, a une restriction ou a des facteurs externes (Child Dutch Eating Behaviour Questionnaire, Eating Attitude Test For Children) chez 63 obeses des deux sexes âges de 7 a 15 ans. Resultats Pres de la moitie des sujets presentaient une anxiete significative ; pres d’un tiers des symptomes depressifs au-dela des seuils habituels et 15 % des symptomes severes d’hyperphagie boulimique. L’alimentation en reponse a des emotions et aux stimuli externes etait correlee a l’hyperphagie boulimique et aux symptomes depressifs et anxieux. Les symptomes d’hyperphagie boulimique etaient associes de maniere independante a l’alimentation en reponse a des emotions ainsi qu’au niveau de depression et d’anxiete. Conclusion Manifestations emotionnelles et conduites alimentaires sont fortement intriquees chez les enfants et adolescents obeses consultant en milieu hospitalier. Il est indispensable de reperer les manifestations emotionnelles et les perturbations des conduites alimentaires dans cette population afin de proposer une prise en charge pluridisciplinaire adaptee.

La prevalencia de la obesidad en el adolescente tiende a estabilizarse en los paises industrializados que siguen politicas de salud publica. La contribucion de factores no geneticos es esencial. Por una parte la inactividad fisica creciente y, por otra, el aumento del consumo de alimentos de alta densidad energetica y refrescos contribuyen ampliamente a explicar el fenomeno. Como no existe un contexto psicopatologico particular en los adolescentes obesos, su estigmatizacion contribuye a disminuir su autoestima, lo cual crea un circulo vicioso. Los entornos desfavorecidos estan particularmente afectados. Los tratamientos preventivo y curativo son esencialmente multidisciplinarios.

La prevalenza dell’obesita nell’adolescenza tende a stabilizzarsi nei paesi industrializzati che conducono delle politiche di salute pubblica. La parte svolta dai fattori non genetici e essenziale. L’inattivita fisica crescente da una parte e l’aumento del consumo di alimenti ad alta densita in energia e di bevande zuccherate dall’altra contribuiscono ampiamente a spiegare il fenomeno. Benche non esista un terreno psicopatologico particolare per gli adolescenti obesi, la loro stigmatizzazione contribuisce a ridurre la loro autostima e, quindi, a creare un circolo vizioso. Gli ambienti piu disagiati sono particolarmente colpiti. I trattamenti preventivi e curativi sono, per la loro stessa essenza, pluridisciplinari.

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.

Objective. To help identify and advance the understanding of the potential mechanisms underlying the association between parents' and adolescents' psychological maladjustment in obesity, we evaluated bulimic behaviours and psychopathology in a clinical sample of obese adolescents and in their parents. Methods. This is a cross-sectional cohort study including 115 severely obese, treatment-seeking adolescents aged 12–17 years (mean age: 14.2; mean body mass index z-score: 4.32), and their parents (115 mothers and 96 fathers). Adolescents filled out the Bulimic Investigatory Test, Edinburgh (BITE), the Beck Depression Inventory (BDI), and the State-Trait Anxiety Inventory for Children (STAIC). Their parents completed the General Health Questionnaire (GHQ) and the BITE. A child psychiatrist filled out the Montgomery and Asberg Depression Rating Scale (MADRS) and the Brief Scale for Anxiety (BSA) for the adolescents. Results. Obese adolescents demonstrated significant correlations between the severity of bulimic symptoms and the degree of emotional symptomatology, such as depression and anxiety, but not with the severity of obesity. Psychopathological maladjustment and bulimic symptoms in obese adolescents were significantly associated with the maternal psychopathological disturbances, especially anxiety and somatisation in mother. In fact, maternal psychopathology, not maternal bulimic symptoms, was the factor most strongly associated with bulimic behaviours in obese adolescents. Discussion. These results highlight the importance of including an adolescent and parental psychiatric assessment (bulimic, depressive and anxiety symptoms), particularly maternal psychopathology in the treatment of severely obese adolescents.

La obesidad del nino y del adolescente es un trastorno multifactorial de origen genetico y ambiental que multiplica los riesgos de enfermedades cardiovasculares, ortopedicas y de canceres en la edad adulta. Su diagnostico se basa en una exploracion fisica completa y requiere el trazado de curvas pondoestaturales antes de interpretar las que corresponden al indice de corpulencia. Las obesidades secundarias son inusuales, pero su diagnostico resulta imprescindible. Las complicaciones metabolicas de la obesidad infantil se desarrollan de manera insidiosa. Su tratamiento, multidisciplinario, consiste en modificar los factores individuales que contribuyan a inducir efectos favorables sobre el metabolismo y el peso. La prevencion, que resulta fundamental, se dirige al conjunto de la poblacion que recibe informacion sobre estilos de vida equilibrados y como adquirirlos. De acuerdo con la carta de la Organizacion Mundial de la Salud, trata de proteger a los ninos, que por naturaleza son muy vulnerables a las presiones de su entorno. Parece haberse producido una estabilizacion de la prevalencia en el nino en paises industrializados en los que se ha establecido una politica de prevencion.

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

L'activite physique joue chez les enfants de multiples roles. Elle contribue en effet au developpement psychomoteur et des capacites cardiorespiratoires, a la socialisation, a l'etablissement du rythme veille sommeil et a la regulation de la depense d'energie et de l'appetit. La sedentarite excessive associee a l'obesite aura des consequences precoces de degres divers sur l'ensemble de ces elements. Son impact, durable, est donc loin de se limiter a une diminution de la depense d'energie. Une fois constituee l'obesite, les techniques a mettre en oeuvre pour la reprise ou le maintien des activites physiques et sportives reposent sur une bonne comprehension de la physiologie de l'effort. Favoriser la lipolyse implique de choisir des activites sous maximales, prolongees. L'exces de poids accroit le travail mecanique et ne permet plus de juger de la qualite d'une effort sur les rendement apparent d'un geste. Une collaboration entre les professionnels de sante et de l'education physique est indispensable qu'il s'agisse de monter des programmes de prevention ou de soin de l'obesite.

Preliminary evidence suggests a comorbidity between attention-deficit/hyperactivity disorder (ADHD) and obesity. This study was carried out to identify the clinical characteristics of obese adolescents with a higher probability of ADHD and advance the understanding of the potential factors underlying the comorbidity between obesity and ADHD. We evaluated the association between ADHD symptoms and bulimic behaviors, depressive and anxiety symptoms, degree of obesity, pubertal stage, age and gender in a clinical sample of obese adolescents.Cross-sectional study.Ninety-nine severely obese adolescents aged 12-17 years.Subjects filled out the Bulimic Investigatory Test, Edinburgh, the Beck Depression Inventory and the State-Trait Anxiety Inventory for Children. Their parents completed the Conners Parent Rating Scale, which assesses ADHD symptoms. The degree of overweight was expressed as body mass index-z score. Puberty development was clinically assessed on the basis of Tanner stages.Bulimic behaviors were significantly associated with ADHD symptoms after controlling for depressive and anxiety symptoms. The degree of overweight, pubertal stage, age and gender were not significantly associated with ADHD symptoms.Obese adolescents with bulimic behaviors may have a higher probability to present with ADHD symptoms independently from associated depressive or anxiety symptoms. The degree of overweight, pubertal stage, age and gender might not be useful for detecting obese adolescents with ADHD symptoms. Therefore, we suggest systematic screening for ADHD in obese adolescents with bulimic behaviors. Further studies are needed to understand which specific dimension of ADHD primarily accounts for the association with bulimic behaviors. Future research should also investigate the causal link between bulimic behaviors and ADHD and explore potential common neurobiological alterations. This may lead to a better understanding of the effectiveness of stimulants for the treatment of bulimic behaviors in obese subjects.

OBJECTIVE: To investigate if a multidisciplinary weight loss program in adolescents suffering severe obesity allows adequate growth and development and avoid lean mass loss. DESIGN: A total of 55 adolescents (33 girls and 22 boys) suffering severe obesity were enrolled in an interdisciplinary weight reduction program lasting 6–12 months. Progressive submaximal physical activity was performed and national dietary allowances for adolescents with low levels of physical activity energy were provided. MEASUREMENTS: Total and segmental body composition was assessed by means of dual-energy X-ray absorptiometry. RESULTS: The mean height significantly increased (P

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.

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.

Very early in life, sodium intake correlates with blood pressure level. This warrants limiting the consumption of sodium by children. However, evidence regarding exact sodium requirements in that age range is lacking. This article focuses on the desirable sodium intake according to age as suggested by various groups of experts, on the levels of sodium intake recorded in consumption surveys, and on the public health strategies implemented to reduce salt consumption in the pediatric population. Practical recommendations are given by the Committee on nutrition of the French Society of Pediatrics in order to limit salt intake in children.

Annual cross-sectional studies were performed between 2001 and 2006 in Algeria in order to evaluate the nutritional status and determine the changes in prevalence of categories of nutritional status, according to the International Obesity Task Force (IOTF) criteria for overweight and obesity and Cole's criteria for thinness. A total of 19 263 children aged 6 to 10 years originating from three economically different areas were enrolled in the study. The overall prevalence of thinness decreased from 34.3% (95% CI: 32.4–36.2) to 24.5% (95% CI: 22.6–26.4) (p

Processed baby foods designed for infants (4-12 months) and toddlers (12-36 months) (excluding infant formula, follow-on formula, the so-called growing-up milks, and cereal-based foods for infants), which are referred to as baby foods, are specific products defined by a European regulation (Directive 2006/125/CE). According to this Directive, such foods have a composition adapted to the nutritional needs of children of this age and should comply with specifications related to food safety in terms of ingredients, production processes, and prevention of infectious and toxicological hazards. Hence, they differ from ordinary foods and from non-specific processed foods. This market segment includes the full range of foods that can be part of children's diet: dairy products (dairy desserts, yoghurts, and fresh cheese), sweet products (nondairy desserts, fruit, and drinks), and salty products (soups, vegetable-based foods, meat, fish, and full dishes). This market amounted to 89,666 MT in France in 2011 and 83,055 MT in 2010 (a total of 325,524 MT in the 27 countries of the European Union in 2010, including 90,438 MT in Germany, 49,144 MT in Spain, and 40,438 MT in Italy). The consumption of baby foods in France varies with infant age and parental choice. Baby foods account for 7 % of total energy intake at 4-5 months, 28 % at 6-7 months, 27 % at 8-11 months, 17 % at 1-17 months, and 11 % at 18-24 months. Among parents, 24 % never offer their children any baby foods, 13 % do so 1-3 days/week and 63 % 4-7 days/week. Among consumers, 55 % of children eat more than 250 g/day of baby foods. As baby foods only account for a minor fraction of overall food intake, their impact on the quality of young children's diet is much less than that of growing-up milks, particularly for preventing insufficient iron and vitamin D intake. Their consumption, however, has an indirect benefit on the nutritional quality of the diet and on food safety, particularly regarding toxicological hazards, as it postpones the introduction of non-specific processed foods, which are inadequate for this age group owing to both their nutritional composition and lower food safety control. Baby foods represent a family of products meeting parents' expectations and adapted to infants and young children. They are clearly beneficial in terms of food safety, but the nutritional benefit to be expected from their consumption is minimal: their main advantage is postponing or decreasing the consumption of non-specific industrially processed foods.

Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. It has a functional and structural impact and increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Pediatric Society recommends weighing and measuring any child when hospitalized or seen in consultation. The body mass index (BMI) must be calculated and analyzed according to references any time growth kinetics cannot be analyzed. Any child with a BMI below the third centile or -2 standard deviations for age and sex needs to be examined looking for clinical signs of malnutrition and signs orienting toward an etiology and requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing up a nutritional strategy along with the overall care plan. A target weight needs to be determined as well as the quantitative and qualitative nutritional care including its implementation. This plan must be evaluated afterwards in order to adapt the nutritional therapy.

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.

The main objective was to assess emotional symptoms (anxiety and depression) and to describe eating behaviours in a population of children and adolescents consulting for obesity. The second objective was to examine the interactions between these parameters.A cross-sectional exploratory study in obese children and adolescents was conducted using self-report questionnaires for depression (Child Depression Inventory), anxiety (State-Trait Anxiety Inventory for Children), binge eating (Binge Eating Scale adapted for children), emotional, external, and restrained eating (Dutch Eating Behaviour Questionnaire adapted for children) in obese children and adolescents, from both sexes, aged 7-15 years old.Fourty-one children and 22 adolescents were assessed, two-third were female, the mean age was 11 years ± 2.3 and the mean BMI z-score was 4.2 ± 0.9. Nearly half had significant anxiety, nearly one-third had depressive symptoms, and 15% had severe binge eating symptoms. Girls reported more anxiety than boys. Emotional and external eating, binge eating, and emotional symptoms were strongly associated. Binge eating was independently associated with emotional eating, depression, and anxiety (r=0.86, P0.001).Emotional eating and emotional symptoms were strongly associated in the child and adolescent overweight population in these out-patient pediatric departments.Emotional symptoms and eating behavior assessments are needed in overweight children and adolescents in order to implement multidisciplinary treatment.

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.

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.

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.