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Brewerton TD, Dennis K, Wiss DA. Dismantling the myth of "all foods fit" in eating disorder treatment. J Eat Disord 2024; 12:60. [PMID: 38760858 PMCID: PMC11102136 DOI: 10.1186/s40337-024-01017-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Kim Dennis
- SunCloud Health, Chicago, IL, USA
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago, IL, USA
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2
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Yuan X, Tan Y, Bajinka O, Jammeh ML, Dukureh A, Obiegbusi CN, Abdelhalim KA, Mohanad M. The connection between epigenetics and gut microbiota-current perspective. Cell Biochem Funct 2024; 42:e3941. [PMID: 38379252 DOI: 10.1002/cbf.3941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/26/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
Both the epigenetic changes and gut microbiota (GM) have attracted a growing interest in establishing effective diagnostics and potential therapeutic strategies for a number of diseases. These disorders include metabolic, central nervous system-related diseases, autoimmune, and gastrointestinal infections (GI). Despite the number of studies, there is no extensive review that connects the epigenetics modifications and GM as biomarkers that could confer effective diagnostics and confer treatment options. To this end, this review hopes to give detailed information on connecting the modifications in epigenetic and GM. An updated and detailed information on the connection between the epigenetics factors and GM that influence diseases are given. In addition, the review showed some associations between the epigenetics to the maternal GM and offspring health. Finally, the limitations of the concept and prospects into this new emerging discipline were also looked into. Although this review elucidated on the maternal diet and response to offspring health with respect to GM and epigenetic modifications, there still exist various limitations to this newly emerging discipline. In addition to integrating complementary multi-omics data, longitudinal sampling will aid with the identification of functional mechanisms that may serve as therapeutic targets. To this end, this review gave a detailed perspective into harnessing disease diagnostics, prevention and treatment options through epigenetics and GM.
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Affiliation(s)
- Xingxing Yuan
- Department of Gastroenterology, Heilongjiang Academy of Traditional Chinese Medicine, Harbin, China
- Department of First Clinical Medicine, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yurong Tan
- Department of Medical Microbiology, Central South University Changsha, Changsha, China
- Department of Medical Science, School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Ousman Bajinka
- Department of Medical Microbiology, Central South University Changsha, Changsha, China
- Department of Medical Science, School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Modou L Jammeh
- Department of Medical Science, School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Abubakarr Dukureh
- Department of Medical Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chidera N Obiegbusi
- Department of Medical Science, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Khalid A Abdelhalim
- Industrial Research and Development, Izmir Biomedicine and Genome Center, Izmir, Turkiye
| | - Mahmoud Mohanad
- Department of Medical Microbiology, Central South University Changsha, Changsha, China
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3
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Verde L, Barrea L, Bowman-Busato J, Yumuk VD, Colao A, Muscogiuri G. Obesogenic environments as major determinants of a disease: It is time to re-shape our cities. Diabetes Metab Res Rev 2024; 40:e3748. [PMID: 38287716 DOI: 10.1002/dmrr.3748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Obesity rates are increasing in almost all high- and low-income countries, and population-based approaches are necessary to reverse this trend. The current global efforts are focused on identifying the root causes of obesity and developing effective methods for early diagnosis, screening, treatment, and long-term management, both at an individual and health system level. However, there is a relative lack of effective options for early diagnosis, treatment, and long-term management, which means that population-based strategies are also needed. These strategies involve conceptual shifts towards community- and environment-focused approaches. This review aimed to provide evidence on how environmental factors contribute to the risk of obesity and how reshaping cities can help slow down obesity prevalence rates and improve long-term management.
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Affiliation(s)
- Ludovica Verde
- Department of Public Health, University of Naples Federico II, Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Luigi Barrea
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Naples, Italy
- Dipartimento di Scienze Umanistiche, U-niversità Telematica Pegaso, Napoli, Italy
| | | | - Volkan Demirhan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Naples, Italy
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Naples, Italy
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
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Jevitt CM, Ketchum K. Pairing Evidence-Based Strategies With Motivational Interviewing to Support Optimal Nutrition and Weight Gain in Pregnancy. J Perinat Neonatal Nurs 2024; 38:25-36. [PMID: 38278641 DOI: 10.1097/jpn.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Because eating, nutrition, and weight management patterns adopted during pregnancy may persist beyond the postpartum period, pregnancy provides an opportunity for health education that affects the future health of the pregnant person, the fetus, and the family. This systematic review aimed to find nutrition and weight management behaviors that could be used safely during pregnancy to optimize gestational weight gain. METHODS PubMed, MEDLINE, and Web of Science were searched for research or systematic reviews published in English from 2018 to 2023 using terms including gestational weight gain maintenance, weight, management, pregnancy, behavior, strategy, and strategies. Excluded research used pediatric or adolescent populations, restrictive diets such as no carbohydrate or no fat diets, fasting, bariatric surgery, weight loss medications, private industry, or profit-earning programs using food brands or specific diet programs. RESULTS The abstracts reviewed in these areas: excessive gestational weight gain (1019), low-glycemic index diet (640), Mediterranean diet (220), MyPlate diet (2), the Dietary Approaches to Stop Hypertension (DASH) diet (50), portion control (6), home meal preparation (6), mindful eating (13), intuitive eating (10), self-weighing (10), and motivational interviewing during pregnancy (107), were reduced to 102 studies. Studies in those 10 areas were reviewed for nutrition and eating behaviors that are safe to use during pregnancy and could be used along with motivational interviewing. CONCLUSION Clinicians can discuss these behaviors using motivational interviewing techniques to assist clients in optimizing gestational weight gain. Dialogue examples pairing these strategies with motivational interviewing principles are included.
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Affiliation(s)
- Cecilia M Jevitt
- Midwifery Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Harb AA, Shechter A, Koch PA, St-Onge MP. Ultra-processed foods and the development of obesity in adults. Eur J Clin Nutr 2023; 77:619-627. [PMID: 36280730 PMCID: PMC10123172 DOI: 10.1038/s41430-022-01225-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022]
Abstract
Ultra-processed foods (UPF) are ubiquitous in the modern-day food supply and widely consumed. High consumption of these foods has been suggested to contribute to the development of obesity in adults. The purpose of this review is to present and evaluate current literature on the relationship between UPF consumption and adult obesity. Cross-sectional studies (n = 9) among different populations worldwide show a positive association between UPF consumption and obesity. Longitudinal studies (n = 7) further demonstrate a positive association between UPF consumption and development of obesity, suggesting a potential causal influence of UPF consumption on obesity risk. However, only one randomized controlled trial has tested the causality of this association. The study included in this review found greater energy intake and weight gain with consumption of a high UPF diet compared to a high unprocessed food diet. The potential mechanisms by which UPF increase the risk of obesity include increased energy intake due to increased sugar consumption, decreased fiber consumption, and decreased protein density; however, more research is needed. Overall, the evidence identified in the current review consistently support a positive relation between high UPF consumption and obesity. While there is a need for more experimental research to establish causality and elucidate the mechanisms, the sum of the evidence supports a need for research on treatment modalities that include reductions in UPF consumption for the management of adult obesity.
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Affiliation(s)
- Amanda A Harb
- Doctoral Candidate, Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA
| | - Ari Shechter
- Department of Medicine, Columbia University Irving Medical Center, New York, USA
| | - Pamela A Koch
- Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA
| | - Marie-Pierre St-Onge
- Department of Medicine, Columbia University Irving Medical Center, New York, USA.
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Samakidou GE, Koliaki CC, Liberopoulos EN, Katsilambros NL. Non-Classical Aspects of Obesity Pathogenesis and Their Relative Clinical Importance for Obesity Treatment. Healthcare (Basel) 2023; 11:healthcare11091310. [PMID: 37174852 PMCID: PMC10178220 DOI: 10.3390/healthcare11091310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
Obesity is a chronic disease and a major public health problem due to its association with non-communicable diseases and all-cause mortality. An increased energy intake and decreased physical activity have been long recognized as the classical parameters that contribute to the development of obesity. However, several other, non-classical factors have also been associated with obesity through various complex mechanisms. Some of them are diet related, such as diet quality, dietary habits and speed of eating. Other factors are non-dietary, such as endocrine-disrupting chemicals, sleep quality and quantity, psychotropic medications and light at night. The scope of the present narrative review is to address these non-classical factors that are implicated in the pathogenesis of obesity, to clarify their potential role in the management of obesity and, where possible, to provide some practical clinical recommendations.
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Affiliation(s)
- Georgia E Samakidou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Chrysi C Koliaki
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Evangelos N Liberopoulos
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Nikolaos L Katsilambros
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
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Detopoulou P, Dedes V, Syka D, Tzirogiannis K, Panoutsopoulos GI. Relation of Minimally Processed Foods and Ultra-Processed Foods with the Mediterranean Diet Score, Time-Related Meal Patterns and Waist Circumference: Results from a Cross-Sectional Study in University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2806. [PMID: 36833504 PMCID: PMC9957033 DOI: 10.3390/ijerph20042806] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Ultra-processed foods are associated with chronic diseases, cardiometabolic factors and obesity. According to the NOVA system, foods are classified into four categories (from 1 = unprocessed to 4 = ultra-processed foods). The purpose of the present study was to assess the consumption of minimally processed foods (MPF) and ultra-processed foods (UPF) in university students and their relationship with obesity, Mediterranean diet adherence and meal patterns. In total, 346 students (269 women) of the University of Peloponnese participated. A food frequency questionnaire was used, and the MedDietScore was calculated. The % energy contribution of MPF and UPF was calculated. The identification of meal patterns was performed via principal component analysis. Both multivariate regression and Spearman's correlations were used to measure the association of UPF/MPF consumption with anthropometric indices (body mass index, BMI and waist circumference, WC), Mediterranean diet adherence and early/late meal patterns. UPF and MPF provided 40.7 ± 13.6% and 44.3 ± 11.9% (mean ± standard deviation) of energy intake, respectively. In multi-adjusted linear regression models UPF consumption (% energy) was positively associated with WC in men but it was not related to BMI (total sample, men, women). UPF consumption was negatively related to the MedDietScore (Spearman rho = -0.214, p < 0.001) and an "early eating" pattern (Spearman rho = -0.120, p = 0.029) and positively associated with a "late eating" meal pattern (Spearman rho = 0.190, p = 0.001). MPF consumption was positively associated with the MedDietScore (Spearman rho = 0.309, p < 0.001) and an "early eating" pattern (Spearman rho = 0.240, p < 0.001). In conclusion, UPF consumption was positively related to WC in male university students. Nutritional and sociodemographic correlates of UPF consumption, such as low Mediterranean diet adherence and having a "late eating" pattern serve as a basis to better understand the UPF consumption-central obesity relation in young adults and should be considered in nutrition education programs for young adults.
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Affiliation(s)
- Paraskevi Detopoulou
- Department of Clinical Nutrition, General Hospital Korgialenio Benakio, Athanassaki 2, 11526 Athens, Greece
| | - Vassilios Dedes
- Department of Nutritional Science and Dietetics, Faculty of Health Sciences, University of Peloponnese, New Building, Antikalamos, 24100 Kalamata, Greece
| | - Dimitra Syka
- Department of Nutritional Science and Dietetics, Faculty of Health Sciences, University of Peloponnese, New Building, Antikalamos, 24100 Kalamata, Greece
| | | | - Georgios I. Panoutsopoulos
- Department of Nutritional Science and Dietetics, Faculty of Health Sciences, University of Peloponnese, New Building, Antikalamos, 24100 Kalamata, Greece
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Kowalczyk M, Piwowarski JP, Wardaszka A, Średnicka P, Wójcicki M, Juszczuk-Kubiak E. Application of In Vitro Models for Studying the Mechanisms Underlying the Obesogenic Action of Endocrine-Disrupting Chemicals (EDCs) as Food Contaminants-A Review. Int J Mol Sci 2023; 24:ijms24021083. [PMID: 36674599 PMCID: PMC9866663 DOI: 10.3390/ijms24021083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Obesogenic endocrine-disrupting chemicals (EDCs) belong to the group of environmental contaminants, which can adversely affect human health. A growing body of evidence supports that chronic exposure to EDCs can contribute to a rapid increase in obesity among adults and children, especially in wealthy industrialized countries with a high production of widely used industrial chemicals such as plasticizers (bisphenols and phthalates), parabens, flame retardants, and pesticides. The main source of human exposure to obesogenic EDCs is through diet, particularly with the consumption of contaminated food such as meat, fish, fruit, vegetables, milk, and dairy products. EDCs can promote obesity by stimulating adipo- and lipogenesis of target cells such as adipocytes and hepatocytes, disrupting glucose metabolism and insulin secretion, and impacting hormonal appetite/satiety regulation. In vitro models still play an essential role in investigating potential environmental obesogens. The review aimed to provide information on currently available two-dimensional (2D) in vitro animal and human cell models applied for studying the mechanisms of obesogenic action of various industrial chemicals such as food contaminants. The advantages and limitations of in vitro models representing the crucial endocrine tissue (adipose tissue) and organs (liver and pancreas) involved in the etiology of obesity and metabolic diseases, which are applied to evaluate the effects of obesogenic EDCs and their disruption activity, were thoroughly and critically discussed.
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Affiliation(s)
- Monika Kowalczyk
- Laboratory of Biotechnology and Molecular Engineering, Department of Microbiology, Prof. Wacław Dąbrowski Institute of Agricultural and Food Biotechnology—State Research Institute, 02-532 Warsaw, Poland
| | - Jakub P. Piwowarski
- Microbiota Lab, Department of Pharmacognosy and Molecular Basis of Phytotherapy, Medical University of Warsaw, 02-097 Warsaw, Poland
- Correspondence: (J.P.P.); (E.J.-K.)
| | - Artur Wardaszka
- Laboratory of Biotechnology and Molecular Engineering, Department of Microbiology, Prof. Wacław Dąbrowski Institute of Agricultural and Food Biotechnology—State Research Institute, 02-532 Warsaw, Poland
| | - Paulina Średnicka
- Laboratory of Biotechnology and Molecular Engineering, Department of Microbiology, Prof. Wacław Dąbrowski Institute of Agricultural and Food Biotechnology—State Research Institute, 02-532 Warsaw, Poland
| | - Michał Wójcicki
- Laboratory of Biotechnology and Molecular Engineering, Department of Microbiology, Prof. Wacław Dąbrowski Institute of Agricultural and Food Biotechnology—State Research Institute, 02-532 Warsaw, Poland
| | - Edyta Juszczuk-Kubiak
- Laboratory of Biotechnology and Molecular Engineering, Department of Microbiology, Prof. Wacław Dąbrowski Institute of Agricultural and Food Biotechnology—State Research Institute, 02-532 Warsaw, Poland
- Correspondence: (J.P.P.); (E.J.-K.)
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Panera N, Mandato C, Crudele A, Bertrando S, Vajro P, Alisi A. Genetics, epigenetics and transgenerational transmission of obesity in children. Front Endocrinol (Lausanne) 2022; 13:1006008. [PMID: 36452324 PMCID: PMC9704419 DOI: 10.3389/fendo.2022.1006008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
Sedentary lifestyle and consumption of high-calorie foods have caused a relentless increase of overweight and obesity prevalence at all ages. Its presently epidemic proportion is disquieting due to the tight relationship of obesity with metabolic syndrome and several other comorbidities which do call for urgent workarounds. The usual ineffectiveness of present therapies and failure of prevention campaigns triggered overtime a number of research studies which have unveiled some relevant aspects of obesity genetic and epigenetic inheritable profiles. These findings are revealing extremely precious mainly to serve as a likely extra arrow to allow the clinician's bow to achieve still hitherto unmet preventive goals. Evidence now exists that maternal obesity/overnutrition during pregnancy and lactation convincingly appears associated with several disorders in the offspring independently of the transmission of a purely genetic predisposition. Even the pre-conception direct exposure of either father or mother gametes to environmental factors can reprogram the epigenetic architecture of cells. Such phenomena lie behind the transfer of the obesity susceptibility to future generations through a mechanism of epigenetic inheritance. Moreover, a growing number of studies suggests that several environmental factors such as maternal malnutrition, hypoxia, and exposure to excess hormones and endocrine disruptors during pregnancy and the early postnatal period may play critical roles in programming childhood adipose tissue and obesity. A deeper understanding of how inherited genetics and epigenetics may generate an obesogenic environment at pediatric age might strengthen our knowledge about pathogenetic mechanisms and improve the clinical management of patients. Therefore, in this narrative review, we attempt to provide a general overview of the contribution of heritable genetic and epigenetic patterns to the obesity susceptibility in children, placing a particular emphasis on the mother-child dyad.
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Affiliation(s)
- Nadia Panera
- Unit of Molecular Genetics of Complex Phenotypes, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Claudia Mandato
- Pediatrics Section, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Salermo, Italy
- *Correspondence: Anna Alisi, ; Claudia Mandato,
| | - Annalisa Crudele
- Unit of Molecular Genetics of Complex Phenotypes, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Sara Bertrando
- Pediatrics Clinic, San Giovanni di Dio e Ruggi d’Aragona University Hospital, Salerno, Italy
| | - Pietro Vajro
- Pediatrics Section, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Salermo, Italy
| | - Anna Alisi
- Unit of Molecular Genetics of Complex Phenotypes, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- *Correspondence: Anna Alisi, ; Claudia Mandato,
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