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Borsani B, Biganzoli G, Penagini F, Bosetti A, Pendezza E, Perico V, Biganzoli E, Verduci E, Zuccotti GV. Resting energy expenditure in children and adolescents with cerebral palsy: accuracy of available prediction formulas and development of population-specific methods. Front Pediatr 2023; 11:1097152. [PMID: 37681200 PMCID: PMC10481865 DOI: 10.3389/fped.2023.1097152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 07/26/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Energy requirements are difficult to estimate in children with cerebral palsy (CP). Resting energy expenditure (REE), necessary to implement personalized nutritional interventions, is most commonly estimated using prediction formulae since indirect calorimetry, the reference method, is not available in all nutrition units. The aims of the present study were: (1) to evaluate the accuracy of the most commonly used REE prediction formulae developed for healthy children, in children with CP; (2) to assess the accuracy of the REE population-specific formula for CP children proposed in our preliminary report; (3) to develop new population-specific methods. Methods REE was measured by indirect calorimetry in 100 children and adolescents with spastic quadriplegic cerebral palsy (SQCP) and estimated on the basis of predictive formulas selected by the clinicians [World Health Organization (WHO), Harris-Benedict, Schofield weight, Schofield weight & height, Oxford, Mifflin formulae and a population-specific formula for CP children developed in our preliminary report]. Results 100 children with SQCP (35 girls, 35%) classified as level V according to gross motor function classification system (GMFCS-V); 64% with oral nutrition, 29% total enteral nutrition (nasogastric tube feeding, percutaneous endoscopic gastrostomy, percutaneous endoscopic transgastric jejunostomy) and 7% mixed nutrition. The median (IQR) REE was 41.96 (17.5) kcal/kg/day.Statistical analysis highlighted a proportional bias between the indirect calorimetry and all considered predictive formulae for REE determination. By studying the relationship between the bias and the mean values of REE, specific conversion equations were obtained. With a pre-specified model having as predictors the variable weight and the variable Triceps Skinfold (TSF) and, as response the variable REE measured by indirect calorimetry, a predictive nomogram was developed to estimate the REE in this population of children. Conclusions We suggest using predictive formulae for healthy children with caution, and where possible carrying out indirect calorimetry to assess REE in children with CP. However, we propose a new tool which could be developed to become an additional help for assessment of REE in the clinical practice.Future objectives will be to obtain a larger sample size, in a multicenter perspective study, to build a specific predictive model for the REE of the studied population.
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Affiliation(s)
- Barbara Borsani
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Giacomo Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Francesca Penagini
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Alessandra Bosetti
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Veronica Perico
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
| | - Elvira Verduci
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
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D'Auria E, Pendezza E, Leone A, Riccaboni F, Bosetti A, Borsani B, Zuccotti G, Bertoli S. Nutrient intake in school-aged children with food allergies: a case-control study. Int J Food Sci Nutr 2022; 73:349-356. [PMID: 34503383 DOI: 10.1080/09637486.2021.1975658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Most studies assessed nutrient intake of young children with food allergy (FA) compared to healthy children. We aimed to compare macro- and micronutrient intake of school-aged children with FA to non-allergic children. This case-control study included 93 Italian children (52 with FA and 41 controls, median age 7.5 and 8.3 years, respectively). Macro- and micronutrient intake was assessed by a three-day food dietary record. Anthropometric measurements were also collected. The median height z-score was significantly lower in the FA group, despite a similar daily energy and protein intake. Calcium, iron and vitamin D intake was suboptimal in both groups, while protein intake was higher than recommended in both groups. Unexpectedly, children with FA consume more protein than controls, while having lower micronutrient intake, especially calcium. Our data suggest the importance of nutritional counseling for children with FA to ensure a balanced nutrient intake while on elimination diet.
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Affiliation(s)
- Enza D'Auria
- Pediatric Department, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Erica Pendezza
- Pediatric Department, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Alessandro Leone
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), Università di Milano, Milan, Italy
| | - Francesca Riccaboni
- Pediatric Department, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Alessandra Bosetti
- Pediatric Department, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Barbara Borsani
- Pediatric Department, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - GianVincenzo Zuccotti
- Pediatric Department, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Simona Bertoli
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), Università di Milano, Milan, Italy
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Calcaterra V, Verduci E, Vandoni M, Rossi V, Di Profio E, Carnevale Pellino V, Tranfaglia V, Pascuzzi MC, Borsani B, Bosetti A, Zuccotti G. Telehealth: A Useful Tool for the Management of Nutrition and Exercise Programs in Pediatric Obesity in the COVID-19 Era. Nutrients 2021; 13:3689. [PMID: 34835945 PMCID: PMC8618189 DOI: 10.3390/nu13113689] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/18/2022] Open
Abstract
The COVID-19 pandemic has led to the implementation of policies that mandate various restrictions on daily life, including social distancing, the closure of public services and schools, and movement limitations. Even though these restrictive measures decreased the COVID-19 spread, they may have detrimental effects on various lifestyle components such as physical inactivity, sedentary behavior, and dietary habits, influencing the maintenance of weight and contributing to obesity among children and adolescents. The coexistence of childhood obesity and COVID-19 and changes in the bioecological environment have put children and adolescents at increased risk for developing obesity and exacerbating the severity of this disorder. The use of telehealth technology is a modern approach useful for the delivery of health care services by health care professionals, where distance is a critical factor. Telehealth is effective in promoting increased self-monitoring and behavioral change, and provides the opportunity to perform online nutritional support and exercise training programs to promote a healthy lifestyle and reduce sedentary behaviors in children and adolescents. Telehealth, including tele-exercise and tele-nutrition, has the potential to address many of the key challenges in providing health services, including in patients with obesity during the COVID-19 outbreak. This narrative review aims to describe the role of telehealth as an opportunity in the management of pediatric obesity in the COVID-19 era, and to deliver nutrition and exercise programs for the maintenance of health.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (V.R.); (E.D.P.); (V.T.); (M.C.P.); (B.B.); (A.B.); (G.Z.)
| | - Elvira Verduci
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (V.R.); (E.D.P.); (V.T.); (M.C.P.); (B.B.); (A.B.); (G.Z.)
- Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy; (M.V.); (V.C.P.)
| | - Virginia Rossi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (V.R.); (E.D.P.); (V.T.); (M.C.P.); (B.B.); (A.B.); (G.Z.)
| | - Elisabetta Di Profio
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (V.R.); (E.D.P.); (V.T.); (M.C.P.); (B.B.); (A.B.); (G.Z.)
| | - Vittoria Carnevale Pellino
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy; (M.V.); (V.C.P.)
| | - Valeria Tranfaglia
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (V.R.); (E.D.P.); (V.T.); (M.C.P.); (B.B.); (A.B.); (G.Z.)
| | - Martina Chiara Pascuzzi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (V.R.); (E.D.P.); (V.T.); (M.C.P.); (B.B.); (A.B.); (G.Z.)
| | - Barbara Borsani
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (V.R.); (E.D.P.); (V.T.); (M.C.P.); (B.B.); (A.B.); (G.Z.)
| | - Alessandra Bosetti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (V.R.); (E.D.P.); (V.T.); (M.C.P.); (B.B.); (A.B.); (G.Z.)
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (V.R.); (E.D.P.); (V.T.); (M.C.P.); (B.B.); (A.B.); (G.Z.)
- Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, 20157 Milan, Italy
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Penagini F, Leone A, Borsani B, Bosetti A, Dilillo D, Rendo G, Calcaterra V, Bertoli S, Mora S, Battezzati A, Bedogni G, Zuccotti GV. Predictive Fat Mass Equations for Children With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2021; 73:e98-e104. [PMID: 34091539 PMCID: PMC10237347 DOI: 10.1097/mpg.0000000000003188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/17/2021] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Evaluate accuracy of skinfold thicknesses and body mass index (BMI) for the prediction of fat mass percentage (FM%) in paediatric inflammatory bowel disease (IBD) and to develop population-specific formulae based on anthropometry for estimation of FM%. METHODS IBD children (n = 30) and healthy controls (HCs, n = 144) underwent anthropometric evaluation and dual-energy X-ray absorptiometry (DEXA) scan, as the clinical reference for measurement of body composition. Body FM% estimated with skinfolds thickness was compared with FM% measured with DEXA. By means of 4 prediction models, population specific formulae for estimation of FM% were developed. RESULTS No significant difference in terms of FM% measured by DEXA was found between IBD population and HCs (FM% 29.6% vs 32.2%, P = 0.108). Triceps skinfold thickness (TSF, Model 2) was better than BMI (Model 1) at predicting FM% (82% vs 68% of variance). The sum of 2 skinfolds (biceps + triceps; SF2, Model 3) showed an improvement in the prediction of FM% as compared with TSF, Model 2 (86% vs 82% of variance). The sum of 4 skinfolds (biceps + triceps + suprailiac + subscapular; Model 4) showed further improvement in the prediction of FM% as compared with SF2 (88% vs 86% of variance). CONCLUSIONS The sum of 4 skinfolds is the most accurate in predicting FM% in paediatric IBD. The sum of 2 skinfolds is less accurate but more feasible and less prone to error. The newly developed population-specific formulae could be a valid tool for estimation of body composition in IBD population and an alternative to DEXA measurement.
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Affiliation(s)
| | - Alessandro Leone
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences
| | - Barbara Borsani
- Department of Pediatrics, “V. Buzzi” Children's Hospital, University of Milan, Milan
| | - Alessandra Bosetti
- Department of Pediatrics, “V. Buzzi” Children's Hospital, University of Milan, Milan
| | - Dario Dilillo
- Department of Pediatrics, “V. Buzzi” Children's Hospital, University of Milan, Milan
| | - Giulia Rendo
- Department of Pediatrics, “V. Buzzi” Children's Hospital, University of Milan, Milan
| | - Valeria Calcaterra
- Department of Pediatrics, “V. Buzzi” Children's Hospital, University of Milan, Milan
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia
| | - Simona Bertoli
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences
| | - Stefano Mora
- Pediatric Bone Densitometry Service and Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Institute, Milan
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy
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Verduci E, D'Auria E, Bosetti A, DI Profio E, Vizzuso S, Milanta C, Pendezza E, Borsani B, Zuccotti GV. Immunomodulatory diet in pediatric age. Minerva Pediatr (Torino) 2021; 73:128-149. [PMID: 33880904 DOI: 10.23736/s2724-5276.21.06214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In the last few decades, the importance of a functioning immune system and health status has become more evident. Multiple factors are able to influence the development of chronic diseases and diet is one of the most important environmental factors. Evidence demonstrates that dietary patterns high in fat and low in fiber are associated with the development of non-communicable diseases. Moreover, optimal nutritional status can modulate immune maturation and response to inflammation. During inflammatory conditions, nutritional deficiencies may occur, establishing a vicious circle, consequently a balanced nutritional status is essential to prevent and counteract infections. Dietary diversity can prevent allergic diseases and nutrients such as DHA, arginine, vitamins and trace elements have an impact on physical barriers (such as gut mucosal barrier and skin), on the immune system response and on microbiome modulation. Protein deficiencies can compromise innate and adaptive immune functions; arginine availability can affect the immune response in injured states and other disease processes; EPA and DHA can modulate both innate and adaptive immunity; prebiotics have a beneficial effect on the functioning of the immune system. Zinc, copper, selenium and iron are involved in the correct development and function of the immune system. Vitamins D, E, A, B and C have a role on immune system through different mechanisms of action. Since a complex interplay exists between diet, microbiome and epigenetic factors which determine nutrient-induced changes on the immune function, the effect of each single nutrient may be difficult to study. Well-designed intervention studies, investigating the effects of whole dietary pattern, should be performed to clarify impact of foods on the immune function and disease risk.
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Affiliation(s)
- Elvira Verduci
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy - .,Department of Health Science, University of Milan, Milan, Italy -
| | - Enza D'Auria
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy.,Department of Health Science, University of Milan, Milan, Italy
| | | | | | - Sara Vizzuso
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
| | - Chiara Milanta
- Department of Health Science, University of Milan, Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
| | - Barbara Borsani
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
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Pelizzo G, Destro F, Selvaggio GGO, Maestri L, Roveri M, Bosetti A, Borsani B, Pendezza E, Meroni M, Pansini A, La Pergola E, Riccipetitoni G, De Silvestri A, Cena H, Calcaterra V. Esophageal Atresia: Nutritional Status and Energy Metabolism to Maximize Growth Outcome. Children (Basel) 2020; 7:children7110228. [PMID: 33202530 PMCID: PMC7696161 DOI: 10.3390/children7110228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term negative sequelae of esophageal atresia (EA) may induce poor growth and impaired nutritional status in childhood. We describe the nutritional profile and energy metabolism of children with repaired EA to identify malnutrition risk factors and optimize growth management. METHODS Twenty-one children (>4 years) were included, and anthropometric measurements, nutritional assessment, and energy metabolism were considered. The subjects were defined as undernourished if they met BMI < -2 standard deviation (SD). To grade undernutrition, we defined the prevalence of underweight, stunting, and wasting (cut-off level of <-2 SD). Medical records were reviewed for the type of EA and surgery and perinatal data. RESULTS Malnutrition was detected in 28.6% of children. Underweight was detected in 23.8% of patients (all with undernutrition p < 0.01). Wasting was noted in 28.6% of patients, of these 5 children were undernourished (p < 0.001) and stunting was noticed in only one patient with malnutrition (p = 0.5). Resting expenditure energy (REE) was lower in undernourished subjects compared to subjects with adequate nutritional status (p < 0.001). Malnutrition was associated to: type of EA (p = 0.003, particularly type A and C); intervention including deferred anastomosis due to long-gap repair (p = 0.04) with/or without jejunostomy (p = 0.02), gastric pull-up (p = 0.04), primary anastomosis (p = 0.04), pyloromyotomy in long-gap (p < 0.01); small for gestational age condition (p = 0.001). CONCLUSIONS undernutrition risk factors, beyond the type of malformation, surgery, and perinatal factors, must be early considered to personalize nutritional programming. Energy metabolism is important to monitor the nutritional requirements. The management of nutritional issues is surely a contributory factor able to counteract the poor growth of children with EA.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milano, 20157 Milano, Italy
- Correspondence:
| | - Francesca Destro
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | - Giorgio Giuseppe Orlando Selvaggio
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | - Luciano Maestri
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | - Margherita Roveri
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | - Alessandra Bosetti
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (A.B.); (B.B.); (E.P.); (V.C.)
| | - Barbara Borsani
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (A.B.); (B.B.); (E.P.); (V.C.)
| | - Erica Pendezza
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (A.B.); (B.B.); (E.P.); (V.C.)
| | - Milena Meroni
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | - Andrea Pansini
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | - Enrico La Pergola
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | | | - Annalisa De Silvestri
- Clinical Epidemiology & Biometry, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy;
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy
| | - Valeria Calcaterra
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (A.B.); (B.B.); (E.P.); (V.C.)
- Pediatric and Adolescent Unit. Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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D’Auria E, Borsani B, Pendezza E, Bosetti A, Paradiso L, Zuccotti GV, Verduci E. Complementary Feeding: Pitfalls for Health Outcomes. Int J Environ Res Public Health 2020; 17:ijerph17217931. [PMID: 33137971 PMCID: PMC7662522 DOI: 10.3390/ijerph17217931] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022]
Abstract
The term complementary feeding is defined as the period in which a progressive reduction of breastfeeding or infant-formula feeding takes place, while the infant is gradually introduced to solid foods. It is a crucial time in the infant's life, not only because of the rapid changes in nutritional requirements and the consequent impact on infant growth and development, but also for a generation of lifelong flavor preferences and dietary habits that will influence mid and long-term health. There is an increasing body of evidence addressing the pivotal role of nutrition, especially during the early stages of life, and its link to the onset of chronic non-communicable diseases, such as obesity, hypertension, diabetes, and allergic diseases. It is clear that the way in which a child is introduced to complementary foods may have effects on the individual's entire life. The aim of this review is to discuss the effects of complementary feeding timing, composition, and mode on mid and long-term health outcomes, in the light of the current evidence. Furthermore, we suggest practical tips for a healthy approach to complementary feeding, aiming at a healthy future, and highlight gaps to be filled.
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Penagini F, Borsani B, Maruca K, Giosia V, Bova S, Mastrangelo M, Zuccotti GV, Mora S. Short-Term Vitamin D3 Supplementation in Children with Neurodisabilities: Comparison of Two Delivery Methods. Horm Res Paediatr 2018; 88:281-284. [PMID: 28898870 DOI: 10.1159/000479690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/19/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Vitamin D deficiency is common in children with neurodisabilities. Oral vitamin D3 may not be absorbed appropriately due to dysphagia and tube feeding. The aim of this study was to compare efficacy of vitamin D3 buccal spray with that of oral drops. METHODS Twenty-four children with neurodisabilities (5-17 years) and vitamin D deficiency (25(OH)D ≤20 ng/mL) were randomized to receive vitamin D3 buccal spray 800 IU/daily (n = 12) or oral drops 750 IU/daily (n = 12) for 3 months during winter. RESULTS Both groups had a significant increase in 25(OH)D (z = 150; p < 0.0001). The differences between baseline and final parathyroid hormone measurements did not reach significance in both groups. Markers of bone formation and resorption did not change significantly in both groups. The satisfaction with the formulation was significantly higher in the patients using spray. CONCLUSION Vitamin D3 supplementation with buccal spray and oral drops are equally effective in short-term treatment of vitamin D deficiency in children with neurodisabilities. Buccal spray may be more acceptable by the patients.
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Affiliation(s)
- Francesca Penagini
- Department of Pediatrics, University of Milan, "V. Buzzi" Children's Hospital, Milan, Italy
| | - Barbara Borsani
- Department of Pediatrics, University of Milan, "V. Buzzi" Children's Hospital, Milan, Italy
| | - Katia Maruca
- Laboratory of Pediatric Endocrinology, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Giosia
- Department of Pediatrics, University of Milan, "V. Buzzi" Children's Hospital, Milan, Italy
| | - Stefania Bova
- Pediatric Neurology Unit, "V. Buzzi" Children's Hospital, Milan, Italy
| | | | - Gian Vincenzo Zuccotti
- Department of Pediatrics, University of Milan, "V. Buzzi" Children's Hospital, Milan, Italy
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Penagini F, Borsani B, Bosetti A, Mameli C, Dilillo D, Ramponi G, Motta F, Bedogni G, Zuccotti GV. Resting energy expenditure in children with cerebral palsy: Accuracy of available prediction formulae and development of a population-specific formula. Clin Nutr ESPEN 2018; 25:44-49. [PMID: 29779817 DOI: 10.1016/j.clnesp.2018.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/18/2018] [Accepted: 04/03/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Energy requirements are difficult to estimate in children with cerebral palsy (CP). Resting energy expenditure (REE), necessary for personalized nutritional intervention, is most commonly estimated using prediction formulae because the reference method, i.e. indirect calorimetry (IC), is not available in all Nutrition Units. The main aim of the present study was to evaluate the accuracy of the most commonly used REE prediction formulae in children with CP. The secondary aim was to develop a new population-specific formula for the estimation of REE in children with CP. METHODS REE was measured by IC in 54 children and adolescents with spastic quadriplegic cerebral palsy (SQCP) and estimated from the five most commonly used prediction formulae, i.e. the World Health Organization (WHO), Harris-Benedict, Schofield weight, Schofield weight & height, and Oxford formulae. RESULTS The mean (standard deviation, SD) difference between the estimated and measured REE was 64 (238) kcal/day for the WHO formula, 79 (226) kcal/day for the Schofield weight formula, 79 (223) kcal/day for the Schofield weight and height formula, 55 (226) kcal/day for the Oxford formula, 37 (224) kcal/day for the Harris-Benedict formula and 0 (213) kcal/day for the purposely developed population-specific formula. Owing to the large SD of the bias, none of these formulae can be reliably applied at the individual level to estimate REE. CONCLUSIONS The most commonly used REE prediction formulas are inaccurate at both the population and individual level in children with SQCP. A purposely developed population-specific formula, despite being accurate at the population level, does not perform better than the most commonly used REE formulae at the individual level.
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Affiliation(s)
- Francesca Penagini
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Barbara Borsani
- Pediatric Nutrition Unit, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Alessandra Bosetti
- Pediatric Nutrition Unit, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Chiara Mameli
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Dario Dilillo
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Giulia Ramponi
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Francesco Motta
- Pediatric Orthopedic Unit, "V. Buzzi" Children's Hospital, Via Castelvetro 32, 20154 Milan, Italy
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Building Q, AREA Science Park, Strada Statale 14 km 163.5, 34012, Basovizza, Trieste, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
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10
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Mameli C, Brunetti D, Colombo V, Bedogni G, Schneider L, Penagini F, Borsani B, Zuccotti GV. Combined use of a wristband and a smartphone to reduce body weight in obese children: randomized controlled trial. Pediatr Obes 2018; 13:81-87. [PMID: 27900849 DOI: 10.1111/ijpo.12201] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 09/10/2016] [Accepted: 10/17/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Technological instruments may help control paediatric obesity. OBJECTIVE We tested whether a personalized programme based on the energy expenditure obtained from a wristband (WB) and the energy intake obtained from a smartphone application (APP) is superior to a standard approach at promoting weight loss. METHODS We performed a randomized controlled trial in obese children aged 10-17 years. The experimental (EXP) and control (CTR) groups were given a low-energy diet and a prescription for physical activity. The EXP group was equipped with a WB and an APP and given personalized feedback every 7 days. The main outcome was weight loss at 3 months. RESULTS The mean (standard deviation) z-score of body mass index at the enrollment was 2.20 (0.47) in the EXP (n = 16 out of 23) and 2.09 (0.34) in the CTR group (n = 14 out of 20) of children who completed the trial. The mean (95%CI) difference in weight loss at 3 months was 0.07 kg (95%CI: 2.81 to 2.96) for EXP vs. the CTR. CONCLUSION A personalized lifestyle programme based on a WB and an APP was not superior to a standard lifestyle programme at promoting weight loss in obese children.
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Affiliation(s)
- C Mameli
- Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
| | - D Brunetti
- Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
| | - V Colombo
- Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
| | - G Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy
| | - L Schneider
- Department of Pediatrics, Luigi Sacco Hospital, Milan, Italy
| | - F Penagini
- Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
| | - B Borsani
- Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
| | - G V Zuccotti
- Department of Pediatrics, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy
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Penagini F, Abbattista L, Borsani B, Ramponi G, D’Auria E, Zuccotti GV. Iron deficiency and iron deficiency anemia in children aged 6–36 months: Is there room for improvement of screening, prophylaxis and treatment? Pharmacol Res 2018; 128:61-62. [DOI: 10.1016/j.phrs.2017.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
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Mameli C, Krakauer NY, Krakauer JC, Bosetti A, Ferrari CM, Moiana N, Schneider L, Borsani B, Genoni T, Zuccotti G. The association between a body shape index and cardiovascular risk in overweight and obese children and adolescents. PLoS One 2018; 13:e0190426. [PMID: 29298340 PMCID: PMC5752028 DOI: 10.1371/journal.pone.0190426] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 12/14/2017] [Indexed: 12/28/2022] Open
Abstract
A Body Shape Index (ABSI) and normalized hip circumference (Hip Index, HI) have been recently shown to be strong risk factors for mortality and for cardiovascular disease in adults. We conducted an observational cross-sectional study to evaluate the relationship between ABSI, HI and cardiometabolic risk factors and obesity-related comorbidities in overweight and obese children and adolescents aged 2–18 years. We performed multivariate linear and logistic regression analyses with BMI, ABSI, and HI age and sex normalized z scores as predictors to examine the association with cardiometabolic risk markers (systolic and diastolic blood pressure, fasting glucose and insulin, total cholesterol and its components, transaminases, fat mass % detected by bioelectrical impedance analysis) and obesity-related conditions (including hepatic steatosis and metabolic syndrome). We recruited 217 patients (114 males), mean age 11.3 years. Multivariate linear regression showed a significant association of ABSI z score with 10 out of 15 risk markers expressed as continuous variables, while BMI z score showed a significant correlation with 9 and HI only with 1. In multivariate logistic regression to predict occurrence of obesity-related conditions and above-threshold values of risk factors, BMI z score was significantly correlated to 7 out of 12, ABSI to 5, and HI to 1. Overall, ABSI is an independent anthropometric index that was significantly associated with cardiometabolic risk markers in a pediatric population affected by overweight and obesity.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V. Buzzi Children’s Hospital, University of Milan, Milan, Italy
- * E-mail:
| | - Nir Y. Krakauer
- Department of Civil Engineering, The City College of New York, New York, NY, United States of America
| | - Jesse C. Krakauer
- Metro Detroit Diabetes and Endocrinology, Southfield, MI, United States of America
| | - Alessandra Bosetti
- Department of Pediatrics, V. Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Chiara Matilde Ferrari
- Department of Pediatrics, V. Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Norma Moiana
- Department of Pediatrics, V. Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Laura Schneider
- Department of Pediatrics, V. Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Barbara Borsani
- Department of Pediatrics, V. Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Teresa Genoni
- Department of Pediatrics, V. Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children’s Hospital, University of Milan, Milan, Italy
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13
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Mameli C, Krakauer JC, Krakauer NY, Bosetti A, Ferrari CM, Schneider L, Borsani B, Arrigoni S, Pendezza E, Zuccotti GV. Effects of a multidisciplinary weight loss intervention in overweight and obese children and adolescents: 11 years of experience. PLoS One 2017; 12:e0181095. [PMID: 28704494 PMCID: PMC5509286 DOI: 10.1371/journal.pone.0181095] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/26/2017] [Indexed: 01/29/2023] Open
Abstract
AIMS To evaluate the effects of an outpatient multidisciplinary weight loss intervention in reducing body mass index (BMI) in children and adolescents suffering overweight and obesity, changes in A Body Shape Index (ABSI, waist circumference normalized to height and weight) and Hip Index (HI, normalized hip circumference) during treatment and correlation between the ABSI and HI with change in BMI z score. METHODS We analyze anthropometric data from pediatric patients affected by overweight and obesity aged 2 to 18 years old who entered our multidisciplinary weight loss intervention, which included medical, psychological and nutritional sessions, from January 1st 2006 to December 31st 2016. Lifestyle modification counselling was delivered. Follow-up visits were planned every month for 3 months and subsequently every 2-4 months. BMI, ABSI, and HI were converted to z scores using age and sex specific population normals. RESULTS 864 patients entered our intervention. 453 patients (208 males), mean age 11.2 ±3.1 years, 392 with obesity (86%, z-BMI 2.90 ±0.80 SD) and 61 patients with overweight (z-BMI 1.73±0.21 SD) attended at least 1 follow-up visit. The mean number of visits was 3.5 (± 1.8 SD) in overweight subjects and 3.9 (±2.2 SD) in ones with obesity. At the last attended follow-up visit (at 16 ± 12 months SD) we observed a reduction in mean z-BMI in patients with obesity (to 2.52 ±0.71 SD) and patients with overweight (to 1.46 ±0.5 SD). Most patients (80.8%) reduced their BMI z scores. Mean ABSI and HI z scores showed no significant change. 78/392 patients (19.8%) recovered from obese to overweight, 5/392 (1.2%) from obese to normal weight. The recovery rate from overweight to normal weight was 13.1%. In a multivariate model, initial BMI z score and number of follow-up visits were significant predictors of weight change, while age, sex, ABSI, and HI were not significant predictors. CONCLUSIONS Patients affected by overweight and obesity involved in a multidisciplinary weight loss intervention reduced their mean BMI z score, while ABSI and HI were stable. Weight loss was not predicted by initial ABSI or HI. More visits predict more weight loss, but dropout rates are high. The great majority of patients leave the weight management program before having normalized their BMI.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V.Buzzi Childrens’ Hospital, University of Milan, Milan, Italy
| | - Jesse C. Krakauer
- Metro Detroit Diabetes and Endocrinology, Southfield, MI, United States of America
| | - Nir Y. Krakauer
- Department of Civil Engineering, The City College of New York, New York, NY, United States of America
| | - Alessandra Bosetti
- Department of Pediatrics, V.Buzzi Childrens’ Hospital, University of Milan, Milan, Italy
| | - Chiara Matilde Ferrari
- Department of Pediatrics, V.Buzzi Childrens’ Hospital, University of Milan, Milan, Italy
| | - Laura Schneider
- Department of Pediatrics, V.Buzzi Childrens’ Hospital, University of Milan, Milan, Italy
| | - Barbara Borsani
- Department of Pediatrics, V.Buzzi Childrens’ Hospital, University of Milan, Milan, Italy
| | - Sara Arrigoni
- Department of Pediatrics, V.Buzzi Childrens’ Hospital, University of Milan, Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, V.Buzzi Childrens’ Hospital, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, V.Buzzi Childrens’ Hospital, University of Milan, Milan, Italy
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Penagini F, Dilillo D, Borsani B, Cococcioni L, Galli E, Bedogni G, Zuin G, Zuccotti GV. Nutrition in Pediatric Inflammatory Bowel Disease: From Etiology to Treatment. A Systematic Review. Nutrients 2016; 8:nu8060334. [PMID: 27258308 PMCID: PMC4924175 DOI: 10.3390/nu8060334] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 05/17/2016] [Accepted: 05/27/2016] [Indexed: 12/11/2022] Open
Abstract
Nutrition is involved in several aspects of pediatric inflammatory bowel disease (IBD), ranging from disease etiology to induction and maintenance of disease. With regards to etiology, there are pediatric data, mainly from case-control studies, which suggest that some dietary habits (for example consumption of animal protein, fatty foods, high sugar intake) may predispose patients to IBD onset. As for disease treatment, exclusive enteral nutrition (EEN) is an extensively studied, well established, and valid approach to the remission of pediatric Crohn’s disease (CD). Apart from EEN, several new nutritional approaches are emerging and have proved to be successful (specific carbohydrate diet and CD exclusion diet) but the available evidence is not strong enough to recommend this kind of intervention in clinical practice and new large experimental controlled studies are needed, especially in the pediatric population. Moreover, efforts are being made to identify foods with anti-inflammatory properties such as curcumin and long-chain polyunsaturated fatty acids n-3, which can possibly be effective in maintenance of disease. The present systematic review aims at reviewing the scientific literature on all aspects of nutrition in pediatric IBD, including the most recent advances on nutritional therapy.
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Affiliation(s)
- Francesca Penagini
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Dario Dilillo
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Barbara Borsani
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Lucia Cococcioni
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Erica Galli
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, 34012 Trieste, Italy.
| | - Giovanna Zuin
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Gian Vincenzo Zuccotti
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
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