G. Massa

Multiple gut–liver axis abnormalities in children with obesity with and without hepatic involvement

Gut–liver axis (GLA) dysfunction appears to play a role in obesity and obesity‐related hepatic complications.

Emerging pathomechanisms involved in obesity.

Objective: Overweight/obesity prevalence has increased dramatically worldwide. Recent evidence suggests sleep deprivation/fragmentation, fructose-exceedingly rich diets, and exposure to endocrine disruptors (eg, bisphenol A, BPA) as emerging additional factors involved in pathomechanisms and in the treatment resistance of obesity and its complications. Our study focuses on these factors for further preventive/therapeutic approaches in paediatric obesity. Methods: Fifty-four Italian children (cases: n = 31 overweight/obese; controls: n = 23 normal weight) were clinically/anthropometrically characterised. Parents completed questionnaires on the relation between obesogenic factors and childhood obesity. BPA was measured by gas chromatography/tandem mass spectrometry on early morning urine samples. Correlations between the continuous variables were analysed using Spearman rank correlation. Results: Sleep deprivation/fragmentation, nocturnal breathing problems, and daytime sleepiness increased with increasing body mass index, correlating with the presence of clinical markers of metabolic syndrome (eg, acanthosis nigricans). Frequency of sugar-enriched drink consumption and the amount of fructose per portion and/or per week increased, paralleling the ponderal excess and all the other anthropometric parameters. In the entire sample population, free and total BPA levels increased paralleling the body mass index increase (r > 0.8), whereas the conjugate demonstrated the opposite trend. The re-use of disposable plastic showed a positive correlation with urinary BPA levels. Conclusions: Despite its exploratory nature, the results of our pilot study confirm the close relation between certain factors and paediatric obesity, underscoring their role as emerging targets for prevention and therapy.

Probiotics to Treat Visceral Obesity and Related Liver Disease

Obesity and its related complications have reached epidemic proportions that cannot be completely explained by energy imbalance between dietary calories and physical exercise. Increasing interest is therefore developing in a number of recently identified obesogenic triggering factors (e.g. endocrine disruptors, sleep deprivation, fructose intake, gut-liver axis, and intestinal microbiota). In this chapter, we will focus on recent advances in our knowledge of the gut-liver axis and gut microbiota, which suggest that: (1) age, geographical origin, breastfeeding, diet, and lifestyle may all influence microbiome composition;

Pediatric non alcoholic fatty liver disease: more on novel treatment targets

The mainstay treatment of non alcoholic fatty liver disease (NAFLD) based on weight loss and/or lifestyle changes is most often unsuccessful at all ages, thus requiring the implementation of pharmacological strategies. Targeting insulin resistance and oxidative stress has recently proven unsatisfactory. Among a number of proposed innovative approaches targeting novel pathomechanisms, probiotics appear an interesting and reasonable option acting on gut-liver axis malfunction through the modulation of diet-driven, obesogenic, and inflammatory intestinal microbiota.A combined multiple pharmacological therapy directed simultaneously towards novel and old pathomechanisms (including, e.g., insulin resistance, oxidative stress, gut-liver axis, apoptosis) along with lifestyle interventions however might be necessary both in adult and pediatric NAFLD therapy.

Relations of gut liver axis components and gut microbiota in obese children with fatty liver: A pilot study

The prevalence of metabolic syndrome and its hepatic component — non-alcoholic fatty liver disease (NAFLD) — has increased alarmingly, paralleling the worldwide obesity epidemics. The pathophysiology of NAFLD is not clearly understood, but it has been proposed to be the result of multiple ‘‘hits’’[1]. A number of studies increasingly supports the pathogenetic role also of the gut microbiota (GM) both in NAFLD onset and progression. In this respect, GM would exert its noxious effects through the dysfunction of the gut-liver axis (GLA), which includes some or all of the following components: increased intestinal permeability (IP), endogenous ethanol (ETOH) and systemic endotoxin (LPS) concentrations [2,3]. As these players have hitherto not been simultaneously investigated in the same patient [reviewed in reference 4], the aim of our study was to explore the possible existence of reciprocal influences of several GLA components and GM composition in the same group of well characterized obese (Ob) children with and without fatty liver compared to normal-weight (NW) control peers. We studied 10 Ob Italian children, consecutively recruited at our center after parental agreement and written informed consent. The inclusion criteria were age 8—13 years, and a body mass index (BMI) > 97th percentile. Six non-Ob and non-overweight (BMI < 85th percentile), healthy normal-weight (NW) controls with normal anthropometric, clinical, laboratory and ultrasonographic (US) hepatic parameters and no other associated diseases were recruited among patients of the Pediatric Surgery Section listed for elective minor surgery. Lifestyle including eventual medications or alcohol exposition and total daily fructose and caloric intake and food preferences were investigated by multiple-choice questionnaires [5]. Weight, height, BMI values and percentiles,

Humanization of pediatric care in the world: focus and review of existing models and measurement tools

BackgroundThe term “humanization” indicates the process by which people try to make something more human and civilized, more in line with what is believed to be the human nature. The humanization of care is an important and not yet a well-defined issue which includes a wide range of aspects related to the approach to the patient and care modalities. In pediatrics, the humanization concept is even vaguer due to the dual involvement of both the child and his/her family and by the existence of multiple proposed models.ObjectiveThe present study aims to analyze the main existing humanization models regarding pediatric care, and the tools for assessing its grade.ResultsThe main Humanization care programs have been elaborated and developed both in America (Brazil, USA) and Europe. The North American and European models specifically concern pediatric care, while the model developed in Brazil is part of a broader program aimed at all age groups. The first emphasis is on the importance of the family in child care, the second emphasis is on the child’s right to be a leader, to be heard and to be able to express its opinion on the program’s own care. Several tools have been created and used to evaluate humanization of care programs and related aspects. None, however, had been mutually compared.ConclusionsThe major models of humanization care and the related assessment tools here reviewed highlight the urgent need for a more unifying approach, which may help in realizing health care programs closer to the young patient’s and his/her family needs.