Michela Salvioni

Influence of parental attitudes in the development of children eating behaviour.

The present paper is a review of available data on effects of parental feeding attitudes and styles on child nutritional behaviour. Food preferences develop from genetically determined predispositions to like sweet and salty flavours and to dislike bitter and sour tastes. There is evidence for existence of some innate, automatic mechanism that regulate appetite. However, from birth genetic predispositions are modified by experience. There are mechanisms of taste development: mere exposure, medicine effect, flavour learning, flavour nutrient learning. Parents play a pivotal role in the development of their childs food preferences and energy intake, with research indicating that certain child feeding practices, such as exerting excessive control over what and how much children eat, may contribute to childhood overweight. Mothers are of particular interest on childrens eating behaviour, as they have been shown to spend significantly more time than fathers in direct interactions with their children across several familial situations.A recent paper describes two primary aspects of control: restriction, which involves restricting childrens access to junk foods and restricting the total amount of food, and pressure, which involves pressuring children to eat healthy foods (usually fruits and vegetables) and pressuring to eat more in general. The results showed significant correlations between parent and child for reported nutritional behaviour like food intake, eating motivations, and body dis- and satisfaction. Parents create environments for children that may foster the development of healthy eating behaviours and weight, or that may promote overweight and aspects of disordered eating. In conclusion positive parental role model may be a better method for improving a childs diet than attempts at dietary control.

Exclusive versus predominant breastfeeding in Italian maternity wards and feeding practices through the first year of life.

Determinants of exclusive versus predominant breastfeeding in the maternity ward and the relationship with later feeding practices were investigated in 1656 mothers who breastfed exclusively or predominantly in the maternity ward. Mothers were interviewed through 12 months postdelivery about feeding practices. Information about the World Heath Organization’s (WHO’s) 10 steps was collected. At hospital stay, breastfeeding was predominant in 43% of infants. Cesarean section (odds ratio [OR] = 1.75), mother’s overweight (OR = 1.74), and non-compliance with the WHO’s steps 6 (OR = 1.58), 7 (OR = 1.43), and 8 (OR = 1.76) were determinants of predominant, as opposed to exclusive, breastfeeding. Mothers exclusively, rather than predominantly, breastfeeding in the hospital showed a longer duration of full breastfeeding (mean = 3.6 vs 3.1 months), later introduction of formula (3.8 vs 3.3 months), and lower rate of introduction of formula within 1 month (23% vs 30%). Hospitals need to be compliant with the WHO’s steps, and Baby-Friendly Hospital Initiatives should be promoted.

Dietary macronutrient intake during the first 10 years of life in a cohort of Italian children

Objective: To describe the longitudinal pattern of dietary energy and macronutrient intakes during the first 10 years of life in a sample of healthy Italian children. Patients and Methods: Sixty-one healthy children were followed from birth to 10 years of age. At 1, 5, 8, and 10 years of age, anthropometric measurements were taken and nutritional habits evaluated using a standardized food frequency questionnaire. Results: Compared to the Italian recommended dietary allowances, the childrens diet was high in protein at any age, high in lipids from age 5 onward, and high in calories at 5 years of age. At 1 year, mean (SD) protein, carbohydrate, and lipid intake, expressed as percentage of total energy, was 20% (3%), 48% (7%), and 34% (5%), respectively. Afterward, the corresponding mean value ranged around 14% to 15%, 57% to 60%, and 29% to 32%. The mean glycemic load and overall glycemic index ranged around 143 to 150 and 58 to 59, respectively. A difference between boys and girls was found in the longitudinal pattern for the intake of energy (P < 0.0001) and glycemic load (P < 0.0001). The individual longitudinal dietary pattern varied over time for the intake of total energy (P < 0.0001), any macronutrient (P < 0.0001), and overall glycemic index (P = 0.05). Conclusions: Although the amount of energy intake was in accordance with the Italian recommended dietary allowances, children consumed a high-protein and high-lipid diet. Early and continuous dietary education of children and parents may provide support for adequate nutritional habits throughout their childhood.

Liver fat change in obese children after a 1-year nutrition-behavior intervention.

Objectives: To evaluate whether a 1-year nutrition-behavior intervention based on normocaloric balanced diet and physical exercise may reduce liver fat in obese children. Patients and Methods: Twenty-six obese children (11 boys and 15 girls), aged 6 to 14 years, underwent anthropometric, nutritional, metabolic, and liver magnetic resonance imaging (MRI) examinations at baseline and after a 1-year nutrition-behavior intervention. Anthropometry included weight, height, waist and hip circumference, and total upper arm area. Body mass index z scores were calculated. Biochemistry included serum aminotransferases, lipid profile, glucose, and insulin. Liver steatosis was judged as hepatic fat fraction (FF) by MRI and was ≥9%. Results: Prevalence of steatosis was 34.6% at baseline and declined to 7.7% after intervention (P < 0.0001). Mean (95% CI) reduction of liver FF was 8.0% (4.0%–12.0%). In 77.8% of children with liver steatosis at baseline, the FF declined lower than 9% at the end of intervention, going from a mean (SD) of 18.7% (9.1) to 1.3% (4.1), (P < 0.0001). At the end of the intervention, children showed a mean reduction in body mass index z score of 0.26 (0.11–0.41) and waist circumference of 1.46 (0.34–2.60) cm. Triglycerides, total cholesterol, apolipoprotein A1, apolipoprotein B, ApoA1/ApoB ratio, and gamma-glutamyltransferase plasma values in plasma decreased at the end of intervention (P < 0.05). Conclusions: The results suggest that in obese children nutritional-behavior interventions may reduce the liver fat.

Plasma long-chain fatty acids and the degree of obesity in Italian children.

Aim: To examine whether the plasma levels of long‐chain polyunsaturated fatty acids (LC‐PUFAs) are associated with the degree of obesity in children. Methods: Sixty‐seven normolipidaemic obese children, aged 8–12 y, and 67 age‐ and sex‐matched normal‐weight children were included in the study. Obesity was defined in accordance with the International Obesity Task Force. BMI z‐scores were calculated. Fasting blood samples were analysed for insulin, glucose, lipid profile and fatty acid (FA) levels (expressed as % total FA). Insulin resistance was estimated by homeostatic model assessment (HOMA). Results: Compared with normal‐weight children, obese children exhibited lower mean plasma total PUFA (37.8% vs 39.7%), ω‐6 PUFAs (35.0% vs 36.8%) and C22:6 ω‐3‐to‐C18:3 ω‐3 ratio (5.52 vs 7.61), and higher total monounsaturated FA (26.6% vs 25.0%), C18:3 ω‐3 (0.28% vs 0.25%) and C20:5 ω‐3 (0.45% vs 0.39%). In obese children, the BMI z‐score was negatively related to plasma PUFA, ω‐3 PUFAs, C22:6 ω‐3, and the C22:6 ω‐3‐to‐C20:6 ω‐6 and C22:6 ω‐3‐to‐C18:3 ω‐3 ratios, and positively with total saturated FA and C20:3 ω‐9.

PPAR-γ2 Pro12Ala Variant, Insulin Resistance and Plasma Long-chain Polyunsaturated Fatty Acids in Childhood Obesity

Pro12Ala variant of peroxisome-proliferator-activated receptor-gamma2 (PPAR-γ2) may be linked to insulin sensitivity. This study examined whether an association of PPAR-γ2 Pro12Ala with insulin resistance and plasma LCPUFAs may exist in obese children. One hundred and forty Italian normolipidemic obese children (58 girls and 82 boys, mean age [SD], 10.2 [2.7] y) entered the study. Obesity was defined according to International Obesity Task Force. BMI Z-scores were calculated. Fasting blood glucose, insulin, lipids and plasma fatty acids were measured. Insulin resistance was estimated by the homeostatic model assessment (HOMA-IR). The frequency of Ala allele was 9%. Mean [SD] values of fasting insulin and HOMA-IR in Pro/Pro versus Pro12Ala groups were: 19.3 [10.6] versus 14.1 [10.4] μU/mL (p = 0.017) and 4.2 [2.3] versus 3.0 [2.3] (p = 0.022). Mean [SD] values of plasma C20:3n-9 and of C20:4n-6, C20:5n-3, C22:6n-3 and n-6/n-3 LCPUFA in phospholipds in Pro/Pro versus Pro12Ala groups were: 0.15 [0.07] versus 0.12 [0.08] % (p = 0.014), 8.9 [1.9] versus 10.2 [2.6] % (p = 0.023), 0.34 [0.15] versus 0.42 [0.11] % (p = 0.005), 2.1 [0.9] versus 2.6 [0.9] % (p = 0.032) and 4.8 [1.2] versus 4.2 [0.7] (p = 0.017). Pro12Ala may be associated with higher insulin sensitivity and higher LCPUFAs, particularly n-3, levels in plasma phosholipids of obese children.

Dietary glycemic load and macronutrient intake in healthy italian children

The objective is of this study is to examine the relationship of dietary glycemic load (GL) and overall glycemic index (OGI) with macronutrients intake, body mass index (BMI) and insulin sensitivity in healthy children. The subjects comprised of 105 healthy non-obese eight -years old children, 60 boys and 45 girls. A Food Frequency Questionnaire (FFQ) evaluating dietary habits, GL and OGI. Insulin sensitivity was evaluated by the homeostatic model assessment (HOMA). GL was positively associated with dietary total (correlation coefficient, r=0.57) and starch (r=0.67) carbohydrates, daily consumption of pasta and white bread, cooked potatoes, bakery products and cookies, and negatively with dietary fats (r=-0.52). OGI was positively associated with daily consumption of white bread and cookies, and negatively associated with soluble carbohydrates (r=-0.35), and consumption of fibres, proteins, fruit, legumes and carrots. No significant association was found of GL or OGI with BMI or insulin sensitivity. In healthy children, GL and OGI may represent a useful indicator of quality of diet. Asia Pac J Public Health 2005; 17(2): 88-92.

Plasma long‐chain fatty acids profile and metabolic outcomes in normolipidaemic obese children after one‐year nutritional intervention

Aim:  To assess the association between changes in plasma long‐chain polyunsaturated fatty acids (LCPUFAs) profile and metabolic outcomes after 1‐year nutritional intervention in normolipidaemic obese children.

Myoinositol and D-Chiro Inositol in Improving Insulin Resistance in Obese Male Children: Preliminary Data

Myoinositol and D-chiro inositol, which are inositol isomers, have been shown to possess insulin-mimetic properties and to improve insulin resistance, especially in women with polycystic ovary syndrome. However, it has not been determined if this relationship exists also in children. Based on these previous findings, we hypothesized that inositol could be effective in improving insulin sensitivity in children with insulin resistance. To evaluate this hypothesis, we administered both inositol formulations before carrying out an oral glucose tolerance test (OGTT) in a group of obese insulin-resistant male children with high basal insulin levels and compared the values obtained with an OGTT previously conducted without inositol, in the same group, with unchanged BMI. Our results confirm that myoinositol and D-chiro inositol acutely reduce insulin increase after glucose intake mainly in children with high basal insulin level.

PO-0144 Triglycerides/glucose Index In Obese Children And Adolescents

Background and aims Triglycerides-glucose index (TyG index) has been associated with homeostatic model assessment (HOMA) index in healthy adults; this might be useful in identifying individuals at high risk of developing diabetes. Moreover, TyG-index has been related to Triglycerides/HDL ratio and carotid atherosclerosis, indicating strong validity to assess cardiovascular risk. (Lee SH et al 2014, Irace C et al 2013). The primary aim of this study was to assess the TyG in obese children and adolescent. Methods Two hundred sixty-eight obese children and adolescents (Cole TJ et al 2000), mean (SD) age 10.05 (1,82) years, were studied. Anthropometry, fasting glucose and insulin, lipid profile were evaluated. HOMA and TyG index were calculated as following, respectively: [fasting Insulin (μU/l) x fasting glucose (mmol/l)] : 22.5; Ln[fasting triglycerides (mg/dl) x fasting glucose (mg/dl)/2] (Simental-Mendía LE et al 2008). Insulin resistance has been defined as HOMA Index > 95°p for sex and pubertal stage (D’Annunzio G et al. 2009). Results 135 subjects showed insulin resistance, with higher TyG index than those with normal insulin sensitivity (P < 0.001) and higher Triglycerides/HL ratio (P < 0.001) (Table). In all the studied population a positive association between TyG index, HOMA index and Triglycerides/HDL ratio was found (P < 0.001); in the non-insulin resistance group a positive association between TyG index and waist/height ratio was observed (p = 0.03). Conclusions TyG index is a good predictor of decreased insulin sensitivity also in paediatric ages and might be considered also a marker of cardiovascular risk considering the association with waist/height ratio and Triglycerides/HDL ratio. Abstract PO-0144 Table 1 Mean values (SD) of the study population, divided in two groups, according to insulin response. Mann-Whitney non parametric test for independent samples Parameters All subjects n = 268 Non insulin resistance n = 133 Insulin resistance n = 135 p* BMI z-score 2.21 (0.39) 2.16 (0.41) 2.25 (0.36) 0.019* Insulin (UI/ml) 16.84 (10.27) 11.747 (5.67) 21.916 (11.28) <0.001* Triglycerides (mg/dl) 107.07 (54.32) 93.63 (39.56) 120.50 (63.19) <0.001* HOMA index 3.60 (2.31) 2.44 (1.20) 4.79 (2.53) <0.001* TyG index 8.33 (0.47) 8.20 (0.41) 8.47 (0.49) <0.001* Triglycerides/HDL ratio 2.42 (1.69) 1.20 (1.09) 2.86 (2.03) <0.001* Waist/Height ratio 0.59 (0.06) 0.58 (0.06) 0.59 (0.05) 0.303 *Significant difference for p < 0.05