Dietary Fibers in Healthy Children and in Pediatric Gastrointestinal Disorders: A Practical Guide.

Dietary fibers include non-digestible plant carbohydrates, lignin and resistant starch. Dietary fibers provide immune, cardiovascular, metabolic and intestinal beneficial effects in humans. Fibers naturally present in foods (fruits, vegetables, legumes, cereals) or used as supplements have different physical, chemical and functional profiles. This narrative review provides an update to the knowledge on the effects of dietary fibers in healthy subjects and in children with gastrointestinal disorders. Soluble fibers are digested by gut bacteria, producing short-chain fatty acids and energy for colonocytes, and may exert prebiotic effects that promote the growth of bifidobacteria and lactobacilli. Non-soluble fibers are bulking agents and may improve intestinal transit. The exact amount and characteristics of the fiber requirement in infants and children need to be further established. There are limited data evaluating fibers in children with gastrointestinal disorders. The low intake of fibers has been associated with constipation, but the intake of excessive fibers is not recommended as it may cause flatulence and abdominal discomfort. Certain fibers (particularly psyllium in irritable bowel syndrome) have shown beneficial effects in children with gastrointestinal disorders, but the limited and heterogenous data do not currently allow a specific recommendation.

Trans-auricular Vagus Nerve Stimulation in the Treatment of Recovered Patients Affected by Eating and Feeding Disorders and Their Comorbidities.

INTRODUCTION: Eating and feeding disorders (EFD's) represent the psychiatric pathology with the highest mortality rate and one of the major disorders with the highest psychiatric and clinical comorbidity. The vagus nerve represents one of the main components of the sympathetic and parasympathetic nervous system and is involved in important neurophysiological functions. Previous studies have shown that vagal nerve stimulation is effective in the treatment of resistant major depression, epilepsy and anxiety disorders. In EFD's there are a spectrum of symptoms which with Transcutaneous auricular Vagus Nerve Stimulation (Ta-VNS) therapy could have a therapeutic efficacy. SUBJECTS AND METHODS: Sample subjects is composed by 15 female subjects aged 18-51. Admitted to a psychiatry community having diagnosed in according to DSM-5: anorexia nervosa (AN) (N=9), bulimia nervosa (BN) (N=5), binge eating disorder (BED) (N=1). Psychiatric comorbidities: bipolar disorder type 1 (N=4), bipolar disorder type 2 (N=6), border line disorder (N=5). The protocol included 9 weeks of Ta-VNS stimulation at a frequency of 1.5-3.5 mA for 4 hours per day. The variables detected in four different times (t0, t1, t2, t3, t4) are the following: Heart Rate Variability (HRV), Hamilton Depression Rating Scale (HAMD-HDRS-17), Body Mass Index (BMI), Beck Anxiety Index (BAI). RESULTS: Data analysis showed statistically significant differences between recording times (p>0.05) in HAM-D (t0=18.28±5.31; t4=9.14±7.15), in BAI (t0=24.7±10.99; t4=13.8±7.0) the reported values show how during (T0-T4) the treatment there are a decay of the degree in the depressive state, in the state of anxiety and an improvement in the value of BMI. In particular, the BMI in the AN-BN sub-sample had a minimum gain of 5% and a maximum of 11%. The analysis of H.R.V. did not show a significant changes among subjects thus confirming the discordance of the activity of the sympathetic and parasympathetic nervous system in EFD's. CONCLUSIONS: Although the sample does not possess a relevant value to determine long-term efficacy of Ta-VNS or on a larger number of patients, this study reports how the application of neuro-stimulation in EFD's may become an ADD-ON in therapeutic approach. Indeed, substantial improvements are highlighted in the results and confirmed hypotheses proposed by the study.

Cardiometabolic healthy and unhealthy obesity: does vitamin D play a role?

OBJECTIVE: The aim of this observational study was to clarify the link between vitamin D status and metabolic syndrome (MetS) in people with visceral obesity. DESIGN AND METHODS: One hundred ninety-six consecutive patients (152 women; mean age 51 ± 13 years) with visceral obesity (mean body weight 103 ± 20 kg, mean waist circumference (WC) 119 ± 13 cm) were enrolled at the Obesity Outpatient Clinic of the University of Insubria in Varese. Anthropometric measurements were recorded. Laboratory tests, including vitamin D (25(OH)D)), fasting blood glucose (FBG), lipid profile, liver and kidney function tests were assessed. Vitamin D status was defined according to the European Society of Endocrinology guidelines, MetS to the 2009 harmonized definition. RESULTS: An inverse association emerged among 25(OH)D, body mass index (BMI) (P = 0.001) and WC (all P = 0.003). Serum 25(OH)D levels were inversely related to FBG and systolic blood pressure (SBP) (respectively, P = 0.01 and 0.02). Median serum 25(OH)D levels were 13.3 ng/mL (CI 95% 12; 15) in MetS and 16 ng/mL (CI 95% 14; 18) (P = 0.01) in non-MetS patients. Among patients with MetS, lower 25(OH)D concentrations were related to higher risk of hypertension (HT) (odds ratio (OR) 1.7, CI 95%, 0.7;4) and hyperglycemia (IFG)/type 2 diabetes (OR 5.5, CI 95% 2; 14). CONCLUSION: Vitamin D status and MetS are inversely correlated in visceral obesity, particularly with regard to glucose homeostasis and BP. More extensive studies are required to investigate the potential for causality.