Long-term health outcome and quality of life in children with multisystem inflammatory syndrome: findings from multidisciplinary follow-up at an Italian tertiary-care paediatric hospital.

Multisystem inflammatory syndrome is a severe complication of SARS-CoV-2 infection in children (MIS-C). To date, data on long-term sequelae mainly concern cardiac outcomes. All ≤ 18 year olds consecutively admitted to the Buzzi Children's Hospital with a diagnosis of MIS-C between October 1, 2020, and May 31, 2022, were followed up for up to 12 months by a dedicated multidisciplinary team. They underwent laboratory tests, multi-organ clinical and instrumental assessments, and psychosocial evaluation. 56/62 patients, 40 M, mean age 8.7 years (95% CI 7.7, 9.7), completed the follow-up. Cardiological, gastroenterological, pneumological, and neurological evaluations, including IQ and EEG, were normal. Alterations of HOMA-IR index and/or TyG index, observed in almost all patients during hospitalisation, persisted in about a third of the population at 12 months. At 6 and 12 months respectively, impairment of adaptive functions was observed in 38/56 patients (67.9%) and 25/56 (44.6%), emotional and behavioural problems in 10/56 (17.9%) and 9/56 (16.1%), and decline in QoL in 14/56 (25.0%) and 9/56 (16.1%). Psychosocial well-being impairment was significantly more frequent in the subgroup with persistent glycometabolic dysfunction at 12 months (75% vs. 40.9% p < 0.001). CONLUSION: The mechanisms that might explain the long-term persistence of both metabolic alterations and neuro-behavioural outcomes and their possible relationship are far from being clarified. Our study points out to the potential long-term effects of pandemics and to the importance of a multidisciplinary follow-up to detect potential negative sequelae in different areas of health, both physical and psychosocial. WHAT IS KNOWN: • Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of SARS-CoV-2 infection. • Few data exist on the medium- and long-term outcomes of MIS-C, mostly focused on cardiac involvement. Emerging evidence shows neurological and psychological sequelae at mid- and long-term follow-up. WHAT IS NEW: • This study reveals that MIS-C may lead to long-term glycometabolic dysfunctions joined to impairment in the realm of general well-being and decline in quality of life, in a subgroup of children. • This study highlights the importance of a long-term multidisciplinary follow-up of children hospitalised with MIS-C, in order to detect the potential long-term sequelae in different areas of health, both physical and psychosocial well-being.

Effect of acute meal and long-term intake of a Mediterranean Diet providing different amounts of carbohydrates on physical performance and biomarkers in non-professional strength athletes.

The study aims to evaluate the effect of an acute meal and long-term intake of Mediterranean Diet (MD) on different parameters such as strength, physical performance, body composition and blood markers in a group of non-professional athletes who practice a strength activity. Thirteen volunteers completed two 8-week dietary interventions in a randomised, cross-over design. Also an acute study was performed. Subjects received a MD High in carbohydrates, characterised by at least five portions of pasta/week and an average 55-60% of daily energy derived from carbohydrates, versus an MD reduced in carbohydrates, with less than two portions of pasta/week and an average of 40-45% of daily energy provided by carbohydrates. Mainly, data did not show significant differences for the parameters analysed, except for Elbow Flexor maximum voluntary contraction (p = .039). Results enlighten that increasing total carbohydrates intake, as typically in the MD, does not negatively affect physical performance, body composition and strength.

The Anti-Neuroinflammatory Effect of Extra-Virgin Olive Oil in the Triple Transgenic Mouse Model of Alzheimer's Disease.

Background: Chronic intake of extra virgin olive oil is beneficial for brain health and protects from age-related cognitive decline and dementia, whose most common clinical manifestation is Alzheimer's disease. Besides the classical pathologic deposits of amyloid beta peptides and phosphorylated tau proteins, another frequent feature of the Alzheimer's brain is neuroinflammation. Objective: In the current study, we assessed the effect that extra virgin olive oil has on neuroinflammation when administered to a mouse model of the disease. Methods: Triple transgenic mice were randomized to receive a diet enriched with extra virgin olive oil or regular diet for 8 weeks. At the end of this treatment period the expression level of several inflammatory biomarkers was assessed in the central nervous system. Results: Among the 79 biomarkers measured, compared with the control group, mice receiving the extra virgin olive oil had a significant reduction in MIP-2, IL-17E, IL-23, and IL-12p70, but an increase in IL-5. To validate these results, specific ELISA kits were used for each of them. Confirmatory results were obtained for MIP-2, IL-17E, IL-23, and IL-12-p70. No significant differences between the two groups were observed for IL-5. Conclusions: Our results demonstrate that chronic administration of extra virgin olive oil has a potent anti-neuroinflammatory action in a model of Alzheimer's disease. They provide additional pre-clinical support and novel mechanistic insights for the beneficial effect that this dietary intervention has on brain health and dementia.

Association between the consumption of ultra-processed foods and the incidence of peptic ulcer disease in the SUN project: a Spanish prospective cohort study.

PURPOSE: Consumption of ultra-processed foods (UPF) has increased despite potential adverse health effects. Recent studies showed an association between UPF consumption and some gastrointestinal disorders. We evaluated the association between UPF consumption and peptic ulcer disease (PUD) in a large Spanish cohort. METHODS: We conducted a prospective analysis of 18,066 participants in the SUN cohort, followed every two years. UPF was assessed at baseline and 10 years after. Cases of PUD were identified among participants reporting a physician-made diagnosis of PUD during follow-ups. Cases were only partially validated against medical records. Cox regression was used to assess the association between baseline UPF consumption and PUD risk. Based on previous findings and biological plausibility, socio-demographic and lifestyle variables, BMI, energy intake, Helicobacter pylori infection, gastrointestinal disorders, aspirin and analgesic use, and alcohol and coffee consumption were included as confounders.We fitted GEE with repeated dietary measurements at baseline and after 10 years of follow-up. Vanderweele's proposed E value was calculated to assess the sensitivity of observed associations to uncontrolled confounding. RESULTS: During a median follow-up of 12.2 years, we recorded 322 new PUD cases (1.56 cases/1000 person-years). Participants in the highest baseline tertile of UPF consumption had an increased PUD risk compared to participants in the lowest tertile (HR = 1.52, 95% CI: 1.15, 2.00, Ptrend=0.002). The E-values for the point estimate supported the observed association. The OR using repeated measurements of UPF intake was 1.39 (95% CI: 1.03, 1.87) when comparing extreme tertiles. CONCLUSION: The consumption of UPF is associated with an increased PUD risk.

[Stroke and stroke prevention in cardiac and thoracic aortic surgery]. / Ictus e prevenzione dell'ictus in cardiochirurgia e in chirurgia dell'aorta toracica.

Perioperative stroke and neurological injuries in general are complications that can occur during and after cardiac surgery, particularly in aortic surgery that involves the aortic arch. The overall incidence of early and delayed stroke is about 1% according to recent meta-analyses. This incidence depends on interindividual risk factor profile and type of surgery. In order to reduce cerebrovascular complications during cardiac surgery, a number of preventative measures can be taken, including the evaluation of atherosclerotic plaques, the site of cannulation and neuroprotection strategies. During aortic arch surgery, main strategies for cerebral protection are represented by deep hypothermic circulatory arrest, retrograde and antegrade cerebral perfusion.

Aluminum Nitride Thin Film Piezoelectric Pressure Sensor for Respiratory Rate Detection.

In this study, we propose a low-cost piezoelectric flexible pressure sensor fabricated on Kapton® (Kapton™ Dupont) substrate by using aluminum nitride (AlN) thin film, designed for the monitoring of the respiration rate for a fast detection of respiratory anomalies. The device was characterized in the range of 15-30 breaths per minute (bpm), to simulate moderate difficult breathing, borderline normal breathing, and normal spontaneous breathing. These three breathing typologies were artificially reproduced by setting the expiratory to inspiratory ratios (E:I) at 1:1, 2:1, 3:1. The prototype was able to accurately recognize the breath states with a low response time (~35 ms), excellent linearity (R2 = 0.997) and low hysteresis. The piezoelectric device was also characterized by placing it in an activated carbon filter mask to evaluate the pressure generated by exhaled air through breathing acts. The results indicate suitability also for the monitoring of very weak breath, exhibiting good linearity, accuracy, and reproducibility, in very low breath pressures, ranging from 0.09 to 0.16 kPa. These preliminary results are very promising for the future development of smart wearable devices able to monitor different patients breathing patterns, also related to breathing diseases, providing a suitable real-time diagnosis in a non-invasive and fast way.

Short-term effects of Mediterranean diet on nutritional status in adults affected by Osteogenesis Imperfecta: a pilot study.

BACKGROUND: Osteogenesis Imperfecta (OI) is a heterogeneous group of connective tissue disorders, characterized by varying degrees of skeletal fragility. Patients experience a range of comorbidities, such as obesity, cardiovascular, and gastrointestinal complications, especially in adulthood. All aspects that could benefit from dietary intervention. The aim of this study was to evaluate the effects of a 6-months restricted Mediterranean Diet (rMD) on nutritional status in adult patients affected by OI. We carried out a 6-months longitudinal pilot study. 14 adults (median age: 35 years; 7 women; 7 OI type III) where recruited in 2019 among the members of As.It.O.I., the Italian Association of Osteogenesis Imperfecta. As.It.O.I. All the evaluations were performed at the University of Milan, Italy. The rMD provided a reduction of 30% from daily total energy expenditure. 45% of calories derived from carbohydrates, 35% from fat and 0.7-1.0 g/kg of body weight from proteins. Comparisons of continuous variables after 6 months of intervention were performed by the paired t-test. All P-values were two-tailed, and p < 0.05 was considered significant. RESULTS: Patients showed significant improvement in anthropometric measurements (BMI = 30.5 vs 28.1 kg/cm2, p < 0.001; Body Fat % = 32.9 vs 29.9, p = 0.006; Waist circumferences = 83.6 vs 79.6 cm; p < 0.001; Arm Fat Area = 29.8 vs 23.07 cm2; p < 0.011) and energy expenditure (REE/kg = 27.2 vs 29.2 kcal/kg, p < 0.001). Glucose and lipid profiles improved (Δglycemia = - 8.6 ± 7.3 mg/dL, p = 0.003; ΔTC = - 14.6 ± 20.1 mg/dL, p = 0.036; ΔLDL = - 12.0 ± 12.1 mg/dL, p = 0.009). Adherence to the MD significantly increased, moving from a moderate to a strong adherence and reporting an increased consumption of white meat, legumes, fish, nuts, fruits and vegetables. CONCLUSION: A rMD was effective in improving nutritional status and dietary quality in adults with OI. These results underscores the need to raise awareness of nutrition as part of the multidisciplinary treatment of this disease.

Optimisation of an Industrial Optical Sorter of Legumes for Gluten-Free Production Using Hyperspectral Imaging Techniques.

The market demand for gluten-free food is increasing due to the growing gluten sensitivity and coeliac disease (CD) in the population. The market requires grass-free cereals to produce gluten-free food. This requires sorting methods that guarantee the perfect separation of gluten contaminants from the legumes. The objective of the research was the development of an optical sorting system based on hyperspectral image processing, capable of identifying the spectral characteristics of the products under investigation to obtain a statistical classifier capable of enabling the total elimination of contaminants. The construction of the statistical classifier yielded excellent results, with a 100% correct classification rate of the contaminants. Tests conducted subsequently on an industrial optical sorter validated the result of the preliminary tests. In fact, the application of the developed classifier was able to correctly select the contaminants from the mass of legumes with a correct classification percentage of 100%. A small proportion of legumes was misclassified as contaminants, but this did not affect the scope of the work. Further studies will aim to reduce even this small share of waste with investigations into optimising the seed transport systems of the optical sorter.

A Deep Learning-Based Platform for Workers' Stress Detection Using Minimally Intrusive Multisensory Devices.

The advent of Industry 4.0 necessitates substantial interaction between humans and machines, presenting new challenges when it comes to evaluating the stress levels of workers who operate in increasingly intricate work environments. Undoubtedly, work-related stress exerts a significant influence on individuals' overall stress levels, leading to enduring health issues and adverse impacts on their quality of life. Although psychological questionnaires have traditionally been employed to assess stress, they lack the capability to monitor stress levels in real-time or on an ongoing basis, thus making it arduous to identify the causes and demanding aspects of work. To surmount this limitation, an effective solution lies in the analysis of physiological signals that can be continuously measured through wearable or ambient sensors. Previous studies in this field have mainly focused on stress assessment through intrusive wearable systems susceptible to noise and artifacts that degrade performance. One of our recently published papers presented a wearable and ambient hardware-software platform that is minimally intrusive, able to detect human stress without hindering normal work activities, and slightly susceptible to artifacts due to movements. A limitation of this system is its not very high performance in terms of the accuracy of detecting multiple stress levels; therefore, in this work, the focus was on improving the software performance of the platform, using a deep learning approach. To this purpose, three neural networks were implemented, and the best performance was achieved by the 1D-convolutional neural network with an accuracy of 95.38% for the identification of two levels of stress, which is a significant improvement over those obtained previously.

Frozen elephant trunk technique using hybrid grafts: 15-year outcomes from a single-centre experience.

OBJECTIVES: The purpose of the study is to compare the short- and long-term outcomes of the frozen elephant trunk (FET) technique based on 2 different hybrid grafts implanted from January 2007 to July 2022. METHODS: The study includes patients who underwent an elective or emergency FET procedure. Short-term, long-term mortality and freedom from thoracic endovascular aortic repair (TEVAR) were the primary end points. Analyses were carried out separately for the periods 2007-2012 and 2013-2022. RESULTS: Of the 367 enrolled, 49.3% received E-Vita Open implantation and 50.7% received Thoraflex Hybrid implants. Overall mean age was 61 years [standard deviation (SD) = 11] and 80.7% were male. The average annual volume of FET procedures was 22.7 cases/year. Compared to E-Vita Open, patients implanted with Thoraflex Hybrid grafts were more likely to receive distal anastomosis in zone 2 (68.3% vs 11.6%, P < 0.001) with a shorter stent portion, mean = 103mm (SD = 11.3) vs mean = 149 mm (SD = 12.7; P < 0.001) and they underwent a reduced visceral ischaemia time, mean = 42.5 (SD = 14.2) vs mean= 61.0 (SD = 20.2) min, P < 0.001. In the period 2013-2022, overall survival at 1, 2 and 5 years was 74.8%, 72.5% and 63.2% for Thoraflex and 73.2%, 70.7% and 64.1% for E-Vita, without significant differences between groups (log-rank test = 0.01, P = 0.907). Overall freedom from TEVAR at 1, 2 and 5 years was 66.7%, 57.6% and 39.3% for Thoraflex and 79%, 69.7% and 66% for E-Vita, with significant differences between groups (log-rank test = 5.28, P = 0.029). In a competing risk analysis adjusted for chronic/residual aortic syndromes and stent diameter, the Thoraflex group was more likely to receive TEVAR during follow-up (subdistribution hazard ratio SHR = 2.12, 95% confidence interval 1.06-4.22). CONCLUSIONS: The FET technique addresses acute and chronic arch disease with acceptable morbidity and mortality. Downstream endovascular reinterventions are very common during follow-up.

Sex Differences in the Relationship between Chronotype and Eating Behaviour: A Focus on Binge Eating and Food Addiction.

BACKGROUND: Men are more likely than women to have subthreshold overeating disorders. Lifestyle plays a role as a determinant, while chronotype is an emerging factor. Chronotype explains the natural preferences of wakefulness and activity throughout the day: evening chronotypes (E-Types), those most productive in the evening, have been linked with unhealthy dietary patterns and a higher propensity to substance addiction than morning types (M-Types). METHODS: We carried out a cross-sectional study on 750 overweight or obese adults (70% females, 48 ± 10 years, BMI 31.7 ± 5.8 kg/m2). The Binge-Eating Scale, the Yale Food Addiction Scale 2.0 (YFAS 2.0), the reduced Morningness-Eveningness Questionnaire (rMEQ), and the MEDAS questionnaire were used to assess binge eating, food addiction, chronotype, and adherence to the Mediterranean diet, respectively. RESULTS: No differences in BES binge-eating and FA food-addiction scores occurred between chronotypes, but we found significant interactions between sex × rMEQ score. While women showed the same prevalence for binge eating and food addiction across all chronotypes, binge eating and food addiction risk increased with reducing rMEQ score in men, indicating that being male and E-Type increases the risk association of binge eating and/or food addiction prevalence. CONCLUSIONS: chronotype is associated with binge eating and food addiction in men, emphasizing the link between chronobiology and sex differences as determinants in appetite and eating behaviour dysregulation and in overweight and obesity.

Transcatheter Aortic Valve Replacement in Degenerated Perceval Bioprosthesis: Clinical and Technical Aspects in 32 Cases.

BACKGROUND: Sutureless aortic bioprostheses are increasingly being used to provide shorter cross-clamp time and facilitate minimally invasive aortic valve replacement. As the use of sutureless valves has increased over the past decade, we begin to encounter their degeneration. We describe clinical outcomes and technical aspects in patients with degenerated sutureless Perceval (CorCym, Italy) aortic bioprosthesis treated with valve-in-valve transcatheter aortic valve replacement (VIV-TAVR). METHODS: Between March 2011 and March 2023, 1310 patients underwent aortic valve replacement (AVR) with Perceval bioprosthesis implantation. Severe bioprosthesis degeneration treated with VIV-TAVR occurred in 32 patients with a mean of 6.4 ± 1.9 years (range: 2-10 years) after first implantation. Mean EuroSCORE II was 9.5 ± 6.4% (range: 1.9-35.1%). RESULTS: Thirty of thirty-two (94%) VIV-TAVR were performed via transfemoral and two (6%) via transapical approach. Vascular complications occurred in two patients (6%), and mean hospital stay was 4.6 ± 2.4 days. At mean follow-up of 16.7 ± 15.2 months (range: 1-50 months), survival was 100%, and mean transvalvular pressure gradient was 18.7 ± 5.3 mmHg. CONCLUSION: VIV-TAVR is a useful option for degenerated Perceval and appears safe and effective. This procedure is associated with good clinical results and excellent hemodynamic performance in our largest single-center experience.

Distal stent graft-induced new entry (dSINE) after frozen elephant trunk: a scoping review.

Background: The introduction of hybrid total arch replacement with the frozen elephant trunk (FET) technique has improved the field of aortic surgery by allowing single-stage treatment of complex aortic pathologies. Although FET has been associated with favorable aortic remodeling, it is also associated with the potential development of distal stent graft-induced new entries (dSINEs). The aim of our review is to collect data about the incidence and the supposed conditions for the occurrence of dSINE after total hybrid arch replacement with FET technique. Methods: The literature review was performed using PubMed databases from inception to January 2022. A descriptive approach to detect and display supposed risk factors and predictors for dSINE occurrence has been adopted. Results: Eight studies summarized the state-of-the-art of dSINE in a total number of 544 FET procedures performed to treat acute and chronic aortic dissections. The scoping review showed dSINEs occurrence in 69 patients (12.7%). The mean time between surgery and the diagnosis ranged from 12.6 to 30.6 months. Most patients that developed dSINE received endovascular treatment, whereas a couple of them needed open surgery. According to our experience, from January 2007 to December 2021, in 225 FET procedures a total of 54 cases of dSINE, both with Thoraflex and E-vita grafts have been detected. The mean time between the surgical procedure and the diagnosis was 27.2±33.6 months. Conclusions: dSINEs are frequent complications after FET. Although not emergent, they require proper treatment. Due to dSINE's asymptomatic nature and potential harm, a rigorous follow-up including angio-computed tomography (CT) should be planned.

The Effect of the Mediterranean Diet on Metabolic Health.

The Mediterranean Diet (MedDiet) is one of the healthiest and most balanced dietary patterns worldwide [...].

Consumption of Ultra-Processed Foods and Health Harm.

In recent decades, research has become increasingly interested in the relationship between diet and health [...].

Human Action Recognition in Smart Living Services and Applications: Context Awareness, Data Availability, Personalization, and Privacy.

Smart living, an increasingly prominent concept, entails incorporating sophisticated technologies in homes and urban environments to elevate the quality of life for citizens. A critical success factor for smart living services and applications, from energy management to healthcare and transportation, is the efficacy of human action recognition (HAR). HAR, rooted in computer vision, seeks to identify human actions and activities using visual data and various sensor modalities. This paper extensively reviews the literature on HAR in smart living services and applications, amalgamating key contributions and challenges while providing insights into future research directions. The review delves into the essential aspects of smart living, the state of the art in HAR, and the potential societal implications of this technology. Moreover, the paper meticulously examines the primary application sectors in smart living that stand to gain from HAR, such as smart homes, smart healthcare, and smart cities. By underscoring the significance of the four dimensions of context awareness, data availability, personalization, and privacy in HAR, this paper offers a comprehensive resource for researchers and practitioners striving to advance smart living services and applications. The methodology for this literature review involved conducting targeted Scopus queries to ensure a comprehensive coverage of relevant publications in the field. Efforts have been made to thoroughly evaluate the existing literature, identify research gaps, and propose future research directions. The comparative advantages of this review lie in its comprehensive coverage of the dimensions essential for smart living services and applications, addressing the limitations of previous reviews and offering valuable insights for researchers and practitioners in the field.

Browning of Adipocytes: A Potential Therapeutic Approach to Obesity.

The increasing prevalence of overweight and obesity suggests that current strategies based on diet, exercise, and pharmacological knowledge are not sufficient to tackle this epidemic. Obesity results from a high caloric intake and energy storage, the latter by white adipose tissue (WAT), and when neither are counterbalanced by an equally high energy expenditure. As a matter of fact, current research is focused on developing new strategies to increase energy expenditure. Against this background, brown adipose tissue (BAT), whose importance has recently been re-evaluated via the use of modern positron emission techniques (PET), is receiving a great deal of attention from research institutions worldwide, as its main function is to dissipate energy in the form of heat via a process called thermogenesis. A substantial reduction in BAT occurs during normal growth in humans and hence it is not easily exploitable. In recent years, scientific research has made great strides and investigated strategies that focus on expanding BAT and activating the existing BAT. The present review summarizes current knowledge about the various molecules that can be used to promote white-to-brown adipose tissue conversion and energy expenditure in order to assess the potential role of thermogenic nutraceuticals. This includes tools that could represent, in the future, a valid weapon against the obesity epidemic.

Innovative technologies to enhance oil recovery.

The processes for extracting and refining edible oils are well-established in industry at different scales. However, these processing lines encounter inefficiencies and oil losses when recovering crude or refined oil. Palm oil and olive oil extraction methods are used mainly as a combination of physical, thermal, and centrifugal methods to recover crude oil, which results in oil losses in the olive pomace or in palm oil effluents. Seed oils generally require a seed steam conditioning, and cooking stage, followed by physical oil recovery through an inefficient expeller. Most of the crude oil remaining in the expeller cake is then recovered by hexane. Crude seed oil is further refined in stages that also undergo oil losses. This chapter provides an overview of innovative technologies using microwave, ultrasound, megasonic and pulsed electric field energies, which can be used in the above-mentioned crude and refined oil processes to improve oil recovery. This chapter describes traditional palm oil, olive oil, and seed oil processes, as well as the specific process interventions that have been tested with these technologies. The impact of such technology interventions on oil quality is also summarized.

Long-term follow-up of nutritional status in children with GLUT1 Deficiency Syndrome treated with classic ketogenic diet: a 5-year prospective study.

Introduction: The classic ketogenic diet (cKD) is an isocaloric, high fat, low-carbohydrate diet that induces the production of ketone bodies. High consumption of dietary fatty acids, particularly long-chain saturated fatty acids, could impair nutritional status and increase cardiovascular risk. The purpose of this study was to evaluate the long-term effects of a 5-year cKD on body composition, resting energy expenditure, and biochemical parameters in children affected by Glucose Transporter 1 Deficiency Syndrome (GLUT1DS). Methods: This was a prospective, multicenter, 5-year longitudinal study of children with GLUT1DS treated with a cKD. The primary outcome was to assess the change in nutritional status compared with pre-intervention, considering anthropometric measurements, body composition, resting energy expenditure, and biochemical parameters such as glucose and lipid profiles, liver enzymes, uric acid, creatinine, and ketonemia. Assessments were conducted at pre-intervention and every 12 months of cKD interventions. Results: Ketone bodies increased significantly in children and adolescents, and remained stable at 5 years, depending on the diet. No significant differences were reported in anthropometric and body composition standards, as well as in resting energy expenditure and biochemical parameters. Bone mineral density increased significantly over time according to increasing age. Body fat percentage significantly and gradually decreased in line with the increase in body weight and the consequent growth in lean mass. As expected, we observed a negative trend in respiratory quotient, while fasting insulin and insulin resistance were found to decrease significantly after cKD initiation. Conclusion: Long-term adherence to cKD showed a good safety profile on anthropometric measurements, body composition, resting energy expenditure, and biochemical parameters, and we found no evidence of potential adverse effects on the nutritional status of children and adolescents.