The Dietary Inflammatory Index and asthma burden in children: A latent class analysis.

INTRODUCTION: Unbalanced dietary intake has been increasingly recognized as an important modifiable risk factor for asthma. In this study, we assessed whether a pro-inflammatory diet is associated with higher asthma burden in three steps: (1) identification of asthma latent classes (LC) based on symptoms, indoor exposures, and pulmonary function; (2) identification of risk factors associated with LC membership; and (3) estimation of the probabilities of LC membership with variation in DII. METHODS: A cross-sectional study on 415 children aged 5-14 years (266 with persistent asthma and 149 controls). LC analysis was performed in asthmatic children. The DII was calculated based on a semiquantitative food frequency questionnaire. Elastic net logistic regression was used to investigate whether increasing DII was associated with worse asthma burden. RESULTS: Two LCs were identified. Children in Class 1, "high burden," had higher symptom burden and worse lung function. Children in Class 2, "low burden," had lower symptom burden and less impaired lung function but were more subject to indoor exposures. DII was the only risk factor significantly associated with Class 1 membership. As the DII increased (from -4.0 to +4.0), the probability of Class 1 membership increased from 32% to 65% when compared with control group, whereas it increased from 41% to 72% when compared with Class 2. CONCLUSIONS: We identified two phenotypes of persistent asthma associated with different disease burden linked to indoor exposures. An increasing DII was associated with high-burden asthma, providing further evidence about the role of a pro-inflammatory diet in asthma morbidity.

Ultra-processed foods consumption and diet quality of European children, adolescents and adults: Results from the I.Family study.

BACKGROUND AND AIMS: Food processing has been indicated as a factor capable of negatively affecting the global food system, including the profile of consumers' diets. The objectives of the present study were to provide a description of the consumption of ultra-processed foods (UPFs) in the large population of children, adolescents and adults from eight European countries participating to the I.Family study, and to investigate the association between UPFs intake and nutritional quality of the diet. METHODS AND RESULTS: Dietary intake was assessed using a 24-h dietary recall. The quality of the diet was evaluated by the Healthy Dietary Adherence Score (HDAS) using an FFQ. UPFs were classified according to the NOVA classification. Almost half of the daily energy intake of the 7073 participants came from UPFs, and this trend decreased progressively with age. UPFs contributed more than 50 % of the daily intake of total and saturated fat, carbohydrates and about 70 % of sugars intake in children and adolescents. No differences in UPFs consumption were found according to the educational and socio-economic status of the population. Energy intake increased across the quintiles of UPFs intake, while HDAS decreased. The frequency of consumption of fruit and vegetable, fish, and fibre rich foods was low in the fifth quintile of UPFs intake, both in adolescents and in adults. The consumption of foods rich in calories and low in nutritional content, operationally defined as "junk food", was significantly higher in the fifth quintile. CONCLUSIONS: In the population of the European I.Family study, UPFs contributed a large proportion of the daily energy intake, especially in children and adolescents. Higher consumption of UPFs was associated with a lower quality of the diet. REGISTRATION NUMBER FOR CLINICAL TRIALS: ISRCTN62310987.

Dietary Advanced Glycation End Products (AGEs) and Urinary Fluorescent AGEs in Children and Adolescents: Findings from the Italian I.Family Project.

Advanced glycation end products (AGEs) have been implicated in chronic diseases in adults, but their role in paediatric populations remains uncertain. This study, conducted on the Italian sample of the I.Family project, aimed to investigate the relationship between dietary and urinary fluorescent AGEs in children and adolescents. The secondary objective was to investigate the sources of dietary AGEs (dAGEs) and their association with dietary composition and anthropometric parameters. Dietary data were collected from 1048 participants via 24 h dietary recall in 2013/2014 to estimate dAGEs intake, while urinary fluorescent AGE levels were measured in 544 individuals. Participants were stratified based on dAGEs intake and compared with respect to urinary fluorescent AGE levels, anthropometric measurements, and dietary intake. The results showed no significant correlation between dietary and urinary fluorescent AGE levels, nor between dAGEs and anthropometric parameters. Notably, higher dAGEs were associated with a diet richer in protein (especially from meat sources) and fat and lower in carbohydrates. In addition, the consumption of ultra-processed foods was lower in participants with a higher DAGE intake. This study highlights the lack of a clear association between dietary and urinary fluorescent AGEs in children, but suggests a distinctive dietary pattern associated with increased dAGEs intake. Further investigation is warranted to elucidate the potential health implications of dAGEs in paediatric populations.

Dietary Diversity and Its Association with Diet Quality and Health Status of European Children, Adolescents, and Adults: Results from the I.Family Study.

Dietary diversity (DD) plays a crucial role in fostering high-quality diets, but its association with health outcomes, particularly body adiposity and non-communicable diseases (NCDs), is inconsistent. This may be due to a lack of a standardized method for estimating DD. Our study investigates the association between two DD indices, namely the dietary diversity score (DDS) and food variety score (FVS), and anthropometric measures, biochemical parameters, and diet quality in a large population sample from the I.Family study across research centers in eight European countries. In our cross-sectional analysis of 3035 participants, DDSs varied among countries, with a higher prevalence in the third DDS tertile among those with higher education. DDS showed a positive association with diet quality across all age groups. Higher DDS tertile individuals showed increased fiber, fruit, and vegetable intake, greater meal frequency, and lower ultra-processed food consumption. No relevant biochemical differences were observed across DDS tertiles, and a higher DDS was associated with lower overweight/obesity prevalence only in adults. No significant associations were found with FVS. Our findings emphasize the need to consider food groups for a more accurate estimation of diet quality. This aligns with studies suggesting DDS alone is not an independent risk factor for obesity in children and adolescents. Public health programs should prioritize food diversity to promote improved nutrition and overall well-being in communities.

The Stance4Health Project: Evaluating a Smart Personalised Nutrition Service for Gut Microbiota Modulation in Normal- and Overweight Adults and Children with Obesity, Gluten-Related Disorders or Allergy/Intolerance to Cow's Milk.

Unhealthy diets represent a major risk for the pathogenesis of metabolic and chronic inflammatory diseases. Improving the quality of diet is important to prevent chronic diseases, and diet-induced modifications of the gut microbiota (GM) community likely play an important role. The EU-funded Stance4Health project aims at performing a randomized clinical trial based on a nutritional intervention program in the context of normal weight and overweight adults as well as children with obesity and gluten-related disorders or allergy/intolerance to cow's milk. The trial will evaluate the efficacy of a Smart Personalised Nutrition (SPN) service in modifying GM composition and metabolic function and improving consumer empowerment through technology adoption.

Nutritional Quality of Pasta Sold on the Italian Market: The Food Labelling of Italian Products (FLIP) Study.

Pasta represents a staple food in many populations and, in recent years, an increasing number of pasta items has been placed on the market to satisfy needs and trends. The aims of this work were: (i) to investigate the nutritional composition of the different types of pasta currently sold in Italy by collecting the nutrition facts on their packaging; (ii) to compare energy, nutrient and salt content per 100 g and serving in fresh and dried pasta; (iii) to compare the nutrition declaration in pairs of products with and without different declarations (i.e., gluten free (GF), organic, and nutrition claims (NC)). A total of 756 items, made available by 13 retailers present on the Italian market, were included in the analysis. Data showed a wide difference between dried and fresh pasta, with high inter-type variability. A negligible amount of salt was observed in all types of pasta, except for stuffed products, which had a median high quantity of salt (>1 g/100 g and ~1.5 g/serving). Organic pasta had higher fibre and lower protein contents compared to conventional pasta. GF products were higher in carbohydrate and fat but lower in fibre and protein than not-GF products, while only a higher fibre content was found in pasta with NC compared to products not boasting claims. Overall, the results show high variability in terms of nutrition composition among the pasta items currently on the market, supporting the importance of reading and understanding food labels for making informed food choices.

Nutritional Quality of Plant-Based Drinks Sold in Italy: The Food Labelling of Italian Products (FLIP) Study.

Plant-based drinks represent a heterogeneous class of beverages, made from several vegetal sources, with a market rapidly expanding around the world. These beverages are mainly drunk in the replacement of milk. Thus, aims of the present study were to: (i) evaluate the nutritional declaration of 330 plant-based drinks currently available on the Italian market; (ii) compare their nutrition facts based on type, presence or not of organic certification and nutrition (NC) or health claims (HC), and of specific claims ("no added sugars" and "source of calcium"); (iii) compare their nutrition composition with cow's milk. A high variability in terms of nutrient profile among products was observed. Limited difference was found between products belonging to both organic and NC categories, while products carrying HC showed lower energy, carbohydrates, sugar, and higher protein contents than the related counterparts. Compared to cow's milk, plant-based drinks showed differences in terms of nutrient profile, mostly regarding the lower protein content (except for soy drinks). Overall, due to the variability, findings from the present survey show that plant-based drinks sold in Italy cannot be considered tout court as milk substitutes and support the importance of improving knowledge towards food labeling to make conscious food choices.

Gender-related differences in the relationships between blood pressure, age, and body size in prepubertal children.

BACKGROUND: The blood pressure (BP) increase with age is well documented in adults and children. However, in the pediatric age group, body size is the most important determinant of age-related BP increases. The aim of the present analysis was to investigate the relationships between age, gender, and body size and BP in children. METHODS: To this purpose, data were analyzed from 4,514 prepubertal children, aged 6-11 years (71% of the eligible sample; boys = 2,283, girls = 2,231) from the ARCA Project, a screening of childhood obesity carried out in southern Italy. Girls who reported the occurrence of menarche were excluded from the analysis. The sample constituted roughly 20% of all the children attending the primary schools in the area. Weight, height, waist circumference, and BP were measured according to standardized procedures. RESULTS: As expected, both systolic and diastolic BP significantly increased (P < 0.001) with age in boys and girls. However, after adjustment for waist circumference (as index of adiposity) and height (as index of body size), BP significantly increased with age only in girls (systolic BP: F = 4.380, P = 0.002; diastolic BP: F = 3.093, P = 0.01) but not in boys (systolic BP: F = 0.711, P = 0.55; diastolic BP: F = 2.180, P = 0.07). The association, however, was no longer apparent after the exclusion of children aged >10 years. CONCLUSIONS: In prepubertal girls in the age range 6-11 years, but not in boys, age is significantly associated with BP independently of body size and adiposity.

The Impact of Adding Sugars to Milk and Fruit on Adiposity and Diet Quality in Children: A Cross-Sectional and Longitudinal Analysis of the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS) Study.

Sugar, particularly as free sugars or sugar-sweetened beverages, significantly contributes to total energy intake, and, possibly, to increased body weight. Excessive consumption may be considered as a proxy of poor diet quality. However, no previous studies evaluated the association between the habit of adding sugars to "healthy" foods, such as plain milk and fresh fruit, and indicators of adiposity and/or dietary quality in children. To answer to these research questions, we Panalysed the European cohort of children participating in the IDEFICS study. Anthropometric variables, frequency of consumption of sugars added to milk and fruit (SAMF), and scores of adherence to healthy dietary pattern (HDAS) were assessed at baseline in 9829 children stratified according to age and sex. From this cohort, 6929 children were investigated again after two years follow-up. At baseline, a direct association between SAMF categories and adiposity indexes was observed only in children aged 6⁻<10 years, while the lower frequency of SAMF consumption was significantly associated with a higher HDAS. At the two year follow-up, children with higher baseline SAMF consumption showed significantly higher increases in all the anthropometric variables measured, with the exception of girls 6⁻<10 years old. The inverse association between SAMF categories and HDAS was still present at the two years follow-up in all age and sex groups. Our results suggest that the habit to adding sugars to foods that are commonly perceived as healthy may impact the adherence to healthy dietary guidelines and increase in adiposity risk as well.