Associations between Dietary Intake, Blood Levels of Omega-3 and Omega-6 Fatty Acids and Reading Abilities in Children.

Lower levels of omega-3 polyunsaturated fatty acids (PUFAs) have been described in individuals with reading difficulties, but the degree and the nature of such deficiencies as well as the role of nutrition are a matter of debate. The aim of the present study was to investigate the associations between PUFA blood levels, nutritional status, and reading/writing/phonological awareness performances in 42 school-age children with varying levels of reading ability. Significant correlations were found between PUFA levels (specific omega-6/omega-3 ratios), the ratio of omega-6-derived calories to the total amount of calories and reading scores. Mediation analysis showed a mediating effect of fatty acids on the association between reading speed scores and nutritional status. Moderation analysis, moreover, showed that the associations of omega-6/omega-3 ratios in the blood and Kcal omega-6/Kcal total in dietary intake were moderated by reading speed performances. Results of the mediation and moderation models confirm that the associations of dietary intake with PUFA levels in the blood vary depending on learning abilities. Reading skills appear to be sensitive to the effects of a complex set of favorable conditions related to the presence of higher omega-3 blood levels. These conditions may reflect the action of dietary as well as genetic and epigenetic mechanisms.

Prevalence and Correlates of Overweight and Obesity in 12 European Countries in 2017-2018.

INTRODUCTION: Using data from the TackSHS survey, we aim to provide updated estimates on the prevalence and determinants of overweight and obesity in Europe. METHODS: A face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain). Overall, 10,810 participants, representative in each country of the general adult population, provided information on self-reported height and weight. RESULTS: Almost half of participants (48.1%; 95% confidence interval, CI: 47.2-49.1) reported to be overweight or obese (54.1% in men and 42.5% in women) and 12.6% (95% CI: 12.0-13.2) obese (11.3% in men and 13.8% in women). Obesity prevalence was lowest in Italy (7.5%) and France (8.8%) and highest in Greece (19.7%) and Romania (21.1%). Multilevel logistic random-effects analyses showed that prevalence of obesity was related with higher age and lower level of education and socioeconomic status. As compared to northern European countries, Western and Southern European ones showed a significantly lower obesity prevalence. When compared to a companion study conducted in 2010, Eastern and Northern European countries showed an increased trend in obesity prevalence. Conversely, countries with the lowest obesity prevalence (less than 10%), such as Italy and France, showed a decreased trend. CONCLUSIONS: Despite a large heterogeneity across countries, overweight and obesity prevalence estimates in Europe are alarming, with most of the countries reporting obesity prevalence approaching 20% or more, particularly in Eastern and Northern Europe. Since 2010, obesity prevalence increased in most of these countries.

Nutritional Habits and Interventions in Childhood.

The present Special Issue of Nutrients aims to host scientific articles contributing to enriching the knowledge in the field of nutritional habits and intervention in childhood [...].

Prevalence and Correlates of Overweight, Obesity and Physical Activity in Italian Children and Adolescents from Lombardy, Italy.

Investigating pediatric overweight and physical activity correlates is essential to design effective preventive programs. We used regional data (Lombardy, northern Italy) from the 2019 survey "OKKio alla Salute" (3093 children aged 8-9 years with measured anthropometric data), and from the 2018 wave of the "Health Behaviour in School-aged Children" survey (2916 adolescents aged 11-15 years with self-reported anthropometric data). In both the surveys, a cluster sampling methodology was used. Unconditional multiple logistic regression models were applied to estimate the odds ratios (OR) and corresponding 95% confidence intervals (CI) of overweight, obesity and poor physical activity. The prevalence of overweight (including obesity) was 22.4% for children aged 8-9 years and 14.4% for adolescents aged 11-15 years. A higher prevalence of overweight was observed among males, children with greater birth weight and those with obese parents. Scant physical activity was higher among females and older adolescents. There was a direct relationship between obesity and increased psychological distress (OR = 2.44; 95% CI: 1.12-5.27) or being victims of bullying (OR = 2.25; 95% CI: 1.17-4.34). Increasing physical activity significantly decreased the frequency of mental health outcomes. Prevention campaigns should be promoted to safeguard childhood physical and psychological wellbeing.

Effect of Vitamin D and Docosahexaenoic Acid Co-Supplementation on Vitamin D Status, Body Composition, and Metabolic Markers in Obese Children: A Randomized, Double Blind, Controlled Study.

Obese children are at high risk of developing vitamin D deficiency. Omega-3 polyunsaturated fatty acids and their derivatives might have a beneficial effect on vitamin D status of obese children, due to their anti-inflammatory action, and increasing its absorption. This multicenter, randomized, double-blind controlled study aims to investigate the effect of vitamin D and docosahexaenoic acid (DHA) co-supplementation for six months on vitamin D status, body composition, and metabolic markers of obese children with vitamin D deficiency. A total of 108 children were enrolled and 73 children completed the study: 33 were supplemented with an oral dose of 500 mg of DHA and 1200 IU/day of vitamin D3 and 41 were supplemented with 1200 IU/day of vitamin D3 + wheat germ oil. At the end of the study, more than 50% of the subjects improved their vitamin D status. However, co-supplementation was not more effective than vitamin D plus wheat germ oil. Fat mass percentage was significantly reduced, and body mass index improved in both groups, even if all the subjects were still obese at the end of the study. Children receiving both vitamin D and DHA presented a higher increase of DHA levels that could be relevant to prevent inflammatory-associated complications of obesity, but they had no effect on vitamin D levels.

Understanding feeding problems in autistic children: Exploring the interplay between internalizing symptoms and sensory features.

LAY ABSTRACT: This study adds to a growing body of research documenting feeding problems in autistic children. Our results indicate that children aged 1.5-5 years with feeding problems may present with elevated internalizing difficulties and alterations in sensory processing when compared to same-age children without feeding problems. Our study also proposes that sensory processing may be an important, mediating factor in the relationship between autism features and feeding problems. The present work suggests, therefore, that implementers should thoroughly consider the sensory profile of autistic children prior to intervening on feeding behaviors. In particular, based on these preliminary findings, feeding interventions could benefit from environments designed to support children who can find them noisy and overwhelming.

Towards a More Sustainable Nutrition: Complementary Feeding and Early Taste Experiences as a Basis for Future Food Choices.

The concept of sustainable nutrition considers different fields: from human health to environmental, economic and socio-cultural aspects. Currently, in Europe, the diets that reflect the assumptions of the sustainable diet are the Mediterranean Diet and the New Nordic Diet. They both encourage the consumption of vegetable, organic and minimally processed foods, as well as regional, seasonal and Fair-Trade products, reducing the ecological impact of the production chain. These eating habits could be established starting from the prenatal period and from infancy during the complementary feeding stage, aiding children to accept of a more variable diet in terms of flavor, taste and texture. In particular, the positive parental role model is an effective method for improving a child's diet and behaviors. Two healthy plates representing a sustainable diet in early infancy, at 6 and 24 months, are here proposed, in line with the "Planetary Health Diet" approved by the EAT-Lancet Commission. Our work aims to highlight how a sustainable diet is possible since infancy, since the introduction of solid foods.

Food advertising during children's television programmes in Italy.

OBJECTIVE: Previous studies from European countries noted that food products promoted on TV for children did not comply with international guidelines, including the World Health Organization European Nutrient Profile Model (WHO-ENPM) and the EU Pledge Nutrition Criteria (EU-PNC, an initiative developed by leading food companies). We aim to provide new data from Italy. DESIGN: Evaluation of Italian TV advertisements. Data on nutritional values for food product advertised were compared with nutritional standards issued by the WHO-ENPM and the EU-PNC. SETTING: In total, 180 h of TV programmes from six Italian channels, 2016-2017. PARTICIPANTS: Eight hundred and ten consecutive advertisements during children's programmes. RESULTS: Out of 810 advertisements, 90 (11·1 %) referred to food products. Among these, 84·5 % of the foods promoted did not meet the WHO-ENPM and 55·6 % the EU-PNC guidelines. Advertisements promoting sweet and salty snacks (i.e. ≥ 70 % of all foods) v. other food products showed higher non-compliance with both the WHO-ENPM (OR: 73·8; 95 % CI: 4·09, 1330) and the EU-PNC (OR: 9·21; 95 % CI: 2·82, 30·1). CONCLUSIONS: In Italy, most food advertisements during children's programmes are not compliant with European nutritional standards. Almost all the advertisements for snacks do not meet international guidelines. As the WHO-ENPM guidelines do not propose standards for all the food products, including meals, there is an urgent need to define independent and easy-to-read guidelines for food advertisements targeting children. As a first step towards the complete ban of food advertisements targeting children recommended by other researchers, these guidelines should be enforced by all the TV broadcasts.

Prediction of Resting Energy Expenditure in Children: May Artificial Neural Networks Improve Our Accuracy?

The inaccuracy of resting energy expenditure (REE) prediction formulae to calculate energy metabolism in children may lead to either under- or overestimated real caloric needs with clinical consequences. The aim of this paper was to apply artificial neural networks algorithms (ANNs) to REE prediction. We enrolled 561 healthy children (2-17 years). Nutritional status was classified according to World Health Organization (WHO) criteria, and 113 were obese. REE was measured using indirect calorimetry and estimated with WHO, Harris-Benedict, Schofield, and Oxford formulae. The ANNs considered specific anthropometric data to model REE. The mean absolute error (mean ± SD) of the prediction was 95.8 ± 80.8 and was strongly correlated with REE values (R2 = 0.88). The performance of ANNs was higher in the subgroup of obese children (101 ± 91.8) with a lower grade of imprecision (5.4%). ANNs as a novel approach may give valuable information regarding energy requirements and weight management in children.

Nutrient intake in aging infants and toddlers: 3-year follow-up of the Nutrintake study.

We performed a 3-year follow-up of the children enrolled into the Nutrintake Study to evaluate the changes of anthropometry and nutrient intake in aging infants and toddlers. Nutrient intake was assessed using a 7-day weighted food-diary. Of the 390 Nutrintake children, 164 (42%) participated in the present study. Their median (IQR) age was 54 (48; 66) months and their anthropometrical status, expressed as standard deviation scores, remained stable during the follow-up. During the same period, there was no biologically relevant change in the intake of macronutrients expressed as percentage of energy while median increases of 757 mg/day, 0.7 mg/day and 3.1 g/1000 kcal per day were detected for sodium, iron and fibre, respectively. As compared to the Italian reference standards, the Nutrintake children continued to show at the 3-year follow-up an excessive intake of simple carbohydrates, proteins, sodium, and a low intake of iron and fibre.

Snacking in nutrition and health.

Many studies suggest that distributing energy and nutrient intake across 4-5 eating occasions/day (rather than across three standard meals) could favourably affect human health. The inclusion of 1-2 snacks in the daily pattern alleviates the potential digestive and metabolic overload caused by fewer heavier meals and might contribute to meet recommendations for food groups (e.g. fruits, dairy) and nutrients like fibre and vitamins. The snack composition should be evaluated taking into account the whole day's diet. In early and late ages, and for specific population groups, snacking may need to follow particular characteristics in order to be optimal, both in terms of composition and timing. This document, which is the result of a collaboration of experts across several fields of research, intends to provide a review of the current scientific literature on meal frequency and health, highlighting the beneficial effects of correct snack consumption across the human lifespan.

Factors Influencing Children's Eating Behaviours.

Relevant factors involved in the creation of some children's food preferences and eating behaviours have been examined in order to highlight the topic and give paediatricians practical instruments to understand the background behind eating behaviour and to manage children's nutrition for preventive purposes. Electronic databases were searched to locate and appraise relevant studies. We carried out a search to identify papers published in English on factors that influence children's feeding behaviours. The family system that surrounds a child's domestic life will have an active role in establishing and promoting behaviours that will persist throughout his or her life. Early-life experiences with various tastes and flavours have a role in promoting healthy eating in future life. The nature of a narrative review makes it difficult to integrate complex interactions when large sets of studies are involved. In the current analysis, parental food habits and feeding strategies are the most dominant determinants of a child's eating behaviour and food choices. Parents should expose their offspring to a range of good food choices while acting as positive role models. Prevention programmes should be addressed to them, taking into account socioeconomic aspects and education.

Early Taste Experiences and Later Food Choices.

BACKGROUND: Nutrition in early life is increasingly considered to be an important factor influencing later health. Food preferences are formed in infancy, are tracked into childhood and beyond, and complementary feeding practices are crucial to prevent obesity later in life. METHODS: Through a literature search strategy, we have investigated the role of breastfeeding, of complementary feeding, and the parental and sociocultural factors which contribute to set food preferences early in life. RESULTS: Children are predisposed to prefer high-energy, -sugar, and -salt foods, and in pre-school age to reject new foods (food neophobia). While genetically determined individual differences exist, repeated offering of foods can modify innate preferences. CONCLUSIONS: Starting in the prenatal period, a varied exposure through amniotic fluid and repeated experiences with novel flavors during breastfeeding and complementary feeding increase children's willingness to try new foods within a positive social environment.

Determinants of children's eating behavior.

Parents have a high degree of control over the environments and experiences of their children. Food preferences are shaped by a combination of genetic and environmental factors. This article is a review of current data on effective determinants of children's eating habits. The development of children's food preferences involves a complex interplay of genetic, familial, and environmental factors. There is evidence of a strong genetic influence on appetite traits in children, but environment plays an important role in modeling children's eating behaviors. Parents use a variety of strategies to influence children's eating habits, some of which are counterproductive. Overcontrol, restriction, pressure to eat, and a promise of rewards have negative effects on children's food acceptance. Parents' food preferences and eating behaviors provide an opportunity to model good eating habits. Satiety is closely related to diet composition, and foods with low energy density contribute to prevent overeating. Parents should be informed about the consequences of an unhealthy diet and lifestyle and motivated to change their nutritional habits. Parents should be the target of prevention programs because children model themselves on their parents' eating behaviors, lifestyles, eating-related attitudes, and dissatisfaction regarding body image. Pediatricians can have an important role in the prevention of diet-related diseases. Informed and motivated parents can become a model for children by offering a healthy, high-satiety, low-energy-dense diet and promoting self-regulation from the first years of life.

Sex differences in the endocrine system in response to protein intake early in life.

BACKGROUND: Nutritional factors during a sensitive period can influence child development in a sex-related manner. OBJECTIVE: Our aim was to investigate whether sex modulates the responses of relevant biochemical parameters and growth to different protein intakes early in life. DESIGN: In a randomized controlled trial, formula-fed infants were assigned to receive formula with higher protein (HP) or lower protein (LP) content. The main outcome measures were insulin-like growth factor (IGF)-1 axis parameters, weight, length, BMI, leptin, and C-peptide/creatinine ratio at 6 mo of age. Dietary intake during the first 6 mo of life was also assessed. RESULTS: The IGF-1 axis response to HP feeding was modulated by sex. Total and free IGF-1 and IGF binding protein 3 concentrations were higher in girls than in boys. Compared with the LP diet, the HP diet was associated with higher IGF-1 and lower IGF binding protein 2 secretion. The response to this HP content formula tended to be stronger in girls than in boys. The HP diet was associated with a higher C-peptide/creatinine ratio. The leptin concentration was higher in girls than in boys and was correlated to the IGF-1 axis parameters. No interaction between sex and nutritional intervention was shown on growth. CONCLUSIONS: Our findings show that the endocrine response to a high protein diet early in life may be modulated by sex. The IGF-1 axis of female infants shows a stronger response to the nutritional intervention than does that of male infants, but there is no enhanced effect on growth. This trial was registered at clinicaltrials.gov as NCT00338689.

The introduction of solid food and growth in the first 2 y of life in formula-fed children: analysis of data from a European cohort study.

BACKGROUND: Early introduction of solid food has been suspected to induce excessive infant energy intake and weight gain. OBJECTIVE: The objective of this study was to test whether introduction of solid foods influences energy intake or growth. DESIGN: Healthy, formula-fed infants who were recruited in 5 European countries were eligible for study participation. Anthropometric measurements were taken at recruitment and at 3, 6, 12, and 24 mo. Time of introduction of solid foods and energy intake were determined by questionnaires and 3-d weighed food records at monthly intervals. Age at introduction of solid food was categorized into 4 groups: ≤ 13 wk, 14-17 wk, 18-21 wk, and ≥ 22 wk. RESULTS: Of 1090 recruited infants, 830 (76%) had data available for age at first introduction of solid food, and 671 (61%) completed the study until 24 mo of age. The median age at introduction of solid food was 19 wk. The time of introduction of solid foods was associated with country, sex, birth weight, parental education and marital status, and maternal smoking. Energy intake was higher in the first 8 mo of life in children with solid-food intake. Solid-food introduction did not predict anthropometric measures at 24 mo. Growth trajectories differed significantly: children with solid-food introduction in the first 12 wk experienced early catch-up growth, whereas those introduced to solid food at >22 wk of age grew more slowly and stayed on lower trajectories. CONCLUSIONS: Solid foods do not simply replace infant formula but increase energy intake. Time of introduction of solid food has little influence on infant growth. This trial was registered at clinicaltrials.gov as NCT00338689.

Milk protein intake, the metabolic-endocrine response, and growth in infancy: data from a randomized clinical trial.

BACKGROUND: Protein intake in early infancy has been suggested to be an important risk factor for later obesity, but information on potential mechanisms is very limited. OBJECTIVE: This study examined the influence of protein intake in infancy on serum amino acids, insulin, and the insulin-like growth factor I (IGF-I) axis and its possible relation to growth in the first 2 y of life. DESIGN: In a multicenter European study, 1138 healthy, formula-fed infants were randomly assigned to receive cow-milk-based infant and follow-on formulas with lower protein (LP; 1.77 and 2.2 g protein/100 kcal) or higher protein (HP; 2.9 and 4.4 g protein/100 kcal) contents for the first year. Biochemical variables were measured at age 6 mo in 339 infants receiving LP formula and 333 infants receiving HP formula and in 237 breastfed infants. RESULTS: Essential amino acids, especially branched-chain amino acids, IGF-I, and urinary C-peptide:creatinine ratio, were significantly (P < 0.001) higher in the HP group than in the LP group, whereas IGF-binding protein (IGF-BP) 2 was lower and IGF-BP3 did not differ significantly. The median IGF-I total serum concentration was 48.4 ng/mL (25th, 75th percentile: 27.2, 81.8 ng/mL) in the HP group and 34.7 ng/mL (17.7, 57.5 ng/mL) in the LP group; the urine C-peptide:creatinine ratios were 140.6 ng/mg (80.0, 203.8 ng/mg) and 107.3 ng/mg (65.2, 194.7 ng/mg), respectively. Most essential amino acids, IGF-I, C-peptide, and urea increased significantly in both the LP and HP groups compared with the breastfed group. Total IGF-I was significantly associated with growth until 6 mo but not thereafter. CONCLUSIONS: HP intake stimulates the IGF-I axis and insulin release in infancy. IGF-I enhances growth during the first 6 mo of life. This trial was registered at clinicaltrials.gov as NCT00338689.

Introduction of potentially allergenic foods in the infant's diet during the first year of life in five European countries.

BACKGROUND: Little information is available on infants' age at first introduction of potentially allergenic foods as part of complementary feeding. We aimed to analyze age at the introduction of potentially allergenic foods in healthy term infants relative to recommendations in 5 European countries. METHOD: Recruitment was conducted from October 2002 to June 2004. A total of 1,678 infants [588 breastfed (BF) and 1,090 formula-fed (FF) infants] were studied. In 1,368 infants, at least one 3-day weighed food diary at the age of 1-9 and 12 completed months was available. RESULTS: Six percent of BF infants and 13% of FF infants consumed some potentially allergenic food already prior to the recommended minimum age of 4 months, and 4% of BF infants and 11% of FF infants had already received gluten. There were significant differences in the timing of the introduction of potentially allergenic foods between the countries at the age of 4-6 months (p < 0.001). CONCLUSION: The time of first introduction of potentially allergenic foods in infants differed significantly between countries, and they were introduced much earlier than recommended in some countries. FF infants received potentially allergenic foods earlier than BF infants. Better information and counseling of parents is desirable.

Methodology for longitudinal assessment of nutrient intake and dietary habits in early childhood in a transnational multicenter study.

OBJECTIVES: The aim of this study was to describe developed methods for repeated longitudinal assessment of feeding habits and nutrient intakes of children in a multicenter trial in different European countries and to assess feasibility. PATIENTS AND METHODS: Nutrient intake and dietary habits of formula-fed and breast-fed infants were assessed in 5 European countries (Belgium, Germany, Italy, Poland, and Spain). Prospective age-adapted 3-day weighed food records were used from birth to 2 years of age (1, 2, 3, 4, 5, 6, 7, 8, 9, 12, 18, and 24 months). Standard operating procedures were developed to check each day's food record for quality. Dietitians were trained by using standardized food records. Data entry and nutrient analyses were performed with a dedicated software developed for this project. RESULTS: Of 1368 study participants, at least one 3-day food record was available; of 25,367 1-day food records, data on quality could be evaluated. Overall, between 81% and 97% (depending on the country) of the food records had been completed with high accuracy. The implementation of solid foods and regular family foods decreased the recording quality significantly during the 2-year time course (P < 0.001). The standardized training shows coefficients of variation up to a maximum of about 41%, indicating differences in data entry. CONCLUSIONS: The experiences gathered indicate that collecting dietary and behavioral data in a large number of infants from different cultures is a challenging but feasible task in which permanent supervision and training is vital. However, we conclude that the established methodology is suitable to obtain valuable results on current infant nutrition practice in Europe.