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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.

Summary Background & aims Children on long-term tube-feeding often need special treatment for oral feeding transitioning. Rapid tube-weaning programs usually result in short-term reductions in food intake and weight loss. This study examined the long-term effects of a “Graz-model” based weaning program on nutritional status and growth. Methods Children aged 0.5–13.0 years on long-term enteral nutritional support (ENS) participated in a three-week multidisciplinary weaning treatment. Data were collected at baseline, after completing the program, and at six and 12 months. Height/length, weight and BMI z-scores were determined according to the WHO growth standards. Energy and protein intake were assessed and presented as % of recommended daily allowance (RDA) values. Results Study participants (n = 58) were 64% male. Four children did not complete the three-week program due to acute illnesses. Complete weaning (from 100% ENS to 100% oral) was achieved in 22 children and partial weaning (at least 80% reduction of ENS) in 23 children. No demographic or clinical success predictors were identified. Thirty of the 45 weaned children completed the 12-month follow-up. A significant reduction in energy intake was observed at the three-week time-point [mean (SE): 56 (5.8)% versus 80 (4.7)%, p = 0.001]. This was followed by improvements in eating skills leading to energy intake at 12 months which did not significantly differ from baseline (p = 0.392). Mean (SE) baseline protein intake was 187 (13.0) %RDA. No significant difference from baseline were noted at 12 months (p = 0.301). Estimated mean (SD) height-, weight- and BMI z-scores at baseline were −2.11(0.28), −1.48(0.25), −0.13(0.31), respectively. No significant differences in growth data were observed over time. Conclusions Short-term reductions in nutritional intake and body weight observed after an intensive weaning program were reversible, and growth patterns were stable over 12 months. Further follow-up is recommended to ensure continued positive development in these children.

This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries., Adolescence is recognized as a time of rapid physiological and behavioral change. In this transition, eating behavior is still being formed and remains an integral part of a person’s lifestyle throughout his or her life. This study aims to assess eating behavior and associations with food intake in European adolescents. We included 2194 adolescents (45.9% boys), aged 12.5 to 17.5 years, from the cross-sectional HELENA study, with two completed 24 h recalls and complete questionnaire data on their eating behavior (Eating Behavior and Weight Problems Inventory for Children- EWI-C). Three subscales of the EWI were evaluated; they measured Strength and motivation to eat (EWI 1), Importance and impact of eating (EWI 2), and Eating as a means of coping with emotional stress (EWI 3). Since these subscales were specially focused on eating behavior, participants were classified as either Low (≤P75) or High (>P75) on each of the subscales. Our results showed a higher consumption of different types of food, in the EWI 1 scales, linked to the hunger and interest in eating, and we observed a relationship with the consumption of energy-dense products. This result was repeated in EWI 3, the subscale linked to emotional eating, where we also found higher consumption of energy-dense products. This study suggests that special features of eating behavior are associated with food intake in adolescents., This HELENA Study was carried out with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034).

Adolescent obesity rates are increasing on an epidemic level and food intake is one of the most important causes of this condition. From an ecological perspective, food intake is, in turn, influenced by many factors that need to be considered. This study aims to evaluate the associations between socio-demographic factors (gender, family origin, socio-economic status, parent’s education level), which consist of social stratifiers, health literacy and family context, as independent variables, and food intake (consumption of fruits, vegetables, soft drinks and sweets and breakfast frequency) and outcomes (Body Mass Index category), as dependent variables. Data were retrieved from 2145 students (13 and 15 years old) from the Lombardy region (Italy) who participated in the 2018 edition of Health Behaviour in School-Aged Children (HBSC). Six multiple binary logistic regression models were used in this study. Fruit, vegetable and soft drinks consumption models were related to all three-factor levels. Breakfast consumption frequency was associated with socio-demographic variables. BMI category was associated with socio-demographic and family variables. The results confirmed the existence of social inequalities, the importance of health literacy in predicting healthy behaviours and the relevance of the family context. The study confirms the importance of the ecological approach to understanding food intake and overweight/obesity status in adolescents.

The health and nutrition of the global adolescent population have been under-researched, in spite of its significant size (1.2 billion). This study investigates the prevalence and associated factors of malnutrition (stunting, thinness and overweight) among adolescents living in South Asia. The sample analysed was 24,053 South Asian schooled adolescents aged 12–15 years that participated in the cross-sectional Global School-Based Student Health Survey (GSHS) between 2009 and 2016. The prevalence of stunting, thinness and overweight was calculated using the World Health Organization (WHO) Child Growth Reference 2007. Associations between the three forms of malnutrition and their possible associated factors were assessed with binary logistic regression analysis using bootstrapping as a resampling method. The overall prevalence of stunting in South Asia was 13%, thinness was 10.8% and overweight was 10.8%. In the logistic regression model of the overall pooled sample, the factors associated with adolescent malnutrition were: age, hygiene behaviours, social support, sedentary behaviour, and tobacco use. A substantial proportion of stunting, thinness and overweight was found among school-going South Asian adolescents, indicating that the double burden of malnutrition is present in this population. Future research should seek to further understand the relationship between all forms of malnutrition and its associated factors in the adolescent population.

Background: Special needs schools (SNS) educate children and young people with major neurological disabilities who are at high risk of oropharyngeal dysphagia (OD) and malnutrition (MN). We aimed to assess the prevalence of OD, MN, dehydration (DH), and oral health (OH) in students at an SNS. Methods: A cross-sectional observational study was conducted at SNS L’Arboç, Catalonia, Spain. We assessed (a) demographics, health status, comorbidities, and gross motor function classification system (GMFCS), (b) swallowing function, oral-motor evaluation, masticatory capacity, and EDACS classification for eating and drinking abilities, (c) nutritional and DH status (anthropometry, bioimpedance and dietary records), and (d) OH (Oral Hygiene Index Simplified). Results: A total of 33 students (mean age 13.3 years, 39.4% level V of GMFCS) were included. Main diagnosis was cerebral palsy at 57.6%. All students presented OD, 90.6% had impaired safety, 68.7% were at levels II–III of EDACS, and 31.3% required PEG, furthermore, 89.3% had chronic MN, 21.4% had acute MN, 70% presented intracellular DH, and 83.9% presented impaired OH. Conclusion: MN, DH, OD, and poor OH are highly prevalent conditions in students with cerebral palsy and other neurological disabilities and must be specifically managed through nutritional and educational strategies. The multidisciplinary team at SNS should include healthcare professionals specifically trained in these conditions.

Objective:To compare the dietary habits of children living in northern villages and in the capital of Greenland, given the reported transition from traditional to westernised diet in adults over recent decades, and to explore the association between consumption of marine mammals and fish (MMF) and the children’s metabolic profile and vitamin D status.Design:Children answered an FFQ encompassing sixty-four individual food types pooled into six food categories. Their pubertal stage, body fat, fitness level, metabolic profile (non-HDL-cholesterol, glycated Hb, insulin, glucose, high-sensitivity C-reactive protein) as well as serum 25-hydroxyvitamin D (25(OH)D) concentration were evaluated.Setting:Siorapaluk and Qaanaaq (north of Greenland) and Nuuk (west).Participants:Children aged 6–18 years (n 177).Results:MMF were most frequently eaten by children from Siorapaluk (mean (sd): 73·4 (14·1) times/month), followed by children from Qaanaaq (37·0 (25·0) times/month), and least often eaten by children from Nuuk (23·7 (24·6) times/month; P < 0·001). Children from Qaanaaq consumed ‘junk food’ more frequently (P < 0·001) and fruits and vegetables less frequently (P < 0·01) than children from Nuuk. MMF consumption was positively associated with serum 25(OH)D concentration (P < 0·05), but the overall prevalence of vitamin D deficiency was high (18 %). No association was found between MMF consumption and metabolic parameters.Conclusions:The dietary transition and influence of western diets have spread to the north of Greenland and only the most remote place consumed a traditional diet highly based on MMF. We found no strong associations of MMF consumption with metabolic health, but a positive association with vitamin D status.

AIM Childhood underweight is a problem being faced by rural black South African populations but little is known about its risk factors. The aim of this study was to investigate the risk factors related to childhood underweight in rural black South African children within the area known as Ellisras. METHODS A cross-sectional study was conducted as part of the ongoing Ellisras Longitudinal Study. The current study comprised a total of 1 811 pre-primary and primary school children (934 males and 877 females) aged between five and 16 years. The chi-squared automatic interaction detection (CHAID) decision tree model was used to identify factors and determine their relationships with childhood underweight. RESULTS A total of 1 811 children were involved in the study, of whom about 81% were severely underweight. The CHAID model showed that the variables: nutrition, age group, gender and school level were the four main predicting variables affecting childhood underweight. Hypertension was not significantly associated with childhood underweight. CONCLUSIONS The prevalence of childhood underweight was found to be high in children aged between five and 16 years. To address this problem, well-thought-out intervention systems are need.

Nutritional geometry (NG) is a novel dietary analysis approach that considers nutrient balance, rather than single nutrient effects, on health and behaviour. Through NG, recent animal experiments have found that lifespan and reproduction are differentially altered by dietary macronutrient distribution. Epidemiological research using NG reports similar findings for human ageing. Yet, the relation of macronutrient balance to human reproduction, especially reproductive maturation, remains undefined. We studied the impact of childhood macronutrient intake on pubertal maturation, by applying NG to an Australian longitudinal adolescent dataset. Food records, collected at age 8 years from 142 pre-pubertal children (females, 92; males, 50), were analysed for absolute energy, percentage energy and energy-adjusted residuals from protein, carbohydrate and fat. Pubertal stage change (assessed at 8, 13 and 15 years) was modelled to obtain individual mathematical estimates of pubertal timing and tempo. Timing of menarche was recorded. The association of macronutrients to pubertal timing/tempo was assessed via NG, involving generalised additive models and heat maps to aid interpretation. Results showed lower dietary protein (relative to carbohydrate and fat) in girls consistently predicted earlier pubertal timing and menarche, and was related to faster pubertal tempo (allP< 0·05). No significant associations were identified in boys for both timing and tempo. Results suggest a role of non-protein macronutrients in facilitating female maturation; corroborating feeding and reproductive behaviour patterns observed in earlier NG studies of primates. Application of NG to other adolescent datasets is required to confirm the present findings. Such work would advance understanding of how nutrient balance shapes human development and health.

Aims This review aimed at investigating fruit, vegetable and legume consumption, salt/sodium intake, and the adherence to the Mediterranean dietary pattern in adolescents, three key aspects towards the adoption of a healthy diet. Data synthesis Three separate searches were carried out on PubMed and Scopus, using the same procedure, searching for studies published in the previous decade with data on fruit and/or vegetable or legume consumption, salt or sodium intake, and adherence to the Mediterranean Diet assessed using the KIDMED questionnaire. The review included a total of 58 papers, which describe original investigations on healthy adolescents (10–19 years old) living in North America, Europe or Oceania, with a sample size >150 participants. The average fruit and vegetable consumption has been found strongly below the recommended values of 400 grams or 5 portions per day in almost all the examined populations. Very little is known about adolescents' legume consumption. Few available data have been found also for sodium intake and, for the majority of the screened populations, levels were far above the recommended 5 grams per day. Lastly, a medium–low adherence to the Mediterranean Diet has been found for adolescents living in Mediterranean Countries. Conclusions Adolescents living in North America, Europe or Oceania are far from being compliant with the nutritional recommendations for fruit, vegetables, legumes, and sodium, and they do not follow the principles of the Mediterranean Diet. Educational and behavioural interventions are required to improve adolescents' dietary patterns.

Dairy is important for children and adolescents' bone development and nutritional needs, and it is not known how the type of milk consumed relates to overall dietary intakes. This study assessed the hypothesis that Australian children and adolescents who drink milk have greater milk, dairy, and micronutrient intakes compared to those who consume milk in other ways or avoid milk. A secondary analysis using day 1 data from the 2011-2012 National Nutrition and Physical Activity Survey was performed (n = 2812, 2-18 years). Children were classified as plain or flavored milk drinkers, other milk drinkers (eg, smoothies, milkshakes), nondrinkers of milk (eg. on cereal), or milk avoiders. Intakes of total dairy, milk, calcium, free sugars, and sugar-sweetened beverages were determined and adjusted for confounders. Milk consumption was popular (81%), and the majority (63%) of milk consumers were drinkers, and of those, 46% were plain, 32% were flavored, and 21% were other milk drinkers. Flavored and plain milk drinkers had higher total daily milk (480, 95% confidence interval [CI] 459-501 and 445, 95% CI 427-462 g, respectively), dairy (2.8, 95% CI 2.7-2.9 and 2.6, 95% CI 2.5-2.7 servings, respectively), and calcium (1049 ± 18 and 980 ± 15 mg, respectively) intakes than all other groups. Plain milk drinkers (10.7%, SD 6.2%) had a lower proportion of daily energy from free sugars than all other groups, but there was no difference in free sugars intake between plain and flavored milk drinkers, and there were no differences in anthropometric measures across groups. Plain and flavored milk drinkers and nondrinkers of milk had the lowest prevalence of sugar-sweetened beverages intake (P

Diet is thought to modulate inflammation. This study shows no relationships between the dietary inflammatory index (DII) and biomarkers of inflammation or bone after adjusting for covariates. Monocyte chemoattractant protein-1 was inversely associated with peripheral tibia cortical thickness and prospective childhood studies should be conducted to better understand this relationship and to determine if there are long-term consequences in adulthood.Examine the relationships between the DII-scores and bone and biomarkers of inflammation in 290 adolescents, ages 9-13 years.DII-scores were calculated from 3-day diet records and categorized into tertiles, low ( - 1.34), medium (- 1.34 to 1.41), and high ( 1.41) inflammation. Radius and tibia bone were assessed via peripheral quantitative computed tomography (Stratec XCT 2000) at the 66% site relative to the distal growth plate. Fasting serum was measured for tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), and monocyte chemoattractant protein-1 (MCP-1). The relationships between DII-scores and bone and biomarkers of inflammation were assessed using bivariate and partial correlations adjusting for sexual maturation, sex, race, muscle cross-sectional area, and height. ANOVA/ANCOVA models were used to compare DII-tertiles with dependent variables.DII-scores were negatively associated with tibia trabecular area (TtAr; r = - .141, P = .019), periosteal perimeter (PsPM; r = - .145, P = .016), endosteal perimeter (r = - .145, P = .016), strength strain index (SSI; r = - .129, P = .032), and radius TtAr (r = - .140, P = .020), PsPM (r = -.138, P = .027) and SSI (r = -.131, P = .036) but nullified when adjusting for covariates. Tibia PsPM was higher in the low DII group compared to the medium (P = .050) and high (P = .046) groups but nullified after controlling for covariates. DII-scores were not associated with TNF-α, VEGF, or IL-6, but were associated with MCP-1 only in the unadjusted model (r = .125, P = .042). In the adjusted model, MCP-1 was inversely associated with tibia cortical thickness (r = -.150 P = .030).The DII-scores were not related to biomarkers of inflammation or bone; however, the biomarker of inflammation, MCP-1 was negatively associated with tibia CtTh. Future prospective pediatric studies should be conducted to better understand this relationship and determine if there are long-term implications in adulthood.

Objective Prior research has documented the influence of social norms on health-related behaviors, though social norms may affect behaviors in more complex ways than have conventionally been modeled. The present research evaluates parent norms and teens' own attitudes as moderators of associations between perceived peer norms and diet and physical activity behaviors (both health-promoting and health-impairing) in a national sample of U.S. adolescents. Methods Adolescent participants (N = 1,859; ages 12-17) from the 2014 Family Life, Activity, Sun, Health, and Eating study reported on the extent to which their friends eat fruits and vegetables; eat junk food or drink sugary drinks; exercise; and watch TV, play on the computer, or play electronic games most days of the week. They also reported on their own attitudes and behaviors as well as their parents' corresponding behaviors and rules. Results Perceived peer norms were associated with teens' own health-promoting behaviors such as fruit and vegetable consumption and physical activity as well as health-impairing behaviors such as junk food consumption and sedentary habits. Teens who reported liking fruits and vegetables or physical activity or perceiving congruent descriptive parental norms demonstrated the strongest positive associations between peer norms and their own behavior. Conclusions Perceived social norms may play a significant role in both health-impairing and health-promoting behaviors, particularly when congruent with attitudes or descriptive parental norms about those behaviors. The findings may inform interventions such as social norms marketing campaigns that aim to change perceptions of peer norms for health-promoting behavior. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Nutrition is essential for children with end-stage renal disease, especially for those suffering from peritoneal dialysis (PD). Although the number of PD children has increased annually at the Vietnam National Hospital of Pediatrics, studies about the diet and nutritional deficiencies status of PD children is still limited. The aim of this study was to describe the actual diet and status of nutritional deficiencies of PD patients. This cross-sectional study was conducted on 31 PD children aged 2-15 years old using the 24-h dietary recall and biochemical parameters in blood (albumin, hemoglobin, calcium, sodium, potassium, and chloride). The energy intake was lowest in children over 13-year-old with only 32.9% of dietary reference intakes (DRIs). Carbohydrate intake among 10-15-year-old children was 38.1% of DRIs. Daily consumption of sodium was 65.6% and 33%-35% of DRIs for children under and over three-year-old, respectively. In comparison with DRIs, daily consumption of magnesium, iron, and calcium of over 10-year-old children was lower than that of younger children. In terms of vitamins, B-group vitamins, Vitamin C achieved the recommended levels except Vitamin A (63.0%) and Vitamin D (20.0%). The prevalence of children with serum albumin concentration lower than the normal range was 45.2% and prevalence of anemia was 51.6%. The proportion of children with decreased plasma calcium, sodium, and potassium levels was 83.8%, 77.4%, and 12.9%, respectively. PD children's diet lacks energy, protein, lipid, carbohydrate, as well as micronutrients. The prevalence of nutritional deficiencies is remarkably high in PD children.

The verification of factors associated with growth, body composition and nutritional and nutritional aspects after HIV infection in children or adolescents in Brazil is fundamental for progress in this area. We selected articles published until 2018, available on the platforms PubMed and Lilacs, using the keywords The following descriptors and their associations were used, extracted from MeSH: “Children”, “Adolescent”, “Anthropometry”, “Nutritional Assessment”, “HIV”, “Brazil” adding the filter “and” for advanced searches. A total of 1,450 articles were found, and after selection and full reading, 19 were selected. The studies agreed that children and adolescents living with HIV present or may present alterations in bone metabolism, lipid metabolism and body composition due to infection or associated with therapy. Significant differences were observed in weight and height in infected infants compared to uninfected infants. The evaluation and monitoring of diet quality, as well as serum micronutrient monitoring, are fundamental to guarantee the clinical and treatment conditions of these patients, as well as to prevent disorders due to low nutrient intakes.

Creatine is a popular ergogenic aid among athletic populations with consistent evidence indicating that creatine supplementation also continues to be commonly used among adolescent populations. In addition, the evidence base supporting the therapeutic benefits of creatine supplementation for a plethora of clinical applications in both adults and children continues to grow. Among pediatric populations, a strong rationale exists for creatine to afford therapeutic benefits pertaining to multiple neuromuscular and metabolic disorders, with preliminary evidence for other subsets of clinical populations as well. Despite the strong evidence supporting the efficacy and safety of creatine supplementation among adult populations, less is known as to whether similar physiological benefits extend to children and adolescent populations, and in particular those adolescent populations who are regularly participating in high-intensity exercise training. While limited in scope, studies involving creatine supplementation and exercise performance in adolescent athletes generally report improvements in a number of ergogenic outcomes with limited evidence of ergolytic properties and consistent reports indicating no adverse events associated with supplementation. The purpose of this article is to summarize the rationale, prevalence of use, performance benefits, clinical applications, and safety of creatine use in children and adolescents.

This study proposes age- and sex-specific percentiles for serum cobalamin and folate, and analyzes the effects of sex, age, body mass index (BMI), and socioeconomic status (SES) on cobalamin and folate concentrations in healthy children and adolescents. In total, 4478 serum samples provided by healthy participants (2 months-18.0 years) in the LIFE (Leipzig Research Centre for Civilization Diseases) Child population-based cohort study between 2011 and 2015 were analyzed by electrochemiluminescence immunoassay (ECLIA). Continuous age-and sex-related percentiles (2.5th, 10th, 50th, 90th, 97.5th) were estimated, applying Cole's LMS method. In both sexes, folate concentrations decreased continuously with age, whereas cobalamin concentration peaked between three and seven years of age and declined thereafter. Female sex was associated with higher concentrations of both vitamins in 13- to 18-year-olds and with higher folate levels in one- to five-year-olds. BMI was inversely correlated with concentrations of both vitamins, whilst SES positively affected folate but not cobalamin concentrations. To conclude, in the assessment of cobalamin and folate status, the age- and sex-dependent dynamic of the respective serum concentrations must be considered. While BMI is a determinant of both vitamin concentrations, SES is only associated with folate concentrations.

Two aspects that characterize the Mediterranean diet (MD) are “what” and “how” we eat. Conviviality relates to “how” we eat and to the pleasure of sharing meals with significant people. The most studied concept is “family meals”, which includes conviviality, which involves “enjoying” family meals. Given the lack of research on convivial family meals in Mediterranean countries, the purpose of this qualitative study was to analyze the family meal representations and practices of families with 12- to 16-year-old adolescents to assess whether they responded to a pattern of conviviality, and to examine their association with MD adherence. Twelve semi-structured interviews were conducted and food frequency and family meal questionnaires were administered. A food pattern analysis was carried out and digital photos of meals were analyzed to examine eating habits and meal composition, respectively. The findings showed that parents believed family meals are a space for socialization and communication. Items relating to the conviviality of family meals identified in the study were meal frequency, meals at the table, lack of digital distractions, pleasant conversations, and time spent on family meals. Attention should be paid to conviviality in Mediterranean families when designing multi-approach strategies to promote healthy eating among adolescents.

High intake of sugar-sweetened beverages (SSBs) contributes to detrimental cardio-metabolic indicators in youth. Monitoring of SSB consumption is lacking in Eastern Europe., info:eu-repo/semantics/published

The Dietary Guidelines for Americans (DGA), 2015-2020 (1), recommends consuming different types of vegetables, including dark green, red or orange, starchy, and other vegetables, and fruit, especially whole fruit. Fruits and vegetables are part of healthy eating patterns; they are sources of many essential nutrients, fiber and phytochemicals, and are associated with decreased risk of chronic diseases (1-3). This report examines the percentage of children and adolescents aged 2-19 who consumed fruits and vegetables on a given day in 2015-2018.

Objective:To investigate whether adherence to the adapted Mediterranean Diet Score for Adolescents (MDS_A) and the adapted Mediterranean Diet Quality Index for Adolescents (KIDMED_A) is associated with better food/nutrient intakes and nutritional biomarkers.Design:The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study is a cross-sectional study aiming to obtain comparable data on a variety of nutritional and health-related parameters in European adolescents aged 12·5–17·5 years.Setting:Nine European countries.Participants:European adolescents (n 2330) recruited to the HELENA study. Dietary intake was obtained with 24 h dietary recalls, an FFQ and a Food Choices and Preferences questionnaire. MDS_A was calculated as a categorical variable using cut-offs (MDS_A), as a continuous variable (zMDS_A) and with energy adjustments (zEnMDS_A). The KIDMED_A score was also calculated.Results:Multilevel linear regression analysis showed positive associations for zMDS_A and KIDMED_A with serum levels of vitamin D, vitamin C, plasma folate, holo-transcobalamin, β-carotene and n-3 fatty acids, while negative associations were observed with trans-fatty acid serum levels. For categorical indices, blood biomarkers showed few significant results. zMDS_A and KIDMED_A showed positive associations with vegetables and fruits intake, and negative associations with energy-dense and low-nutritious foods. zMDS_A and KIDMED_A were positively associated with all macronutrients, vitamins and minerals (all P < 0·0001), except with monosaccharides and PUFA for KIDMED_A and cholesterol for both indices (P < 0·05).Conclusions:zMDS_A and KIDMED_A have shown the strongest associations with the dietary indicators and biomarkers that have been associated with the Mediterranean diet before, and are therefore considered the most appropriate and valid Mediterranean diet scores for European adolescents.

The influence of free sugar intake on nutrient intake remains unclear in Japanese children and adolescents with relatively low free sugar intake. This cross-sectional study aimed to investigate the relationship between free sugar and selected nutrient intakes using data from the 2016 National Health and Nutrition Survey, Japan, based on the WHO recommendations (n 2919). Mean intakes for selected nutrients and food groups were compared according to free sugar intake categories (

Background: Nutrition and diet-related non-communicable diseases are a major cause of death worldwide. Food preferences and eating behaviours are likely to be established during adolescence, making it an important period to promote healthy behaviours. Aim: To review the effectiveness of gamification to improve fruit and vegetable intake in adolescents. Methods: A systematic search was conducted using eight databases and grey literature sources for articles published to date on the effectiveness of gamification on fruit and vegetable intake in adolescents. Search criteria included articles that were complete and peer reviewed, conducted empirical research, described gamified elements used, focused on individuals between 10 and 24 years, and were available in English. Results: Out of 402 studies identified by the search, 7 were included in the review. Overall, short-term gamified interventions showed promise in improving fruit and vegetable intake in those aged 10 to 24 years old. Gamification was primarily facilitated through extrinsic motivation (i.e. points, badges, vouchers, leaderboard, narration, avatars, challenges) rather than intrinsic motivation (i.e. team-based competition). Studies were moderate in quality and key methodological issues related to non-randomized study design, lack of comparison group, inadequate control for confounding, and small sample size. Conclusions: Gamification can be an effective tool in changing nutrition-related behaviour in adolescents over the short term. Future research should consider gamified interventions that are of longer duration, incorporate additional intrinsic gamified elements, tailor game elements for population subgroups, and address methodological issues.

Diet during adolescence can have lasting effects on nutritional status, health, and development. We hypothesized that dietary patterns with low-quality nutrition are associated with overweightness. We collected data for 882 Chilean adolescents from the Growth and Obesity Cohort Study (mean age: 12 years). Dietary intake was assessed through 24-h recalls and weight status data were obtained during clinical visits. Dietary patterns were obtained through exploratory factor analysis. Multiple logistic regression models were used to examine cross-sectional associations between dietary patterns and overweight (BMI z-score &ge, 1SD). Four dietary patterns were identified: &ldquo, Breakfast/Light dinner&rdquo, &ldquo, Natural foods&rdquo, Western&rdquo, and &ldquo, Snacking&rdquo, patterns provided higher energy and excess nutrients (sodium, saturated fat, and added sugar). Moreover, adolescents with higher adherence to &ldquo, or &ldquo, patterns (third tertile) had higher odds of being classified as overweight (OR = 1.67, 95%CI: 1.103&ndash, 2.522 and OR = 1.86, 95%CI: 1.235&ndash, 2.792, respectively) than those with lower adherence (first tertile). &ldquo, pattern was also associated with overweightness (OR = 1.83, 95%CI: 1.219&ndash, 2.754). These dietary patterns were associated with overconsumption of nutrients of public health concern. Three of the four main dietary patterns were associated with overweightness. These results highlight the need of prioritizing adolescents on obesity prevention strategies.

Breakfast plays an important role in health because it has been associated with overall health, which includes a high daily nutrient intake and a low risk of chronic diseases. For this reason, we investigated the associations between breakfast consumption and daily energy, macronutrients, and food and beverage consumption. We systematically searched peer-reviewed articles in three datasets (Pubmed, Scopus, and Cochrane). Two independent reviewers evaluated 3188 studies against the inclusion criteria using the Appraisal tool for Cross-Sectional Studies (AXIS) critical appraisal and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodologies. The meta-analysis was performed by comparing results based on type of breakfast consumed (ready to eat cereal breakfasts or other types of breakfasts). Ultimately, 38 studies were included in the review and 7 of them in the energy and macronutrients intake meta-analysis. In the Systematic Review, breakfast consumers had higher energy intake (EI), fibre intake, and higher consumption of fruits and vegetables and lower consumption of soft drinks than breakfast skippers. In the Meta-Analysis, breakfast consumers had a higher carbohydrates intake (MD, −8.21; 95%CI: −11.37, −5.05) and fibre intake (MD, −8.43; 95%CI: −12.63, −4.23) than breakfast skippers. However, breakfast consumers had a lower fat intake (MD, 4.59; 95%CI: 2.04, 7.15). Our review suggests that breakfast consumption is associated with better macronutrient intake and healthier food and beverage consumption.

The first follow-up study of the original Institute of Nutrition of Central America and Panama Longitudinal Study was conducted in 1988 to 1989 when participants were between the ages of 11 and 27 years. The longer term effects of the original supplementation in early life of either high protein and energy, Atole, or no protein and low energy, Fresco, were seen in anthropometry, skeletal maturation, physical work capacity, and intellectual development, with maximum benefit seen in those participants who had maximum exposure to the supplementation during prenatal and early postnatal years. No effects were observed in bone mineralization and menarche. The long-term positive effects are consistent with the promotion of improved nutrition during the first 1000 days and established the foundation for further follow-up studies as the participants move into adulthood and further develop their human capital.

Salt iodization is the main public health policy to prevent and control iodine deficiency disorders. The National Salt Iodization Impact Assessment Survey (PNAISAL) was conducted to measure iodine concentration among Brazilian schoolchildren. A survey including 6&ndash, 14-year-old schoolchildren from public and private schools from all 26 Brazilian states and the Federal District was carried out in the biennia 2008&ndash, 2009 and 2013&ndash, 2014. Municipalities, schools, and students were randomly selected. Students were interviewed at school using a standard questionnaire, which included the collection of demographic, educational, weight, height, and 10 mL non-fasting urine collection information. The analyses were weighted according to the population of students per federative unit. The median urinary iodine concentration (MUIC) for the entire sample by region, federative unit per school, and student characteristics, was described from the cutoff points defined by the World Health Organization (severe disability: &lt, 20 &micro, g/L, moderate: 20&ndash, 49 &micro, g/L, mild: 50&ndash, 99 &micro, g/L, adequate: 100&ndash, 199 &micro, g/L, more than adequate: 200&ndash, 299 &micro, g/L, and excessive: &gt, 300 &micro, g/L). In total, 18,864 students (95.9% of the total) from 818 schools in 477 municipalities from all federative units were included in this study. Almost 70% were brown skin color, nine-years-old or older, studied in urban schools, and were enrolled in elementary school. The prevalence of overweight/obesity, as measured by body mass index (BMI) for age, was about twice as high compared to nutritional deficits (17.3% versus 9.6%). The MUIC arrived at 276.7 &micro, g/L (25th percentile = 175.5 &micro, g/L and 75th percentile = 399.71 &micro, g/L). In Brazil as a whole, the prevalence of mild, moderate, and severe deficit was 6.9%, 2.6%, and 0.6%, respectively. About one-fifth of the students (20.7%) had adequate iodine concentration, while 24.9% and 44.2% had more than adequate or excessive concentration, respectively. The prevalence of iodine deficits was significantly higher among younger female students from municipal public schools living in rural areas with the lowest BMI. The median urine iodine concentration showed that Brazilian students have an adequate nutritional intake, with a significant proportion of them evidencing overconsumption of this micronutrient.

Background: Marketing, including the use of cartoon animations on packaging, has been shown to influence the food children choose to eat. This paper aims to determine the nutritional quality of UK food and drink products featuring child-friendly characters on pack. Methods: A comprehensive cross-sectional survey of food and drink with packaging appealing to children available in the UK. Products were classified high in fat, salt and/or sugar (HFSS) according to the UK nutrient profiling model and guidance for front of pack nutrition labelling. Logistic regression was used to determine whether there was a significant relationship between nutritional quality of products, and animation type. Results: Over half (51%) of 532 products with animations on packaging were classified as HFSS. Food products featuring unlicensed characters were significantly more likely to be deemed HFSS than those with licensed characters, according to both the nutrient profiling model (odds ratio (OR) 2.1, 95% CI: 1.3 to 3.4) and front of pack nutrition labelling system (OR 2.3, 95% confidence interval CI: 1.4 to 3.7). Conclusions: The use of cartoon characters on HFSS products is widespread. Policies to restrict the use of such marketing tactics should be considered to prevent children being targeted with unhealthy foods and drinks.

Objective:Consumption of fruits and vegetables (F&V) among adolescents falls below recommendations in many Western countries. The impact of social and emotional aspects of family life on adolescent dietary behaviour may contribute to this, yet remains under-investigated. The present study examines the association between adolescents’ perceptions of emotional home atmosphere (EHA) and their F&V consumption frequency.Design:An FFQ was used to assess F&V consumption frequency. EHA was assessed by an eight-item measure with three subscales: perceived home warmth, strictness and relational tension. EHA subscales were used as binary variables: a score equal to or above the median value was considered as a higher perception, while a score below the median was considered as a lower perception of the EHA in question. Country differences in meeting the European 5-a-day recommendations were described. Further, the association between EHA and F&V consumption frequency was investigated using multiple linear regression.Setting:Regional examination centres in eight European countries.Participants:Adolescents (n 3196) aged 12–18 years.Results:The mean F&V consumption frequency was 3·27 (sd 2·84) times/d. Only 16·1 % of boys and 18 % of girls in our study sample met the recommendation of five F&V daily. After controlling for age, sex, education level of the parents and country of origin, perceived home warmth was associated with a 16 (95 % CI 9, 22) % higher F&V consumption frequency (P < 0·001).Conclusions:F&V consumption frequency was suboptimal in the survey areas. Interventions targeting perceived warmth as a component of EHA could potentially have a positive effect on adolescents’ dietary behaviour.

Obesity and metabolic syndrome (MetS) are worldwide major health challenges. The Mediterranean diet (MD) is associated with a better cardiometabolic profile, but these beneficial e ects may be influenced by genetic variations, modulating the predisposition to obesity or MetS. The aim was to assess whether interaction e ects occur between an obesity genetic risk score (obesity-GRS) and the MD on adiposity and MetS in European adolescents. Multiple linear regression models were used to assess the interaction e ects of an obesity-GRS and the MD on adiposity and MetS and its components. Interaction e ects between theMDon adiposity and MetS were observed in both sex groups (p < 0.05). However, those interaction e ects were only expressed in a certain number of adolescents, when a limited number of risk alleles were present. Regarding adiposity, a total of 51.1% males and 98.7% females had lower body mass index (BMI) as a result of higher MD adherence. Concerning MetS, only 9.9% of males with higher MD adherence had lower MetS scores. However, the same e ect was observed in 95.2% of females. In conclusion, obesity-related genotypes could modulate the relationship between MD adherence and adiposity and MetS in European adolescents; the interaction e ect was higher in females than in males., Iberus Talent Pre-doctoral fellowships 2018, under the European Union's H2020 research and innovation programme under Marie Sklodowska-Curie grant 801586, Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, CIBERObn ISCIII-CB15/00043, European Union (EU) FOOD-CT-2005-007034, HELENA project, Spanish Ministry of Economy and Competitiveness RYC-2010-05957 RYC-2011-09011, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn)

This article examines how nutritional status is treated throughout the lifecycle. In doing so, the review identifies promising life stages during which intervention may improve nutritional status of future generations. A life course perspective suggests that nutritional changes are most likely to be sustained when they occur during times of developmental transition, such as pregnancy or adolescence. Adolescence is a unique period in which malnutrition in future generations may be addressed because it is the first life stage at which pregnancy becomes feasible and individuals seek independence from parents. A need exists to begin investigating not just how nutrition changes are sustained throughout the lifespan, but how nutritional intervention in one generation impacts the next. This intergenerational approach should be undertaken with cross-discipline collaboration to have the best chance at impacting underlying determinants of malnutrition like poverty and women’s education.

Cystic fibrosis (CF) is a severe, progressive, multisystemic disease that is caused by mutations in the cystic fibrosis transmembrane conductance regulator gene. Optimizing nutrition is critical, as higher growth parameters are associated with better pulmonary function and outcomes, but unfortunately patients with this disease are prone to malnutrition, growth failure, and vitamin deficiencies. The purpose of this review is to provide a timely highlight of the physiologic processes and outcome data to support today's management strategies, as well as review these principles themselves. Areas covered: This review covers the background of the importance of vigilant attention to nutrition and growth in these patients, the underlying physiology leading to an abnormal gastrointestinal tract and its role in CF malnutrition, and current evaluation and management strategies to address nutrition in CF. Analysis of up-to-date relevant literature was performed using PubMed. Expert commentary: Advances in research and clinical developments over the years have improved knowledge of this disease as well as patient outcomes. Of particular importance is optimizing nutrition especially in the early stages of life, as well as accounting for the markedly abnormal CF intestinal milieu when addressing the gastrointestinal and nutritional needs of these patients.

Summary Background & aims This study was designed to assess clinical characteristics and nutritional status of pediatric outpatients with cerebral palsy (CP) and to determine prevalence of malnutrition based on physicians' clinical judgment and on anthropometric data in relation to percentile reference values. Methods A total of 1108 pediatric neurology outpatients (mean ± SEM age: 7.2 ± 0.1 years, 59.3% were males) diagnosed with CP were included in this cross-sectional, non-interventional multicenter single-visit study conducted between October 2015 and July 2016 at 20 centers across Turkey. Data on patient and CP characteristics, concomitant nonneuromotor impairments and gastrointestinal disorders as well as anthropometrics, outcome of nutritional status assessment (via physicians' clinical judgment and Gomez classification and Waterlow classification of anthropometric data) and physician's view on nutritional care in CP patients were collected at a single visit. Results The most common CP etiology was asphyxia (62.5%). The most common clinical category was spastic CP (87.5%) with quadriplegic (54.0%) topography and level V gross motor dysfunction (45.4%) in most of patients. The prevalence of malnutrition was considered to be 57.2% based on physicians' clinical judgment, while shown to be 94.3% (3rd degree in 86.7%) according to Gomez classification of Neyzi weight for age (WFA) percentiles and to be 91.3% (severe in 88.3%) according to Waterlow classification of Neyzi height for age (HFA) percentiles. Conclusions In conclusion, our findings revealed high prevalence of malnutrition, while also emphasize the likelihood of overestimation of malnutrition in children with CP when anthropometric assessment was based on use of growth charts for general pediatric population. This large-scale survey provided valuable data regarding nutritional assessment practice and malnutrition prevalence among children with CP in Turkey, which may be utilized for future proactive strategies in the prevention and treatment of malnutrition in this population.

Summary Background and Aims Use of extracorporeal membrane oxygenation (ECMO) in children is increasing. Yet, little is known about optimal nutritional practices in these children. We aim to describe the nutritional adequacy, factors associated with enteral nutrition, and the association between nutritional adequacy and mortality in children supported on ECMO. Methods We conducted a retrospective review of all children (1 month–18 years) requiring ECMO between 2010 and 2016. Data on enteral and parenteral energy and protein intake in the first 7 days of ECMO were collected. Adequacy of nutrition intake was defined as total intake vs. total requirements, expressed as a percentage. Results 51 patients were included, of which 43 (84.3%) were supported on veno-arterial ECMO. Median ECMO duration was 8.6 days [interquartile range (IQR) 6.1–16.2]. Overall energy and protein adequacy across the first 7 days of ECMO were 48.3% (IQR 28.0–67.4) and 44.8% (IQR 26.9–67.0) respectively. Parenteral nutrition provided majority of calories [median 88.0% (IQR 62.9–100)] and protein [median 91.0% (IQR 62.3–100)] intake. Enteral nutrition (EN) was initiated in 33 (64.7%) patients. Time to EN initiation, vasoactive-inotropic score just before ECMO initiation, veno-arterial ECMO mode and continuous renal replacement therapy in the first week of ECMO were factors associated with EN energy adequacy. Hospital mortality rate was 55% (28/51). Compared to survivors, non-survivors had lower adequacy of EN energy intake [0.5% (IQR 0–4.4) vs . 11.8% (IQR 0–24.5), p = 0.034]. After correcting for ECMO duration, need for continuous renal replacement therapy and number of vasoactive drugs required on ECMO, greater EN energy adequacy remained associated with lower risk of mortality [adjusted odds ratio 0.93 (95% confidence interval: 0.86–0.99), p = 0.048]. Conclusions Nutritional adequacy, especially that of EN, remains low in children supported on ECMO. EN energy adequacy was found to be associated with lower mortality. Further studies on nutritional adequacy in pediatric ECMO, as well as strategies to optimize EN in these children, are warranted.

The main purposes of this study were to elucidate the effects of supervised-exercise training (ET) interventions on hepatic fat content and on non-alcoholic fatty liver disease (NAFLD) prevalence in children and adolescents and to provide information about the optimal ET prescription (type, intensity, volume, and frequency) needed to reduce hepatic fat content in youths. Supervised-ET interventions performed in children and adolescents (6–19 years) that provided results of exercise effects on hepatic fat content or NAFLD prevalence were included. Supervised-exercise significantly reduced hepatic fat content compared to the control groups. Lifestyle interventions that included supervised-ET significantly reduced the prevalence of NAFLD. This systematic review and meta-analysis shows that supervised-ET could be an effective strategy in the management and prevention of NAFLD in children and adolescents. Both aerobic and resistance ET, at vigorous or moderate-to-vigorous intensities, with a volume ≥60 min/session and a frequency ≥3 sessions/week, aiming to improve cardiorespiratory fitness and muscular strength, had benefits on hepatic fat content reduction in youth. These data concur with the international recommendations of physical activity for health promotion in youth and may be useful when designing ET programs to improve and prevent hepatic steatosis in the pediatric population.

BACKGROUND Evaluation of energy requirements is an important part of the nutrition assessment of pediatric oncology patients. Adequate provision of energy in this population is of extreme importance because of the prevalence of malnutrition and its effect on growth, development, quality of life, morbidity, and mortality. Numerous methods are used in clinical practice for estimating the resting energy expenditures (REE), specifically indirect calorimetry and predictive equations. A relatively new instrument used to assess REE is the hand-held indirect calorimeter. The purpose of this quality improvement project was to compare the accuracy of REE measurements taken by a hand-held indirect calorimeter and predictive equations to that of a standard indirect calorimeter metabolic cart. METHODS Patients receiving therapy for pediatric cancer, aged 7-18 years, and having a weight ≥15 kg and scheduled for a REE nutrition assessment were eligible. Sequentially, the patient's REE was assessed with the cart and the hand-held indirect calorimeter along with the predictive equation calculation. RESULTS Post hoc pairwise comparisons revealed that all 3 methods were significantly different from one another (P < .0001). When compared with the cart, the portable hand-held calorimeter was found to underestimate REE by 11.9%, whereas predictive equations overestimated REE by 12.4%. CONCLUSION Our quality improvement project suggests that the hand-held indirect calorimeter underestimated REE, and predictive equations overestimated REE in pediatric oncology nutrition assessment. Therefore, we recommend that these limitations in assessment be considered when assessing REE using a hand-held indirect calorimeter or predictive equations.

Background: This study aimed to evaluate the relationship between sodium intake and insulin resistance indices. Methods: A total of 718 Korean children and adolescents (411 boys) aged 10–18 years who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) were included in the study. The urinary sodium to urinary creatinine ratio was used as a surrogate for sodium intake. The homeostatic model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) were used as indices of insulin resistance. Results: The mean urinary sodium to urinary creatinine ratio was 11.34 in males and 10.17 in females. The urinary sodium to urinary creatinine ratio was significantly positively correlated with HOMA-IR (r=0.165, p Conclusions: Our results suggest that sodium intake, as estimated by the urinary sodium to urinary creatinine ratio, may be independently associated with insulin resistance in children and adolescents.

This paper reviews information on why the nutrition of older children (5–9 years) and adolescents (10–19 years) is important and the consequences that it can have over generations. Developing countries still face a high burden of undernutrition and anemia, while the burden of overweight and obesity is on the rise in both developing and developed countries. There are evidence-based interventions which can improve the nutritional status and these include interventions for a balanced and diverse diet and micronutrient supplementation, especially iron and multiple micronutrient supplementation where there is sufficient evidence to reduce anemia. There is mixed evidence for the effective strategies to prevent and control obesity and a dearth of evidence from developing countries. Adolescent pregnancy also poses greater challenges to the health of mother and child, and advocacy should be rampant to delay the age of marriage and pregnancy. Interventions targeted to improving the nutritional status among “pregnant adolescents” have shown improvement in birth weight and a reduction in low birth weight and preterm delivery. Traditional platforms including school-based and community-based approaches offer a mixed picture of effectiveness, but emerging avenues of mHealth and social media could also be channelized to reach this population. The population of this age group is on the rise globally, and failure to invest in improving the nutrition of older children and adolescents will further increase the number of dependents in coming generations and negatively influence the health of future generations and progress of nations.

Background Most of the studies investigating the effects of breakfast on cognitive performance have compared performance in subjects who have or have not consumed this meal. However, characteristics of breakfast itself may influence mental abilities. Moreover, as far as the positive effects of having breakfast is more evident, research may focus on the specific characteristics of an adequate breakfast. Methods To update an existing systematic review, published at the beginning of 2014, on the role of nutrient composition and/or energy intake at breakfast on the accomplishment of school-related tasks and cognition, we carried out a systematic review of the literature through PUBMED database. Results From the literature search, we identified 39 papers, of which 2 were eligible according to our inclusion criteria. Both the selected papers concerned randomized crossover studies on the acute effect of breakfast carried out in a school setting in the United Kingdom. Both studies compared 2 iso-energetic breakfasts with a similar macronutrient composition; however, the alternative breakfasts were meant to differ in terms of glycemic index or glycemic load. The effects of breakfast composition were investigated on memory, attention, and information processing in both studies. However, different tests and subdomains were considered. Limitations Studies on these issues are still inconsistent and quantitatively insufficient to draw firm conclusions. Conclusions While the hypothesis of a better mental performance with breakfast>20% daily energy intake still needs confirmation, there does appear to be extra evidence that a lower postprandial glycemic response is beneficial to mental performance.

Childhood obesity is one of the country's most significant health problems. Researchers estimate that 32.2% of children and adolescents ages 2 to 19 in the United States are overweight and obese (Skinner and Skelton, 2014). The prevalence of childhood obesity in 2011-2014 was 17.0% and extreme obesity was 5.8% among US children and adolescents aged 2 to 19years (Ogden et al., 2016). The high rates of obesity and diabetes, poor nutrition, and lack of physical activity in children and adolescents makes cardiovascular risk reduction in this population critical. There is a strong body of evidence that showed practicing healthful lifestyle behaviors can reduce the risk of these chronic diseases. The goal of this article is to outline the current research and evaluation with policy and practice efforts, and strategies to accelerate the translation of replicable nutrition and physical education interventions for successful implementation of Community-Based Healthy Lifestyle Medicine among children and adolescents K-12.

Understanding how dietary intakes vary over the course of the school day can help inform targeted school-based interventions, but little is known about the distribution or determinants of school-day dietary intakes in Canada. This study examined differences between school-hour and non–school-hour dietary intakes and assessed demographic and socioeconomic correlates of school-hour diet quality among Canadian children. Nationally representative data from the Canadian Community Health Survey were analyzed using 24-h dietary recalls falling on school days in 2004 (n = 4827). Differences in nutrient and food-group densities during and outside of school hours and differences in School Heathy Eating Index (School-HEI) scores across sociodemographic characteristics were examined using survey-weighted, linear regression models. Children reported consuming, on average, 746 kcal during school hours (one-third of their daily energy intakes). Vitamins A, D, B12, calcium, and dairy products densities were at least 20% lower during school hours compared with non-school hours. Differences in School-HEI scores were poorly explained by sociodemographic factors, although age and province of residence emerged as significant correlates. The school context provides an important opportunity to promote healthy eating, particularly among adolescents who have the poorest school-hour dietary practices. The nutritional profile of foods consumed at school could be potentially improved with increased intake of dairy products, thereby increasing intakes of protein, vitamin A, vitamin D, calcium, and magnesium.

Polymorphisms in the Fat Mass and Obesity Associated (FTO) gene are robustly associated with overweight and obesity among children, although the underlying mechanisms are poorly understood. We tested if appetitive traits partially mediated the association between FTO genotype and increased BMI among a sample of US preadolescents. Data were from 178 unrelated 9–10 year olds who participated in an experimental study between 2013 and 2015. Children’s DNA was isolated from buccal swabs, and the rs9939609 SNP in the FTO gene was genotyped. Children’s age- and sex-adjusted BMI z-scores were computed using height and weight measured at the laboratory. Parents completed the Child Eating Behavior Questionnaire that includes three validated scales of habitual appetitive traits related to drive and regulation: satiety responsiveness, enjoyment of food and food responsiveness. Structural equation modeling was used to assess if those traits mediated the relationship between FTO and BMI z-score. The sample of children was 48.9% male and 91.0% non-Hispanic white. FTO distribution was in Hardy Weinberg equilibrium, and 16.3% of participants were homozygous for the high-risk allele. Mean BMI z-score was greatest among those with the high-risk genotype (ANOVA P

Children with loss of control (LOC) eating and attention-deficit/hyperactivity disorder (ADHD) are at risk for excessive weight gain. However, it is unclear whether or not these children show disturbances in hunger and satiety regulation. The goal was to examine the food intake and sense of LOC over eating as well as LOC eating-related characteristics during test meal in children with LOC eating and ADHD. Children aged 8–13 y with LOC eating (n = 33), ADHD (n = 32), and matched healthy controls (n = 33), consumed a test meal consisting of their chosen lunch food, with the instruction to eat until feeling full. Sense of LOC over eating, desire to eat, feelings of hunger, and liking of food were repeatedly assessed during test meal. Children with LOC eating and ADHD did not show a higher food intake at maximum satiety compared to control children. Sense of LOC over eating was significantly higher in children with LOC eating compared to children with ADHD and matched controls. Secondary analyses revealed that children with LOC eating ate marginally faster than control children. Both children with LOC eating and ADHD reported greater desire to eat, feelings of hunger, and liking of food during test meal than control children. Even though the results did not reveal statistical evidence to support the assumption of a disturbed food intake in children with LOC eating and ADHD, LOC eating related characteristics were significantly higher in these children compared to the control children. Sense of LOC over eating was confirmed as a specific characteristic of LOC eating. The examination of behavioral indicators of hunger and satiety dysregulation should be complemented with physiological indicators in future research.

Enteral nutrition as a treatment for inflammatory bowel diseases is an ongoing area of interest. Even in the era of biologic agents, exclusive enteral nutrition (EEN) offers a unique, drug-free measure for induction of remission in luminal Crohn's disease. The purpose of this review is to discuss the role of EEN in the evolving therapeutic scheme for Crohn's disease, to report on new evidence for short and long-term efficacy and highlight findings on the mechanisms of the anti-inflammatory effects of EEN in light of current understanding of disease pathogenesis.Recent clinical studies have suggested that EEN has an established advantage over corticosteroids for inducing remission in children with luminal Crohn's disease with comparable clinical efficacy but superior mucosal healing effect as well as better safety profile. Preoperative EEN therapy can also improve postoperative outcome of intestinal resection. Basic research has demonstrated that EEN has direct anti-inflammatory properties, can correct localization of tight junction proteins, alter micro RNAs expression, and profoundly affect the intestinal microbiota.EEN is an effective treatment for induction of remission in pediatric luminal Crohn's disease and should be offered as a first-line treatment. Accumulating evidence suggest that EEN has direct anti-inflammatory properties with an effect on the intestinal microbiota. However, the relationships between these effects and the specific triggers for these changes have yet to be elucidated.

Background The A3669G single nucleotide polymorphism (SNP) of the glucocorticoid receptor (GR) gene NR3C1 is associated with altered tissue sensitivity to glucocorticoids (GCs). GCs modulate the food reward circuitry and are implicated in increased intake of palatable foods, which can lead to the metabolic syndrome and obesity. We hypothesized that presence of the G variant of the A3669G SNP would affect preferences for palatable foods and alter metabolic, behavioural, and neural outcomes. Methods One hundred thirty-one adolescents were genotyped for the A3669G polymorphism, underwent anthropometric assessment and nutritional evaluations, and completed behavioural measures. A subsample of 74 subjects was followed for 5 years and performed a brain functional magnetic resonance imaging (fMRI) paradigm to verify brain activity in response to food cues. Results Sugar and total energy consumption were lower in A3669G G allele variant carriers. On follow-up, this group also had reduced serum insulin concentrations, increased insulin sensitivity, and lower anxiety scores. Because of our unbalanced sample sizes (31/37 participants non-G allele carriers/total), our imaging data analysis failed to find whole brain-corrected significant results in between-group t-tests. Conclusion These results highlight that a genetic variation in the GR gene is associated, at the cellular level, with significant reduction in GC sensitivity, which, at cognitive and behavioural levels, translates to altered food intake and emotional stress response. This genetic variant might play a major role in decreasing risk for metabolic and psychiatric diseases.

ObjectivePhiladelphia passed a 1·5-cent-per-ounce sweetened beverage tax (SBT). Revenue will fund 10 000 quality pre-kindergarten slots for poor children. It is imperative to understand how revenue from SBT can be used to fund programmes to address education and other social determinants of health. The objective of the present study was to simulate quality pre-kindergarten attendance, educational achievement and sugar-sweetened beverage (SSB) consumption among Philadelphia children and adolescents under six intervention scenarios: (i) no intervention; (ii) 10 000 additional quality pre-kindergarten slots; (iii) a 1·5-cent-per-ounce SBT; (iv) expanded pre-kindergarten and 1·5-cent-per-ounce SBT; (v) a 3-cent-per-ounce SBT; and (vi) expanded pre-kindergarten and 3-cent-per-ounce SBT.DesignWe used an agent-based model to estimate pre-kindergarten enrolment, educational achievement and SSB consumption under the six policy scenarios. We identified key parameters in the model from the published literature and secondary analyses of the Panel Study of Income Dynamics – Child Development Supplement.SettingPhiladelphia, Pennsylvania, USA.SubjectsPhiladelphia children and adolescents aged 4–18 years.ResultsA 1·5-cents-per-ounce tax would reduce SSB consumption by 1·3 drinks/week among Philadelphia children and adolescents relative to no intervention, with larger effects among children below the poverty level. Quality pre-kindergarten expansion magnifies the effect of the SBT by 8 %, but has the largest effect on moderate-income children just above the poverty level. The SBT and quality pre-kindergarten programme each reduce SSB consumption, but primarily benefit different children and adolescents.ConclusionsPairing an excise tax with a complementary programme to improve a social determinant of health represents a progressive strategy to combat obesity, a disease regressive in its social patterning.