Search

BackgroundThe vast majority of the world population declares affiliation to a religion, predominantly Christianity and Islam. Many religions have special dietary rules, which may be more or less strictly adhered to.MethodsReligious food rules were collected from holy books and religious websites as well as their translation into dietary practices. The literature was searched for potential associations between these rules and potential nutritional consequences.ResultsJewish, Islamic and Indian religions support prolonged breastfeeding. Religious avoidance of alcohol is probably beneficial to health. When strictly applied, a few rules may lead to nutritional inadequacies, mainly in populations living in unfavourable socio-economic or environmental conditions. In Jewish and Muslim observants, animal slaughtering procedures may increase the risk of iron deficiency. Jews may be at risk of excess sodium intake related to home-prepared foods. A vegan diet, as observed by some believers, often by drifting from original precepts, or by some Hindus or Buddhists, may result in vitamin B12, calcium, iron, zinc, selenium and n-3 fatty acids deficiencies.ConclusionWhen implemented in accordance with the rules, most religious food precepts are not detrimental to health, as suggested by the fact that they have more or less been followed for millennia. Nevertheless, some practices may lead to nutritional inadequacies, such as iron, calcium, vitamin D and vitamin B12 deficiencies. Patients with low socio-economic status, children and women of childbearing age are of particular risk of such deficiencies. Being aware of them should help health professionals to take an individualized approach to decide whether to supplement or not.

International audience

International audience; Due to transient gut immaturity, most very preterm infants receive parenteral nutrition (PN) in the first few weeks of life. Yet providing enough protein and energy to sustain optimal growth in such infants remains a challenge. Extrauterine growth restriction is frequently observed in very preterm infants at the time of discharge from hospital, and has been found to be associated with later impaired neurodevelopment. A few recent randomized trials suggest that intensified PN can improve early growth; whether or not such early PN improves long-term neurological outcome is still unclear. Several other questions regarding what is optimal PN for very preterm infants remain unanswered. Amino acid mixtures designed for infants contain large amounts of branched-chain amino acids and taurine, but there is no consensus on the need for some nonessential amino acids such as glutamine, arginine, and cysteine. Whether excess growth in the first few weeks of life, at a time when very preterm infants receive PN, has an imprinting effect, increasing the risk of metabolic or vascular disease at adulthood continues to be debated. Even though uncertainty remains regarding the long-term effect of early PN, it appears reasonable to propose intensified initial PN. The aim of the current position paper is to review the evidence supporting such a strategy with regards to the early phase of nutrition, which is mainly covered by parenteral nutrition. More randomized trials are, however, needed to further support this type of approach and to demonstrate that this strategy improves short- and long-term outcome.

International audience; Avoidant/restrictive food intake disorder (ARFID) has recently been added to the DSM V (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) as a new class of eating disorders (EDs). ARFID is characterized by a lack of interest in eating or avoiding specific types of foods because of their sensory characteristics. This avoidance results in decreased nutritional intake, eventually causing nutritional deficiencies. In severe cases, ARFID can lead to dependence on oral nutritional supplements, which interferes with psychosocial functioning. The prevalence of ARFID can be as high as 3% in the general population, and it is often associated with gastrointestinal symptoms and mainly appears in children with anxiety disorders. Given the high prevalence of ARFID, a rapid and systematic nutrition survey should be conducted during every pediatric consultation. Its treatment should also be adapted depending on the severity of the nutritional problem and may involve hospitalization with multidisciplinary care (pediatrician, nutritional therapist, dietitian, psychologists, and speech therapists).

The increasing prevalence of paediatric obesity and related metabolic complications has been mainly associated with lower aerobic fitness while less is known regarding potential musculoskeletal impairments. The purpose of the present systematic review was to report the evidence regarding muscular fitness in children and adolescents with obesity. A systematic article search was conducted between November 2014 and June 2015 using MEDLINE, EMBASE, CINAHL psycINFO, SPORTDiscus and SocINDEX. Articles published in English and reporting results on muscle strength and muscular fitness in children and adolescents aged 6 to 18 years were eligible. Of 548 identified titles, 36 studies were included for analyses. While laboratory-based studies described higher absolute muscular fitness in youth with obesity compared with their lean peers, these differences are negated when corrected for body weight and lean mass, then supporting field-based investigations. All interventional studies reviewed led to improved muscular fitness in youth with obesity. Children and adolescents with obesity display impaired muscular fitness compared to healthy-weight peers, which seems mainly due to factors such as excessive body weight and increased inertia of the body. Our analysis also points out the lack of information regarding the role of age, maturation or sex in the current literature and reveals that routinely used field tests analysing overall daily muscular fitness in children with obesity provide satisfactory results when compared to laboratory-based data.

Background: Health risks associated with the high consumption of sugar-sweetened beverages (SSBs) include overweight or obesity and their complications such as diabetes, as well as oral and dental decay, among others. Aim: The aim of the present statement is to inform health care professionals, parents, care-givers, teachers and school head teachers, stakeholders and governing bodies about the risks associated with drinking SSBs in infants, children and adolescents. Methods: We searched PubMed and the Cochrane databases for English language studies published from 2010 through October 1, 2018, for randomized clinical trials, meta-analyses, systematic reviews and observational studies (search terms are reported in eAppendix in the Supplement). We also manually searched the references of selected articles, reviews, meta-analyses and practice guidelines. Recommendations: Consumption of SSB by children and adolescents should be limited, and the consumption of water and other non-sweetened beverages should be promoted. Educational institutions such as nurseries, pre-schools and schools should offer unlimited access to drinking water, whereas the sale of SSBs should be banned.

Childhood Obesity : The Need to Translate Research into Daily Practice: Announcing the Annals of Nutrition and Metabolism as the Official Journal of the European Childhood Obesity Group

The prevalence of pediatric obesity continues to increase worldwide, bringing with it various metabolic, functional, social, and psychological complications.1 Both the prevention and treatment of childhood obesity must be based on multidisciplinary approaches combining nutrition, physical activity (PA), and psychological support.2 As an essential element of these multicomponent strategies, regular physical activity has been acknowledged as having beneficial effects on children's and adolescents’ body composition, physical fitness, and metabolic profile, as well as on their health-related quality of life, social and psychological health, and academic achievement.3, 4 Given that only a relatively small proportion of children and adolescents meet the public health recommendations for PA,5 and given that weight loss exercise-based interventions suffer from a high attrition rate, there is a clear need for appropriate PAs. Traditional sports, including football, handball, gymnastics, athletics, and martial arts, are usually defined as specific and structured activities organized through rules and specific regulations under the control and administration of sports associations and federations. As a part of the overall PA compendium, could these and other classical sporting activities provide a relevant alternative for the prevention and treatment of pediatric obesity? An entire session was dedicated to this question at the 28th European Childhood Obesity Group Congress (ECOG) held in Porto, Portugal, on 13–16 November 2018; the session brought together international experts in the field. This article summarizes the initial conclusions of this expert panel and details the main considerations when it comes to recommending traditional sports for the prevention and/or treatment of pediatric overweight and obesity.

International audience; CONTEXT: Infrequent mutations have been reported in the leptin receptor (LEPR) gene in humans with morbid obesity and endocrine disorders. However LEPR mutations are rarely examined in large populations from different ethnicities in a given country. OBJECTIVE: We estimated the prevalence of LEPR mutations in French patients with severe obesity and evaluated mutated patients' phenotype. DESIGN AND PATIENTS: We sequenced the LEPR gene in 535 morbidly obese French participants. We conducted clinical investigations to determine whether individuals with a novel shared mutation display particular characteristics relative to obesity history, body composition, hormonal functions, and the outcome of bariatric surgery. RESULTS: We identified 12 patients with a novel LEPR mutation (p.C604G, p.L786P, p.H800_N831del, p.Y422H, p.T711NfsX18, p.535-1G\textgreaterA, p.P166CfsX7). Six unrelated subjects were carriers of the p.P166CfsX7 mutation leading to deletion overlapping exons 6 to 8. All subjects originated from Reunion Island (France). Their clinical features (severe early-onset obesity, food impulsivity, and hypogonadotropic hypogonadism) did not differ from other new LEPR mutation carriers. Results concerning weight loss surgery were inconsistent in homozygous LEPR mutation carriers. Heterozygous LEPR mutation carriers exhibited variable severity of obesity and no endocrine abnormality. CONCLUSION: Among seven newly discovered LEPR mutations in this French obese population, we identified a LEPR frameshift mutation shared by six subjects from Reunion Island. This observation suggests a founder effect in this Indian Ocean island with high prevalence of obesity and supports a recommendation for systematic screening for this mutation in morbidly obese subjects in this population.

Objective: This paper introduces health professionals to the different psychological models thought to influence eating behaviour in the absence of hunger in children who are obese and to propose a method of assessing these behaviours in practice. Methods: Clinical researchers from the European Childhood Obesity Group (ECOG) adopted an evidence-based approach to examine the literature concerning the assessment of eating behaviour in children who are obese. Studies published in English were filtered out of the medical and psychological literature from 1960 to the present, and the resulting bibliography was searched for relevant articles. Key themes from the current evidence were compiled and classified according to the underpinning psychological models. Based on the current evidence and the authors' combined clinical experience, a three-staged approach to assessment was agreed by consensus. Results: Valid and reliable tools for assessing and monitoring each of the three identified models (Dietary Restraint Theory, Emotional Eating and the Diathesis-Stress Model) are suggested for use in clinical practice, and the ECOG three-staged approach to assessing eating behaviours in the absence of hunger is described. Conclusions: This paper presents practical guidance on how to assess eating behaviour in the absence of hunger in children who are clinically obese and suggests a focus for future research.

Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. It has a functional and structural impact and increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Pediatric Society recommends weighing and measuring any child when hospitalized or seen in consultation. The body mass index (BMI) must be calculated and analyzed according to references any time growth kinetics cannot be analyzed. Any child with a BMI below the third centile or -2 standard deviations for age and sex needs to be examined looking for clinical signs of malnutrition and signs orienting toward an etiology and requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing up a nutritional strategy along with the overall care plan. A target weight needs to be determined as well as the quantitative and qualitative nutritional care including its implementation. This plan must be evaluated afterwards in order to adapt the nutritional therapy.

The goal of this study is to determine whether cardiovascular risk and the methylenetetrahydrofolate reductase 677 C-T polymorphism (MTHFR), an enzyme involved in folate metabolism and in epigenetics, are linked in morbidly obese non-diabetic adolescents. One-hundred and thirteen obese (BMI = 39.1 ± 6.4 kg/m(2)) adolescents aged 14.4 ± 1.5 years were investigated before entering a weight reduction program. Information on growth obtained from individual health records was available at birth (n = 107), 1 (n = 102), 2 (n = 106), 4 (n = 91) and 8 (n = 73) years of age. Fifty-nine subjects were heterozygote (CT, 52.2%) and 8 were homozygote for the mutation (TT, 7.0%). Birth weights were lower in TT (2.95 ± 0.48 kg, p = 0.004) than in CC (3.34 ± 0.43 kg) and CT (3.38 ± 0.50 kg) subjects, as well as birth lengths (CC: 0.50 ± 0.02 m, CT : 0.50 ± 0.02 m, TT: 0.47 ± 0.03 m, p = 0.01). These differences persisted until 1 year of age. Median and mean fasting glycaemia were similar. Insulin levels were higher in TT (median: 26.4 UI/mL) than in CC (median: 15.0 UI/mL) or CT (median: 16.0 UI/mL) (p = 0.017) subjects, as well as HOMA IR (p = 0.04). Body composition, blood pressure, plasma lipids, homocysteine and leptin concentrations were similar among the three genotypes in both boys and girls. The common 677 C-T mutation seems therefore to represent a link between altered early growth and enhanced degree of insulin resistance that occurs later in obese adolescents.

Background/Aims: To compare body fat (BF) measurements obtained with a new ultrasound method with those assessed by dual-energy X-ray absorptiometry (DEXA) in obese adolescents. Methods: In 94 adolescents (57 females and 37 males) aged 12–19 years and body mass index (BMI) exceeding 30 kg·m–2, the z-score BMI for age was 6.7 (adolescent girls) and 6.6 (adolescent boys) >97th percentile. BF was measured using DEXA and a method based on ultrasound measurements, body weight, height, abdominal circumference and mid-thigh circumference. Results: Obesity class I was noted in 39%, II in 28% and III in 33% of the patients. BF by ultrasound correlated closely with BF by DEXA, in both females (r = 0.958) and males (r = 0.981), with standard errors of the estimates (SEE) being 2.9 and 2.5 kg, respectively. The ultrasound method was more accurate than the skinfold technique (n = 24; SEE: 2.2 vs. 6.5 kg, respectively). In 13 adolescents who had marked weight loss after 6 months of treatment, the decrease in DEXA-measured BF correlated closely with the decrease in ultrasound-measured BF (r = 0.95). Conclusions: Our innovative portable ultrasound technique has advantages in terms of reliability, reproducibility, accuracy and costs for screening and monitoring obese adolescents. A patent application has been submitted. Our method should prove valuable for epidemiological studies.

The rapid rising prevalence of childhood obesity is related to increased risk of obesity-related diseases during adulthood. The aim of the present study was to review the data concerning the prevalence of metabolic syndrome (MS) in European children and adolescents (Part 1) and to determine and compare the prevalence of MS among overweight and obese children, and adolescents in five European countries using four MS definitions (Part 2). In total, 1 241 European obese children from five different countries (France: n =283, Greece: n =145, Italy: n =274, Poland: n =90, and Hungary: n =449) were studied for MS according to the definition of Ferranti et al., the World Health Organisation, the National Cholesterol Education Program and the International Diabetes Federation. We used age- and sex-specific cut-off values for the diagnosis of high blood pressure and increased waist circumference. The prevalence of MS was 35.7%, 31.4%, 20.3%, and 16.4%, respectively, according to the above-mentioned definitions. Only 6.3-8.8% of obese adolescents were free from any risk factors and the clustering of three risk factors or more was very high: 20.3-35.7% (depending on the type of definition). A total of 12.2% of children had MS and 55.8% were free from MS according to all four definitions.The prevalence of MS is high among European obese children whatever criteria are used. There is an urgent need to achieve consensus concerning the definition of MS in adolescents and children.

International audience; The relationship between taste acuity and food neophobia, food familiarity and liking has been studied in the context of a residential Weight Reduction Session (WRS, mean duration: 10 months) in 39 obese adolescents. Taste acuity was assessed using recognition thresholds for sucrose, citric acid, sodium chloride and 6-nprophylthiouracyl (PROP) and supra-threshold perceived intensities for sucrose, sodium chloride and PROP. Food neophobia was assessed by using the Food Neophobia Scale at the beginning and at the end of the WRS. At the same times, a Food Familiarity and Liking Questionnaire was used to assess changes in food familiarity and likes or dislikes for different food categories. Taste acuity appeared to mediate behavioural food-related changes during the WRS. High taste acuity was associated with limited reductions in food neophobia; less sensitive subjects showed greater increases in the acceptability of healthy foods, especially fruits and vegetables. Therefore, taste perception (and particularly PROP perception) appears to be a predictor of the magnitude of food-related behavioural change achieved during a Weight Reduction Session.

Aim. The present study assessed caries experience in an adolescent population being treated for severe obesity. The DMFT indices of a group of obese adolescents (n = 41) and a group of nonobese adolescents (n = 41) were compared. Design. The parameters examined in this transversal study were body mass index (BMI) and the number of decayed, missing, and filled teeth (DMFT). The obese and nonobese groups were matched by age, gender, and parental socio-occupational category. Differences between the two groups were assessed using nonparametric tests. Results. There was a significant association between BMI and DMFT indices (P = 0.01) in the severely obese group. The obese adolescents were more likely to have caries than the nonobese ones. Conclusions. The severely obese children (n = 16) had a high level of caries experience. Given the tremendous increase in the prevalence of obesity in children, dentists should promote a healthy diet not only to prevent dental decay but also to reduce the risk for obesity. Dentists should participate in multidisciplinary medical teams managing obese adolescents.

OBJECTIVE The objective of this study was to investigate the consequences of low dietary folate intake and the impact of the 677 C-->T methylenetetrahydrofolate reductase (MTHFR) common mutation on liver function in obese adolescents. METHODS Fifty-seven obese girls (BMI = 36.1 +/- 6.0 kg/m) aged 14.1 +/- 1.5 years were included before starting a weight reduction program. Dietary intakes for folate were assessed by means of an adapted food frequency questionnaire (n = 50). Liver enzymes, plasma lipids, glucose metabolism parameters, ferritin, homocysteine and erythrocyte folate content were measured in plasma or blood obtained under fasting conditions. The MTHFR 677 C-->T polymorphism, which is associated with decreased enzyme activity, was determined using PCR. Body composition was assessed using dual x-ray absorptiometry. RESULTS Twenty-three subjects were heterozygote (CT) for the mutation and 5 were homozygote (TT). An increase in alanine amino transferase (ALT) and ALT/aspartate aminotransferase ratio was associated with the mutation (F = 4.46, P = 0.016 and F = 5.92, P = 0.0049, respectively). Alanine amino transferase was correlated negatively to folate intake (r = -0.32, P = 0.024) (n = 50) and positively to homocysteine concentrations (r = 0.30, P = 0.025). Body composition was similar among the 3 genotypic groups. Ferritin was also correlated to ALT concentrations of the entire group (P = 0.009). CONCLUSION Our data suggest that folate intake and the MTHFR polymorphism represent a part of the link between antioxidant status and liver disease in obese adolescent girls.

Previous studies in humans have shown that short to middle-term pre-exposure to multiple foods can reduce the negative response to novel foods (neophobia). In order to explore the effects of a long-term exposure to varied foods on food neophobia, we studied a population of obese adolescents observed in a longitudinal protocol in which the multiple food experiences are induced by a residential weight reduction program (WRP) that encourages the consumption of a wide variety of foods. Seventy-two massively obese adolescents (22 boys) filled the food neophobia scale (FNS, [Pliner, P., & Hobden, K. (1992). Development of a scale to measure the trait of food neophobia in humans. Appetite 19, 105-120]) and an ad hoc food familiarity and liking questionnaire at the beginning and at the end of the program (mean duration: 8.9 months). Their scores were compared to those of a control group of 51 adolescents (14 boys) tested within a similar period. FNS results show a decrease of food neophobia, without significant difference between the control group and the WRP subjects, although only WRP have encountered new foods experiences as attested by the familiarity and liking results. Methodological considerations, concerning the characteristics of the participants, the nature of the multiple food exposure and the food neophobia measurements, will be proposed to explain differences among studies.

Estimates of the prevalence of childhood overweight and obesity have been made in several European countries during the last decade. The methods used and the assessment criteria differ from survey to survey. The present paper reports the prevalence data from 21 surveys in Europe using a single, internationally accepted definition of overweight in childhood, allowing direct comparisons to be made. A tendency for a higher prevalence of overweight among children in western and especially southern Europe is shown and some possible reasons for this are discussed.

Biophysical factors Introduction Adolescence is a key period in life for major physiological and psychological change. Obesity, perhaps dating from infancy, may peak in severity at adolescence. It is thus highly desirable to intervene with vigorous preventive or curative actions early in life. However, adolescents' aspirations and their developing capacity to control their own lives can act as useful adjuncts to the management of obesity in those for whom earlier interventions have been unsuccessful. From the practical point of view, it is critically important that adolescents understand the biological processes affecting them. Stressing the advantages (e.g. growth spurt, increased fat-free mass (FFM) and, as a consequence, increased energy expenditure and requirements) as well as the disadvantages (e.g. increased fat mass in girls) of the pubertal changes in body composition can help adolescents feel more in control of weight management. The differences that develop between sexes should be discussed so that they are understood, accepted and not just seen as further disadvantages for subjects already suffering low self-esteem. Adolescents also want better understanding of their own behaviour. A recent study from the United States found 24% of a nationally representative sample of adolescents were overweight, but 45% of the girls and 20% of the boys had been dieting, and 13% and 7% of girls and boys, respectively, reported disordered eating. The risk of disordered eating increased during adolescence and correlated with depressive patterns of behaviour (Kaltzman et al., 2000).

Nineteen overweight girls 14.54 +/- 0.38 years of age were studied. Results were compared with those obtained in eight age-matched (14.07 +/- 0.51 years) and sex-matched normal weight controls. Energy expenditure (EE) was determined using open-circuit indirect calorimetry at rest, both after a 12-h fast and after an oral sucrose load of 3 g/kg ideal body weight. Food-induced thermogenesis (FIT) was evaluated by computing the area under the curve of the EE response above resting energy expenditure (REE) during the first 3 h after the sucrose load, REE (kcal/day) was higher in the overweight patients (1,818 +/- 46 vs. 1,527 +/- 67; p = 0.002); REE standardized by fat-free mass (FFM) (kcal/kg FFM/day) was lower in obese children than in controls (35.2 +/- 1.0 vs. 44.9 +/- 1.9; p = 0.0001). A linear correlation between REE and FFM was evidenced in both controls and overweight subjects (r = 0.78 and 0.68, respectively; p = 0.05 and p < 0.001, respectively). Actual REE in the obese children was significantly lower than the value predicted by applying the regression equation of REE on FFM in controls to the actual FFM in obese children (paired t test; p = 0.003). FIT was identical in overweight and normal weight subjects, regardless of whether it was expressed in absolute value, as the percentage calorie intake, or standardized by FFM.(ABSTRACT TRUNCATED AT 250 WORDS)