Serum Calprotectin and Chemerin Concentrations as Markers of Low-Grade Inflammation in Prepubertal Children with Obesity.

In adults, obesity is associated with chronic low-grade inflammation, which may cause long-term adverse health consequences. We evaluated whether obesity in prepubertal children also generates this kind of inflammation and whether calprotectin and chemerin may be useful markers for early detection of such inflammation in this group of children. The study population included 83 children aged 2 to 10 years; 62 with obesity and without components of metabolic syndrome and 21 healthy controls with normal body weight. White blood cell (WBC) count, concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), calprotectin, and chemerin were determined in peripheral blood. Our study showed that in the group with obesity, serum concentrations of calprotectin and chemerin, as well as CRP were significantly higher as compared with the controls. We found a significant positive correlation between serum chemerin concentrations and BMI z-score (r = 0.33, p < 0.01) in children with obesity. Chemerin concentration was also positively correlated with CRP level (r = 0.36, p < 0.01) in the whole group of children. These findings suggest that obesity may generate chronic low-grade inflammation as early as in the prepubertal period which can be indicated by significantly higher serum concentrations of calprotectin and chemerin. Calprotectin and especially chemerin seem to be promising indicators of this type of inflammation in children with obesity, but the correlation between these markers requires further research.

Dietary Patterns of Children Aged 1-3 Years in Poland in Two Population Studies.

BACKGROUND: The levels of nutrition that children receive in their first years of life greatly determine their psychosomatic development. AIM: The study was to identify dietary patterns of children aged 1-3 years based on data on food consumption structure from 2 population studies performed in Poland (2011 and 2016) and to assess changes in product selection in the children's diets with respect to their nutritional status. METHODS: Both studies were performed on nationwide representative samples (2011: n = 400; 2016: n = 612) using questionnaire surveys. Nutritional status was estimated using body weight-to-height z-score. Feeding practices were evaluated based on 3-day dietary/food records, including 1 weekend day. RESULTS: Four dietary patterns of toddlers were identified and changes in the distribution of these patterns in the population after 5 years were analysed and compared. Diets of children in the second year of life were better balanced in terms of energy and nutritional value owing to young child formula content. Diets of children in the third year of life were higher in energy and protein, with a higher percentage of energy derived from saccharose. Diets of all groups of children were deficient in long-chain polyunsaturated fatty acids, vitamin D and potassium but excessive in sodium. CONCLUSIONS: Over 5 years, the percentage of children on a diet with high intake of formula for young children significantly decreased but increased on a diet with high dairy content. Dietary patterns of toddlers were associated with their weight by height z score and nutrient profile.

Dietary patterns in toddlers with excess weight. The 2016 pitnuts study.

INTRODUCTION: Children's appropriate dietary pattern determines their optimal development, reduces the risk of childhood diseases and the risk of diet-dependent diseases, including obesity in adulthood. AIM: To analyze the dietary patterns of children with excess weight aged 1-3 years in comparison with the main components of the safe nutrition model including: the organization of meals (frequency of meals), selection of products (food intake), energy and nutritional value of children's diets. MATERIAL AND METHODS: The study was carried out in 2016 on a representative nationwide sample of children aged 5-36 months (n=1059). The analysis of dietary patterns covered 173 with excess weight children aged 13-36 months (BMI-z-score >1 SD). Their nutritional status was evaluated based on BMI and its standardisation according to the WHO reference child growth standards for children aged 0-5 years (BMI z-score). The diets of children were assessed using 3-day dietary records. The dietary patterns of the children who were analysed were determined using the cluster analysis (k-means method), including 11 variables concerning average daily intake of main food group products (cow's milk, junior formula, milk products, bread, groats and rice, cereals, cured meats, fats, sugar and sweets, fruits, nectars and juices). RESULTS: Three clusters of overweight and obese children with different dietary patterns were identified. The diet of children from the first cluster (n=58) was based primarily on junior formula and foods for infants and toddlers. This dietary pattern was defined as the "baby food diet". The second cluster comprised 33 children whose diets were characterised by high consumption of cow's milk and dairy products, as well as cereal products, including bread, groats, rice and breakfast cereals. This dietary pattern was defined the "milk and cereals diet". The third cluster consisted of 82 children whose dietary pattern was characterised by high consumption of bread, cold meats and fats, sweets, juices and fruits (the "sandwich and sugar diet"). In all the clusters the average intake of vegetables and fruit by children with excess weight was significantly lower than the recommended amounts. The study showed too high intake of energy, protein, sodium, B vitamins and saccharose and an insufficient supply of calcium, fibre, vitamin D, vitamin E, LCPUFA, iodine and potassium in the children's diet in reference to nutritional recommendations. Younger children with the "baby food diet" pattern, due to the contribution of enriched food, had a more balanced diet in relation to the model of safe nutrition (nutritional norms). Older children's diets - in the third year of life, were characterized by a diversified choice of products that are a source of protein and carbohydrates (milk, breakfast cereals, meat, bread, cold meats, sugar from beverages, dairy desserts and juices). CONCLUSION: The identified dietary patterns of toddlers with excess weight differ from the safe nutrition model in terms of product selection and nutrient profile.

Total Oxidant and Antioxidant Status in Prepubertal Children with Obesity.

AIMS: Obesity is accompanied by the formation of oxygen free radicals, whose intensified activity without effective defense mechanisms can lead to oxidative stress and related complications. We evaluated the presence of oxidative stress in obese prepubertal children. METHODS: The study included 83 healthy children aged 2-10 years (62 with obesity and 21 nonobese controls). Total oxidant capacity (TOC), total antioxidant capacity (TAC), oxidized low-density lipoprotein (ox-LDL), lipid parameters, glucose, and C-reactive protein (CRP) were measured in serum. Oxidative stress index (OSI) was calculated. RESULTS: Serum TOC concentration was significantly higher (p < 0.05) and TAC concentration was lower (p < 0.05) in obese children. OSI was higher (p < 0.01) in obese subjects compared with controls. CRP levels were normal in all children, but median CRP value was higher (p < 0.01) and HDL cholesterol levels were lower (p < 0.05) in the obese group. We found a significant negative correlation between TAC and ox-LDL concentrations (r = -0.27, p < 0.05) in obese children. Furthermore, obesity duration was positively correlated with TOC level (r = 0.32, p < 0.05) in this group. CONCLUSIONS: Obesity-related oxidative stress already occurs in prepubescence. Early obesity diagnosis and the necessary therapeutic activity implementation is a vital strategy for the prophylaxis of free radical damage and related multiorgan complications.

Nutrition of infants and young children in Poland - Pitnuts 2016.

The study evaluating the feeding practices and the nutritional status of children aged 5 to 36 months in a general, Polish, representative population (n=1059) was carried out from May to July 2016. The aim of this study was to evaluate the feeding practices in children aged 5 to 36 months with regard to models of safe nutrition on the basis of the outcome of the population study performed in 2016. The data obtained show that the feeding practices in children in their first year of life do not meet the guidelines presented in the model of safe nutrition, particularly in matters of timing of complementary feeding introduction and food choice. The analysis of nutrient profile in toddlers' diets indicated the differentiated energy and protein intake is significantly higher than population norms (EAR/AI). It is necessary to modify the nutrition of infants and young children through a better selection of products. Nutritional practice should always be monitored and modified according to the model of safe nutrition as part of medical nutritional counselling. More educational efforts are required to increase the awareness of the relation between the diet and nutritional status of young children among healthcare professionals.

Dietary intake of vitamin D in obese children aged 1-3 years.

BACKGROUND: Obese children are predisposed to vitamin D deficiency. Most of the findings suggest that requirement for vitamin D is increased in obese children due to this vitamin sequestration in adipose tissue. OBJECTIVE: The aim of the study was to evaluate dietary intake of vitamin D in children with simple obesity in relation to nutritional standards. MATERIALS AND METHODS: The study included 73 children aged 1-3 years: 38 with simple obesity (group I) and 35 non-obese ones (group II - control). The inclusion criterion for the obese group was BMI z-score > +2.0, for the control group BMI z-score between -1.0 and +1.0.The intake of vitamin D was estimated using the Dieta 5.0 software on the basis of 3-days dietary record. Outcomes were related to nutritional standards. Differences in intake of energy and nutrients between both groups were assessed using the Mann-Whitney test (statistical significance was set at p = 0.05). RESULTS: Vitamin D intake in both groups was below the nutritional standards (10 µg/400 IU). Median values / interquartile ranges of results were 2.0 / 1.3-5.9 µg and 4.0 / 1.1-7.6 µg daily, for obese and non-obese children, respectively. The risk of deficient vitamin D intake was observed in 94.7% of obese children and in 82.4% of control group. The main dietary source of vitamin D in both groups was growing-up milk/Junior formula. The median intake of energy, protein, fat and carbohydrates in the obese children were significantly higher than in the control group (p<0.05). CONCLUSIONS: In obese children aged 1-3 years adequate dietary intake of vitamin D was not achieved. Similarly, the intake of vitamin D by normal weight children was lower than recommended. Consequently, it is necessary to provide products rich in vitamin D in the diet of toddlers, particularly obese.

Assessment of vitamin D status in children aged 1-5 with simple obesity.

BACKGROUND: Proper vitamin D intake is important due to its pleiotropic effect. It seems that obese population is a groups at risk of the vitamin D deficiency. OBJECTIVE: To assess the vitamin D status in 1-5-year-old children with simple obesity. MATERIALS AND METHODS: The study included 100 children: classified according to their body mass index (BMI) as obese - Group I (n=50) and non-obese - Group II (n=50). Their serum 25-hydroxyvitamin D (25(OH)D) concentrations were determined in the spring-summer and autumn-winter seasons and vitamin D intake (diet/supplements) was assessed. The study results were statistically analysed by means of Statistica 10PL. RESULTS: In Group I the mean serum 25(OH)D level was 23.6±10.8 ng/ml, while in Group II it reached 26.6±9.8 ng/ml (p=0.08). The concentration ≤30 ng/ml was observed in 80% of children in Group I and in 70% of Group II. In autumn- winter and spring-summer period, respectively, 88.5% and 70.9% of the obese children had an insufficient vitamin D status (p=0.002). The mean daily intake of vitamin D was 128 IU (3.2 µg) in Group I and 188 IU (4.7 µg) in Group II. CONCLUSIONS: Children aged 1-5 (obese and non-obese) are a group at risk of the vitamin D deficiency, as a consequence of its insufficient intake and the lack of appropriate supplementation. Those particularly exposed to that risk are obese children in the autumn-winter season. Children aged 1-5 should be monitored with regard to their vitamin D status. KEY WORDS: vitamin D, obesity, children, obese children, vitamin D deficiency.

[The evaluation of selected parameters of calcium and phosphorus metabolism in children with cow's milk allergy]. / Ocena wybranych parametrów gospodarki wapniowo-fosforanowej u dzieci z alergia na bialka mleka krowiego.

UNLABELLED: THE AIM of this study was to evaluate selected parameters of calcium and phosphorus metabolism in children with CMA treated with the following milk substitute formulas: lactose-containing extensively hydrolyzed wheat protein formula, lactose-free extensively hydrolyzed casein protein formula, as well as soy-based formula. MATERIAL AND METHODS: The study involved 66 children with CMA aged 2-5 years treated with milk-free diet for at least one year. Group I included 31 children fed with a lactose-containing formula, group II - 35 children treated with lactose-free formula. In all children the mean energy intake and nutritional value of daily food rations were assessed. Serum concentrations of calcium (Ca), phosphorus (P), sodium (Na) and magnesium (Mg) were determined using standard methods. Serum values of 25 hydroxyvitamin D (25-OH D) and parathormone (PTH) were assessed by chemiluminescence, whereas concentrations of biochemical markers of bone formation-bone alkaline phosphatase (BALP), osteocalcin (OC) and bone resorption marker-collagen type I crosslinked C-telopeptide (CTX) were determined by immunoenzymatic methods (ELISA), using specific monoclonal antibodies. RESULTS: There were no significant differences in the mean dietary supply of calcium, phosphorus, magnesium, sodium, total protein and vitamin C in children from both groups. In the diets of children from group II, the mean content of lactose (0.5±1.0 vs 10.0±6.8 g/d) and 25-OH vitamin D (4.1±2.3 vs 8.5±4.0 ug/d) were significantly lower and dietary fibre content (14.7±3.9 vs 10.4±3.9 g/d) was higher. Calcium and vitamin D dietary supply was lower with respect to nutritional recommendations in all the studied children, whereas the dietary deficiency of vitamin D was higher in children from group II. The mean serum concentrations of evaluated biochemical parameters did not reveal any differences in children from the study groups and were in the normal ranges. There were also no differences in the mean serum concentration of 25-OH vitamin D, ALP, BALP, CTX and PTH in patients from both groups. The mean concentration of OC was significantly higher in group II (71±26.6 ng/ml) than in children from group I (61.1±23.4 ng/ml) <0.01. Positive correlation was found between OC and CTX in both study groups. CONCLUSIONS: 1. In children with CMA basic blood laboratory tests may have limited importance in the evaluation of calcium and phosphorus metabolism. 2. Our results suggest that the disturbances in the balance between bone formation and bone resorption processes may occur in children with CMA treated with lactose-free formulas. 3. In order to assure optimal conditions for achieving adequate bone mass by children with CMA, it is necessary to provide them with regular medical and nutritional care.

Analysis of nutrition of children aged 13-36 months in Poland: a nation-wide study.

AIM: The aim of the study was to analyse the diets of children aged 13-36 months in Poland compared to nutritional recommendations. MATERIAL AND METHODS: The questionnaire study was conducted between June and September 2010 on a representative, nation-wide sample of children aged 13-36 months. The study concerned 400 children from across Poland. They were selected by means of drawing their PESEL (personal identity) number. The nutritional status of children was assessed using anthropometric data, i.e. their current weight and height. The relative body mass index BMI (kg/m2) and the BMI z-score were calculated for each child and compared with the WHO child growth standards. The diets of children were assessed using an original questionnaire with 3-day diet records. Nutritional value was calculated using Dieta 4.0 computer programme. RESULTS: The study demonstrated that 45.5% of children were in the normal BMI z-score range (from -1.0 to +1.0). Underweight children accounted for 12.5% (BMI z-score between -2.0 and -1.0) and severely underweight for 14.5% (BMI z-score < -2.0) of the studied group. The share of overweight and obese children was 14.5% and 13.0%, respectively. Large individual variation in food intake was observed in diets of the children. The intake of cereal products, meat, poultry and cold meats in daily diets was twice higher than recommended. The children ate significantly less vegetables and fruits and drank less milk and fermented milk beverages than recommended in model food rations. Energy and nutritional value of an average daily food ration differed considerably from the standards for majority of nutrients. The intake of proteins was three times higher than the current norms. CONCLUSIONS: The diets of children aged 13-36 months differed from current recommendations but the nutritional status evaluated based on BMI was normal in 45.5% of children from the analysed group. The content of majority of macronutrients, in particular protein, in average daily food rations was incompliant with nutritional norms, which in long term may increase the risk of diet-related diseases. Current nutritional recommendations concerning the diets of children in the post-infancy period need to be verified and disseminated.

Can leptin and soluble leptin receptor concentrations be used in assessing the efficacy of weight reduction programme in prepubertal obese children? Preliminary report.

INTRODUCTION: Children's simple obesity and its adverse health effects need efficient dietary treatment and physical activity recommendations. Anthropometric parameters may not identify all positive changes associated with lifestyle modifications. AIM: The aim of this study was to investigate if leptin and soluble leptin receptor concentration can be clinically useful markers for the monitoring of therapy efficacy in prepubertal obese children. MATERIAL AND METHODS: Changes in clinical, anthropometric and metabolic parameters including leptin and soluble leptin receptor in 26 patients aged 4-10 years, before and after a 3-months lifestyle intervention programme, were determined. This programme consisted of dietary and physical activity modifications and behaviour therapy, including individual psychological care of the child and its family. The recommended daily intake from a low-energy diet was 1200-1400 kcal/day. The reference group consisted of 30 healthy normal-weight children. Concentration of serum leptin and soluble leptin receptor were measured by ELISA kits. RESULTS: After a 3-months therapy in the obese children we observed decreased leptin concentration by about 50% (p<0.001) and increased leptin receptor concentration by about 20% (p<0.05), in comparison to the baseline. Significant negative correlation was obtained between both markers before (r= -0.506, p<0.001) and after therapy (r= -0.572, p<0.001). In children with lifestyle intervention programme lower body mass index, by about 10% (p<0.05) was found. CONCLUSIONS: The presented results suggest that leptin, as well as soluble leptin receptor, may identify positive changes in metabolism associated with weight reduction. Further studies with longer term therapy of the study group are continued, in order to confirm the value of these biochemical markers in the management of prepubertal obese children.

[Dietetic treatment in infants with food allergy]. / Postepowanie zywieniowe u niemowlat z alergia pokarmowa.

Prevalence of food allergy and variability of symptoms in infants is described. Proposals concerning dietetic treatment underlining the importance of breastfeeding, indications for proteins hydrolysate and for meat-vegetable diet introduction are presented. Feeding schedule for infants with food allergy is also included.