Emerging pathomechanisms involved in obesity.

OBJECTIVE: Overweight/obesity prevalence has increased dramatically worldwide. Recent evidence suggests sleep deprivation/fragmentation, fructose-exceedingly rich diets, and exposure to endocrine disruptors (eg, bisphenol A, BPA) as emerging additional factors involved in pathomechanisms and in the treatment resistance of obesity and its complications. Our study focuses on these factors for further preventive/therapeutic approaches in paediatric obesity. METHODS: Fifty-four Italian children (cases: n = 31 overweight/obese; controls: n = 23 normal weight) were clinically/anthropometrically characterised. Parents completed questionnaires on the relation between obesogenic factors and childhood obesity. BPA was measured by gas chromatography/tandem mass spectrometry on early morning urine samples. Correlations between the continuous variables were analysed using Spearman rank correlation. RESULTS: Sleep deprivation/fragmentation, nocturnal breathing problems, and daytime sleepiness increased with increasing body mass index, correlating with the presence of clinical markers of metabolic syndrome (eg, acanthosis nigricans). Frequency of sugar-enriched drink consumption and the amount of fructose per portion and/or per week increased, paralleling the ponderal excess and all the other anthropometric parameters. In the entire sample population, free and total BPA levels increased paralleling the body mass index increase (r > 0.8), whereas the conjugate demonstrated the opposite trend. The re-use of disposable plastic showed a positive correlation with urinary BPA levels. CONCLUSIONS: Despite its exploratory nature, the results of our pilot study confirm the close relation between certain factors and paediatric obesity, underscoring their role as emerging targets for prevention and therapy.

Nutritional problems in children with neuromotor disabilities: an Italian case series.

BACKGROUND AND AIMS: Several neuromotor disorders share exclusive, although often overlooked, nutritional problems. The objective of this study is therefore to delineate the frequency of malnutrition, evaluate the effectiveness of nutritional care, and identify issues needing to be possibly strengthened when caring for these patients into a general pediatrics department. PATIENTS AND METHODS: The study included 30 patients, 21 males and 9 females, aged between 2 and 15 years, affected by cerebral palsy, epileptic encephalopathy, and severe psychomotor developmental delay.Nutritional status was assessed by a dietary questionnaire administered to parents to investigate feeding difficulties; 3 days food diary to quantify daily calorie intake; anthropometrical (weight, height/length, body mass index percentiles, plicometry, specific body segments measurement) and blood (blood count, serum iron, albumin, transferrin, calcium, phosphorus) parameters. RESULTS: More than 44% individuals of the study population was at risk of malnutrition, according to feeding difficulties, progressive depletion of weight, reduced daily calorie intake, reduced albumin and transferrin levels. This occurred despite a massive caregivers commitment, as documented by almost universal parental constant assistance during their long-duration meals. CONCLUSIONS: Our results individuate the nutritional aspect being still a problem in the care of children with severe neuromotor disability.

Pediatric non alcoholic fatty liver disease: more on novel treatment targets.

The mainstay treatment of non alcoholic fatty liver disease (NAFLD) based on weight loss and/or lifestyle changes is most often unsuccessful at all ages, thus requiring the implementation of pharmacological strategies. Targeting insulin resistance and oxidative stress has recently proven unsatisfactory. Among a number of proposed innovative approaches targeting novel pathomechanisms, probiotics appear an interesting and reasonable option acting on gut-liver axis malfunction through the modulation of diet-driven, obesogenic, and inflammatory intestinal microbiota.A combined multiple pharmacological therapy directed simultaneously towards novel and old pathomechanisms (including, e.g., insulin resistance, oxidative stress, gut-liver axis, apoptosis) along with lifestyle interventions however might be necessary both in adult and pediatric NAFLD therapy.