Fact-based nutrition for infants and lactating mothers-The NUTRISHIELD study.

Background: Human milk (HM) is the ideal source of nutrients for infants. Its composition is highly variable according to the infant's needs. When not enough own mother's milk (OMM) is available, the administration of pasteurized donor human milk (DHM) is considered a suitable alternative for preterm infants. This study protocol describes the NUTRISHIELD clinical study. The main objective of this study is to compare the % weight gain/month in preterm and term infants exclusively receiving either OMM or DHM. Other secondary aims comprise the evaluation of the influence of diet, lifestyle habits, psychological stress, and pasteurization on the milk composition, and how it modulates infant's growth, health, and development. Methods and design: NUTRISHIELD is a prospective mother-infant birth cohort in the Spanish-Mediterranean area including three groups: preterm infants <32 weeks of gestation (i) exclusively receiving (i.e., >80% of total intake) OMM, and (ii) exclusively receiving DHM, and (iii) term infants exclusively receiving OMM, as well as their mothers. Biological samples and nutritional, clinical, and anthropometric characteristics are collected at six time points covering the period from birth and until six months of infant's age. The genotype, metabolome, and microbiota as well as the HM composition are characterized. Portable sensor prototypes for the analysis of HM and urine are benchmarked. Additionally, maternal psychosocial status is measured at the beginning of the study and at month six. Mother-infant postpartum bonding and parental stress are also examined. At six months, infant neurodevelopment scales are applied. Mother's concerns and attitudes to breastfeeding are registered through a specific questionnaire. Discussion: NUTRISHIELD provides an in-depth longitudinal study of the mother-infant-microbiota triad combining multiple biological matrices, newly developed analytical methods, and ad-hoc designed sensor prototypes with a wide range of clinical outcome measures. Data obtained from this study will be used to train a machine-learning algorithm for providing dietary advice to lactating mothers and will be implemented in a user-friendly platform based on a combination of user-provided information and biomarker analysis. A better understanding of the factors affecting milk's composition, together with the health implications for infants plays an important role in developing improved strategies of nutraceutical management in infant care. Clinical trial registration: https://register.clinicaltrials.gov, identifier: NCT05646940.

Joint Microbiota Activity and Dietary Assessment through Urinary Biomarkers by LC-MS/MS.

Accurate dietary assessment in nutritional research is a huge challenge, but essential. Due to the subjective nature of self-reporting methods, the development of analytical methods for food intake and microbiota biomarkers determination is needed. This work presents an ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS) method for the quantification and semi quantification of 20 and 201 food intake biomarkers (BFIs), respectively, as well as 7 microbiota biomarkers applied to 208 urine samples from lactating mothers (M) (N = 59). Dietary intake was assessed through a 24 h dietary recall (R24h). BFI analysis identified three distinct clusters among samples: samples from clusters 1 and 3 presented higher concentrations of most biomarkers than those from cluster 2, with dairy products and milk biomarkers being more concentrated in cluster 1, and seeds, garlic and onion in cluster 3. Significant correlations were observed between three BFIs (fruits, meat, and fish) and R24h data (r > 0.2, p-values < 0.01, Spearman correlation). Microbiota activity biomarkers were simultaneously evaluated and the subgroup patterns detected were compared to clusters from dietary assessment. These results evidence the feasibility, usefulness, and complementary nature of the determination of BFIs, R24h, and microbiota activity biomarkers in observational nutrition cohort studies.

The effectiveness of technology-based interventions for weight loss maintenance: A systematic review of randomized controlled trials with meta-analysis.

OBJECTIVE: To systematically review and meta-analyze randomized controlled trials on the effects of technology-based interventions for maintenance of lost weight. METHODS: A systematic literature search was performed to identify randomized controlled trials with at least one intervention arm delivered through the internet or mobile application, published in English until September 2021. Weight change at the end of the weight loss maintenance phase was considered the primary outcome. RESULTS: Twelve manuscripts with 2941 adults were included in the review; 10 studies were meta-analyzed. Included interventions had a duration of 3-30 months and were tested compared with minimum interventions (no contact with the study staff or intervention with only a limited number of features) or in-person groups. Technology-based interventions resulted in similar weight regain when compared with minimum interventions (ES = -0.07 kg; 95% CI = [-0.57, 0.42]; p = 0.770). However, when compared with in-person interventions, technology-based interventions were found to lead in significantly higher weight regain (ES = 1.36 kg; 95% CI = [0.29, 2.43]; p = 0.010). CONCLUSION: Web- and app-based interventions for weight loss maintenance produced similar results with minimum interventions and resulted in greater weight regain compared with in-person interventions. Appropriate interventions for weight loss maintenance provide benefits against weight regain, only when provided in-person.

Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis.

BACKGROUND: Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. OBJECTIVE: The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. METHODS: A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. RESULTS: In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference -0.61, 95% CI -1.10 to -0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference -0.36, 95% CI -0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. CONCLUSIONS: The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations.

The bone response to non-weight-bearing exercise is sport-, site-, and sex-specific.

OBJECTIVE: To examine whether skeletal adaptations to chronic non-weight-bearing exercise depend on the type of aquatic exercise (swimming or water polo) as well as on sex (men or women). DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional study at the Laboratory of Nutrition and Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. A total of 43 water polo players, 26 swimmers, and 30 sedentary individuals, aged 17 to 34 years, were recruited (52 men, 47 women). MAIN OUTCOME MEASURES: Bone mineral content (BMC) and areal bone mineral density (aBMD) of the total body and of various subregions. RESULTS: : Compared with controls, swimmers had lower leg and total aBMD (P < 0.05), whereas water polo players had lower leg but higher arm and trunk aBMD (all P < 0.05). Swimmers and water polo athletes differed at the arms (men only), trunk, and total body (all higher in water polo players, at P < 0.05). Bone adaptations to water polo playing were unaffected by sex. Female swimmers, but not male swimmers, had 13% higher arm BMC than controls (P < 0.05), whereas male swimmers, but not female swimmers, had 12% lower leg BMC than controls (P < 0.05). CONCLUSIONS: Athletes participating in long-term water polo playing and swimming have substantially different total and regional aBMD. The effect is not mediated by sex in water polo players; however, sex may mediate the differences between swimmers and controls. Whether the observed differences between athlete groups and sexes arise from different bone adaptations to activity or from other factors cannot be answered by the current data. CLINICAL RELEVANCE: Water polo playing may be preferable over swimming for maintaining bone health; both types of aquatic exercise at the elite level of participation, however, have unfavorable effects on the lower limb bones.

Water polo is associated with an apparent redistribution of bone mass and density from the lower to the upper limbs.

The bone response to exercise is site-specific and load-dependent. Recent evidence suggests that an inverse relationship may exist between loaded and unloaded sites, such that the former may benefit at the expense of the latter. The present study examined this possibility in 48 males (21 water polo players, 12 handball players, and 15 sedentary controls). Water polo and handball are alike with respect to the active loading of the upper limbs during overhead throwing; however, the weight-supporting environment of water polo removes the weight-bearing effect from the lower limbs. Bone mineral content (BMC), bone projected area (Ap), and areal bone mineral density (aBMD) of the total body and of various subregions were determined by dual-energy X-ray absorptiometry. After adjusting for age, height, and weight, water polo players had higher arms BMC, Ap, and aBMD (by 22.2, 11.1, and 10.5%, respectively; P<0.05), but lower legs aBMD (-6.3%; P<0.05) relative to controls. On the contrary, compared to controls, handball players had higher BMC (from 11.8 to 24.3%), Ap (from 5.2 to 11.7%), and aBMD (from 6.4 to 11.9%) for the total body at all sites. Water polo athletes had increased arms and decreased legs aBMD ratios (regional-to-total) than either handball players or sedentary subjects (P<0.001). Water polo is associated with an apparent redistribution of bone mass and density from the lower to the upper limbs, with no major effects on the rest of the body.