Special Issue "New Challenges in Nutritional Management of Childhood Obesity and Diabetes"

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (30 December 2018).

Special Issue Editors

Prof. Dr. Elvira Verduci
Website
Guest Editor
1. Department of Health Sciences, Università di Milano, 20122 Milan, Italy
2. Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
Interests: pediatrics; nutrition; childhood obesity; metabolic syndrome; gut microbiota
Special Issues and Collections in MDPI journals
Prof. Dr. Gian Vincenzo Zuccotti
Website
Guest Editor
Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Via Grassi 74, 20157 Milan, Italy
Interests: pediatric nutrition; pediatric gastroenterology; food allergy; gut microbiome
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

WHO regards childhood obesity as one of the most serious global health challenge for the 21st century. The increasing prevalence of childhood obesity is associated with emergence of comorbidities including type 2 diabetes mellitus, hypertension, non-alcoholic fatty liver disease, obstructive sleep apnea, and dyslipidemia. In the last decade important research have been conducted aimed to find strategy to prevent obesity during critical early life periods. However current treatment approaches are less than satisfactory not only in adults but also in pediatric population. Lifestyle interventions, including dietary modifications and increased physical activity, are the milestones of weight management in children but have shown only modest effect on weight loss, particularly in children with severe obesity, and without a long-lasting effect. Nutrition is one of the most important pillars also of diabetes management. All patients with T1DM should receive nutrition counseling and be given individualized meal plans based on cultural, regional, traditional and seasonal variations and their socioeconomic status and familial food preferences should be considered while formulating a dietary planning.

This requires understanding of how different foods affect blood glucose levels, their glycemic index and load and the insulin dose adjustments.

This Special Issue will include original research and scientific perspectives on new challenges in dietary management of childhood obesity and diabetes and the role of specific nutrients, either as individual components or as part of a dietary pattern.

Dr. Elvira Verduci
Prof. Gianvincenzo Zuccotti
Guest Editors

Manuscript Submission Information

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Keywords

  • Childhood obesity
  • Pediatric diabetes
  • Dietary management
  • Pediatric metabolic syndrome

Published Papers (7 papers)

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Research

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Open AccessArticle
Diurnal Patterns of Energy Intake Derived via Principal Component Analysis and Their Relationship with Adiposity Measures in Adolescents: Results from the National Diet and Nutrition Survey RP (2008–2012)
Nutrients 2019, 11(2), 422; https://doi.org/10.3390/nu11020422 - 17 Feb 2019
Cited by 3
Abstract
Mounting evidence points towards the existence of an association between energy intake in the evening and an increased prevalence and risk of being overweight and of obesity. The present study aimed to describe diurnal eating patterns (DEP) in a nationally representative sample of [...] Read more.
Mounting evidence points towards the existence of an association between energy intake in the evening and an increased prevalence and risk of being overweight and of obesity. The present study aimed to describe diurnal eating patterns (DEP) in a nationally representative sample of UK adolescents and to relate the derived DEP to anthropometrical measures. Data from four-day food records of adolescents aged 11–18 years participating in the 2008–2012 UK National Diet and Nutrition Survey Rolling Programme (NDNS RP) was utilised. The DEP were derived using a principal component analysis on the correlation matrix. Three orthogonal diurnal patterns were interpretable as (i) a linear contrast (8% of total system variation) between breakfast and an earlier lunch vs. a later lunch, late dinner, and evening/night snack, renamed “phase shift” DEP; (ii) a linear contrast (6.0% of system variation) between midmorning snacks, late lunch, and early dinner vs. breakfast, early and late morning snacks, early lunch, midafternoon snacks, and late dinner, renamed “early eating and grazing” DEP; (iii) a linear contrast (6.0% of system variation) between late main meals vs. early main meals and night snacks which was renamed “early main meals and night snacks vs. late main meals” DEP. After the adjustment for confounders, every 1 unit increase in the “early main meals and night snacks vs. late main meals”’ DEP score was significantly associated with a 0.29 kg/m2 and 11.6 mm increase in Body Mass Index (BMI) and waist circumference, respectively. There were no significant associations with the other two main DEPs. In conclusion, adolescents who tended to eat large early main meals and night snacks rather than slightly later main meals without night snacks had higher BMI and waist circumference. Further research is required to explore the determinants of DEP and to explore the impact of the context of eating and socioecological factors in the development of specific DEP. Full article
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Open AccessArticle
The Obemat2.0 Study: A Clinical Trial of a Motivational Intervention for Childhood Obesity Treatment
Nutrients 2019, 11(2), 419; https://doi.org/10.3390/nu11020419 - 16 Feb 2019
Cited by 2
Abstract
The primary aim of the Obemat2.0 trial was to evaluate the efficacy of a multicomponent motivational program for the treatment of childhood obesity, coordinated between primary care and hospital specialized services, compared to the usual intervention performed in primary care. This was a [...] Read more.
The primary aim of the Obemat2.0 trial was to evaluate the efficacy of a multicomponent motivational program for the treatment of childhood obesity, coordinated between primary care and hospital specialized services, compared to the usual intervention performed in primary care. This was a cluster randomized clinical trial conducted in Spain, with two intervention arms: motivational intervention group vs. usual care group (as control), including 167 participants in each. The motivational intervention consisted of motivational interviewing, educational materials, use of an eHealth physical activity monitor and three group-based sessions. The primary outcome was body mass index (BMI) z score increments before and after the 12 (+3) months of intervention. Secondary outcomes (pre-post intervention) were: adherence to treatment, waist circumference (cm), fat mass index (z score), fat free mass index (z score), total body water (kg), bone mineral density (z score), blood lipids profile, glucose metabolism, and psychosocial problems. Other assessments (pre and post-intervention) were: sociodemographic information, physical activity, sedentary activity, neuropsychological testing, perception of body image, quality of the diet, food frequency consumption and foods available at home. The results of this clinical trial could open a window of opportunity to support professionals at the primary care to treat childhood obesity. The clinicaltrials.gov identifier was NCT02889406. Full article
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Open AccessArticle
Time Trends in Age at Menarche and Related Non-Communicable Disease Risk during the 20th Century in Mexico
Nutrients 2019, 11(2), 394; https://doi.org/10.3390/nu11020394 - 13 Feb 2019
Cited by 5
Abstract
Developed countries have shown a time trend towards a younger age at menarche (AAM), which is associated with increased risk of later obesity and non-communicable diseases. This study aimed to assess whether a time trend in AAM is associated with disease risk in [...] Read more.
Developed countries have shown a time trend towards a younger age at menarche (AAM), which is associated with increased risk of later obesity and non-communicable diseases. This study aimed to assess whether a time trend in AAM is associated with disease risk in Mexican women (n = 30,826), using data from the Mexican National Health Survey (2000). Linear and log binomial regression was used for nutritional and disease outcomes, while Welch–ANOVA was used to test for a time trend. AAM (in years) decreased over time (p < 0.001), with a maximal difference of 0.99 years between the 1920s (13.6 years) and 1980s (12.6 years ). AAM was negatively associated with weight (β = −1.01 kg; 95% CI −1.006, −1.004) and body mass index (BMI) (β = −1.01 kg/m2; −1.007, −1.006), and positively with height (β = 0.18 cm; 0.112, 0.231). AAM was associated with diabetes (RR = 0.95; 0.93, 0.98) and hypercholesterolemia (RR = 0.93; 0.90, 0.95), but not with hypertension, breast cancer or arthritis. In Mexico, AAM decreased significantly during the 20th century. AAM was inversely associated with adult weight and BMI, and positively with height. Women with a later AAM had a lower risk of diabetes and hypercholesterolemia. Full article
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Open AccessArticle
The Impact of Adding Sugars to Milk and Fruit on Adiposity and Diet Quality in Children: A Cross-Sectional and Longitudinal Analysis of the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS) Study
Nutrients 2018, 10(10), 1350; https://doi.org/10.3390/nu10101350 - 21 Sep 2018
Cited by 5
Abstract
Sugar, particularly as free sugars or sugar-sweetened beverages, significantly contributes to total energy intake, and, possibly, to increased body weight. Excessive consumption may be considered as a proxy of poor diet quality. However, no previous studies evaluated the association between the habit of [...] Read more.
Sugar, particularly as free sugars or sugar-sweetened beverages, significantly contributes to total energy intake, and, possibly, to increased body weight. Excessive consumption may be considered as a proxy of poor diet quality. However, no previous studies evaluated the association between the habit of adding sugars to “healthy” foods, such as plain milk and fresh fruit, and indicators of adiposity and/or dietary quality in children. To answer to these research questions, we Panalysed the European cohort of children participating in the IDEFICS study. Anthropometric variables, frequency of consumption of sugars added to milk and fruit (SAMF), and scores of adherence to healthy dietary pattern (HDAS) were assessed at baseline in 9829 children stratified according to age and sex. From this cohort, 6929 children were investigated again after two years follow-up. At baseline, a direct association between SAMF categories and adiposity indexes was observed only in children aged 6–<10 years, while the lower frequency of SAMF consumption was significantly associated with a higher HDAS. At the two year follow-up, children with higher baseline SAMF consumption showed significantly higher increases in all the anthropometric variables measured, with the exception of girls 6–<10 years old. The inverse association between SAMF categories and HDAS was still present at the two years follow-up in all age and sex groups. Our results suggest that the habit to adding sugars to foods that are commonly perceived as healthy may impact the adherence to healthy dietary guidelines and increase in adiposity risk as well. Full article
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Review

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Open AccessEditor’s ChoiceReview
The Role of Probiotics and Prebiotics in the Prevention and Treatment of Obesity
Nutrients 2019, 11(3), 635; https://doi.org/10.3390/nu11030635 - 15 Mar 2019
Cited by 50
Abstract
Obesity is a global pandemic complex to treat due to its multifactorial pathogenesis—an unhealthy lifestyle, neuronal and hormonal mechanisms, and genetic and epigenetic factors are involved. Scientific evidence supports the idea that obesity and metabolic consequences are strongly related to changes in both [...] Read more.
Obesity is a global pandemic complex to treat due to its multifactorial pathogenesis—an unhealthy lifestyle, neuronal and hormonal mechanisms, and genetic and epigenetic factors are involved. Scientific evidence supports the idea that obesity and metabolic consequences are strongly related to changes in both the function and composition of gut microbiota, which exert an essential role in modulating energy metabolism. Modifications of gut microbiota composition have been associated with variations in body weight and body mass index. Lifestyle modifications remain as primary therapy for obesity and related metabolic disorders. New therapeutic strategies to treat/prevent obesity have been proposed, based on pre- and/or probiotic modulation of gut microbiota to mimic that found in healthy non-obese subjects. Based on human and animal studies, this review aimed to discuss mechanisms through which gut microbiota could act as a key modifier of obesity and related metabolic complications. Evidence from animal studies and human clinical trials suggesting potential beneficial effects of prebiotic and various probiotic strains on those physical, biochemical, and metabolic parameters related to obesity is presented. As a conclusion, a deeper knowledge about pre-/probiotic mechanisms of action, in combination with adequately powered, randomized controlled follow-up studies, will facilitate the clinical application and development of personalized healthcare strategies. Full article
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Open AccessReview
A Systematic Review of the Association of Skipping Breakfast with Weight and Cardiometabolic Risk Factors in Children and Adolescents. What Should We Better Investigate in the Future?
Nutrients 2019, 11(2), 387; https://doi.org/10.3390/nu11020387 - 13 Feb 2019
Cited by 37
Abstract
The incidence of skipping breakfast in pediatric subjects is rising, and a relationship with overweight (OW) and obesity (OB) has been shown. Associations with cardiovascular outcomes and skipping breakfast in adults have been reported. The purpose of this systematic review was to summarize [...] Read more.
The incidence of skipping breakfast in pediatric subjects is rising, and a relationship with overweight (OW) and obesity (OB) has been shown. Associations with cardiovascular outcomes and skipping breakfast in adults have been reported. The purpose of this systematic review was to summarize the association of skipping breakfast with body weight and metabolic outcomes in the pediatric population. We searched relevant databases (2008–2018) and identified 56 articles, of which 39 were suitable to be included, basing on inclusion criteria (observational; defined breakfast skipping; weight and/or metabolic outcomes). Overall, 286,804 children and adolescents living in 33 countries were included. The definitions of OW/OB, skipping breakfast, and the nutrient assessment were highly heterogeneous. Confounding factors were reported infrequently. The prevalence of skipping breakfast ranged 10–30%, with an increasing trend in adolescents, mainly in girls. Skipping breakfast was associated with OW/OB in the 94.7% of the subjects. The lack of association was shown mainly in infants. Moreover, 16,130 subjects were investigated for cardiometabolic outcomes. Skipping breakfast was associated with a worse lipid profile, blood pressure levels, insulin-resistance, and metabolic syndrome. Five studies reported a lower quality dietary intake in breakfast skippers. This review supports skipping breakfast as an easy marker of the risk of OW/OB and metabolic diseases, whether or not it is directly involved in causality. We encourage intervention studies using standardized and generalizable indicators. Data on confounders, time of fasting, chronotypes, and nutrition quality are needed to establish the best practice for using it as a tool for assessing obesity risk. Full article
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Open AccessReview
Current Recommendations for Nutritional Management of Overweight and Obesity in Children and Adolescents: A Structured Framework
Nutrients 2019, 11(2), 362; https://doi.org/10.3390/nu11020362 - 09 Feb 2019
Cited by 8
Abstract
Nutritional management is an important component of the treatment of pediatric overweight and obesity, but clinicians struggle to keep abreast with the abundant literature. Therefore, our aim is to provide a tool that integrates the current recommendations and clinical expertise to assist dietitians [...] Read more.
Nutritional management is an important component of the treatment of pediatric overweight and obesity, but clinicians struggle to keep abreast with the abundant literature. Therefore, our aim is to provide a tool that integrates the current recommendations and clinical expertise to assist dietitians and other practitioners in their decision making about the nutritional management of pediatric overweight and obesity. To construct this practice-based evidence-informed framework, we conducted a systematic review of the guidelines on nutritional management of pediatric overweight or obesity in 2 databases and in the grey literature. We analyzed and synthesized recommendations of 17 guidelines. We selected the recommendations that were common to at least 30% of the guidelines and added by consensus the recommendations relevant to clinical expertise. Finally, we structured the framework according to the Nutritional Care Process in collaboration with a specialized team of dietitians who assessed its validity in clinical practice. The framework contributes to facilitate the integration of evidence-based practice for dietitians by synthesizing the current evidence, supporting clinical expertise, and promoting structured care following Nutrition Care Process model for children and adolescents with obesity. Full article
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