Influence of Glycaemic Control on Cognitive Function in Diabetic Children and Adolescents

According to the World Health Organisation (WHO), the number of people with diabetes has risen to 422 million in 2014. Poorly managed diabetes leads to chronic hyper and/or hypoglycaemia, which are associated with neurological complications in type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Therefore, the primary target of diabetic treatment is to achieve a good glycaemic control (GC). In this chapter, we reviewed studies published up to September 2017 about GC and cognitive development in diabetic children and adolescents, as well as the nutritional approaches used for the management of diabetes in childhood, focusing on low glycaemic index (GI) diets. According to different studies, low GI diets effectively improve GC, which may reduce the risk of diabetes-related complications, such as cognitive dysfunction; however, the evidence is not sufficiently robust and the results are inconclusive. Despite the fact that, low GI diets are consistent with healthy eating recommendations and should be encouraged in the prevention and nutritional management of diabetes. Further research is needed in diabetic children and adolescents at risk, especially well-designed long-term randomised controlled trials, with larger sample size, to determine the true value of low GI diets on long-term GC and diabetes prevention and management

Short- and Long-Term Implications of Human Milk Microbiota on Maternal and Child Health

Conceptualization, C.C. and T.C.; searching and review of published articles: M.E.-M., E.D., M.G.-R., J.A.G.-S., T.C. and C.C.; writing—original draft preparation, M.E.-M., E.D., C.C., M.G.-R., J.A.G.-S. and T.C.; writing—review and editing, M.G.-R., J.A.G.-S. and T.C.; visualization, M.G.-R.; J.A.G.-S. and T.C.; supervision, T.C. and C.C. All authors have read and agreed to the published version of the manuscript.Human milk (HM) is considered the most complete food for infants as its nutritional composition is specifically designed to meet infant nutritional requirements during early life. HM also provides numerous biologically active components, such as polyunsaturated fatty acids, milk fat globules, IgA, gangliosides or polyamines, among others; in addition, HM has a "bifidogenic effect ", a prebiotic effect, as a result of the low concentration of proteins and phosphates, as well as the presence of lactoferrin, lactose, nucleotides and oligosaccharides. Recently, has been a growing interest in HM as a potential source of probiotics and commensal bacteria to the infant gut, which might, in turn, influence both the gut colonization and maturation of infant immune system. Our review aims to address practical approaches to the detection of microbial communities in human breast milk samples, delving into their origin, composition and functions. Furthermore, we will summarize the current knowledge of how HM microbiota dysbiosis acts as a short- and long-term predictor of maternal and infant health. Finally, we also provide a critical view of the role of breast milk-related bacteria as a novel probiotic strategy in the prevention and treatment of maternal and offspring diseases

Maternal weight, gut microbiota, and the association with early childhood behavior: the PREOBE follow-up study

Background and aim Maternal overweight and breastfeeding seem to have a significant impact on the gut microbiota colonization process, which co-occurs simultaneously with brain development and the establishment of the “microbiota-gut-brain axis”, which potentially may affect behavior later in life. This study aimed to examine the influence of maternal overweight, obesity and/or gestational diabetes on the offspring behavior at 3.5 years of age and its association with the gut microbiota already established at 18 months of life. Methods 156 children born to overweight (OV, n = 45), obese (OB, n = 40) and normoweight (NW, n = 71) pregnant women participating in the PREOBE study were included in the current analysis. Stool samples were collected at 18 months of life and gut microbiome was obtained by 16S rRNA gene sequencing. Behavioral problems were evaluated at 3.5 years by using the Child Behavior Checklist (CBCL). ANOVA, Chi-Square Test, ANCOVA, Spearman’s correlation, logistic regression model and generalized linear model (GLM) were performed. Results At 3.5 years of age, Children born to OV/OB mothers showed higher scores in behavioral problems than those born to NW mothers. Additionally, offspring born to OB mothers who developed gestational diabetes mellitus (GDM) presented higher scores in attention/deficit hyperactivity and externalizing problems than those born to GDM OV/NW mothers. Fusicatenibacter abundance found at 18 months of age was associated to lower scores in total, internalizing and pervasive developmental problems, while an unidentified genus within Clostridiales and Flavonifractor families abundance showed a positive correlation with anxiety/depression and somatic complaints, respectively. On the other hand, children born to mothers with higher BMI who were breastfed presented elevated anxiety, internalizing problems, externalizing problems and total problems scores; likewise, their gut microbiota composition at 18 months of age showed positive correlation with behavioral problems at 3.5 years: Actinobacteria abundance and somatic complaints and between Fusobacteria abundance and withdrawn behavior and pervasive developmental problems. Conclusions Our findings suggests that OV/OB and/or GDM during pregnancy is associated with higher behavioral problems scores in children at 3.5 years old. Additionally, associations between early life gut microbiota composition and later mental health in children was also found.Andalusian Government, Economy, Science and Innovation Ministry P06-CTS-02341Spanish Government SB2010-0025EU Project FP7 MyNewGut KBBE-2013-7 613979Ministry of Economic Transformation, Industry, Knowledge, and University of the Junta de Andalucia (Andalusian Plan for Research, Development and Innovation, PAIDI 2020)Institute of Health Carlos III (ISCIII) CD21/0018

Growth patterns and breast milk/infant formula energetic efficiency in healthy infants up to 18 months of life: the COGNIS study

This project has been funded by Laboratorios Ordesa, S. L. Contract University of Granada General Foundation, No. 3349 and SMARTFOODS (CIEN) Contract University of Granada General Foundation, No. 4003, Spanish Ministry of Economy, Industry and Competitiveness, and partially funded by HORIZON 2020 EU DynaHEALTH Project (GA No.633595). N. S-V. has been granted with a scholarship from Fundaci ' on Carolina, Madrid, Spain.Type of feeding during early life influences growth trajectory and metabolic risk at later ages. Modifications in infant formula composition have led to evaluate their effects on growth and energetic efficiency (EE) compared with breast-feeding. Main goal was to analyse type of feeding potential effects during first months of life, plus its EE, on growth patterns in healthy formula fed (standard infant formula (SF) vs. experimental infant formula enriched with bioactive nutrients (EF)) and breastfed (BF) infants participating in the COGNIS RCT (http://www.ClinicalTrials.gov, Identifier: NCT02094547) up to 18 months of age. Infants follow-up to 18 months of age (n 141) fed with a SF (n 48), EF(n 56), or BF (n 37), were assessed for growth parameters using WHO standards. Growth velocity (GV) and catch-up were calculated to identify growth patterns. EE of breast milk/infant formula was also estimated. Infants' growth at 6 months showed higher length and lower head circumference gains in SF and EF infants than BF infants. Both weight-for-length and weight-for-age catch-up growth showed significant differences in formula fed groups compared with the BF. No significant differences in GV or catch-up were found at 6-12 and 12-18 months. Regarding EE, infant formula groups showed significantly lower weight and length gains/g of milk protein, and higher weight and length gains/g of milk lipids, than the BF infants. GV during first 6 months, which may be influenced by feeding, seems to be the main predictor of subsequent growth trajectory. Breast-feeding may have positive effects on growth programming due to its nutrients' EE.Laboratorios Ordesa, S. L. Contract University of Granada General Foundation 3349SMARTFOODS (CIEN) Contract University of Granada General Foundation 4003Spanish Ministry of Economy, Industry and CompetitivenessHORIZON 2020 EU DynaHEALTH Project 633595Fundacion Carolina, Madrid, Spai

The Effect of Maternal Obesity on Breast Milk Fatty Acids and Its Association with Infant Growth and Cognition—The PREOBE Follow-Up

This study analyzed how maternal obesity affected fatty acids (FAs) in breast milk and their association with infant growth and cognition to raise awareness about the programming effect of maternal health and to promote a healthy prenatal weight. Mother–child pairs (n = 78) were grouped per maternal pre-pregnancy body mass index (BMI): normal-weight (BMI = 18.5–24.99), overweight (BMI = 25–29.99) and obese (BMI > 30). Colostrum and mature milk FAs were determined. Infant anthropometry at 6, 18 and 36 months of age and cognition at 18 were analyzed. Mature milk exhibited lower arachidonic acid (AA) and docosahexaenoic acid (DHA), among others, than colostrum. Breast milk of non-normal weight mothers presented increased saturated FAs and n6:n3 ratio and decreased a-linolenic acid (ALA), DHA and monounsaturated FAs. Infant BMI-for-age at 6 months of age was inversely associated with colostrum n6 (e.g., AA) and n3 (e.g., DHA) FAs and positively associated with n6:n3 ratio. Depending on the maternal weight, infant cognition was positively influenced by breast milk linoleic acid, n6 PUFAs, ALA, DHA and n3 LC-PUFAs, and negatively a ected by n6:n3 ratio. In conclusion, this study shows that maternal pre-pregnancy BMI can influence breast milk FAs and infant growth and cognition, endorsing the importance of a healthy weight in future generations.This research was funded by the European Commission (DynaHEALTH-HORIZON 2020GANo: 633595) and the Spanish Ministry of Economy and Competitiveness (BFU2012-40254-C03-02). Further support was obtained from, Spanish Ministry of Innovation and Science (Junta de Andalucía), Excellence Projects (P06-CTS-02341). ADLGP thanks the Mexican government and the National Council on Science and Technology (CONACYT) for her PhD grant. The funders had no role in the study design, data collection, data analysis, decision to publish, or preparation of the manuscript

A synbiotics, long chain polyunsaturated fatty acids, and milk fat globule membranes supplemented formula modulates microbiota maturation and neurodevelopment

Supplementary data to this article can be found online at https://doi.org/10.1016/j.clnu.2022.05.013.Acknowledgments The authors wish to acknowledge the parents and children who participated in the study, and also the paediatricians and researchers of the EURISTIKOS team at the Department of Paediatrics as well as the Genetics Service at Centro de Instrumentación Científica e UGR for their contributions.Funding This project was supported by CDTI (Centro para el Desarrollo Tecnológico e Industrial) and FEDER (SMARTFOODS: IDI-20141206), Ordesa Laboratories, S.L. (Contract FE-UGR No. 3349), and The Spanish Ministry of Economy, Industry and Competitiveness, and partially supported by HORIZON 2020 EU DynaHEALTH Project (GA No.633595). Alicia Ruiz and Inmaculada Acuña were granted Ph.D. scholarships from the Spanish Ministry of Economy and Competitivity. Tomás Cerdó was granted a Ph.D. scholarship from Carlos III Health Institute. Natalia Sepúlveda-Valbuena was granted with a scholarship from Fundación Carolina, Madrid, Spain.Background & aims The critical window of concurrent developmental paths of the nervous system and gut microbiota in infancy provides an opportunity for nutritional interventions with potential health benefits later in life. Methods We compared the dynamics of gut microbiota maturation and explored its association with neurodevelopment at 12 months and 4 years of age in 170 full-term healthy infants fed a standard formula (SF) or a new formula (EF) based on standard formula supplemented with synbiotics, long chain polyunsaturated fatty acids (LC-PUFA) and bovine milk fat globule membranes (MFGM), including a breastfed reference group (BF). Results Using Dirichlet Multinomial Modelling, we characterized three microbial enterotypes (Mixed, anaerobic and aerobic profile; Bact, Bacteroides-dominant; Firm, Firmicutes-enriched) and identified a new enterotype dominated by an unidentified genus within Lachnospiraceae (U_Lach). Enterotypes were associated with age (Mixed with baseline, U_Lach with month 6, Bact and Firm with months 12 and 18). Trajectories or timely enterotype shifts in each infant were not random but strongly associated with type of feeding. Trajectories in SF shifted from initial Mixed to U_Lach, Bact or Firm at month. Microbiota maturation in EF split into a fast trajectory as in SF, and a slow trajectory with Mixed to U_Lach, Bact or Firm transitions at months 12 or 18, as in BF. EF infants with slow trajectories were more often in–home reared and born by vaginal delivery to mothers with pre-pregnancy lean BMI. At 12 months of age, language and expressive language scores were significantly higher in EF infants with fast trajectories than in BF. Neurodevelopmental outcomes were similar between EF infants with slow trajectories and BF at 12 months and 4 years of age. Conclusions Feeding a synbiotics, LC-PUFA and MFGM supplemented formula in a specific infant environment promoted probiotic growth and retarded gut microbiota maturation with similar neurodevelopment outcomes to breastfed infants.CDTI (Centro para el Desarrollo Tecnológico e Industrial) and FEDER (SMARTFOODS: IDI- 20141206)Ordesa Laboratories, S.L. (Contract FE-UGR No. 3349)Spanish Ministry of Economy, Industry and CompetitivenessHORIZON 2020 EU DynaHEALTH Project (GA No.633595

Chapter Influence of Glycaemic Control on Cognitive Function in Diabetic Children and Adolescents

According to the World Health Organisation (WHO), the number of people with diabetes has risen to 422 million in 2014. Poorly managed diabetes leads to chronic hyper and/or hypoglycaemia, which are associated with neurological complications in type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Therefore, the primary target of diabetic treatment is to achieve a good glycaemic control (GC). In this chapter, we reviewed studies published up to September 2017 about GC and cognitive development in diabetic children and adolescents, as well as the nutritional approaches used for the management of diabetes in childhood, focusing on low glycaemic index (GI) diets. According to different studies, low GI diets effectively improve GC, which may reduce the risk of diabetes-related complications, such as cognitive dysfunction; however, the evidence is not sufficiently robust and the results are inconclusive. Despite the fact that, low GI diets are consistent with healthy eating recommendations and should be encouraged in the prevention and nutritional management of diabetes. Further research is needed in diabetic children and adolescents at risk, especially well-designed long-term randomised controlled trials, with larger sample size, to determine the true value of low GI diets on long-term GC and diabetes prevention and management

Influence of Gestational Diabetes and Pregestational Maternal BMI on the Brain of Six-Year-Old Offspring

Background: Gestational diabetes (GD) and maternal excess weight are common pregnancy conditions that increase the risk of future complications for both the mother and her offspring. Their consequences on neurodevelopment are widely described in the literature, but less is known concerning the potential transgenerational influence on the brain structure. Methods: We used a combination of support vectors machine and hierarchical clustering to investigate the potential presence of anatomical brain differences in a sample of 109 children aged six years, born to mothers with overweight or obesity, or to mothers diagnosed with GD during pregnancy. Results: Significant effects are visible in the brain of children born to mothers with GD associated with pregestational excess weight, especially overweight instead of obesity. No differences in children's brain were observed when considering those born to normal-weight mothers. Conclusions: Our study highlights the need for clinical attention of pregnant women at risk to develop GD, and especially those with pregestational excess weight, since this status was found to be associated with detectable transgenerational brain changes. These effects may be due to the absence of specific and individualized intervention in these mothers during pregnancy.Spanish Ministry of Innovation and Science. Junta de Andalucía: Excellence Projects (P06-CTS-02341)Spanish Ministry of Economy and Competitiveness (BFU2012-40254-C03-01)DynaHEALTH EU Project - HORIZON 2020 Research and Innovation Programme, Grant Agreement No 633595Spanish Ministry of Science, Innovation and Universities (FJCI-2017-33396

The Nutritional Profile of Food Advertising for School-Aged Children via Television: A Longitudinal Approach

The prevalence of childhood obesity continues to increase. Screen time, one of the most documented reasons for the obesogenic environment, enhances childhood obesity, since advertisements for unhealthy food products are still broadcast on channels for children. This is presently one of the main challenges for the government in Spain, since the current laws and obligations are not updated. This study aims to analyze food advertising aimed at children on Spanish television in 2013 and 2018 on children's and general channels to test the effect of laws and obligations over time. In total, we viewed 512 h of the most viewed channels, two children's and two general channels, during the week and on weekends during specific periods of 2013 and 2018. Food advertising was categorized as core, non-core, and other food advertisement (CFA, NCFA, and OFA, respectively) according to the nutritional profile. A total of 2935 adverts were analyzed, 1263 in 2013 and 1672 in 2018. A higher proportion of NCFAs were broadcast on children's channels than in prior years, rising from 52.2% to 69.8% (p 2.5; p < 0.001), due to exposure to adverts for high-sugar and high-fat foods such as cakes, muffins, cookies, and fried and frozen meals rich in fat. In conclusion, the trends of nutritional profiles in food advertising on television are worsening over time, since the prevalence of NCFAs was higher in 2018 than in 2013. Currently, CFAs are not mainly broadcast on children's channels, confirming high-risk exposure to non-core food advertising by watching them. Thus, food advertising laws and obligations should be adapted to increase compliance.This work was supported by the Commission of the European Community’s 7th Framework Programme (FP7/2008-2013), grant agreement no. 212652 (NUTRIMENTHE project), within the 6th Framework Programme, contract no. 007036 (EARNEST project), and supported in part by the Commission of the European Community within the 5th Framework Programme, contract no. QLK1-CT-1999-00888 (NUHEAL project). This publication is the work of the authors and does not necessarily reflect the views of the Commission of the European Community. The funders had no role in the design, analysis or writing of this article.Ye

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care