Personalized Nutrition in Food Allergy : Tips for Clinical Practice

Nowadays, food allergies are considered as a wide spectrum of disorders that need different approaches. The \u201cone size fits all\u201d approach is giving way to a \u201ctargeted approach,\u201d based on the identification of the patient's phenotype. Thus, the approach of nutritional management of food allergy has moved on from simply being \u201cyes or no\u201d to \u201chow much?\u201d, \u201cin which form?\u201d and \u201cfor which patients?\u201d Different factors should be considered in order to make a patient-tailored nutritional plan in clinical practice. Tailored nutritional plans may help to reduce the nutritional, social and economic burden of food allergy

Potential role of omega-3 polyunsaturated fatty acids in pediatric food allergy

Polyunsaturated fatty acids (PUFAs) are involved both in immune system regulation and inflammation. In particular, within the PUFAs category, omega-3 (ω-3) may reduce inflammation, whereas omega-6 (ω-6) PUFAs are generally considered to have a proinflammatory effect. Recent evidence highlights an imbalance in the ω-3: ω-6 ratio with an increased intake of ω-6, as a consequence of the shift towards a westernized diet. In critical age groups such as infants, toddlers and young children, as well as pregnant and lactating women or fish allergic patients, ω-3 intake may be inadequate. This review aims to discuss the potential beneficial effects of PUFAs on pediatric food allergy prevention and treatment, both at prenatal and postnatal ages. Data from preclinical studies with PUFAs supplementation show encouraging effects in suppressing allergic response. Clinical studies results are still conflicting about the best timing and dosages of supplementation and which individuals are most likely to benefit; therefore, it is still not possible to draw firm conclusions. With regard to food-allergic children, it is still debated whether PUFAs could slow disease progression or not, since consistent data are lacking. In conclusion, more data on the effects of ω-3 PUFAs supplementation alone or in combination with other nutrients are warranted, both in the general and food allergic population

Effects of a multidisciplinary weight loss intervention in overweight and obese children and adolescents: 11 years of experience

Aims To evaluate the effects of an outpatient multidisciplinary weight loss intervention in reducing body mass index (BMI) in children and adolescents suffering overweight and obesity, changes in A Body Shape Index (ABSI, waist circumference normalized to height and weight) and Hip Index (HI, normalized hip circumference) during treatment and correlation between the ABSI and HI with change in BMI z score. Methods We analyze anthropometric data from pediatric patients affected by overweight and obesity aged 2 to 18 years old who entered our multidisciplinary weight loss intervention, which included medical, psychological and nutritional sessions, from January 1st 2006 to December 31st 2016. Lifestyle modification counselling was delivered. Follow-up visits were planned every month for 3 months and subsequently every 2'4 months. BMI, ABSI, and HI were converted to z scores using age and sex specific population normals. Results 864 patients entered our intervention. 453 patients (208 males), mean age 11.2 \uc2\ub13.1 years, 392 with obesity (86%, z-BMI 2.90 \uc2\ub10.80 SD) and 61 patients with overweight (z-BMI 1.73\uc2\ub10.21 SD) attended at least 1 follow-up visit. The mean number of visits was 3.5 (\uc2\ub1 1.8 SD) in overweight subjects and 3.9 (\uc2\ub12.2 SD) in ones with obesity. At the last attended follow-up visit (at 16 \uc2\ub1 12 months SD) we observed a reduction in mean z-BMI in patients with obesity (to 2.52 \uc2\ub10.71 SD) and patients with overweight (to 1.46 \uc2\ub10.5 SD). Most patients (80.8%) reduced their BMI z scores. Mean ABSI and HI z scores showed no significant change. 78/392 patients (19.8%) recovered from obese to overweight, 5/392 (1.2%) from obese to normal weight. The recovery rate from overweight to normal weight was 13.1%. In a multivariate model, initial BMI z score and number of follow-up visits were significant predictors of weight change, while age, sex, ABSI, and HI were not significant predictors. Conclusions Patients affected by overweight and obesity involved in a multidisciplinary weight loss intervention reduced their mean BMI z score, while ABSI and HI were stable. Weight loss was not predicted by initial ABSI or HI. More visits predict more weight loss, but dropout rates are high. The great majority of patients leave the weight management program before having normalized their BMI

Growth Pattern, Resting Energy Expenditure, and Nutrient Intake of Children with Food Allergies

Growth impairment has been reported in children with food allergies (FA). However, the available data on the dietary intake of FA children are controversial, and no data are available on their resting energy expenditure (REE). The aim of this study was to test whether REE differs between FA and healthy children. In this study, 30 FA children were matched by sex and age, with 31 healthy controls using coarsened exact matching (CEM). Their REE was measured by indirect calorimetry (IC). Energy and macronutrient intake were evaluated using a three-day dietary record. Between-group comparisons were performed by robust median regression using CEM-related weights. The association of REE with allergies was also evaluated using robust median regression models. Anthropometric measurements, REE, and nutrient intake were similar in FA children and matched controls. Taking into account the association of REE with gender and age, a statistically significant but biologically negligible association was detected between median REE and allergy status (+9% in FA children). In conclusion, we did not find any biologically relevant difference in REE, anthropometry, and dietary intake in children with FA compared to healthy children

Complementary Feeding: Pitfalls for Health Outcomes

The term complementary feeding is defined as the period in which a progressive reduction of breastfeeding or infant-formula feeding takes place, while the infant is gradually introduced to solid foods. It is a crucial time in the infant's life, not only because of the rapid changes in nutritional requirements and the consequent impact on infant growth and development, but also for a generation of lifelong flavor preferences and dietary habits that will influence mid and long-term health. There is an increasing body of evidence addressing the pivotal role of nutrition, especially during the early stages of life, and its link to the onset of chronic non-communicable diseases, such as obesity, hypertension, diabetes, and allergic diseases. It is clear that the way in which a child is introduced to complementary foods may have effects on the individual's entire life. The aim of this review is to discuss the effects of complementary feeding timing, composition, and mode on mid and long-term health outcomes, in the light of the current evidence. Furthermore, we suggest practical tips for a healthy approach to complementary feeding, aiming at a healthy future, and highlight gaps to be filled

Hydrolysed formulas in the management of cow’s milk allergy: New insights, pitfalls and tips

9nononeAn allergy to cow’s milk requires the avoidance of cow’s milk proteins and, in some infants, the use of a hypoallergenic formula. This review aims to summarize the current evidence concerning different types of hydrolysed formulas (HF), and recommendations for the treatment of IgE-and non-IgE-mediated cow’s milk allergy and functional gastrointestinal disorders in infancy, for which some dietary intervention and HF may be of benefit to both immune and motor mechanisms. Current guidelines recommend cow’s milk protein (i.e., whey or casein) extensively hydrolysed formula (eHF) as the first choice for cow’s milk allergy treatment, and amino acid formulas for more severe cases or those with reactions to eHF. Rice hydrolysed formulas (rHF) have also become available in recent years. Both eHF and rHF are well tolerated by the majority of children allergic to cow’s milk, with no concerns regarding body growth or adverse effects. Some hydrolysates may have a pro-active effect in modulating the immune system due to the presence of small peptides and additional components, like biotics. Despite encouraging results on tolerance acquisition, evidence is still not conclusive, thus hampering our ability to draw firm conclusions. In clinical practice, the choice of hypoallergenic formula should be based on the infant’s age, the severity, frequency and persistence of symptoms, immune phenotype, growth pattern, formula cost, and in vivo proof of tolerance and efficacy.noneD'auria E.; Salvatore S.; Acunzo M.; Peroni D.; Pendezza E.; Di Profio E.; Fiore G.; Zuccotti G.V.; Verduci E.D'Auria, E.; Salvatore, S.; Acunzo, M.; Peroni, D.; Pendezza, E.; Di Profio, E.; Fiore, G.; Zuccotti, G. V.; Verduci, E