The role of fetal, infant, and childhood nutrition in the timing of sexual maturation

Puberty is a crucial developmental stage in the life span, necessary to achieve reproductive and somatic maturity. Timing of puberty is modulated by and responds to central neurotransmitters, hormones, and environmental factors leading to hypothalamic-pituitary-gonadal axis maturation. The connection between hormones and nutrition during critical periods of growth, like fetal life or infancy, is fundamental for metabolic adaptation response and pubertal development control and prediction. Since birth weight is an important indicator of growth estimation during fetal life, restricted prenatal growth, such as intrauterine growth restriction (IUGR) and small for gestational age (SGA), may impact endocrine system, affecting pubertal development. Successively, lactation along with early life optimal nutrition during infancy and childhood may be important in order to set up timing of sexual maturation and provide successful reproduction at a later time. Sexual maturation and healthy growth are also influenced by nutrition requirements and diet composition. Early nutritional surveillance and monitoring of pubertal development is recommended in all children, particularly in those at risk, such as the ones born SGA and/or IUGR, as well as in the case of sudden weight gain during infancy. Adequate macro and micronutrient intake is essential for healthy growth and sexual maturity

EXPOsure : Milan, May 1st-October 31st

The city of Milan is experiencing the great event of EXPO 2015 and heavy construction has been ongoing since 2012 over an area of more than 1 million meters squared in the north-west suburban area of the city. We compared the number of hospital admissions for upper and lower respiratory tract infections (URTI and LRTI) and acute asthma, in infants and children aged between 0 and 13 years from 2011 to 2014 in two Pediatric Departments, one near and one far from the EXPO construction area. Hospital admission frequencies resulted to be similar in the two Pediatric Departments

Predictive ability of the estimate of fat mass to detect early-onset metabolic syndrome in prepubertal children with obesity

Body mass index (BMI), usually used as a body fatness marker, does not accurately dis-criminate between amounts of lean and fat mass, crucial factors in determining metabolic syndrome (MS) risk. We assessed the predictive ability of the estimate of FM (eFM) calculated using the following formula: FM = weight − exp(0.3073 × height2 −10.0155×d-growth-standards/standards/body-mass-index-for-age-bmi-for-age weight−1 +0.004571×weight− 0.9180×ln(age) + 0.6488×age0.5 + 0.04723×male + 2.8055) (exp = exponential function, score 1 if child was of black (BA), south Asian (SA), other Asian (AO), or other (other) ethnic origin and score 0 if not, ln = natural logarithmic transformation, male = 1, female = 0), to detect MS in 185 prepubertal obese children compared to other adiposity parameters. The eFM, BMI, waist circumference (WC), body shape index (ABSI), tri-ponderal mass index, and conicity index (C-Index) were calculated. Patients were classified as hav-ing MS if they met ≥ 3/5 of the following criteria: WC ≥ 95th percentile; triglycerides ≥ 95th percen-tile; HDL-cholesterol ≤ 5th percentile; blood pressure ≥ 95th percentile; fasting blood glucose ≥ 100 mg/dL; and/or HOMA-IR ≥ 97.5th percentile. MS occurred in 18.9% of obese subjects (p < 0.001), with a higher prevalence in females vs. males (p = 0.005). The eFM was correlated with BMI, WC, ABSI, and Con-I (p < 0.001). Higher eFM values were present in the MS vs. non-MS group (p < 0.001); the eFM was higher in patients with hypertension and insulin resistance (p <0.01). The eFM shows a good predictive ability for MS. Additional to BMI, the identification of new parameters determi-nable with simple anthropometric measures and with a good ability for the early detection of MS, such as the eFM, may be useful in clinical practice, particularly when instrumentation to estimate the body composition is not available

“CoVidentary”: An online exercise training program to reduce sedentary behaviours in children with type 1 diabetes during the COVID-19 pandemic

Aim: We explored the physical activity (PA) level and the variation in glycaemic control in children with type 1 diabetes (T1D) before and during the lockdown. Then, we proposed an online training program supported by sport-science specialists. Methods: Parents of children with T1D (&lt;18 years) filled out an online survey. Anthropometric characteristics, PA, play, sport and sedentary time and the medical related outcomes were recorded. An adapted online program “Covidentary” was proposed through full-training (FT) and active breaks (AB) modality. Results: 280 youth (11.8 ± 3.3 years) were included in the analysis. We reported a decline in sport (-2.1 ± 2.1 h/week) and outdoor-plays (-73.9 ± 93.6 min/day). Moreover, we found an increase in sedentary time (+144.7 ± 147.8 min/day), in mean glycaemic values (+25.4 ± 33.4 mg/dL) and insulin delivery (71.8% of patients). 37% of invited patients attended the training program, 46% took part in AB and 54% in FT. The AB was carried out for 90% of the total duration, while the FT for 31%. Both types of training were perceived as moderate intensity effort. Conclusion: A decline of participation in sport activities and a subsequent increase of sedentary time influence the management of T1D of children, increasing the risk of acute/long-term complications. Online exercise program may contrast the pandemic's sedentary lifestyle

Subcutaneous Adipose Tissue Transcriptome Highlights Specific Expression Profiles in Severe Pediatric Obesity: A Pilot Study

The prevalence of pediatric obesity is rising rapidly worldwide, and "omic" approaches are helpful in investigating the molecular pathophysiology of obesity. This work aims to identify transcriptional differences in the subcutaneous adipose tissue (scAT) of children with overweight (OW), obesity (OB), or severe obesity (SV) compared with those of normal weight (NW). Periumbilical scAT biopsies were collected from 20 male children aged 1-12 years. The children were stratified into the following four groups according to their BMI z-scores: SV, OB, OW, and NW. scAT RNA-Seq analyses were performed, and a differential expression analysis was conducted using the DESeq2 R package. A pathways analysis was performed to gain biological insights into gene expression. Our data highlight the significant deregulation in both coding and non-coding transcripts in the SV group when compared with the NW, OW, and OB groups. A KEGG pathway analysis showed that coding transcripts were mainly involved in lipid metabolism. A GSEA analysis revealed the upregulation of lipid degradation and metabolism in SV vs. OB and SV vs. OW. Bioenergetic processes and the catabolism of branched-chain amino acids were upregulated in SV compared with OB, OW, and NW. In conclusion, we report for the first time that a significant transcriptional deregulation occurs in the periumbilical scAT of children with severe obesity compared with those of normal weight or those with overweight or mild obesity

Acute Inflammation and Elevated Cardiac Markers in a Two-Month-Old Infant with Severe Acute Respiratory Syndrome Coronavirus 2 Infection Presenting with Cardiac Symptoms

Severe acute respiratory syndrome coronavirus 2 infection in children mainly shows a milder course. In complicated cases, it is unknown whether inflammation is predictive of disease severity, as in adults. Moreover, cardiac involvement is anecdotally described. We report the case of a 2-month-old infant with severe acute respiratory syndrome coronavirus 2 infection presenting with fever, tachycardia and elevated interleukin-6, who was diagnosed with myocarditis and treated with immunoglobulins

Human papillomavirus 9-valent vaccine for cancer prevention: a systematic review of the available evidence.

In 2014, the Food and Drug Administration approved a new human papillomavirus 9-valent vaccine (9vHPV), targeting nine HPV types: HPV types 6, 11, 16, and 18, which are also targeted by the quadrivalent HPV vaccine (qHPV), plus five additional high cancer risk HPV types (HPV types 31, 33, 45, 52, and 58). The aim of the current study was to systematically retrieve, qualitatively and quantitatively pool, as well as critically appraise all available evidence on 9vHPV from randomized controlled trials (RCTs). We conducted a systematic review of the literature on 9vHPV efficacy, immunogenicity and safety, as well as a systematic search of registered, completed, and ongoing RCTs. We retrieved and screened 227 records for eligibility. A total of 10 publications reported on RCTs' results on 9vHPV and were included in the review. Sixteen RCTs on 9vHPV have been registered on RCT registries. There is evidence that 9vHPV generated a response to HPV types 6, 11, 16 and 18 that was non-inferior to qHPV. Vaccine efficacy against five additional HPV type-related diseases was directly assessed on females aged 16-26 years (risk reduction against high-grade cervical, vulvar or vaginal disease = 96·7%, 95% CI 80·9%-99·8%). Bridging efficacy was demonstrated for males and females aged 9-15 years and males aged 16-26 years (the lower bound of the 95% CIs of both the geometric mean titer ratio and difference in seroconversion rates meeting the criteria for non-inferiority for all HPV types). Overall, 9vHPV has been proved to be safe and well tolerated. Other RCTs addressed: 9vHPV co-administration with other vaccines, 9vHPV administration in subjects that previously received qHPV and 9vHPV efficacy in regimens containing fewer than three doses. The inclusion of additional HPV types in 9vHPV offers great potential to expand protection against HPV infection. However, the impact of 9vHPV on reducing the global burden of HPV-related disease will greatly depend on vaccine uptake, coverage, availability, and affordability

Sexually transmissible infections among young adolescents in Milan areas: a multicentre study

Objective: Sexually transmitted infections (STIs) are a major health problem affecting mostly young people, the exact magnitude of STIs is frequently unknown due to lack of country surveillance systems. Aim of this study was to determine the prevalence of STIs and relative risk factors among and adolescents in Milan areas, Italy. Methods: From May to October 2011, 117 adolescents (63 female, 54%), median age 15 years, attending hospitals from the north-western areas of Milan, Italy, were enrolled. All subjects completed a questionnaire and provided a urine sample, which was tested for Neisseria gonorrhea, Chlamidia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum/parvum, Trichomonas vaginalis, Treponema pallidum, Streptococcus agalatiae, Haemophylus ducrey, Citomegalovirus (CMV), Herpes Simplex Virus 1(HSV1) and Lymphogranuloma venereum by a multiplex PCR assay: Seeplex\uae STI Master ACE Detection (Seegene, Seoul, Korea). Forty tree out of 117 adolescents (36%) were HIV-1 positive, 63% (74/117) were without any underlying infectious disease. Results: Fifty seven (48,7%) out of 117 adolescent were sexually active (SA), 20 out of 57 (35%) had STIs as follow: 24.5% (14 cases) U.urealyticum/parvum, 7% (4cases) C.trachomatis, 1.7% (one case each) M. genitalium and N.gonorrhoea. Thirty-two (56%) out of 57 SA adolescents were HIV-1 positive and infected with U. urealyticum/parvum (37.5%, 12 cases) and C.trachomatis (6.2% 2 cases). A single case (3.1%) of mixed infection due to C.trachomatis, N.gonorrhoea and U.urealyticum/parvum was observed. Six out of 60 (10%) sexually inactive (SI) adolescents resulted positive for U.urealyticum/parvum (3 cases), C.trachomatis (2 cases) and N.gonorrhoea (1 case). Eleven out of 60 were HIV-1 positive and among this group one case of C.trachomatis and U.urealyticum/parvum infection was reported. For T.vaginalis, T. pallidum, S. agalatiae, H.ducrey, CMV, HSV1 and Lymphogranuloma venereum any infection was reported. Conclusion: STIs as expected were higher in SA adolescent than in SI and in HIV-1 positive patients (P <0.025).Twenty-two percent of SA adolescents resulted positive for at least one STIs. A prevalence of 14.5% (17/117) for U. urealyticum/parvum, was detected in the adolescents studied, even if its clinical significance has yet to be assessed. Findings suggest that surveillance and screening programs should be implemented to prevent sequels on this vulnerable population