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

Pidotimod : the past and the present

At the end of 1990s, acute respiratory tract infections (ARTIs) were called the 'forgotten pandemic', with a clear dichotomy between developing and industrialised countries in mortality and morbidity, the main outcomes associated with ARTIs. This definition still applies 20 years later, when the introduction of new and safe antibiotics and vaccines has certainly contributed to controlling the most life-threatening ARTIs, but has not had a major impact on viral ARTIs in paediatric age. One functional approach to preventing and treating ARTIs is non-specifically increasing the immune response or enhancing the children's innate defence mechanisms. Different kinds of biologically active substances - called immunostimulants - of natural and synthetic origins and with different mechanisms of action have been introduced in some countries for the prevention of ARTIs in children. Recently, research focused on one of these compounds, Pidotimod, has attempted to better clarify and define its mechanisms of action both in vitro and in vivo. In this paper, we critically examine the most recent findings on Pidotimod. Certainly the improvement of research methodology in the last 20 years and the acquired knowledge in various fields of clinical immunology should be the starting point for research on Pidotimod. Preclinical research will be essential to better understand the mechanisms of action of this compound. However, in vivo studies, especially randomised control trials, will be necessary to establish the real efficacy of Pidotimod in the prevention of ARTIs in paediatric age

Strategies for preventing influenza : future perspectives in influenza vaccine technology

Prevention of influenza transmission and containment of epidemics and pandemics require effective strategies that can be efficiently and easily addressed to the whole population. Annual vaccination is undoubtedly the most effective way to provide protection against influenza infection. Numbers of vaccines are actually available for yearly immunisation. However, the continuous increasing demand for rapidly available vaccine doses for immunisation of a larger proportion of population represents the stimulus for study and development of more efficient vaccine production technologies, which can guarantee reduction of vaccine manufacture times and better compliance by availability of easier routes of administration. New perspectives in influenza vaccination technology are making their way in the future panorama of influenza prevention strategies

Nutrition in the First 1000 Days : The Origin of Childhood Obesity

Childhood obesity is a major global issue. Its incidence is constantly increasing, thereby offering a threatening public health perspective. The risk of developing the numerous chronic diseases associated with this condition from very early in life is significant. Although complex and multi-factorial, the pathophysiology of obesity recognizes essential roles of nutritional and metabolic aspects. Particularly, several risk factors identified as possible determinants of later-life obesity act within the first 1000 days of life (i.e., from conception to age 2 years). The purpose of this manuscript is to review those key mechanisms for which a role in predisposing children to obesity is supported by the most recent literature. Throughout the development of the human feeding environment, three different stages have been identified: (1) the prenatal period; (2) breast vs. formula feeding; and (3) complementary diet. A deep understanding of the specific nutritional challenges presented within each phase might foster the development of future preventive strategies

Immunization in adolescents : past, present and future

In the past, immunization programs worldwide mainly focused on the delivery of infant and early childhood vaccines. An increasing awareness of the importance of investing in adolescents\u2019 health has led to the introduction of new vaccines targeted specifically to adolescents over the last ten years: this has improved the adolescent\u2019s opportunities to protect from certain diseases for which they are at an increased risk. Safe and effective vaccines against human papilloma virus, Neisseria meningitides and Bordetella pertussis are recommended in many parts of the world; nevertheless, vaccination coverage in this age group is relatively low compared to coverage in infants. Barriers to adolescent immunization are believed to be complex and multifactorial but overcoming these barriers will be of primary importance for the future

What Pediatricians Should Know Before Studying Gut Microbiota

Billions of microorganisms, or "microbiota", inhabit the gut and affect its homeostasis, influencing, and sometimes causing if altered, a multitude of diseases. The genomes of the microbes that form the gut ecosystem should be summed to the human genome to form the hologenome due to their influence on human physiology; hence the term "microbiome" is commonly used to refer to the genetic make-up and gene-gene interactions of microbes. This review attempts to provide insight into this recently discovered vital organ of the human body, which has yet to be fully explored. We herein discuss the rhythm and shaping of the microbiome at birth and during the first years leading up to adolescence. Furthermore, important issues to consider for conducting a reliable microbiome study including study design, inclusion/exclusion criteria, sample collection, storage, and variability of different sampling methods as well as the basic terminology of molecular approaches, data analysis, and clinical interpretation of results are addressed. This basic knowledge aims to provide the pediatricians with a key tool to avoid data dispersion and pitfalls during child microbiota study

Indications and complications of inpatient parenteral nutrition prescribed to children in a large tertiary referral hospital

Background: Parenteral Nutrition (PN) is prescribed to children with intestinal failure. Although life saving, complications are common. Recommendations for indications and constituents of PN are made in the 2005 guidelines by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). The aim of this study was to establish if the indications for prescribing PN in a tertiary children's hospital were appropriate, and to identify complications encountered. Data were compared to those published by the National Confidential Enquiry into patient outcome and death (NCEPOD) carried out in the United Kingdom in 2010. Methods: Children and newborns receiving inpatient PN over a 6 months period were entered into the study and data was collected prospectively. The appropriate indications for the use of PN were based on the ESPGHAN guidelines. Recorded complications were divided into metabolic, central venous catheter (CVC) related, hepatobiliary and nutritional. Results: A total of 303 children (67 newborns) were entered into the study. The main indications for the start of PN were critical illness (66/303), surgery (63/303) and bone marrow transplantation (28/303). The ESPGHAN recommendations were followed in 91.7% (278/303) of cases (95.5% of newborns, 90.7% of children). PN was considered inappropriate in 12/303 patients and equivocal in 13. The mean PN duration was 18 days (1-160) and the incidence of complications correlated to the length of PN prescribed. Metabolic, hepatobiliary and CVC related complications affected 74.6, 24.4, 16.4% of newborns and 76.7, 37.7 and 24.6% of children respectively. In relation to the appropriate indications for the start of PN our results mirrored those reported by the NCEPOD audit (92.4% of newborns and 88.6% children). However, the incidence of metabolic disturbances was higher in our cohort (74.6% vs 30.4% in children, 76.7% vs 14.3% in newborns) but CVC related complications lower amongst our newborns (16,4% vs 25%). Conclusions: Although the indications for inpatient PN in children is mostly justified, there is still a proportion who is receiving PN unnecessarily. PN related complications remain common. There is a need for better education amongst health professionals prescribing PN and access to nutritional support teams to reduce unwanted side effects

Is Macronutrients Intake a Challenge for Cardiometabolic Risk in Obese Adolescents?

(1) Background: Pediatric obesity is an emerging public health issue, mainly related to western diet. A cross-sectional study was conducted to explore the association between macronutrients intake and cardiometabolic risk factors in obese adolescents. (2) Methods: Ninety-three Italian obese adolescents were recruited; anthropometric parameters, body composition, glucose and lipid metabolism profiles were measured. Macronutrients intake was estimated by a software-assisted analysis of a 120-item frequency questionnaire. The association between macronutrients and cardiometabolic risk factors was assessed by bivariate correlation, and multiple regression analysis was used to adjust for confounders such as age and sex. (3) Results: By multiple regression analysis, we found that higher energy and lower carbohydrate intakes predicted higher body mass index (BMI) z-score, p = 0.005, and higher saturated fats intake and higher age predicted higher HOmeostasis Model Assessment of insulin resistance (HOMA-IR) and lower QUantitative Insulin-sensitivity ChecK (QUICK) index, p = 0.001. In addition, a saturated fats intake <7% was associated with normal HOMA-IR, and a higher total fats intake predicted a higher HOMA of percent \u3b2-cell function (HOMA-\u3b2), p = 0.011. (4) Conclusions: Higher energy intake and lower carbohydrate dietary intake predicted higher BMI z-score after adjustment for age and sex. Higher total and saturated fats dietary intakes predicted insulin resistance, even after adjustment for confounding factors. A dietary pattern including appropriate high-quality carbohydrate and reduced saturated fat intakes could result in reduced cardiometabolic risk in obese adolescents

Serotonin reuptake inhibitors in pregnancy : can genes help us in predicting neonatal adverse outcome?

Lots has been written on use of SSRI during pregnancy and possible short and long term negative outcomes on neonates. the literature so far has described a various field of peripartum illness related to SSRI exposure during foetal life, such as increased incidence of low birth weight, respiratory distress, persistent pulmonary hypertension, poor feeding, and neurobehavioural disease. We know that different degrees of outcomes are possible, and not all the newborns exposed to SSRIs during pregnancy definitely will develop a negative outcome. So far, still little is known about the possible etiologic mechanism that could not only explain the adverse neonatal effects but also the degree of clinical involvement and presentation in the early period after birth. Pharmacogenetics and moreover pharmacogenomics, the study of specific genetic variations and their effect on drug response, are not widespread. This review describes possible relationship between SSRIs pharmacogenetics and different neonatal outcomes and summarizes the current pharmacogenetic inquiries in relation to maternal-foetal environment