Background and Aims

. Fasting f to treat fatty liver is yet to be tested in Paediatric population. We planned the following prospective pilot study incorporating fasting to

1) Find out the feasibility and effect of Intermittent Fasting (IF) in overweight adolescents with fatty liver

2) Compare it with dietary and lifestyle changes (DLS) in similar cohort

Methods

Consecutive overweight adolescents with fatty liver, were randomised to either an intermittent fasting(IF) or a diet and lifestyle(DLS) group. . The IF Group followed home diet without strict calorie restrictions (unlike the DLS group ) exercises and a 16 hours fast every day with one normal Sunday every 15 days. At 3 months all were reassessed with blood tests and ultrasound scan.

Results

. Table 1 Baseline and post treatment parameters of nondiabetic cohort( median age 17yrs)

Conclusions

This study is the first ever in the world to demonstrate the feasibility & superiority of intermittent fasting in adolescents with PFLD

Background and Aims

Body composition assessment aides in evaluating energy stores and determining medication doses and disease effects. Current U.S. pediatric reference ranges from NHANES include 20% of children with obesity, BMI >95^th percentile. We aimed to develop DXA-based reference ranges in a geographically diverse cohort with lower obesity prevalence from the Bone Mineral Density in Childhood Study (BMDCS).

Methods

Healthy children (height and BMI within 3^rd to 97^th percentiles), 5-19y, from 5 U.S. centers were measured annually for up to 7 visits. Whole body DXA scans were acquired using Hologic scanners. Precision was determined in a subsample who underwent repeat measurements. Lean soft-tissue mass index (LSTMI) and fat mass index (FMI) reference ranges were generated using the LMS method and compared to NHANES and across self-identified race/ethnicity groups.

Results

We enrolled 2014 participants (51% female, 22% Black, 17% Hispanic, 48% White, 7% Asian/Pacific Islander, 6% with obesity) who collectively underwent 9846 DXA scans. Precision (%CV) was excellent (0.7 to 1.96%). LSTMI and FMI median (0 SD) and -2 SD curves for BMDCS and NHANES were similar, but NHANES +2 SD LSTMI and FMI curves were distinctly greater than the respective BMDCS curves. Race/ethnicity differences were more extreme for LSTMI-Z (Asian -0.47±0.98 vs Black 0.48±0.95) than for FMI-Z (Hispanic 0.29±0.98 vs Black -0.14±1.1).

Conclusions

Because of the lower obesity prevalence in BMDCS, BMDCS body composition reference ranges may be preferred to the pediatric NHANES reference. Awareness of expected differences among race/ethnicity groups will aide in interpreting results.

Funding: NO1-HD-1-3228, NO1-HD-1-3329, NO1-HD-1-3330, NO1-HD-1-3331, NO1-HD-1-3332, NO1-HD-1-3333, R01HD100406, MO1-RR-000240, UL1RR-026314

Background and Aims

Maternal obesity before pregnancy is associated with higher offspring birthweight and obesity during childhood. The aim of this study was to investigate the effect of high vs. moderate protein intake during pregnancy on children’s body weight and composition during early childhood.

Methods

We conducted a follow-up study of children born to women (pre-pregnancy BMI 28-45 kg/m²) who were randomized to ad libitum diets during pregnancy: high-protein low-glycemic index (HPLGI) diet or medium-protein moderate-glycemic index (MPMGI) diet. Gestational weight gain (GWG) was within recommendations for women with obesity (5-9 kg) in both groups and was significantly lower for women who had followed the HPLGI diet than women who had followed the MPMGI diet (6.8±1.3kg and 8.5±1.3kg, respectively, P=0.004).

Results

152 children were assessed at the age of 3 years (HPLGI=79, 29 girls; MPMG=73, 31 girls). There were no statistically significant differences in anthropometric outcomes between children born to women who had followed the HPLGI diet during pregnancy compared to those who had followed the MPMGI diet: weight, mean(SE): 15.2kg(0.2) vs. 15.3kg(0.2); BMI Z-score, mean(SE): 0.60SD(0.1) vs. 0.66SD(0.1); abdominal circumference, mean(SE): 50.7cm(0.3) vs. 50.6cm(0.4); hip circumference, mean (SE): 51.8cm(0.4) vs. 52.2cm(0.4).

Conclusions

Children born to women with pre-pregnancy overweight/obesity who manage to limit their GWG within recommendations have normal body weight and BMI Z-score at the age of 3 years. Therefore, limiting GWG within recommendations for women with pre-pregnancy overweight/obesity by following a healthy diet independent of its protein content and glycemic index is likely a key to healthy anthropometric outcomes during early childhood.

Background and Aims

Survival after childhood cancer significantly improved over the last decades, nevertheless among other possible late complications, an increased incidence of metabolic syndrome (MS) and cardiovascular (CV) disease among childhood cancer survivors (CCS) has been reported. Aim of this study was to identify body composition parameters relating with MS in CCS.

Methods

Data of CCS at least 2 years since the end of therapies, 10-16 years old at follow-up and without any concurrent steroid treatment were collected. BMI, waist circumference (WC), WC-height ratio (WC/H), laboratory blood tests and body composition by DEXA were considered. BMI>85^thp/97^thp, WC>90^thp and WC/H>0.5 were chosen as criteria of overweight/obesity, visceral obesity, and increased CV-risk respectively. Fat-to-Lean mass Ratio (FLR) was calculated from DEXA measurements. ROC-curve was used to test the performance of FLR in predicting metabolic and CV-risk. Nonparametric statistic was performed.

Results

We enrolled 205 CCS (111M/94F) previously treated for a hematologic cancer (n=72), solid-tumor (n=82) or central-nervous-system tumor (n=51). FLR resulted a predictor of visceral obesity (p<0.001, AUC=0.838) and of CV-risk (p<0.001, AUC=0.815). The best FLR cut-off was 0.6. CCS with FLR>0.6 (43%) were more frequently overweight/obese (p<0.001); presented high levels of triglycerides (p=0.011), HOMA-IR (p=0.001), ALT (p=0.004), trunk-fat (p<0.001); and low IGF-1 (p<0.001) and lean mass (p=0.009).

Conclusions

Cancer therapies may have an impact on fat and lean mass. An increased FLR is suggestive of altered body composition phenotype allowing to identify patients at risk of MS. Diet and physical activity are needed to prevent overall nutritional status derangement and maintain it over the long-term.

Background and Aims

PFAS are non-degradable and accumulate in humans. PFAS-exposure in early life is thought to affect several developmental processes, mostly based on concerning results in rodent studies. Recently, we described that breastfeeding is an important PFAS-exposure determinant in early life. Exclusively breastfed infants had 6-times higher daily-PFAS-intake and 3-times higher PFAS-plasma-levels, compared to exclusively formula-fed infants at age 3 months. This is concerning, since PFAS could potentially reduce breastfeeding’s health benefits. We now investigated growth and body composition outcomes at age 2 years and associations with PFAS-exposure.

Methods

In 369 healthy term-born infants, included in birth cohort Sophia Pluto, we determined anthropometrics, visceral and subcutaneous fat by abdominal ultrasound and body composition by Dual-energy X-ray Absorptiometry(DXA) longitudinally until age 2 years. Levels of 5 individual PFAS were determined by liquid-chromatography-electrospray-ionization-tandem-mass-spectrometry(LC-ESI-MS/MS) in blood samples collected at age 3 months. We studied the associations between PFAS-levels and body composition outcome using multiple regression models.

Results

Higher individual and total PFAS-levels at age 3 months were associated with lower weight-for-height-SDS, total fat-mass(FM) SDS, FM-index-SDS and subcutaneous fat at age 2 years. However, infants with high PFOA-levels had 3.495 higher odds (p=0.030) of accelerated rise (>0.67 SDS) in FM% during the first 6 months of life.

Conclusions

PFAS exposure in early life is associated with body composition, but it seems not to attenuate the health benefits of breastfeeding at age 2 years. However, the association with accelerated rise in FM% during the critical window in early life could potentially lead to an unfavorable body composition in later life.

Background and Aims

Obesity is known as a causal risk factor for the development of altered glucose metabolism and insulin resistance.

Methods

We analyzed the relationship between glucose homeostasis, body fat mass (BFM) and dietary intake in 92 children at 6 years of age who received a standard infant formula (SF,n=32), experimental formula (EF,n=32) or were breastfed (BF,n=28) during the first 18 months of life (COGNIS Study). They were classified as normal- or overweight according to body fat mass (BFM) and bioimpedance (TANITAâ). 24-hour continuous glucose monitoring (CGM) was performed for 7 days (FreeStyle Glucose FlashMonitoring System). Glycemic variability (GV) was assessed using the multiscale sample entropy (MSE) approach and measures of entropy at various time series with R software (CGManalyzer package). 3 daily dietary records were obtained based on FAO methods and DIAL software (Alce Ingeniería, Madrid, Spain) was used to obtain macro- & micronutrients intakes.

Results

BF children showed lower mean glucose levels compared to SF children. EF children with excess weight had higher entropy or GV compared to normal weight children. Higher omega 3 polyunsaturated fatty acids intake seems to be associated with lower BFM and skinfolds.

Conclusions

BF protect against dysregulation of glucose homeostasis. Higher adiposity at school age and the type of diet associated with greater GV, normally linked to higher risk of developing metabolic disorders later in life.

Project funded by Ordesa Laboratories, S.L. and SMARTFOODS (CIEN Project), Spanish Centre for Technology and Industrial Development (CDTI); Contracts University of Granada General Foundation, No.3349 and 4003, Granada. Spain, and EU Project DynaHEALTH (HORIZON 2020-GA No.633595).

Background and Aims

Overweight and obesity in early childhood constitute a burgeoning public health problem worldwide. Low-birth-weight infants are at higher risk of developing obesity and comorbidities later in life. Our objective was to investigate whether a multidisciplinary intervention including nutritional counseling could prevent the development of overweight and obesity in under-five low-birth-weight children.

Methods

Nutritional evaluation and counseling were carried out periodically from 2 months age as part of a multidisciplinary intervention. Anthropometric measurements of 469 low-birth-weight infants were assessed at least once at 6, 36 and 60 months of age, and Growth Indicators were determined for chronological age according to the Child Growth Standards of the World Health Organization. Data were analyzed by paired samples t-test and chi-square in SPSS 25.

Results

97% of the participants were preterm. 46.4% of the evaluated population was female, and 23.6% came from multiple pregnancies. Weight-for-age (WAZ), length-for-age (LA), head circumference-for-age (HcAZ) and BMI-for-age (BAZ) z-scores were different between sexes at 6 months. Subsequently, differences were only found in BAZ and HcAZ at 36 months. WAZ, LA, HcAZ and BAZ were different between 6 and 36 months (p < 0.000) and between 36 and 60 months (p < 0.000). The combined prevalence of overweight and obesity was 3.2% at 36 months, while 4.0% at 60 months.

Conclusions

Early nutritional intervention and counseling in low-birth-weight infants appears to be effective in preventing overweight and obesity as the national average combined prevalence of overweight and obesity is calculated in 8.4%.

Background and Aims

Obesity-related gene polymorphisms may be risk factors for adverse outcomes in high-risk pregnancies, influencing the newborns’ nutritional status. We investigated if the mothers’ polymorphisms in FTO (rs9939609T/A, rs17817449T/G) and ADRB2 (rs1042713G/A, rs1042714C/G) genes influenced the birthweight of the newborns.

Methods

We conducted a nutrigenetic trial in a public hospital at Rio de Janeiro/Brazil (2016-2020), which is reference for high-risk pregnancies. Pregnant women with pregestational diabetes mellitus (types 1 or 2) receiving nutritional assistance were included (n=70). The DNA was extracted from saliva samples and genotyped using real-time PCR. We compared the adequacy of birthweight for sex and gestational age according to the Intergrowth-21th Standards and the prevalence of macrosomia (birthweight 4000 g or above) between mother’s genotypes, using Chi-square tests.

Results

The sample had 66 live newborns, 52.2% males, 90.9% delivered by C-section, at 38.0 weeks of pregnancy (SD 1.3), birthweight 3322.3 g (SD 714.9) for males and 3360.9 g (SD 628.3) for females. The prevalence of macrosomia was 16.7% and 36.4% of large-for-gestational age (LGA). The newborns from mothers A allele carriers for FTO rs9939609 had lower LGA prevalence than TT genotypes (25.0% vs. 53.8%, p= 0.02). All women with GG genotype for ADRB2 rs1042714 had LGA newborns, with significative difference comparing to the C allele carriers (p=0.04). We found no statistic difference for macrosomia prevalence.

Conclusions

The mothers’ genotypes for FTO rs9939609 and ADRB2 rs1042714 influenced the prevalence of LGA newborns. The nutrigenetics approach deserves deeper investigation to improve the antenatal care in high-risk pregnancies. Funding acknowledgements: CNPQ, CAPES, and FAPERJ.