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Nutrition in Pediatric Gastroenterology: Selected Papers from SIGENP

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (31 March 2018) | Viewed by 106728

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Prof. Dr. Carlo Catassi

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1. Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy
2. Italian Society for Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP), Milan, Italy
Interests: celiac disease; gluten-related disorders; gluten sensitivity; pediatric gastroenterology; pediatric nutrition
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Prof. Dr. Carlo Agostoni

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Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
Interests: n-3 polyunsaturated fatty acids; nutrition; lipid metabolism; metabolic diseases; EPA; DHA; neurodevelopment
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pediatric Gastroenterology (GE) is one of the most important subspecialty areas in the field of childhood diseases, due to the large number of conditions affecting the intestinal tract, the high prevalence of these disorders in the pediatric population, and the possible impact on childhood mortality, morbidity and quality of life. The pediatric GE scenario ranges from severe conditions such as congenital microvillus atrophy or chronic intestinal pseudo obstruction requiring total parenteral nutrition or intestinal transplant, to chronic disorders affecting the quality of life, such as inflammatory bowel diseases (IBD) and celiac disease (CD) to highly prevalent conditions such as irritable bowel syndrome (IBS) or functional constipation.

Due to the unique interaction between ingested nutrients, the intestinal microbiota and the digestive tract, such as the colonocyte trophic effect of short chain fatty acids (SCFA) produced by intestinal bacteria from dietary fiber, nutrition has a special role in intestinal diseases, that goes well beyond the mere support of energy, macro- and micro-nutrients. For example, an “anti-inflammatory” diet to treat IBDs is currently under scrutiny. Food itself may be the elective cause and treatment of the disease, such as food allergy, a disorder that is particularly common in infants and children due to the immaturity of the intestinal immune system and barrier function.

This Special Issue originates from the collaboration between Nutrients and the Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP), one of the most active organization in the Italian pediatric setting, which is well known for many important scientific contributions and collaborative studies. This Special Issue will accept original articles and reviews from authors with interest on the physiological, pathogenic and therapeutic role of nutrition in pediatric gastroenterology, including nutrition of the healthy infant and child, eating disorders, and artificial (enteral and parenteral) nutrition.

Prof. Dr. Carlo Catassi
Prof. Dr. Carlo Agostoni
Guest Editors

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

pediatric gastroenterology
pediatric nutrition
nutritional therapy
artificial nutrition
eating disorders

Published Papers (10 papers)

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Research

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14 pages, 600 KiB

Open AccessArticle

Impaired Gastric Myoelectrical Reactivity in Children and Adolescents with Obesity Compared to Normal-Weight Controls

by Katja Weimer, Helene Sauer, Bjoern Horing, Francesco Valitutti, Nazar Mazurak, Stephan Zipfel, Andreas Stengel, Paul Enck and Isabelle Mack

Nutrients 2018, 10(6), 699; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10060699 - 31 May 2018

Cited by 10 | Viewed by 3902

Abstract

Obesity often has its onset in childhood and can be accompanied by various comorbidities such as functional gastrointestinal disorders and altered gastric myoelectrical activity (GMA). This study investigates whether obesity in childhood and adolescence is already associated with altered GMA, and whether an inpatient weight loss program affects GMA. Sixty children with obesity (OBE) and 27 normal-weight children (NW) (12.9 ± 1.7 years; 51% female) were compared for their GMA at rest, after a stress test, and after a drink-to-full water load test. A continuous electrogastrogram (EGG) was recorded and analyzed with respect to gastric slow waves and tachygastric activity. OBE were examined upon admission (T1) and before discharge (T2) following an inpatient weight loss program; NW served as control group. Compared to NW, children with obesity showed flattened GMA as indicated by lower tachygastric reactivity after stress and water load test at T1. Data of OBE did not differ between T1 and T2. EGG parameters were associated neither with sex, age, and BMI nor with subjective stress and food intake. Children with obesity show impaired gastric myoelectrical reactivity in response to a stress and water load test compared to normal-weight controls, which does not change during an inpatient weight loss program. Full article

(This article belongs to the Special Issue Nutrition in Pediatric Gastroenterology: Selected Papers from SIGENP)

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8 pages, 401 KiB

Open AccessArticle

Standard Polymeric Formula Tube Feeding in Neurologically Impaired Children: A Five-Year Retrospective Study

by Valeria Dipasquale, Maria Ausilia Catena, Sabrina Cardile and Claudio Romano

Nutrients 2018, 10(6), 684; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10060684 - 28 May 2018

Cited by 25 | Viewed by 5116

Abstract

Malnutrition is frequent in neurologically impaired (NI) children. Enteral feeding via gastrostomy tube is increasingly being used to provide adequate nutrition. Our aim was to assess the outcomes of exclusive gastrostomy tube feeding with standard polymeric formula in children with NI, severe oro-motor dysfunction, and malnutrition, and to investigate the role of the underlying NI-associated disease. A five-year retrospective study from January 2013 to November 2017 was conducted. The primary aim was to assess the nutritional outcomes of exclusive gastrostomy tube feeding with standard polymeric formula in malnourished NI children. The secondary aim was to investigate gastrostomy complications and the impact of the underlying NI-associated disease on the nutritional outcomes. We enrolled 110 consecutive children with NI. Of these patients, 34.5% (N = 38) were categorized as malnourished and started exclusive enteral feeding with a standard (1.0 kcal/mL) polymeric formula (Nutrini, Nutricia) after percutaneous endoscopic gastrostomy (PEG) placement. Seventy-three percent of patients (N = 28) had cerebral palsy (CP); other diagnoses included metabolic (13%, N = 5) and genetic (13%, N = 5) diseases. Tricep skinfold thickness had significantly improved in all patients at 12-months follow-up, while body weight and body mass index showed significant increases mainly in children with CP. No serious complications occurred. We found that standard polymeric formula via gastrostomy tube represents a safe and efficient nutritional intervention in children with NI and malnutrition. Full article

(This article belongs to the Special Issue Nutrition in Pediatric Gastroenterology: Selected Papers from SIGENP)

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14 pages, 1582 KiB

Open AccessArticle

The Role of Lipids in Human Milk and Infant Formulae

by Alessandra Mazzocchi, Veronica D’Oria, Valentina De Cosmi, Silvia Bettocchi, Gregorio Paolo Milani, Marco Silano and Carlo Agostoni

Nutrients 2018, 10(5), 567; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10050567 - 04 May 2018

Cited by 50 | Viewed by 7253

Abstract

The quantity and quality of dietary lipids in infant formulae have a significant impact on health outcomes, especially when fat storing and/or absorption are limited (e.g., preterm birth and short bowel disease) or when fat byproducts may help to prevent some pathologies (e.g., atopy). The lipid composition of infant formulae varies according to the different fat sources used, and the potential biological effects are related to the variety of saturated and unsaturated fatty acids. For example, since lipids are the main source of energy when the normal absorptive capacity of the digestive tract is compromised, medium-chain saturated fatty acids might cover this requirement. Instead, ruminant-derived trans fatty acids and metabolites of n-3 long-chain polyunsaturated fatty acids with their anti-inflammatory properties can modulate immune function. Furthermore, dietary fats may influence the nutrient profile of formulae, improving the acceptance of these products and the compliance with dietary schedules. Full article

(This article belongs to the Special Issue Nutrition in Pediatric Gastroenterology: Selected Papers from SIGENP)

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12 pages, 1076 KiB

Open AccessArticle

Assessment of Lactose-Free Diet on the Phalangeal Bone Mineral Status in Italian Adolescents Affected by Adult-Type Hypolactasia

by Alessandro Baldan, Sylvie Tagliati, Daniela Saccomandi, Andrea Brusaferro, Laura Busoli, Andrea Scala, Cristina Malaventura, Giuseppe Maggiore and Caterina Borgna-Pignatti

Nutrients 2018, 10(5), 558; https://doi.org/10.3390/nu10050558 - 01 May 2018

Cited by 12 | Viewed by 4870

Abstract

Adult-type hypolactasia (ATH) is a clinical syndrome of primary lactase deficiency. A lactose-free diet is advisable to avoid the symptoms linked to the condition, but this potentially creates problems for optimal bone mineralization due to reduced calcium intake. To evaluate the effect of the lactose-free diet on the bone mineral status (BMS), we compared the phalangeal BMS of adolescents with ATH to that of peers on a normal diet. Also, we analyzed the correlations between BMS and dietary behavior, physical exercise, and calcium and vitamin D intake. A total of 102 cases and 102 healthy controls filled out a diet record and underwent phalangeal Quantitative Ultrasound (QUS). No difference in BMS was observed. The time spent on lactose-free diet (4.8 ± 3.1 years) was inversely correlated to the BMS. More than 98% of cases consumed lactose-free milk, but calcium and vitamin D intake were significantly lower. Calcium intake was correlated to physical exercise but not to BMS. Our results suggest that a lactose-free diet does not affect the phalangeal BMS of adolescents with primary lactase deficiency when their diet includes lactose-free cow’s milk. However, there is still a significantly lower calcium intake than in the population reference. The inverse correlation observed between the BMS and the time spent on a lactose-free diet suggests that a long-term follow-up is advisable. Full article

(This article belongs to the Special Issue Nutrition in Pediatric Gastroenterology: Selected Papers from SIGENP)

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9 pages, 644 KiB

Open AccessArticle

Assessment of Mycotoxin Exposure in Breastfeeding Mothers with Celiac Disease

by Francesco Valitutti, Barbara De Santis, Chiara Maria Trovato, Monica Montuori, Simona Gatti, Salvatore Oliva, Carlo Brera and Carlo Catassi

Nutrients 2018, 10(3), 336; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10030336 - 10 Mar 2018

Cited by 22 | Viewed by 4552

Abstract

Objective: To assess the risk of mycotoxin exposure (aflatoxin M1, ochratoxin A, and zearalenone) in celiac disease (CD) breastfeeding mothers and healthy control mothers, as well as in their offspring, by quantifying these contaminants in breast milk. Study design: Thirty-five breastfeeding women with CD on a gluten-free diet and 30 healthy breastfeeding controls were recruited. Milk sampling was performed three times per day for three consecutive days. Mycotoxin content was investigated by an analytical method using immunoaffinity column clean-up and high-performance liquid chromatography (HPLC) with fluorometric detection. Results: Aflatoxin M1 (AFM1) was detected in 37% of CD group samples (mean ± SD = 0.012 ± 0.011 ng/mL; range = 0.003–0.340 ng/mL). The control group showed lower mean AFM1 concentration levels in 24% of the analyzed samples (0.009 ± 0.007 ng/mL; range = 0.003–0.067 ng/mL, ANOVA on ranks, p-value < 0.01). Ochratoxin A and zearalenone did not differ in both groups. Conclusion: Breast milk AFM1 contamination for both groups is lower than the European safety threshold. However, the estimated exposures of infants from CD mothers and control mothers was much higher (≃15 times and ≃11 times, respectively) than the threshold set by the joint FAO/WHO Expert Committee on Food Additives (JECFA). Since incongruities exist between JECFA and the European Union standard, a novel regulatory review of the available data on this topic is desirable. Protecting babies from a neglected risk of high AFM1 exposure requires prompt regulatory and food-control policies. Full article

(This article belongs to the Special Issue Nutrition in Pediatric Gastroenterology: Selected Papers from SIGENP)

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13 pages, 830 KiB

Open AccessArticle

Effectiveness and Safety of a Probiotic-Mixture for the Treatment of Infantile Colic: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial with Fecal Real-Time PCR and NMR-Based Metabolomics Analysis

by Maria Elisabetta Baldassarre, Antonio Di Mauro, Silvio Tafuri, Valentina Rizzo, Maria Serena Gallone, Paola Mastromarino, Daniela Capobianco, Luca Laghi, Chenglin Zhu, Manuela Capozza and Nicola Laforgia

Nutrients 2018, 10(2), 195; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10020195 - 10 Feb 2018

Cited by 49 | Viewed by 9572

Abstract

Introduction: To investigate the effectiveness and the safety of a probiotic-mixture (Vivomixx^®, Visbiome^®, DeSimone Formulation^®; Danisco-DuPont, Madison, WI, USA) for the treatment of infantile colic in breastfed infants, compared with a placebo. Methods: A randomized, double-blind, placebo-controlled trial was conducted in exclusively breastfed infants with colic, randomly assigned to receive a probiotic-mixture or a placebo for 21 days. A structured diary of gastrointestinal events of the infants was given to the parents to complete. Samples of feces were also collected to evaluate microbial content and metabolome using fecal real-time polymerase chain reaction (qPCR) and Nuclear magnetic resonance (NMR)-based analysis. Study registered at ClinicalTrials.gov (NCT01869426). Results: Fifty-three exclusively-breastfed infants completed three weeks of treatment with a probiotic-mixture (n = 27) or a placebo (n = 26). Infants receiving the probiotic-mixture had less minutes of crying per day throughout the study by the end of treatment period (68.4 min/day vs. 98.7 min/day; p = 0.001). A higher rate of infants from the probiotic-mixture group responded to treatment (defined by reduction of crying times of ≥50% from baseline), on day 14, 12 vs. 5 (p = 0.04) and on day 21, 26 vs. 17 (p = 0.001). A higher quality of life, assessed by a 10-cm visual analogue scale, was reported by parents of the probiotic-mixture group on day 14, 7.1 ± 1.2 vs. 7.7 ± 0.9 (p = 0.02); and on day 21, 6.7 ± 1.6 vs. 5.9 ± 1.0 (p = 0.001). No differences between groups were found regarding anthropometric data, bowel movements, stool consistency or microbiota composition. Probiotics were found to affect the fecal molecular profile. No adverse events were reported. Conclusions: Administration of a probiotic-mixture appears safe and reduces inconsolable crying in exclusively breastfed infants. Full article

(This article belongs to the Special Issue Nutrition in Pediatric Gastroenterology: Selected Papers from SIGENP)

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490 KiB

Open AccessArticle

Pediatric Chronic Intestinal Failure in Italy: Report from the 2016 Survey on Behalf of Italian Society for Gastroenterology, Hepatology and Nutrition (SIGENP)

by Antonella Diamanti, Teresa Capriati, Paolo Gandullia, Grazia Di Leo, Antonella Lezo, Laura Lacitignola, Maria Immacolata Spagnuolo, Simona Gatti, Lorenzo D’Antiga, Giovanna Verlato, Paola Roggero, Sergio Amarri, Maria Elisabetta Baldassarre, Francesco Cirillo, Domenica Elia, Renata Boldrini, Angelo Campanozzi, Carlo Catassi, Marina Aloi, Claudio Romano, Manila Candusso, Nicola Cecchi, Tommaso Bellini, Elaine Tyndall, Fabio Fusaro, Tamara Caldaro, Daniele Alberti, Piergiorgio Gamba, Mario Lima, Pietro Bagolan, Jean De Ville de Goyet, Luigi Dall’Oglio, Marco Spada and Francesca Grandi Show full author list Hide full author list

Nutrients 2017, 9(11), 1217; https://0-doi-org.brum.beds.ac.uk/10.3390/nu9111217 - 05 Nov 2017

Cited by 28 | Viewed by 4796

Abstract

Background: Intestinal failure (IF) is the reduction in functioning gut mass below the minimal level necessary for adequate digestion and absorption of nutrients and fluids for weight maintenance in adults or for growth in children. There is a paucity of epidemiologic data on pediatric IF. The purpose of this study was to determine the prevalence, incidence, regional distribution and underlying diagnosis of pediatric chronic IF (CIF) requiring home parenteral nutrition (HPN) in Italy. Methods: Local investigators were selected in 19 Italian centers either of reference for pediatric HPN or having pediatric gastroenterologists or surgeons on staff and already collaborating with the Italian Society for Pediatric Gastroenterology, Hepatology and Nutrition with regard to IF. Data requested in this survey for children at home on Parenteral Nutrition (PN) on 1 December 2016 included patient initials, year of birth, gender, family’s place of residence and underlying diagnosis determining IF. Results: We recorded 145 CIF patients on HPN aged ≤19 years. The overall prevalence was 14.12/million inhabitants (95% CI: 9.20–18.93); the overall incidence was 1.41/million inhabitant years (95% CI: 0.53–2.20). Conclusion: Our survey provides new epidemiological data on pediatric CIF in Italy; these data may be quantitatively useful in developing IF care strategy plans in all developed countries. Full article

(This article belongs to the Special Issue Nutrition in Pediatric Gastroenterology: Selected Papers from SIGENP)

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Review

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17 pages, 1498 KiB

Open AccessReview

Factors Influencing Children’s Eating Behaviours

by Silvia Scaglioni, Valentina De Cosmi, Valentina Ciappolino, Fabio Parazzini, Paolo Brambilla and Carlo Agostoni

Nutrients 2018, 10(6), 706; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10060706 - 31 May 2018

Cited by 571 | Viewed by 53848

Abstract

Relevant factors involved in the creation of some children’s food preferences and eating behaviours have been examined in order to highlight the topic and give paediatricians practical instruments to understand the background behind eating behaviour and to manage children’s nutrition for preventive purposes. Electronic databases were searched to locate and appraise relevant studies. We carried out a search to identify papers published in English on factors that influence children’s feeding behaviours. The family system that surrounds a child’s domestic life will have an active role in establishing and promoting behaviours that will persist throughout his or her life. Early-life experiences with various tastes and flavours have a role in promoting healthy eating in future life. The nature of a narrative review makes it difficult to integrate complex interactions when large sets of studies are involved. In the current analysis, parental food habits and feeding strategies are the most dominant determinants of a child’s eating behaviour and food choices. Parents should expose their offspring to a range of good food choices while acting as positive role models. Prevention programmes should be addressed to them, taking into account socioeconomic aspects and education. Full article

(This article belongs to the Special Issue Nutrition in Pediatric Gastroenterology: Selected Papers from SIGENP)

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18 pages, 836 KiB

Open AccessFeature PaperReview

Prevention and Treatment of Intestinal Failure-Associated Liver Disease in Children

by Lorenzo Norsa, Emanuele Nicastro, Angelo Di Giorgio, Florence Lacaille and Lorenzo D’Antiga

Nutrients 2018, 10(6), 664; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10060664 - 24 May 2018

Cited by 36 | Viewed by 7172

Abstract

Intestinal failure-associated liver disease (IFALD) is a threatening complication for children on long-term parenteral nutrition because of intestinal failure. When progressive and intractable, it may jeopardize intestinal rehabilitation and lead to combined liver and intestinal transplantation. The institution of dedicated intestinal failure centers has dramatically decreased the incidence of such complication. IFALD may rapidly fade away if very early management aimed at preventing progression to end-stage liver disease is provided. In this review, we address the etiology and risk factors of IFALD in order to introduce pillars of prevention (nutritional management and catheter-related infections control). The latest evidence of therapeutic strategies, such as medical and surgical treatments, is also discussed. Full article

(This article belongs to the Special Issue Nutrition in Pediatric Gastroenterology: Selected Papers from SIGENP)

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Other

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6 pages, 211 KiB

Open AccessBrief Report

Weaning Time in Preterm Infants: An Audit of Italian Primary Care Paediatricians

by Maria Elisabetta Baldassarre, Antonio Di Mauro, Annarita Pedico, Valentina Rizzo, Manuela Capozza, Fabio Meneghin, Gianluca Lista, Nicola Laforgia and On behalf of Italian Society of Pediatrics (SIP), Italian Society of Neonatology (SIN), Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (SIGENP) and Italian Federation of Paediatricians (FIMP)

Nutrients 2018, 10(5), 616; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10050616 - 15 May 2018

Cited by 18 | Viewed by 3958

Abstract

Introduction: According to the 2016 Italian National Institute of Statistics (Istat) data in Italy, about 6.7% of all newborns are born prematurely. Due to the lack of data on current complementary feeding in preterm infants in Italy, the aim of the survey was to evaluate individual attitudes of primary care paediatricians, concerning the introduction of complementary foods in preterm infants. Methods: An internet-based survey was conducted among primary care paediatricians, working in Italy, regarding (1) timing of the introduction of complementary foods to preterm newborns; (2) type of complementary foods introduced; (3) vitamin D and iron supplementations. Results: A total of 347 primary care Italian paediatricians answered the questionnaire; 44% of responders based the timing of the introduction of solid food exclusively on an infant’s age, 18% on an infant’s neurodevelopmental status and 4% on the body weight; the remaining 34% based the timing on two or more of these aspects. The type of complementary foods did not comply with an evidence-based sequence; 98% of participants promoted vitamin D supplementation and 89% promoted iron supplementation with great diversity in timing and doses. Conclusions: Due to limited evidence, there is a great heterogeneity in the attitudes of primary care paediatricians concerning the introduction of complementary foods to preterm newborns. Further research is needed to provide evidence-based guidelines regarding weaning preterm newborns. Full article

(This article belongs to the Special Issue Nutrition in Pediatric Gastroenterology: Selected Papers from SIGENP)

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