Nutraceuticals in practice

Cristina Pederiva, Vanessa Nadia Dargenio, Fernanda Cristofori, Ruggiero Francavilla

¹U.O. Clinica Pediatrica. Servizio Clinico Dislipidemie per lo Studio e la Prevenzione dell’Aterosclerosi in età Pediatrica. ASST Santi Paolo e Carlo, Milano. Università degli Studi di Milano. ²Unità Operativa Pediatria Generale e Specialistica, Sezione di Gastroenterologia, Epatologia e Nutrizione Pediatrica Università degli Studi di Bari “Aldo Moro” Ospedale Pediatrico Giovanni XXIII, Bari

In recent decades there has been a growing interest in nutraceutics and its beneficial applications on human health. The control of dyslipidemia is one of the fields that has gained particular interest and on which most of these trials are focused. We will try to examine the benefits and limitations of the use of different nutraceuticals in pediatrics and to draw possible indications for their use in clinical practice.

Food Aversion in Paediatric Population with Short Bowel Syndrome: Mechanisms and Treatment Strategies

Maria Chiara Cianci, Riccardo Coletta, Antonino Morabito

Azienda Ospedaliera Universitaria Meyer; Università degli studi di Firenze; Dipartimento di Chirurgia Pediatrica; Centro di Ricostruzione e Riabilitazione Intestinale.

Food aversion (FA) is a condition of extreme negative reaction towards food orally introduced and it is characterized by partial or complete refusal of food leading to growth and development delay. In paediatric population Short Bowel Syndrome (SBS) is reported as that most frequently leads to AF, about 25%. SBS is characterized by loss of small intestine resulting from congenital or acquired anomalies with consequent malabsorption and intestinal dysmotility. In most cases parenteral nutrition or enteral nutrition with nasogastric tube is required. In the most recent literature review regarding AF in this cohort of patients, Hopkins showed that AF is related to both physical and social factors. Adverse oral stimuli, failure to develop patterns of behavior related to nutrition, reduced ability to suck / swallow and lack of interaction with family members during the meal contribute to FA development in SBS children. A multidisciplinary approach is needed with the aim to desensitize the child from negative oral experiences, promoting positive stimulation interventions towards the introduction of food by mouth. No specific strategies however are reported for patients with SBS. According to the analysis performed by Hopkins, centres specialized in SBS treatment, as the Manchester Children Hospital and the Meyer Paediatric Hospital in Florence, structured a refeeding program called Messy Play Therapy (MPT). MPT is based on the gradual desensitization of children against smells and / or textures of foods generally introduced by mouth with play techniques. This psychological / playful expedient aims to make the patient familiar with food, gradually eliminating that psychological component of the negative stimulus. Results obtained in the reference centres for SBS showed that MPT in association with parents education regarding the approach to the disease leads to an increase in the tolerance of children towards oral food in 100% of cases with substantial nutritional and social benefit. Further studies and application in clinical practice are required, but MPT seems to be an effective protocol in the treatment of AF in paediatric patients with SBS.

Pediatric incidentaloma of the liver: how to get oriented

Maria Chiara Rocco, Angelo Colucci, Lucia Nazzaro, Pietro Vajro

Cattedra di Pediatria & Scuola di Specializzazione in Pediatria UNISA Dipartimento di Medicina, Chirurgia e Odontoiatria “Scuola Medica Salernitana” Università di Salerno. Baronissi (Sa) - Italia

Ultrasonographic studies originally prescribed with a different indication and extended by chance to the hepatic district may detect unexpected benign/malignant liver lesions also in asymptomatic children (“incidentaloma”). The clinician has to deal with the need to make a specific diagnosis quickly and to evaluate the most advantageous cost-benefit ratio in the use of available diagnostic resources.

Nutritional management of Crohn’s disease, new perspective

Luca Scarallo1,Paolo Lionetti2

¹Struttura Complessa Gastroenterologia e Nutrizione, Ospedale Meyer, Firenze ²Dipartimento NEUROFARBA, Università di Firenze

It has been endorsed that interaction between genetic and environmental factors contribute to Crohn’s Disease (CD) pathogenesis. Diet has proven to be able to shape gut microbiota composition and thus is suspected to play a significant role. For these reasons, dietary therapies has a recognized role in management of CD. Novel dietary interventions, such as CD Exclusion Diet or CD treatment with eating, have shown their efficacy in induction of remission in pediatric patients.

Biologics beyond anti-TNFs

Matteo Bramuzzo

Institute for Maternal and Child Health IRCCS Burlo Garofolo

The need to offer a therapeutic alternative to patients who are not responsive to anti-TNF biologics and the understanding of the pathogenetic mechanisms of inflammatory bowel diseases have led to the development of new biological drugs. To date, the main new biologics include vedolizumab, an anti-integrin antibody that inhibits leukocyte migration, and ustekinumab, an anti IL12 / IL 23 antibody. Trials on new biologics and non-biological molecules are ongoing.

Hypertransaminasemia and anemia in anorexia: a chinese box diagnosis!

Teresa Capriati1, Francesca Ferretti1, Antonella Mosca2, Giulia Bolasco1 e Antonella Diamanti1

¹U.O.C. Gastroenterologia e Riabilitazione Nutrizionale, Ospedale Pediatrico Bambino Gesù, Roma ²U.O.S. Epatogastroenterologia e Nutrizione, Ospedale Pediatrico Bambino Gesù, Roma

A 16 years old girl, already diagnosed with eating disorder, was admitted for fever, refusal of food and weight loss, asthenia and pharyngodynia. At the exams: anemia (Hb 8.7 g / dL), increase in inflammation indexes (PCR 8.61) and LDH (422 IU / L), moderate hypertransaminasemia (AST 133 IU / L, ALT 272 IU / L) with GGT (214 IU / L) in the absence of alterations in hepatic synthesis function. There were also signs of dehydration with rise in uric acid (6.9 mg / dL), BUN (21 mg / dL) and creatinine (1.8 mg / dL) and decreased clearance (up to 50 ml / min); in the medical history he had taken 2 doses of ibuprofen. This case is an example of diagnoses linked like to Chinese boxes.

Cardiovascular risk reduction: an achievable goal since pediatric age

Irene Rutigliano1,2, Angelo Campanozzi3

¹UO Pediatria, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG) ²Dottorato di Ricerca in “Medicina Traslazionale e Management dei Sistemi Sanitari”, Università di Foggia ³Clinica Pediatrica, Policlinico Universitario di Foggia

Cardiovascular disease (CVD) is the leading cause of death worldwide. The stigmata of CVD pathogenesis may be present as early as in childhood. It is very important to define risk factors in children and adolescents, promoting cardiovascular health. Current evidence stresses the importance of comprehensive assessment of children and their families from the prenatal period, taking into account multiple risk factors in CVD risk stratification.

“Non dietary therapies for celiac disease: where are we now?”

Donatella Iorfida1, Chiara Maria Trovato2, Monica Montuori2, Francesco Valitutti3

¹Dipartimento Materno-Infantile, Sapienza Università di Roma, Polo Pontino, Ospedale Santa Maria Goretti, Latina ²Dipartimento Materno-Infantile e Scienze Urologiche, Sapienza Università di Roma, Policlinico Umberto I, Roma ³UOC Pediatria, AOU “San Giovanni di Dio e Ruggi d’Aragona”, Salerno

To date, a strict and life-long gluten-free diet (GFD) is the sole safe and effective treatment for celiac disease. Difficulties in adhering to the GFD justify last decade efforts for alternative/integrative therapies. The aim of this review is to sum up current evidence regarding preclinical and clinical studies on pharmacological approaches that might go beyond the GFD or can possibly integrate it in the upcoming years.

Use and efficacy of oral nutritional supplements in children

Simona Gatti, Martina Vallorani

SOD di Clinica Pediatrica, Università Politecnica delle Marche, Ospedale Pediatrico G. Salesi, Ancona

Oral Nutritional Supplements (ONS) include any substance taken by mouth added to the diet to provide macro and/or micro nutrients. ONS are used to achieve and/or preserve nutritional status and support normal growth when the child is unable to do so from their diet alone. ONS, as a not invasive form of nutritional support, can positively impact auxological parameters and disease’s outcome in several chronic pediatric diseases.

Monica Malamisura1, Basilio Malamisura2

¹Specialista in Pediatria, U.O. di Endoscopia Digestiva, Dipartimento Pediatrico Universitario-Ospedaliero, Ospedale Pediatrico Bambino Gesù - Roma ²Specialista in Pediatria, Diploma di perfezionamento in Gastroenterologia pediatrica, già Direttore U.O. di Pediatria e Centro di riferimento regionale per la Celiachia, Azienda Ospedaliera Universitaria di Salerno

La sindrome dell’intestino irritabile (IBS) è il più frequente tra i disturbi gastrointestinali funzionali. I suoi sintomi, a volte anche associati a manifestazioni extraintestinali, incidono negativamente sulla qualità di vita del paziente. Sebbene la patogenesi non sia completamente conosciuta, sempre maggiori evidenze suggeriscono che il microbiota intestinale riveste un ruolo primario nello sviluppo della patologia e del suo fenotipo attraverso il cross-talk “intestino-cervello”. Per tale motivo i probiotici rappresentano una pietra miliare nella gestione della problematica e in un futuro non troppo lontano l’obiettivo sarà quello di un approccio personalizzato del paziente in base al suo fenotipo clinico e al suo patrimonio microbico.

A silent threat

E. Bove, B. D’Agostino, M. Distante, S. Iavarone, C. Imondi, F. Leone, F. Liguori, E. Pignataro, S. Veraldi, G. D’Arcangelo, D. Rossetti, C.M. Trovato, S. Oliva, M. Aloi, S. Cucchiara 1, S. Ceccanti, D. Cozzi 2

¹Dipartimento Materno-Infantile e Scienze Urologiche Azienda ospedaliera universitaria Policlinico Umberto I, Università degli Studi di Roma “La Sapienza”, Roma Unità di Gastroenterologia e Epatologia Pediatrica (dir. Prof. Salvatore Cucchiara)²S. Ceccanti, D. Cozzi UOC di Chirurgia Pediatrica (dir. Prof. Denis Cozzi):