CONTEXT:Accurately assessing dietary intake in children and adolescents is challenging due to the limitations of traditional self-reported methods. Metabolomics has emerged as a valuable tool for assessing the body's biochemical response to specific foods, food groups, or dietary patterns, thereby improving the evaluation of diet-health relationships. However, evidence on how diet influences metabolomic profiles in pediatric populations remains limited. OBJECTIVE:To evaluate the evidence on the relationship between nutritional interventions or habitual dietary intake and metabolites measured in blood or urine among children and adolescents. DATA SOURCES:A systematic search was conducted in PubMed, Cochrane, and Embase databases up to September 2024. DATA EXTRACTION:This systematic review was conducted in accordance with the principles of the Cochrane Collaboration, and PRISMA guidelines were followed. Randomized clinical trials and observational studies in children and adolescents were included. DATA ANALYSIS:From 659 records, 8 studies met the inclusion criteria, involving 5992 participants across 12 countries. The included studies reported associations across 3 dietary categories: dietary patterns, food groups, and specific food ingredients. Both targeted and untargeted metabolomic analyses were used to identify diet-related biomarkers in blood and urine. Positive associations were observed between higher adherence to the Mediterranean diet and greater fruit and vegetable consumption with metabolites such as hippurate, trigonelline, and proline betaine. In contrast, higher intake of ultra-processed foods and adherence to vegan diets were inversely associated with branched-chain amino acids and aromatic amino acids such as tyrosine and docosahexaenoic acid. CONCLUSION:This review identifies several metabolites consistently associated with specific dietary components across different studies in children and adolescents. These findings support the potential of metabolomics for validating dietary biomarkers and improving the accuracy of dietary assessment in pediatric populations. Although metabolomic markers reflect actual dietary intake, their implications for health outcomes remain to be explored. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration no. CRD42024506437.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common reason for elevated liver enzymes in children in Europe, affecting more than 5% of all children. Since the last iteration of this position paper, there have been substantial advances in our understanding of the disease. After a detailed literature review and thorough discussion, we established consensus recommendations for the diagnosis and assessment of MASLD in children. Alanine aminotransferase (ALT) >= 30 IU/L is a suitable screening test for MASLD in children over 10 years of age with obesity (body mass index z-score >=+2), or in children of any age with additional risk factors. All patients with suspected MASLD should be assessed for alternative or concomitant diagnoses, as well as comorbidities. Patients who are not overweight, under 8 years old, or have any other red flags should be promptly referred for specialist assessment. Liver biopsy remains the gold standard for diagnosis and staging of MASLD, but should be reserved for diagnostic uncertainty, to guide treatment decisions, and risk stratification (e.g., prior to transition to adult care). While there is emerging data for non-invasive tests (e.g., transient elastography), it is unclear how to routinely implement these investigations in clinical practice. Combined changes of >= 20% in both ALT and gamma-glutamyl transferase may represent a useful non-invasive tool for monitoring disease severity over time. Most patients are appropriately investigated and managed by non-specialists where the focus is on holistic management of obesity and its complications. Future research should focus on how to use non-invasive tests to risk-stratify children, in particular, how to identify those with advanced fibrosis.

BACKGROUND AND AIM:Early-life nutrition plays a critical role in long-term health. Although complementary feeding has been widely studied, the influence of portion size during this stage on subsequent overweight risk remains unclear. This study aimed to evaluate whether portion size during complementary feeding is associated with overweight risk in childhood and preadolescence. METHODS:Secondary analysis of the European Childhood Obesity Project, a randomised clinical trial across five European countries. Dietary data was collected at 6, 12, 18 and 24 months using 3-day food records and food portions standardised as internal z-scores; anthropometry was assessed at 2, 8 and 11 years. Associations between early portion size and later overweight were examined using logistic regression (adjusted for feeding type, country, parental education, birth weight, meal frequency and energy intake) and structural equation modelling. RESULTS:Larger portion sizes at 6 months were associated with more than a twofold higher risk of overweight at 2 years (OR 2.36, p = 0.031). Portion size at later complementary feeding stages showed positive trends with overweight at 2, 8 and 11 years and indirect associations with overweight at 8 and 11 years mediated by portion size at 8 years. CONCLUSION:Larger portion sizes early in life are associated with increased risk of overweight later in childhood. These findings highlight portion size guidance during complementary feeding as a potential early target for obesity prevention.

Cow’s milk allergy (CMA) is among the most common food allergies in early childhood, affecting approximately 2–3% of children under 3 years of age. Management requires strict elimination of cow’s milk and dairy products, typically replaced with hypoallergenic formulas. Although essential, this dietary restriction may predispose infants—particularly during the first 2 years of life—to nutritional imbalances. This mini review synthesizes current evidence on micronutrient status and growth outcomes in children with CMA, with emphasis on the impact of dietary management. Across observational studies, vitamin D inadequacy is the most consistently reported abnormality, with insufficiency affecting approximately 30–55% of children and deficiency around 20–25%. Iron deficiency is also frequent, including both overt anemia and subclinical depletion. Lower levels of calcium, vitamin B12, and iodine have been described, generally within reference ranges but suggestive of suboptimal intake. Growth impairment is commonly observed at diagnosis, particularly affecting weight more than linear growth. Appropriate nutritional management, including the use of hypoallergenic formulas (HF) and dietary counselling, is associated with significant catch-up growth. However, an increased risk of being overweight has been reported during follow-up, highlighting the need for balanced nutritional strategies. Key risk factors for nutritional compromise include multiple food allergies, prolonged dietary restriction without adequate substitution, poor adherence to supplementation, and restrictive maternal diets during breastfeeding. Overall, CMA management should extend beyond allergen avoidance to include proactive nutritional surveillance, targeted supplementation, and individualized dietary planning to support optimal growth and long-term health.

Diet during early infancy, as well as dietary patterns during childhood and parental feeding styles influence children’s eating behaviours and long-term health. While extensive data exist on the timing of complementary feeding introduction and recommended food frequencies during infancy and childhood, data on portion sizes during this period remains limited in Europe, despite their clear relevance for evaluating dietary patterns and supporting evidence-based guidance. This longitudinal study, secondary to the European Childhood Obesity Project (EU CHOP), aims to describe portion sizes consumed by infants and children aged 6 months to 8 years across five European countries. Dietary intake was recorded using 3-day food diaries and analysed by trained personnel following standardized procedures at multiple infant and childhood ages (6, 7, 8, 9, 12, 24, 36, 48, 60, 72 and 96 months). Portions sizes were calculated for 33 food groups and expressed as percentiles in the overall sample and stratified by country. A total of 1018 3-day food records were available at 6 months, with sample size gradually declining over the 11 follow-up time points to 400 records at 8 years. The results revealed a wide variation in portion sizes across food groups, ages and countries. Food portion sizes vary across food groups, age and countries. These findings provide reference percentiles representing typical portion sizes when foods are consumed. The data can support guidance provided to parents by healthcare professionals (pediatricians, nurses, and dietitian-nutritionists) and assist public health authorities in defining appropriate portion sizes and mitigating risks associated with both overeating and undereating, while respecting children’s hunger and satiety cues. These results also have practical applications in school meal planning and dietary assessment methodologies in research.

BACKGROUND:Socioeconomic inequalities in children's emotional and behavioural problems are already present at school entry. We examined associations between early-life socioeconomic conditions and children's externalising and internalising problems and assessed whether early-life risk factors mediated these associations. METHODS:We analysed harmonised individual participant data from eight birth cohorts within the EU Child Cohort Network. Maternal educational level during pregnancy was used as an indicator of early-life socioeconomic conditions (SECs). Scores of children's externalising and internalising problems around school entry age were used as the outcome variables. Inequalities were quantified using the Slope Index of Inequality which captures the difference in prevalence of problems between children from highest and lowest SECs. Mediation analysis was used to assess the mediating role of five early-life risk factors: maternal smoking during pregnancy, gestational age, small for gestational age, postpartum depression and breastfeeding. RESULTS:Inequalities in externalising and internalising problems by SECs were consistent across cohorts: Children of mothers with low educational level had on average a 12 and 11 percentage point increased prevalence of externalising and internalising problems respectively. Early-life factors explained around 8% (DNBC, Denmark) to 54% (INMA, Spain) of the inequality in externalising problems and 7% (ELFE, France) to 25% (ALSPAC, UK) in internalising problems. CONCLUSIONS:Children from lower SECs consistently had a higher prevalence of both externalising and internalising problems around school entry age. These inequalities were partly mediated by early-life factors. Public health interventions in pregnancy and the preschool period are critical to address the early emergence of inequalities in children's mental health.

Colonoscopy is a diagnostic technique used for gastrointestinal tract pathologies that presents additional challenges when used in individuals with phenylketonuria (PKU). The dietary requirements for colonoscopy preparation conflict with a phenylalanine (Phe) restricted diet essential in classical PKU, and aspartame containing laxatives must also be avoided. This case study highlights the complexities of applying conventional colonoscopy protocols to patients with PKU and emphasis the importance of personalized preparation strategies that consider strict dietary requirements. A 24-year-old White British woman with classical PKU, with a Phe tolerance of 250 mg/day (5 g/day natural protein) and a consistent maintenance of blood Phe < 360 µmol/L, required an urgent colonoscopy/gastroscopy for investigation of bowel cancer. In the 3 days preceding the procedure, for the first 48 h she followed a low fibre/residue diet (avoiding fruit/vegetables), followed by 24 h of clear fluids only, omitting the Phe-free amino acid supplements. On the evening before the procedure, the first dose of a bowel preparation solution (Plenvu®, containing Macrogol 3350 but aspartame-free) was taken. Immediately, she was lightheaded, had a headache with extreme fatigue. Three hours later, she took the second dose of Plenvu®, containing aspartame (0.88 g/493 mg Phe). Her headache became intense, she felt exhausted and was unaware of her surroundings. It was unclear if the symptoms were caused by side effects associated with the bowel preparation solution or probable high Phe levels following 3 days of a very low energy diet with cessation of protein substitute, together with a high Phe intake associated with the aspartame load. Awareness of potential dietary conflicts with standard procedures, together with effective communication within and between healthcare teams, is essential to ensure patient-centered care. Developing practical guidelines and specific warnings could significantly support both patients and healthcare providers.

Abstract Background Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) are common in infants and children. Non-pharmacological approaches are widely used, but their efficacy and safety remain uncertain. This systematic review evaluates the current evidence on non-pharmacological interventions for pediatric GER and GERD. Methods We conducted a systematic review following Cochrane methodology and PRISMA 2020 guidelines (PROSPERO: CRD420251041380). We included randomized controlled trials and systematic reviews of non-pharmacological interventions for GER or GERD in individuals aged 0–18 years. Eligible interventions included dietary modifications, positioning, alginates, probiotics, massage, and complementary therapies. Study selection, data extraction, and risk of bias assessment were performed in duplicate. Due to heterogeneity, meta-analyses were not conducted. Certainty of evidence was assessed using the GRADE approach. Results We included 40 studies: 39 RCTs (15 crossover) and one systematic review. Most studies involved infants with uncomplicated GER or GERD. Interventions included dietary modifications (n = 25), probiotics (n = 3), alginates (n = 4), positioning (n = 6), and massage therapy (n = 2). Most trials reported regurgitation or Infant Gastro-Esophageal Reflux Questionnaire Revised as primary outcomes. Several interventions, especially thickened feeds, probiotics, alginates, and left lateral positioning, were associated with reduced regurgitation frequency. Risk of bias was frequently high, and GRADE certainty ranged from very low to moderate, depending on outcome and intervention type. Conclusions Thickened formulas and alginates showed the most consistent symptom improvement in infants with GER or GERD, though overall evidence quality was low to moderate. Other interventions yielded mixed results. Non-pharmacological strategies appear generally safe, but further high-quality research is needed to support clinical decision-making.

BACKGROUND:Gut microbiota imbalances may contribute to obesity, yet whether dietary interventions can modulate the microbiota and improve metabolic health in pediatrics has not been thoroughly reviewed. This systematic review and meta-analysis explores the impact of dietary interventions on the gut microbiota of children and adolescents with overweight or obesity, and its association with cardiometabolic improvements. METHODS:A systematic search of clinical trials in Pubmed, Cochrane and EMBASE was conducted following PRISMA guidelines (PROSPERO n°CRD42024505494). Risk of bias was assessed with RoB2 and ROBINS, for randomized and non-randomized intervention studies. RESULTS:Overall, 60 articles were assessed for full-text eligibility, 8 were included, and 4 provided alpha-diversity data for meta-analysis. A total of 200 participants were included (6-16 years). Six studies implemented calorie-restricted diets, one a low free-sugar diet, and one CHILD-1 diet. The meta-analysis revealed a significant increase in Chao1 (48.76 [95%CI 1.81; 95.70]; I2 = 86.8%, p < 0.001) following a balanced calorie-restricted dietary intervention. Although there was heterogeneity in taxa-level changes, several butyrate-producing genera (Clostridium XVIa, Coprococcus, Roseburia, Faecalibacterium, Blautia, Butyricimonas) increased following dietary intervention. CONCLUSIONS:Balanced dietary interventions with calorie-restriction adequate for pediatric age could increase gut microbiota richness and butyrate-producing bacteria abundance. Future trials should clarify diet-driven gut microbiota changes in childhood obesity and related metabolic changes. IMPACT:Balanced calorie restriction diet may increase gut microbiota richness in childhood obesity Butyrate-producer expansion needs long-term dietary intervention Gaps in linking microbiota-metabolism interplay in pediatric obesity.

Short stature is a frequent reason for pediatric referral, yet clear diagnostic criteria remain elusive. Variability in clinical definitions, reference growth charts, and laboratory screening tests complicates the evaluation of affected children. This systematic review aimed to analyze the diagnostic approaches used in clinical and biochemical assessments of short stature in children in the primary care setting. This systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251002215). Two independent literature searches were performed to address two domains: clinical and biochemical assessment. Studies were selected based on predefined inclusion and exclusion criteria, and risk of bias was assessed using the JBI critical appraisal tools. All procedures were conducted by independent reviewers, and discrepancies were resolved by consensus or through a third reviewer. A total of 424 studies were included, 35 in the clinical and 7 in the biochemical domain. Definitions of short stature considered in the studies varied considerably: 28 studies used a threshold of < 2 standard deviation score, while 19 applied percentile-based cut-offs (mostly the 3rd percentile); 8 studies considered both definitions, 3 studies do not report any definition. Growth velocity and target height were rarely used, despite their diagnostic value. Local growth charts were employed when available; otherwise, WHO and CDC references were most used. Laboratory assessments also varied greatly, with complete blood count and urine/stool analyses commonly performed, while thyroid function and celiac disease screening were inconsistently applied. There is substantial heterogeneity in the clinical and biochemical evaluation of children with short stature across studies. This reflects the absence of universally accepted diagnostic criteria and standardized screening protocols. These findings emphasize the need for internationally accepted, evidence-based guidelines to improve diagnostic accuracy and clinical management of children with short stature.

GM1 gangliosidosis is a lysosomal storage disease (LSD) caused by β-galactosidase deficiency, characterized by the accumulation of gangliosides in various tissues. Among different GM1 forms (infantile form, late-infantile and juvenile form, and late-onset form), the infantile form is the most severe: despite an early clinical onset with rapid neurodegeneration, coarse face, abdominal visceromegaly and skeletal abnormalities, the diagnosis is usually delayed, given the lack of recognized early disease-specific markers. We report the case of a newborn presenting with mild edema of hands and feet, mild transient hypoalbuminemia and isolated hyperphosphatasemia at three weeks of life. The first cardiological evaluation showed mild mitral regurgitation. Despite the absence of neurological symptoms, organomegaly, or a coarse face, the turgid consistency of the limbs, together with mitral regurgitation and persistent hyperphosphatasemia, led to multiorgan investigations with discovery of bilateral cherry-red spots and a beak-shaped lumbar vertebra. The cardiological follow-up revealed a dysplastic mitral valve. In the suspicion of a lysosomal disease, biochemical investigations were planned. An altered profile of urinary oligosaccharides, along with low β-galactosidase activity in leukocytes, led to the diagnosis of infantile GM1 gangliosidosis at 3 months of age. The GLB1 gene analysis confirmed the diagnosis. Genetic testing for GLB1 should be considered in cases of persistent hyperphosphatemia, especially if it is associated with any other clinical indicator of GM1, such as limb edema.

The primary aim of the Polymets Study is to evaluate the effect on gut microbiota composition of a polysaccharide-based complex administration combined with dietary and lifestyle interventions in a group of children and adolescents with metabolically unhealthy obesity (MUO). In this clinical trial, children and adolescents (8–14 years) with obesity (defined as body mass index > + 2 standard deviation score [BMI SDS] according to World Health Organization) and cardio-metabolic alteration (hypertriglyceridemia, hypertension, hypo-HDL cholesterol, altered glucose metabolism) were enrolled. Participants received from baseline (T0) to 4 months (T1) combined polysaccharide-based complex administration (5 g/day mixture of soluble and insoluble fibres) and Mediterranean diet intervention; from 4 to 8 months (T2) they underwent dietary intervention alone. At T0, T1 and T2 gut microbiota analysis, body composition assessment, blood tests and Mediterranean diet adherence (KIDMED score) were assessed. Overall, 31 children were enrolled (10.9 ± 1.6 years, F/M 8/23). BMI SDS significantly decreased at each timepoint (p < 0.001), whilst fat mass

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common reason for elevated liver enzymes in children in Europe, affecting more than 5% of all children. Since the last iteration of this position paper, there have been substantial advances in our understanding of the disease. After a detailed literature review and thorough discussion, we established consensus recommendations for the diagnosis and assessment of MASLD in children. Alanine aminotransferase (ALT) ≥ 30 IU/L is a suitable screening test for MASLD in children over 10 years of age with obesity (body mass index z-score ≥+2), or in children of any age with additional risk factors. All patients with suspected MASLD should be assessed for alternative or concomitant diagnoses, as well as comorbidities. Patients who are not overweight, under 8 years old, or have any other red flags should be promptly referred for specialist assessment. Liver biopsy remains the gold standard for diagnosis and staging of MASLD, but should be reserved for diagnostic uncertainty, to guide treatment decisions, and risk stratification (e.g., prior to transition to adult care). While there is emerging data for non-invasive tests (e.g., transient elastography), it is unclear how to routinely implement these investigations in clinical practice. Combined changes of ≥20% in both ALT and gamma-glutamyl transferase may represent a useful non-invasive tool for monitoring disease severity over time. Most patients are appropriately investigated and managed by non-specialists where the focus is on holistic management of obesity and its complications. Future research should focus on how to use non-invasive tests to risk-stratify children, in particular, how to identify those with advanced fibrosis.

Childhood obesity is the main driver of early metabolic risk, predisposing to cardiovascular disease (CVD) and type 2 diabetes (T2D), which cause millions of deaths worldwide. Their progression is influenced by biological, behavioral, and environmental factors. Digital Twin Systems (DTS) offer innovative ways to monitor and predict cardiometabolic risk. This work presents a prototype digital twin platform called PODiaCarD designed for managing pediatric obesity and related cardiometabolic complications. The system integrates clinical, anthropometric, and lifestyle data with machine learning to estimate outcomes in youth. Built on a three-layer architecture (frontend, backend, predictive engine), PODiaCarD ensures scalability, observability, and reproducibility while enabling continuous model improvement. Models, trained on the PODiaCar project dataset (n = 552, 12.2 ± 2.9 years) with cross-validation and target-specific algorithms, predict eight key metabolic outcomes. The infrastructure follows privacy-by-design and GDPR standards, ensuring security, auditability, and clinical compliance. PODiaCarD achieved excellent performance for TyG index (F1 = 0.975 ± 0.014, random forest) and solid results for HbA1C (F1 = 0.844 ± 0.028, random forest). Moderate accuracy was observed for HOMA (F1 = 0.670 ± 0.070, Gradient Boosting). In contrast, models for blood pressure (R2 = 0.05–0.21; F1 = 0.446 ± 0.045) and glycemia (F1 = 0.113 ± 0.113) showed poor predictive capacity, while insulin regression (R2 = 0.211) remained limited, highlighting the need for richer datasets. Conclusions: PODiaCarD is a promising tool for managing pediatric obesity and complications. It integrates clinical, anthropometric, and behavioral data with ML-based models to support pediatricians in early risk detection, dynamic monitoring, and personalized prevention. Its federated design allows continuous dataset growth and improved predictive performance, strengthening its role in pediatric cardiometabolic care.

Background/Objectives: The first 1000 days of life represent a critical window for growth and neurodevelopment, during which nutrition strongly influences brain development and metabolic programming. In phenylketonuria (PKU), dietary management is essential to prevent neurological impairment and later-life risk of non-communicable diseases (NCDs). This review examines current evidence on PKU from pregnancy through complementary feeding, highlighting the impact of nutritional strategies on neurodevelopmental and metabolic outcomes. Methods: This narrative review, following PRISMA guidelines, used a systematic search of PubMed and Scopus with defined PICO questions. Original research, reviews, and guidelines on PKU nutrition during the first 1000 days were included, emphasizing neurological and metabolic outcomes. Results: Articles addressed prenatal and postnatal factors in PKU. Optimised metabolic control in women with PKU is critical to prevent maternal PKU syndrome, reducing risks of miscarriage, congenital heart defects, microcephaly, and neurocognitive impairment. Pre-conception dietary management, frequent blood Phe monitoring, supplementation with Phe-free protein substitutes (PSs), micronutrients, and emerging pharmacological therapies support maternal and foetal health. Following newborn screening, early dietary treatment in infants with PKU maintains plasma Phe within safe ranges, promoting growth and neurodevelopment. Breastfeeding, combined with Phe-free infant PSs, is feasible, and complementary feeding should be introduced carefully. Frequent monitoring and tailored dietary adjustments, including second-stage PSs, support metabolic control, while data on gut microbiota remain limited. Conclusions: Early multidisciplinary interventions are crucial to optimise metabolic and neurodevelopmental outcomes during this window of opportunity. Further research is needed to address remaining gaps and optimise PKU management across the first 1000 days.

Intestinal failure (IF) patients suffer a loss of intestinal mass or function and alterations in gut microbiota (GM) composition and function. Our objectives are to (1) characterise GM in IF, (2) explore associations between GM and IF health outcomes, and (3) analyse the effect of GM-based interventions on disease course. A systematic review was conducted in PubMed/MEDLINE, Embase, and Web of Science up to March 2026. Eligible studies included observational studies, prospective studies, and clinical trials in patients with IF, without age or date restrictions. The main outcomes identified included GM diversity indices, GM taxonomy, and IF complications. Risk of bias was assessed using CASP checklists. Twenty-eight studies including children (4 case reports, 1 case series, 19 cohort studies [14 cross-sectional, 5 prospective], 1 quasi-experimental study, 3 RCTs, for a total of 391 cases) and 19 studies including adults (2 case reports, 1 case series, 14 cohort studies [12 cross-sectional, 2 prospective], 2 quasi-experimental studies, for a total of 604 cases) were analysed. Given the heterogeneity among studies, only qualitative synthesis was performed. Reduced alpha diversity and marked phylum-level dysbiosis are consistently reported in patients with IF compared with healthy controls. Different IF aetiologies and bowel anatomy are associated with distinctive GM patterns. IF complication rate increases with the magnitude of GM alteration. GM-modifying interventions are poorly studied. Encouraging improvements in GM dysbiosis, enteral tolerance, and IF complications have been reported in observational studies using various interventions. Still, these findings are not confirmed in RCTs. A distinguishing GM dysbiosis, associated with worse clinical outcomes, clearly emerges in patients with IF. The low quality and heterogeneity of the studies analysed limit data interpretation. The need for a better definition of microbiota assessment, both as a bedside tool and as a therapeutic target, is highlighted as a prominent study topic for the future of IF rehabilitation.

While the Mediterranean diet (MD) is associated with numerous health benefits, in children there is limited information on effects of assessment methods, cross-country differences, and the tracking of MD adherence over time. We aimed to compare and combine dietary assessment tools in young children, to provide an informative method for scoring adherence to MD, and to examine cross-country variations. 3-Day Food Diaries (3-DFD) and Food Frequency Questionnaires (FFQ) were assessed at 4 time points during the ages of 3 to 6 years across five European countries: Belgium, Germany, Italy, Poland, and Spain. Information from both tools was used to calculate the Mediterranean Diet Quality Index for children and adolescents (KIDMED), both independently and in combination. For the latter, country and time point differences were examined. Individual diet score variance per country across time points was determined using Intraclass Correlation Coefficient (ICC). The combined KIDMED score (3.76 ± 2.28) was higher compared to both the FFQ (3.31 ± 2.33) and the 3-DFD score (1.78 ± 2.45) across follow-ups. The combined KIDMED score was higher in Mediterranean countries (Italy 5.00 ± 1.60; Spain 4.54 ± 1.70) than non-Mediterranean countries (Belgium 1.96 ± 2.07; Germany 3.13 ± 2.01; Poland 1.65 ± 2.12) (p < 0.01), driven by more children from Mediterranean countries consuming fruits, vegetables, fish, pulses, and olive oil. The combined KIDMED score was rather stable over time. Intra-individual consistency over time was poor to moderate (Germany: 0.620, Belgium: 0.604, Italy: 0.429, Poland: 0.564, and Spain: 0.493). Combining FFQ and 3-DFD led to a higher KIDMED score reflecting more detected details of frequencies in food consumption. MD adherence was poor to moderate and remained stable over time in early childhood, suggesting that dietary patterns established at a young age are likely to persist. Trial registration: This trial was registered at clinicaltrials.gov as NCT00338689.

OBJECTIVES:Paediatric intestinal pseudo-obstruction (PIPO) is the most severe disorder of gut motility in childhood. Consensus on how and if patients should be fed (solid or bite and dissolve oral diet, gastric, jejunal, or parenteral feeding) is lacking. Our aim was to investigate the current nutrition practices among European referral centers, to aid in developing a future evidence-based consensus guideline. METHODS:An electronic questionnaire was circulated via the Network of Intestinal Failure Rehabilitation and Transplantation in Europe. Data collected between October 2023 and March 2024 included patient demographics, disease phenotype based on the European Society for Paediatric Gastroenterology, Hepatology and Nutrition PIPO criteria, and type of feeding. RESULTS:Data from 84 patients from 9 centers (8 European and 1 Israeli) were received. A total of 73 children fulfilled PIPO criteria and were included; 48 (65.8%) females, 55 (75%) became symptomatic within the first year of life; 9 (12.3%) ate a normal solid diet, 64 (87.7%) required permanent nutrition support; 2 (2.7%) were on exclusive tube enteral nutrition (EN), 9 (12.3%) on exclusive parenteral nutrition (PN), 53 (72.6%) on a combination of PN and oral diet (normal/bite and dissolve/normal but minimal intake) and/or EN. Use of exclusive PN is more common in adolescents compared to younger children. 19 (26%) eventually re-established enteral/oral intake: 8 (42.1%) after stoma formation, 7 (36%) following prokinetic induction, 1 (5.2%) after intestinal transplantation. CONCLUSIONS:Nutrition practices in children with PIPO vary widely. Only 12.3 3% of children can tolerate an increase in EN after medical and surgical interventions.

BACKGROUND:Home Artificial Nutrition (HAN), including Home Enteral Nutrition (HEN) and Home Parenteral Nutrition (HPN), is essential for managing pediatric patients with complex nutritional needs. This article presents the first report from the Italian Pediatric HAN registry, promoted and endorsed by the Italian Society for Pediatric Gastroenterology, Hepatology, and Nutrition (SIGENP) in order to document HAN practices and clinical outcomes. AIMS:The registry aims to analyze data from the Italian network of pediatric HAN to provide insights into its epidemiology, efficacy and safety. METHODS:Established in 2020, the registry is an online platform accessible via the SIGENP website (www.nad-sigenp.org/site/home) for recording data on pediatric patients aged 0-19 years who currently or previously required HAN. Registered SIGENP network centers enter data on patient demographics, nutritional support details, clinical outcomes and complications. RESULTS:As of December 31, 2022, the registry included 3525 home artificial nutrition programs (2402 HEN, 917 oral nutritional supplements [ONS]and 206 HPN) provided by 13 centers across 9 regions. The prevalence of pediatric HAN in Italy reached 365 programs per million inhabitants aged 0-19 years (249 HEN, 57 ONS, and 21 HPN), showing a clear increase compared to previous national surveys conducted by the Italian Society of Artificial Nutrition and Metabolism (SINPE) [12]. Mean age at initiation was 1.8 years for HEN and 0.9 years for HPN. Median duration of HEN was 1.4 years, predominantly prescribed for neurological patients, showing significant correlation between early HEN initiation and improved nutritional outcomes. Major complication rate for HEN was 2.3 % (n = 55; e.g. gastrocolic fistula, aspiration pneumonia, significant bleeding). Among HPN patients, intestinal failure-associated liver disease (IFALD) was detected in 8.3 % based on gamma-glutamyl transferase (GGT) ≥2 × normal, 3.9 % based on bilirubin >1 mg/dL, and 11.6 % based on alanine aminotransferase (ALT) ≥2 × normal each persisting for more than three months. Hepatic steatosis and biliary sludge occurred in 23.3 % and 16.0 % of patients, respectively. Complications rate and prevalence align with international trends, confirming the importance and safety of home care in children with chronic diseases. CONCLUSIONS:The registry provides a comprehensive overview of pediatric HAN practices in Italy, highlighting a significantly growing need for specialized nutritional care. The predominance of HEN, especially among neurological patients, underscores its critical role in long-term nutritional management. The observed correlation between early initiation of HEN and improved nutritional outcomes reinforces the importance of timely nutritional interventions. HPN remains less common, as it is mainly indicated for patients with primary intestinal failure. The registry's data provide valuable insights into epidemiological trends and clinical practices, which contribute to future policy development for pediatric HAN.