Dietary Inflammatory Potential in Pediatric Diseases: A Narrative Review

Inflammatory status is one of the main drivers in the development of non-communicable diseases (NCDs). Specific unhealthy dietary patterns and the growing consumption of ultra-processed foods (UPFs) may influence the inflammation process, which negatively modulates the gut microbiota and increases the risk of NCDs. Moreover, several chronic health conditions require special long-term dietary treatment, characterized by altered ratios of the intake of nutrients or by the consumption of disease-specific foods. In this narrative review, we aimed to collect the latest evidence on the pro-inflammatory potential of dietary patterns, foods, and nutrients in children affected by multifactorial diseases but also on the dietetic approaches used as treatment for specific diseases. Considering multifactorial diet-related diseases, the triggering effect of pro-inflammatory diets has been addressed for metabolic syndrome and inflammatory bowel diseases, and the latter for adults only. Future research is required on multiple sclerosis, type 1 diabetes, and pediatric cancer, in which the role of inflammation is emerging. For diseases requiring special diets, the role of single or multiple foods, possibly associated with inflammation, was assessed, but more studies are needed. The evidence collected highlighted the need for health professionals to consider the entire dietary pattern, providing balanced and healthy diets not only to permit the metabolic control of the disease itself, but also to prevent the development of NCDs in adolescence and adulthood. Personalized nutritional approaches, in close collaboration between the hospital, country, and families, must always be promoted together with the development of new methods for the assessment of pro-inflammatory dietary habits in pediatric age and the implementation of telemedicine.

Prader–Willi Syndrome and Weight Gain Control: From Prevention to Surgery—A Narrative Review

Severe obesity remains one of the most important symptoms of Prader–Willi Syndrome (PWS), and controlling weight represents a crucial point in the therapeutical approach to the syndrome. We present an overview of different progressive patterns of growth that involve controlling weight in PWS. Mechanisms involved in the development of obesity and in preventive and therapeutic strategies to control weight gain are discussed. Early diagnosis, a controlled diet regimen, regular physical activity, follow-up by multidisciplinary teams, and hormonal treatment improved the management of excessive weight gain. In selected cases, a surgical approach can be also considered. Controlling weight in PWS remains a challenge for pediatricians. The importance of consulting different healthcare specialists, starting from the neonatal and pediatric age, is also considered as a crucial approach to controlling weight, as well as to limiting and preventing the onset of obesity and its complications.

Influence of peritoneal dialysis catheter type on dislocations and laxative use: a retrospective observational study

Background

There is currently no consensus regarding the optimal type of peritoneal dialysis (PD) catheter. Although few studies showed that weighted catheters result in lower complication rates and superior long-term outcomes than non-weighted catheters, there are no studies on the use of laxatives linked to catheter malfunction, a patient-related outcome potentially affecting the quality of life. Thus, we compared the burden of acute and chronic laxative use in a cohort of PD patients having either weighted or non-weighted catheters.

Methods

We performed a single-center, retrospective, observational study in two renal units, comparing acute and chronic laxative therapy related to catheter drainage failure in a cohort of 74 PD patient,s divided by peritoneal dialysis catheter type. In addition, we evaluated the number of patients who experienced minor and major dislocations, catheter-related infection rate, hospitalization for catheter malfunctioning, episodes of catheter repositioning, and dropout from PD.

Results

Laxative use was significantly more common among patients in the non-weighted catheter group (acute: 30.3% vs. 9.8%, p = 0.03; chronic: 36.4% vs. 12.2%; p≤0.02). Furthermore, weighted catheters were superior to non-weighted catheters for all the secondary outcomes (dislocations: 12.2% vs. 45.5%; p = 0.001).

Conclusions

Weighted self-locating catheters have lower drainage failure, thus reducing the need and burden of acute and chronic laxative use among PD patients.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40620-022-01329-6.

COVID-19 and cancer: How outpatients (pts) and their caregivers (CGs) face to the pandemic—A survey from the midst of the Italian outbreak

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Background: COVID-19 pandemic led to a reorganization of Health Care System for cancer pts, also because of the application of containment measures. The aim of our study was to investigate the emotional discomfort of pts and their CGs who needed to access the day-hospital to receive treatment during pandemic. Methods: This is a single-institution, prospective, cross-sectional study. From 5th May to 5th June 2020 a survey was conducted at a Department of Oncology in the midst of the Italian outbreak. We compared the points of view of both the “players” through 2 different multiple-choice questionnaires enquiring demographic characteristics, changes in emotional status, interpersonal relationships with health professionals (HCPs) and self-perception of treatment outcomes. Results: 625 pts and 254 CGs were enrolled. Female were prevalent (pts:65%, CGs:56%). Pts were generally older than CGs (pts:70% > 60 y, CGs:50.4% 41-60 y; p < 0.001). 50.5% pts had a low education level (EL) while 67.5% CGs had a higher degree. About half of pts (52.8%) reached the hospital with their own CG who lived together in the 58.3% of cases. 52.5% of pts felt more vulnerable to COVID-19 compared to CGs. Differently, CGs did not feel more exposed to infection, although they were involved in taking care or lived together with pts. The EL influenced the risk contagion perception: people with a lower EL were less worried about being infected with SARS-CoV-2. Regardless of the perceived contagion risk, study participants considered the containment measures a valid support to avoid the spread of infection (pts:92%, CGs:89%; p = 0.163) without an excessive loss of time (pts:78%, CGs:88.6%; p = 0.003). A personal emotional change caused by waiting and performing visits/treatments alone was reported more by CGs (66%) than by pts (32.7%; p < 0.001). Specifically, CGs had greater anxiety (58.8%) and fear of not properly managing pts at home (19.8%). The majority of pts (73%) and CGs (62%) thought that the pandemic didn’t influence treatment outcomes. The relationship with HCPs was not negatively affected for both pts (79.6%) and CGs (95%), but about a quarter of pts (25%) and CGs (29%) thought that the attention of HCPs was more focused on COVID-19 than on cancer treatment. Conclusions: The majority of pts felt at higher risk of COVID-19 infection and therefore approved the application of safety standards to help them feel more protected. Good relationships with HCPs contributed to receive treatments without experiencing additional distress. For CGs the main troubles are limitations which don’t allow to fully share the pts' care route and the perceive an impairment in HCPs relationship. Starting from these data, we can better understand the current psychological distress of pts and their families in order to develop potential strategies to support them in this strenuous period of crisis.