Dal 2nd International Forum on Food and Nutrition, 30 novembre-1 dicembre 2010, Milano. Nutrizione e salute: chi ben comincia….- Claudio Maffeis

1. Children’s diet, lifestyle and health: today’s challenges for tomorrow’s generations

2. Nutrizione e salute: chi ben comincia…. Claudio Maffeis Pediatra, Università di Verona

3. accrescimento sviluppo mantenimento stato salute nutrizione

4. Alzheimer Parkinson Autism ADHD Chronic inflammation Allergies Asthma Metabolic disorders (obesity, diabetes, cardiovascular, …) Neuro/Brain Immune System (Epi)Genetics Nutrition/Gut

5. Early life: setting the right course for later life birth -9 months + 36 months Growth & Metabolism Absorption Brain and Neuro-development Infection Allergy Taste disease health Allergy Obesity Coronary Heart Disease Diabetes Autoimmunity Health Life

6. Epigenetic mechanisms non-sequence changes in DNA/chromatin that influence gene-expression Histone modifications DNA methylation Cytosines in CpG dinucleotides CpG dinucleotides (CpG island) in promoter DNA methylation gene silencing (interference with TF binding)

7. obesità ipertensione diabete dislipidemie intolleranze/allergie malattie tubo digerente magrezze - anoressia tumori nutrizione e morbilità

8. sovrappeso obesità ADULTI BAMBINI Obesita’: prevalenza in Italia 40% 12% 24% 12% UN BAMBINO OBESO HA PIU’ DEL 50% DI PROBABILITA’ DI ESSERE UN ADULTO OBESO 52% 36% totale 23% sovrappeso + obesita’ 49% sovrappeso + obesità Italian Ministry of Health, October 2008

9. Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death Franks PW, et al NEJM 2010

10. Maffeis C, et al. J Pediatr 2008 Odds ratio to have the metabolic syndrome in subjects with a W/Hr >0.5 W/Hr = waist/height ratio * P < .05. ** P < .001. W H Metabolic syndrome Risk to develop metabolic syndrome Independent variables No Yes OR (95% CI) Normal weight with W/Hr <0.5 938 22 1 Normal weight with W/Hr >0.5 13 1 4.01 (0.49-32.97) Over weight with W/Hr <0.5 132 10 3.34 (1.52-7.37) * Over weight with W/Hr >0.5 72 16 8.16 (3.87-17.23) ** Obese with W/Hr >0.5 208 67 12.11 (7.08-20.71) **

13. American Academy of Pediatrics: Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight & Obesity: Target behaviors Breastfeeding Breakfast Family meals (fast food) Balanced macronutrients diet (RDA) Fruits and vegetables, Fiber Energy density Portion size Sugar-sweetened beverages (Calcium) TV other screen exposition Physical activity Barlow SE & the Expert Committee Pediatrics 2007 (suppl.) (modified)

17. massa e composizione corporea organi metabolicamente attivi: cervello - cuore fegato - rene muscolo fabbisogni livello di attività organi/apparati locomozione ambiente fisico malattia 25 15 5 MASSA GRASSA (%) 0 9 18 ETA’ (anni) ATTIVITA’ FISICA E GRASSO CORPOREO 3 1.5 0 LIVELLO DI ATTIVITA’ FISICA (PAL)

18. DECLINE IN PHYSICAL ACTIVITY DURING ADOLESCENCE MET-times/week study year Kimm SYS, et al. N Engl J Med 2002 1 3 5 7 9 0 10 20 30 40 0 age (yrs) 9 11 13 15 17 white girls black girls

21. Tre grandi attori del rapporto alimentazione-salute-benessere Pediatri (promuovere) Scuola (educare) Famiglia (crescere) 1 3 2 Alimentazione e stile di vita del bambino

26. Children’s diet, lifestyle and health: today’s challenges for tomorrow’s generations