INNOVATIVE TOOLS FOR THE STUDY OF ENVIRONMENTAL RISK FACTORS IN PEDIATRIC AGE

Overweight and obesity in childhood and adolescence is a global health-care issue, with an estimated 38,2 million overweight and obese children under the age of 5 in 2019, and over 340 million 5-19 years-old subjects classified as overweight or obese in 2016 worldwide. Reliable (i.e. both accurate and precise) and easily accessible tools for the assessment of dietary habits and physical activity in pediatric age are important for monitoring population trends, examining associations with health outcomes, and evaluating the effectiveness of public-health recommendations and interventions. The main objectives of this work are to carry out a comprehensive analysis on the available methods to assess dietary habits in pediatric population, providing results from the use of traditional tools and the application of new approaches, evaluating the opportunity to achieve the development and the biological validation of a technology-based children-oriented tool for research and surveillance purposes. The present thesis is divided in 3 main experimental parts. 1) A few studies so far have described nutrient intakes, food sources, and/or adherence to national and international dietary recommendations in primary-school children. We provided a comprehensive overview of dietary intake in 381 7-year-old children from NAC-II cohort study, Friuli Venezia Giulia (Italy). Energy, macro-, and micronutrient intakes were derived from 3-day dietary records. Standard (median and percentage) and index-based approaches were used to evaluate adequacy to Italian dietary reference values at nutrient- and overall-diet-level. The enrolled children showed suboptimal intakes of several macro- and micronutrients, in line with Italian and European studies on primary school children. 2) Research from different sources supports a link between nutrition and neurodevelopment, but evidence is still sparse regarding the relationship between a posteriori dietary patterns (DPs) and cognitive performance in school-aged children. Within the Northern Adriatic Cohort II, Friuli Venezia Giulia, Italy, 379 7-year-old children were cross-sectionally evaluated. Dietary patterns were identified through a principal component factor analysis based on 37 nutrients from children’s 3-day dietary records. The Wechsler Intelligence Scale of Children (WISC-IV) test provided measures of cognitive performance. In the absence of a relation with the overall score, single DPs might influence specific cognitive functions, including verbal and reasoning abilities, as targeted by single indexes, in the expected direction. 3) Currently, no technology-based food-frequency questionnaires (FFQ) have been designed and validated against biomarkers in Italian primary-school children. Thus, primarily we performed a feasibility study to examine critical issues, tricky points, and the newly data collection, management, and analysis approach, turning a traditional and validated FFQ for the assessment of adults’ dietary habits in its web-based version. Secondly, we developed and submitted for grants a validation study protocol for the realization of a technological, children-oriented FFQ validated against doubly labeled water, to be used across research, surveillance, and clinical settings on large samples size.