Overweight

0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

National reference I.O.T.F. C.D.C.

males

females

totale

Obesity

0,0%

2,0%

4,0%

6,0%

8,0%

10,0%

12,0%

14,0%

16,0%

18,0%

National reference I.O.T.F. C.D.C

males

females

totale

PREVALENCE OF OVERWEIGHT AND OBESITYIN 2-6-YEAR-OLD ITALIAN CHILDREN

Maffeis C et al. 2005 (submitted)

fat mass (%)

0-0.1-0.2 2 4 6 8 10 12 14 16 18

Age (years)

35

30

25

20

15

10

5

0

-0.8

male

female

pregnancy firstyear

adiposity rebound puberty

Dietz WH Am J Clin Nutr 1994

birth weight and type 2 diabetesin Pima Indian children and young adults

Dabelea D et al. Diab Care 1999;22:944

20

15

10

5

0

< 2.5

2.5 - 3.5

Pre

vale

nce

(%

)

3.5 - 4.5

birth weight (kg)

> 4.5

25

age group (years)

5 - 9 10 - 14 15 - 19 20 - 29

(Mantel-Haenszel X2 test, controlled for age and sex)

energy requirementsin breast fed infants compared with FAO

recommendations

Lucas et al.

Wells & Davies

Butte et al.

Salazar et al.

FAO/WHO/UNU

Age

(days)

35

36

32

34

402

421

383

391

485

referenceWeight

(kg)

TDEE

(kJ/day)

Metabolizable

EI (kJ/kg/d)

Diff. From

FAO (%)

4.5

4.5

4.7

4.5

1280

1270

1212

1205

17

13

21

19

year

energy(kcal/d)

energy intake

4000

3000

2500

1900 1920 1940 1960 1980 2000

3500

Bray G, 2004

0

5

10

15

20

25

0 5 10 15 20

maschi

femmine

variazioni della spesa energetica per l’accrescimento (EEG) espressa in rapporto alla spesa energetica totale (TEE), in funzione dell’età

età (anni)

EEG/TEE (%)

rapid weight gain during infancy and obesity in young adulthood in a cohort of African Americans

Stettler N, et al. Am J Clin Nutr 2003

obese in young adulthood:

rapid weight gain category

(0 to 4 months):

sex (F)

birth weight (kg)

gestational age (wk)

firstborn status

birth year

maternal BMI (kg/m2)

maternal age (y)

maternal education (y)

5.22

6.57

17.6

0.77

2.33

3.43

1.2

0.93

0.97

155, 17.6

1.83,23.5

2.22,140

0.35,1.68

0.54,10.2

1.01,11.7

1.04,1.39

0.83,1.03

0.69,1.37

0.008

0.004

0.007

0.5

0.3

0.049

0.013

0.16

0.9

Adjusted analysis

OR 95% CI P

Erikson JG, et al. BMJ 1999;318:427-31

catch-up growth in childhood and death from coronary heart disease: longitudinal study

ponderal Index

(kg/m2)*

body mass index at the age of 11 yrs

< 15.5 -16.5 -17.5 >17.5

< 25

- 27

- 29

> 29

2.7

1.5

2.2

1.0

3.3

3.2

1.6

1.7

3.7

4.0

1.8

1.5

5.3

2.7

3.2

1.9

* adjusted for length of gestation

The infant: a model of physiological overfeeding

weight (g)

7,000

3,500

25

fatmass (%)

14

0 4age (months)

2

human milk:

fat = > 50% of EI

cho = < 40% of EI

1,750

fatmass (g)

500

protein requirements during the first year of file

1.8

0.6

proteinintake

(g/kg/d)

2.4

age (months)

0 4 8 12

Dupon C Am J Clin Nutr 2003

1.2

estimated protein intake from human milk

estimatedprotein needs

basis of weaning recommendations

months

0 3 6 9 12 15 18 21 24

breast milk

staple weaning foodand other grains

soft fruits and vegatables

meats and otherprotein rich foods

transitional period given regularly

0

20

40

60

80

PROTEIN

NUTRIENT INTAKE IN ITALIAN CHILDREN(%)

FAT CARBOHYDRATE

LARN

LARN

LARN

covert manipulation of dietary fat and energy density: effect on substrate flux and food intake in men eating ad

libitum

0

- 5

0

5

10

15

1 2 3 4

fat balance

time (days)

Stubb RJ, et al. AJCN 1995; 62:316-29.

- 10

20

5 6 7 0

- 5

0

5

10

15

1 2 3 4

energy balance

time (days)

- 10

20

5 6 7

MJ MJ

high fat

medium fat

low fat

50

25

0

fatmass (%)

10 30 50

lipid intake (% of energy intake)

Maffeis C et al. Int J Obes ‘96

r = 0.28 P< 0.01

Gazzaniga JM, et al.AJCN ‘93

Klesges RC et al. AJCN ‘94

fatty foodmore palatable

high energy density

less satiating

gross national products per capita/grouping of countries: fiftiles

0

200

400

600

THE SWEETING OF THE WORLD’S DIET

Popkin &Nielsen Obes Res 2004

kca

l/ca

pita

/day

add

ed

sug

ar I II III IV V

1962 2000

1978 -1994adolescents

soft drinks: + 70%milk: -65%

Warren, J. M. et al. Pediatrics 2003;112:e414

Mean differences in lunch intake after different breakfasts, compared with lunch intake after habitual breakfast

adiposity rebound

Kimm SYS, et al Lancet, 2005

livelli di attività fisica durante l’adolescenza possono influenzare significativamente il BMI e l’adiposità nell’età adulta.

lipidstore

G G

GLYCOGEN

GLYCOLYSIS

Acetyl CoA KC ox

FFA FFA

CO2

H+

ATPADP + Pi

O2

AcetylCoA

pre-pubertal physical activity of boys and girls

activityrelated energy

expenditure (kcal/day)

age (years)4 106 8

700

500

300

age (years)4 106 8

9

6

3

activity(h/week)

males

females

Goran MI, et al. Pediatrics 1998;101:887

TV viewing, TV in the bedroom and overweight risk

For each additional hour per day of TV/video viewed (adjusted for age, sex, parental education, race) the odds ratio of children having a BMI > 85th percentile was 1.06.

Almost 40% of children had a TV set in their bedroom (OR 1.31)Dennison BA, et al.Pediatrics 2002

INFLUENCE OF CHANGES IN SEDENTARY BEHAVIOR ON ENERGY AND MACRONUTRIENT INTAKE IN YOUTH

150

DECREASE PHASE

75

- 75

- 150

INCREASE PHASE

changes intargeted sedentary behavior from baseline(min/day)

Epstein LH, et al. AJCN 2005;81:361-6

BOYS GIRLS

Morningsnack

Afternoonsnack

0

10

20

30

40

Breakfast Lunch DinnerNight snack

percentage distribution of the energy intake among the different meals

Maffeis C, et al. Int J Obes 1999

conclusioni

• gli eccessi alimentari sono numericamente più rilevanti

delle carenze.

• l’energia richiesta per la crescita è molto contenuta (2 - 8 aa).

• bevande zuccherate e alimenti ad alta densità calorica sono

fattori di rischio di obesità

• è consigliabile moderare gli apporti energetici del pasto serale

• La limitazione dell’esposizione al video e la regolare pratica

di uno sport sono importanti quanto un’alimentazione

equilibrata

ENERGY-DENSE SNACK (EDS) FOOD INTAKE IN ADOLESCENCE:LONGITUDINAL RELATIONSHIP TO WEIGHT AND FATNESS

Phillips SM et al. Obes Res 2004;12:461-72

• relationship between total EDS food consumption and SDS BMI or %BF: no significant

• relationship between soda consumption and SDS BMI or %BF: significant

• relationship between EDS food consumption and TV viewing: significant

SNACK FOOD INTAKE DOES NOT PREDICT WEIGHT CHANGE AMONG CHILDREN AND ADOLESCENTS

Field AE et al. Int J Obes 2004;28:10:1210

• prospective study of 8203 girls and 6774 boys, 9-14 y of age in 1996.

• boys consumed more snack foods than girls

• after controlling for Tanner stage, age, height change, activity, and inactivity, there was no relationship between intake of snack foods and subsequent changes in SDS BMI.