Needs for a tailored nutritional intervention in critical periods of development?

• Published in: Appetite Vol. 76; p. 205
• Main Authors: PODAGROSI, M., MERCURIO, R., PIEDIMONTE, A., DE LUCIA, I.C., CIMBOLLI, P., MOSCA, A., VANIA, A.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.05.2014
• ISSN: 0195-6663; 1095-8304
• DOI: 10.1016/j.appet.2014.01.040

Aim of paediatric nutritional approach is eating education, needing patient and family full cooperation. We present a male patient who attended our Centre 4 times through 11 years, with progressive deterioration. M first approach to our Centre was in 2002 (10 years old): mild obesity (H 161.4, W 65.7, both pc >99.9, BMI 25.22, pc >99.9) no organ damage, mild hypertension (BP 130/90, pc >97). Prescribed balanced low-calorie diet (1350kcal/day), quarterly checks without improvement. Back in 2008, with a slight improvement (H 191, pc 98, W 110.4, pc <99.9, BMI 30.26, pc >99.9, Waist 105, WtHR 0.55), also in the next check (BMI 30,18, pc >99.9). After a new drop-out, M reappears at 18: further deterioration (H 191.5, W 128, BMI 34.90, Waist 119.4, WtHR 0.62), hypertension with two-drugs treatment, cardiac hypertrophy, hypertriglyceridemia, hypertransaminasemia, hyperinsulinism at OGTT (basal HOMA-IR 2.31). M drops out again after just one check and poor compliance to diet (1800kcal). Back again at 21, severe deterioration of the nutritional status (H 192.1, W 135, BMI 35.5, Waist 122, WtHR 0.63), hypertension with three-drugs therapy, NAFLD, severe hypertriglyceridemia, basal hyperinsulinism (HOMA-IR 6.3). Presently the patient checks regularly, but with poor compliance despite focused nutritional instructions. Conclusions. This therapeutic failure is probably due to: obese parents with low SES, bad environmental context, critical moment (adolescence and post-adolescence). For similar cases it is hoped a different management with closer checks and more tailored interventions, at best before nutritional habits consolidate and complications appears.