Parents have a high degree of control over the environments and experiences of their children. Food preferences are shaped by a combination of genetic and environmental factors. This article is a review of current data on effective determinants of children's eating habits. The development of children's food preferences involves a complex interplay of genetic, familial, and environmental factors. There is evidence of a strong genetic influence on appetite traits in children, but environment plays an important role in modeling children's eating behaviors. Parents use a variety of strategies to influence children's eating habits, some of which are counterproductive. Overcontrol, restriction, pressure to eat, and a promise of rewards have negative effects on children's food acceptance. Parents' food preferences and eating behaviors provide an opportunity to model good eating habits. Satiety is closely related to diet composition, and foods with low energy density contribute to prevent overeating. Parents should be informed about the consequences of an unhealthy diet and lifestyle and motivated to change their nutritional habits. Parents should be the target of prevention programs because children model themselves on their parents' eating behaviors, lifestyles, eating-related attitudes, and dissatisfaction regarding body image. Pediatricians can have an important role in the prevention of diet-related diseases. Informed and motivated parents can become a model for children by offering a healthy, high-satiety, low-energy-dense diet and promoting self-regulation from the first years of life.

Summary Cardiomyopathy is a frequent complication in propionic acidemia. It is mostly rapidly fatal and independent of the metabolic control or medical intervention. Here, we present the reversal of a severe cardiomyopathy after liver transplantation in a patient with propionic acidemia and the long‐term stability after ten years. Liver transplantation in patients with propionic acidemia may be considered a valid and long‐lasting treatment when cardiomyopathy is progressive and unresponsive to medical therapy.

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AIM: To assess a relationship between longitudinal changes in liver fat content and biochemical parameters in obese children after 1-year nutritional intervention. METHODS:Forty-six obese children, 21 males and 25 females, aged 6-14 years, underwent metabolic measurements, liver ultrasonography (US) and chemicalshift magnetic resonance imaging (MRI) examinations at baseline and after 1-year nutritional intervention. A child was defined obese if her/his body mass index (BMI) was above the age-and sex-adjusted BMI Cole's curve passing through the cut-off of 30 kg/m 2 at 18 years.BMI Z scores were calculated and adjusted for age and gender by using the Cole's LMS-method and Italian reference data. Biochemistry included serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Abdominal US and chemical-shift MRI were performed according to a randomized sequence.The same radiologist performed US by a GE Logiq 9 (General Electric Healthcare Medical Systems, Milwaukee, WI, United States) using a 3.5-MHz convex array transducer. Liver echogenicity was evaluated independently on videotape by 3 radiologists unaware of the child and MRI outcomes, and a consensus was established. Another experienced radiologist, unaware of the child and US data, performed the abdominal chemicalshift MRI with a 1-t system NT-Intera (Philips Medical Systems, Best, The Netherlands) and a phased-array coil. Liver fat fraction (FF) on MRI was judged elevated when greater than 9%. A FF > 18% was considered expressing more severe cases of fatty liver according to Fishbein. A nutritional-behavioral intervention was recommended to promote a normocaloric balanced diet and active lifestyle based on the Italian guidelines for treatment of childhood obesity. RESULTS:Compared to baseline, at the end of intervention children showed lower intakes of energy (mean ± SD: 2549 ± 1238 Kcal vs 1770 ± 622 Kcal, P < 0.0001), total fat (90 ± 47 g vs 52 ± 23 g, P < 0.0001), carbohydrates (356 ± 174 g vs 241 ± 111 g, P = 0.001), and protein (99 ± 48 g vs 75 ± 23 g, P = 0.006) intakes. Prevalence of FF ≥ 9% declined from 34.8% to 8.7% (P < 0.01), with a mean reduction of 7.8% (95%CI: 5.0-10.6). At baseline, FF was associated with liver biochemical parameters (maximum P < 0.001). At the end of the intervention association was found with AST (P = 0.017). Change of FF was associated with change in AST (P = 0.027) and ALT (P = 0.024). Rate of increased liver echogenicity declined from 45.6% to 21.7% (P < 0.0001). Liver echogenicity was associated with ALT at baseline only (P < 0.001). An age-and sexadjusted multiple regression analysis showed that FF 505Verduci E et al . Liver fat in obese childrenSeptember 27, 2013|Volume 5|Issue 9| WJH|www.wjgnet.com change was independently associated with change in serum AST (adjusted regression coefficient 0.348, P = 0.048). CONCLUSION:The results suggest that in obese children longitudinal changes in liver fat content based on MRI may be associated with change in serum transaminases suggesting novelty in mon...

Introduction The diagnosis of neonatal cholestasis (NC) is urgent in order to define a specific diagnosis, as well as, for the immediate treatment with vitamins' supplements. Objectives Understand the modification of NC aetiology in a tertiary centre, throughout 17 years.Determine age at diagnosis, aetiology, hepatic function, need of imaging studies and hepatic biopsy. Methods Retrospective study of newborns and infants with NC diagnosed in a central hospital.Results During 17 years, were diagnosed 100 cases of NC. Median age at diagnosis was 9,5 days. The most frequent causes of NC were premature newborns under prolonged parenteral nutrition (34%), neonatal sepsis (29%), alpha-1 antitrypsin deficiency (5%) and cytomegalovirus congenital infection (5%).From those that due to jaundice, realised abdominal ultrasound to exclude biliary atresia (n = 59), 3 had biliary atresia and 9 had other alterations. Hepatic biopsy has been performed in 7 cases (biliary atresia n = 3; paucity of biliary ducts n = 1; Byler n = 1; Morsier's syndrome n = 1, idiopathic n = 1).Thirteen patients died, 5 developed chronic hepatitis and 2 were transplanted.Death occurred in those with neonatal sepsis (n = 4), premature newborns with prolonged parenteral nutrition (n = 4), Zellweger syndrome (n = 2) and liver failure (n = 3). Conclusions The majority of NC occurred in newborns and infants hospitalised in intensive neonatal unit care, due to neonatal sepsis/prolonged parenteral nutrition, in opposed to the classic aetiology of biliary atresia/ alpha-1 antitrypsin deficiency.The celerity of NC diagnosis continues to be crucial, in order to avoid delay in a biliary atresia diagnosis. All children with suspected inflammatory bowel disease (IBD) should undergo endoscopy to confirm diagnosis, requiring referral from secondary unit to a tertiary paediatric unit. Delay in diagnosis can occur at three stages: PO-0143 IMPROVING TIME TO DIAGNOSIS IN CHILDREN REFERRED LOCALLY WITH SUSPECTED INFLAMMATORY BOWEL DISEASE WITHIN A MANAGED CLINICAL NETWORK -A SINGLE CENTRE, SECONDARY CARE EXPERIENCE• Referral from primary care, • referral to tertiary care, • securing tissue diagnosis. Children presenting to the Royal Cornwall Hospital (RCH) in Truro are referred to the Bristol Royal Hospital for Children (BRHC). Good working relationships between RCH and BRHC mean that the majority of referrals for suspected IBD go "straight to endoscopy" rather than initial clinical review. A review of the literature did not find previously set standards against which to assess time to diagnosis.Index cases with IBD diagnosed 2010-2012 were identified from the gastroenterology clinic. Case notes were reviewed retrospectively to establish time to tissue diagnosis. Patients were then grouped by year for further analysis.Over the 3 year period, through excellent working relationships between RCH and BRCH the total time to endoscopy and therefore diagnosis was reduced by more than 50%, from 99 days to 41 days. Individual cases with longer referral times were reviewed to loo...