Pediatric obesity management strategies suffer from a high rate of dropout and persistence of weight excess, despite the use of new tools, such as automated mobile technology (MT). We aimed to compare the efficacy of two 6-month personalized MT protocols in terms of better engagement, adherence to follow-up visits and improved anthropometric and lifestyle parameters. MT contacts consisted of three personalized/not automated What’s App® self-monitoring or challenge messages per week. Messages, sent by a dedicated coach were inserted between three-monthly in-presence regular visits with (PediaFit 1.2) or without (PediaFit 1.1) monthly free-of charge short recall visits carried out by a specialized pediatric team. The sample included 103 children (mean age 10 years, range 6–14) recruited in the Pediatric Obesity Clinic between January 2017 and February 2019, randomized into Intervention group (IG) (n = 24 PediaFit 1.1; n = 30 PediaFit 1.2) and Control group (CG) (total n = 49). Controls received standard treatment only (indications for healthy nutrition and physical activity, and three months in presence regular visits). Overall, both IGs achieved significantly better results than the CGs for all considered parameters. Comparison of the two IGs at the sixth month in particular showed an IG 1.2 statistically significantly lower drop-out rate (10% vs. 62%, p = 0.00009), along with significantly improved BMI (p = 0.003), Screen Time (p = 0.04) and fruit and vegetables consumption (p = 0.02). The study suggests that the hybrid association of messaging through personalized/not automated MT plus monthly free-of charge recall visits may improve the prefixed outcomes of MT weight loss intervention programs.

SUMMARY: This is the second part of a retrospective and review MR imaging study aiming to define the frequency rate, timing, imaging features, and evolution of gray matter changes in Menkes disease, a rare multisystem X-linked disorder of copper metabolism characterized by early, severe, and progressive neurologic involvement. According to our analysis, neurodegenerative changes and focal basal ganglia lesions already appear in the early phases of the disease. Subdural collections are less common than generally thought; however, their presence remains important because they might challenge the differential diagnosis with child abuse and might precipitate the clinical deterioration. Anecdotal findings in our large sample seem to provide interesting clues about the protean mechanisms of brain injury in this rare disease and further highlight the broad spectrum of MR imaging findings that might be expected while imaging a child with the suspicion of or a known diagnosis of Menkes disease. ABBREVIATION: MD ϭ Menkes disease

The term non-alcoholic fatty liver disease (NAFLD) appears unfitting both in adults and in children. As obesity and metabolic syndrome play a relevant pathogenic role, an international group of adults’ liver disease experts has proposed to rename this condition metabolic (dysfunction)-associated fatty liver disease (MAFLD). While this new more appropriate and useful definition has mostly been met with good reactions in adults, it may present a tangled path in pediatrics. Here we further stress the recommendations of the North American and the European Societies for Pediatric Gastroenterology, Hepatology and Nutrition that a hyperechogenic liver in a child affected by obesity or overweight with chronically elevated liver enzymes should not be assumed to have NAFLD only. Especially in those patients who are not in the classic age range or who have particularly severe laboratory anomalies, other genetic, metabolic (inborn errors of metabolism, IEM), endocrine, intestinal and hepatic pediatric-onset conditions, should in fact be excluded, particularly when response to a weight loss trial is not available. The term pediatric fatty liver disease (PeFLD) with three subtypes (1. contextual diagnosis of an IEM; 2. Metabolic (dysfunction)-associated fatty liver; 3. unknown cause of fatty liver) has recently been proposed aiming to separate true MAFLD from IEM and/or the other above mentioned conditions, which may be rare when considered individually but represent a large group when considered collectively. Although the cost-effectiveness ratio of this attitude is still indeterminate, it is likely that the advantage of the early identification of a specifically treatable pediatric-onset liver disease associated to/mimicking MAFLD would be rewarding.

SUMMARY:Menkes disease is a rare multisystem X-linked disorder of copper metabolism. Despite an early, severe, and progressive neurologic involvement, our knowledge of brain involvement remains unsatisfactory. The first part of this retrospective and review MR imaging study aims to define the frequency rate, timing, imaging features, and evolution of intracranial vascular and white matter changes. According to our analysis, striking but also poorly evolutive vascular abnormalities characterize the very early phases of disease. After the first months, myelination delay becomes evident, often in association with protean focal white matter lesions, some of which reveal an age-specific brain vulnerability. In later phases of the disease, concomitant progressive neurodegeneration might hinder the myelination progression. The currently enriched knowledge of neuroradiologic finding evolution provides valuable clues for early diagnosis, identifies possible MR imaging biomarkers of new treatment efficacy, and improves our comprehension of possible mechanisms of brain injury in Menkes disease. ABBREVIATION: MD ϭ Menkes disease

Background and Aims We describe the relationship between overweight and obesity and Hypertension on ABPM. Method We conducted a cross-sectional study using a database of patients aged 6-16 years, who had undergone 24h ABPM from December 2002 through December 2016. ABPM were performed using the validated device Spacelab 90217. Were evaluated the 24h MAP, daytime MAP, nocturnal MAP, systolic and diastolic load, MAP Systolic and Diastolic. Subjects were grouped by BMI Z-score into overweight (>1<2), obese (BMI Z-score >2<3) and severe obese (BMI Z-score >3). A total of 1016 patients were enrolled and recorded n.1210 ABPMs. Obese pts were 202 (19.8%); 126 M;76F;median age 10,2 y. Overweight childrens were 97 (11.9%);52 M;45F;median age 8,4y. Results Among overweight childrens (BMI Z-Score >1<2): 12 (12.3%) had hypertension, 22 (22.6%) pre-hypertension, 15 (15.4%) MH; non dipping pattern was recorded in 26 (52%). 48 were normotensive. Among obese childrens, 122 had hypertension (60.3%): 24 pts had Masked Hypertension (19.6%); 72 (59.0%) had severe ambulatory hypertension with BMI z-score >3 (mean 3.8) ,and in this category all pts were both systolic and diastolic non dipping. 32 (64%) obese with BMI z-score >2, <3 were non-dipping. Diastolic load was significantly higher (p>0,0001) in severe obese. 28 pts had ambulatory prehypertension (13.8%), 11 pts had White Coat Hypertension (4.9%).41 pts had normotension (20.2%). Conclusion The severity of ambulatory hypertension increased with increased BMI Z-score. The non-dipping status is associated, not only with higher BMI Z-score, but was present in overweight and obese with BMI z-score >2<3 also. ABPM is an effective tool that should become routine in all obese patient, but also in overweight childrens, which may lead to better treatments and prevention methods.