Children's Memorial Health Institute

Diet during early infancy, as well as dietary patterns during childhood and parental feeding styles influence children’s eating behaviours and long-term health. While extensive data exist on the timing of complementary feeding introduction and recommended food frequencies during infancy and childhood, data on portion sizes during this period remains limited in Europe, despite their clear relevance for evaluating dietary patterns and supporting evidence-based guidance. This longitudinal study, secondary to the European Childhood Obesity Project (EU CHOP), aims to describe portion sizes consumed by infants and children aged 6 months to 8 years across five European countries. Dietary intake was recorded using 3-day food diaries and analysed by trained personnel following standardized procedures at multiple infant and childhood ages (6, 7, 8, 9, 12, 24, 36, 48, 60, 72 and 96 months). Portions sizes were calculated for 33 food groups and expressed as percentiles in the overall sample and stratified by country. A total of 1018 3-day food records were available at 6 months, with sample size gradually declining over the 11 follow-up time points to 400 records at 8 years. The results revealed a wide variation in portion sizes across food groups, ages and countries. Food portion sizes vary across food groups, age and countries. These findings provide reference percentiles representing typical portion sizes when foods are consumed. The data can support guidance provided to parents by healthcare professionals (pediatricians, nurses, and dietitian-nutritionists) and assist public health authorities in defining appropriate portion sizes and mitigating risks associated with both overeating and undereating, while respecting children’s hunger and satiety cues. These results also have practical applications in school meal planning and dietary assessment methodologies in research.

The choice of vascular access (VA) plays a key role in the success of hemodialysis (HD). Despite their widespread use, central venous catheters (CVCs) are associated with higher rates of dysfunction, thrombosis, and catheter-related bloodstream infections (CRBSI). We investigated current practices in pediatric HD across European pediatric nephrology centers, focusing on VA choices, infection control measures, and CRBSI management. An online questionnaire was e-mailed to 119 members of the European Society for Pediatric Nephrology (ESPN) Dialysis Working Group and European Pediatric Dialysis Working Group (EPDWG). Descriptive statistics were used to summarize practices across centers, comparative analyses between centers in countries with Human Development Index (HDI) > 0.90 and < 0.90. Thirty-one centers across Europe participated in the survey. CVCs were the primary VA in 73.1% of the centers. Twenty (66.7%) centers reported malfunction as the most common CVC complication, followed by catheter thrombosis (19.4%) and CRBSI (12.9%). The diagnostic approach for CRBSI varied widely, with 35.4% of centers relying on a single positive catheter culture, while 57.9% did not collect a second culture from the peripheral vein or HD circuit. The most common empirical treatment was glycopeptides combined with third-generation cephalosporins. Nearly all centers used intravenous antibiotics for less than 3 weeks, and over half modified lock solutions with antibiotics following CRBSI diagnosis. Catheter removal practices were inconsistent, even in cases of severe infection. Centers reported a total of 548 HD patients. Exit-site infections and CRBSI were observed in 98 (17.8%) and 155 (28.2%) patients, respectively. CRBSI rates and CRBSI-related catheter replacements were significantly higher in centers from countries with HDI < 0.90 and in centers without a dedicated pediatric HD unit.Conclusion: The suboptimal adherence to current VA recommendations and wide variability in catheter care practices including the prevention, diagnosis, and management of CRBSI highlight the need for standardized pediatric-specific protocols to enhance catheter longevity and improve patient outcomes.What is Known:• Central venous catheters are widely used in pediatric hemodialysis but carry a high risk of complications, especially catheter-related bloodstream infections (CRBSI).What is New:• This multinational survey reveals significant variability in vascular access selection, CRBSI prevention, diagnosis, and treatment across European pediatric hemodialysis centers, with clear disparities by national HDI levels.• The findings highlight the need for standardization of vascular access care and CRBSI management and evidence-based pediatric-specific guidelines.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00431-025-06703-7.

Abstract Background Tasty&amp;Healthy (T&amp;H) is a whole food diet shown to induce clinical and biological remission in Crohn’s disease (CD)(1). It eliminates processed foods, gluten, red meat, and dairy (except plain yogurt); no formula or mandatory components are needed. Here we aimed to evaluate whether T&amp;H diet maintenance treatment induces radiologic and endoscopic remission while gradually reintroducing gluten and dairy. Methods Patients, aged 4–37 years, achieving deep remission (MINI index&amp;lt;8 and wPCDAI&amp;lt;12.5/CDAI&amp;lt;150) in the previous TASTI-MM (T&amp;H vs. EEN) and TASTI-E (T&amp;H vs. regular diet) induction RCTs, were enrolled in this open-label maintenance trial and completed 24 weeks on the diet. Gluten and dairy were reintroduced monthly; &amp;gt;30% increase in fecal calprotectin prompted re-elimination of the specific ingredient. Intestinal Ultrasound with Segmental Activity Scoring (IUS-SAS) was performed at weeks 0, 8 and 24 and, in a subset who consented, video capsule-endoscopy (VCE) or ileocolonoscopy at week 24. Results Forty-three patients were enrolled: age 16±5.8 years, 33 children/adolescents; 91% not receiving any therapy besides T&amp;H. Clinical remission at 24 weeks was maintained in 37/43 (86%) participants; 53% successfully re-introduced gluten and dairy. All IUS parameters improved from baseline to weeks 8 and 24 ( including the maximal bowel score (IBUS-SAS 44.9 [IQR 2.1-64.9], 14 [0-48.5], 13.6 [0-34,6]; p = 0.0068) and in the terminal ileum (43 [IQR 0-64.8], 14 [0- 47.5], 5 [0-31], respectively; p = 0.0069). Among 29 patients with paired IUS assessments at baseline and week 24, 86% showed improvement or normalization of the ileal IBUS-SAS score, and 83% (24/29) demonstrated improvement in both the maximal and panenteric cumulative scores. Of the 23 patients who underwent VCE/ileocolonoscopy, 14 (61%) exhibited complete endoscopic healing or had only a few aphthous ulcers. Conclusion The T&amp;H diet, combined with structured, calprotectin-guided reintroduction of gluten and dairy, maintained clinical remission and improved radiological and endoscopic inflammation in patients up to 24 weeks. Reference: 1. Aharoni-Frutkoff Y, Plotkin L, Pollak D, et al. Whole Food Diet Induces Remission in Children and Young Adults With Mild to Moderate Crohn’s Disease and Is More Tolerable Than Exclusive Enteral Nutrition: A Randomized Controlled Trial. Gastroenterology 2025. Conflict of interest: Plotkin, Luba: No conflict of interest Aharoni-Frutkoff, Yonat: No conflict of interest Shavit, Zivia: No conflict of interest Ms. Focht, Gili: No conflict of interest Livovsky, Jessica: No conflict of interest Lev Zion, Raffi: No conflict of interest Ledder, Oren: No conflict of interest Cytter- Kuint, Ruth: No conflict of interest Zharkov, Elena: No conflict of interest Broide, Efrat: No conflict of interest Assa, Amit: No conflict of interest Sigall-Boneh, Rotem: No conflict of interest Weiss, Batia: No conflict of interest Slae, Mordechai: No conflict of interest Dotan, Iris: No conflict of interest Godny, Lihi: No conflict of interest Kierkuś, Jarosław: No conflict of interest Griffiths, Anne: No conflict of interest Naftali, Timna: No conflict of interest Aloi, Marina: No conflict of interest Yerushalmy-Feler, Anat: No conflict of interest Schwerd, Tobias: No conflict of interest Reifen, Ram: No conflict of interest Turner, Dan: No conflict of interest

Abstract Background Tasty&amp;Healthy (T&amp;H) diet is an exclusion whole food diet shown to induce clinical and biological remission in Crohn’s disease (CD). We aimed to explore fecal and serum metabolomic response to T&amp;H vs. EEN and habitual diet arms in the TASTI-MM (T&amp;H vs. EEN) and TASTI-E (T&amp;H vs. habitual) RCTs. Methods We analyzed 670 serum and fecal metabolites at baseline, week 4 (fecal only) and week 8. Remission was defined by MINI index&amp;lt; 8 in TASTI-MM and by 50% decrease in calprotectin in TASTI-E. Univariate testing with multiple comparisons correction (FDR&amp;lt;0.25) were applied to each week, measured both in absolute level and in relative to baseline level. Principal component analysis (PCA) was applied for each metabolomics dataset to identify total signature shift or trends in metabolic patterns. Finally, metabolite set enrichment analysis (MESA) was applied to identify biological pathways associated with the diets using MetaboAnalyst v6.0, reporting pathway-level enrichment strength (Q statistic &amp;gt; 10) and significance (FDR &amp;lt; 0.05). Results Overall 121 children were enrolled in both RCTs with a total of 227 serum samples and 312 fecal samples collected over the RCTs’ duration with no observed metabolic differences at baseline. 140 serum and 63 fecal metabolites (in both weeks 4 and 8) consistently differed between T&amp;H and EEN in both absolute and relative comparisons. 17 serum metabolites consistently differed between T&amp;H and habitual diet in both absolute and relative comparisons while none differed in stool. PCA analysis showed overall metabolic shift in serum (Figure A) and fecal (Figure B) metabolomics signature in TASTI-MM, the most noticable shift was observed in stool at week 4, while a trend of metabolic shift in serum metabolomics was observed in TASTI-E. Both shifts were in concordance with differential metabolites detected in univariate analysis. MESA was used to infer biological interpretation which revealed in fecal metabolomics consistent and robust significant enrichment (Q-Statistic &amp;gt; 10, FDR &amp;lt; 0.05 at both weeks 4 and 8) of butyrate, histidine and tryptophan metabolism pathways in the T&amp;H group in comparison to EEN. Conclusion The T&amp;H diet promoted a distinct systemic metabolic signature which differed from those treated with EEN or continuing their habitual diet. The consistent and robust enrichment of butyrate, histidine and tryptophan metabolism pathways points to restoration of host–microbial amino acid and short-chain fatty acid networks that are implicated in intestinal homeostasis and immune regulation. Conflict of interest: Mr. Azulay, Asaf: No conflict of interest Plotkin, Luba: No conflict of interest Aharoni-Frutkoff, Yonat: No conflict of interest Livovsky, Jessica: No conflict of interest Focht, Gili: Other: Received in the past 3 years consultation fee from Lilly Lev Zion, Raffi: No conflict of interest Ledder, Oren: No conflict of interest Assa, Amit: No conflict of interest Yogev, Dotan: No conflict of interest Orlansky Meyer, Esther: No conflict of interest Broide, Efrat: No conflict of interest Kierkuś, Jarosław: Grant: Nestle Other: Nutricia, Abbvie, Nestle Kang, Ben: Other: For the past 3 years, Ben Kang has served as a speaker or consultant for Celltrion, Janssen, Eisai, Abbvie, Takeda, Yuhan, Yungjin, JW Pharmaceutical, and Samsung Bioepis and has received research funding from Celltrion. Weiss, Batia: No conflict of interest Aloi, Marina: Personal Fees: AbbVie Pfizer Dicofarm Slae, Mordechai: No conflict of interest Yerushalmy-Feler, Anat: No conflict of interest Wine, Eytan: Personal Fees: Janssen, AbbVie, Nestle Health Sciences, Mead Johnson Nutrition, Pfizer, BioJamp Turner, Dan: Consultation fee: Janssen, Pfizer, Ferring, Abbvie, Takeda, Prometheus Biosciences, Lilly, SorrisoPharma, Boehringer Ingelheim, Galapagos, BMS, AlfaSigma, Merck, Gentech Research support: Janssen, Abbvie, Takeda, Pfizer Royalties: Shaare Zedek Medical Center, Hospital for Sick Children

Abstract Background Approved treatment options for children and adolescents with ulcerative colitis (UC) are limited.1 The KEPLER phase 3 trial evaluated the efficacy, immunogenicity, pharmacokinetics (PK) and safety of vedolizumab (VDZ), an anti-α4β7 integrin biologic, administered as intravenous (IV) induction and maintenance therapy in children and adolescents with moderately to severely active UC. Methods This phase 3, single arm trial (NCT04779307) enrolled patients with moderate-to-severe UC (modified Mayo score of 5-9 with endoscopic subscore ≥2) aged 2-17 years and weighing ≥10kg with prior failure of conventional therapy such as steroids, immunomodulators, and/or tumour necrosis factor (TNF) antagonists. VDZ IV was administered during a 14-week, open-label induction period followed by a 40-week, randomised, double-blind maintenance period evaluating low- (LD) or high-dose (HD) VDZ (1:1) by body weight (10-15kg [100 vs 150mg]; &amp;gt;15-&amp;lt;30kg [100 vs 200mg]; ≥30kg [150 vs 300mg]) given every 8 weeks. The primary endpoint was clinical remission by modified Mayo score at Week 54 in the intention-to-treat maintenance population. Secondary endpoints included clinical remission at Week 14, sustained clinical remission (at Weeks 14 and 54), corticosteroid-free clinical remission at Week 54, immunogenicity, PK, and safety. Results The trial enrolled 121 patients (10-15kg, n = 3; &amp;gt;15-&amp;lt;30kg, n = 27; ≥30kg, n = 91), of whom 120 were dosed; 93 were subsequently randomised into LD (n = 47) or HD n = 46) groups for maintenance therapy (Table 1). Forty-four of 93 (47.3%) patients achieved the primary endpoint of clinical remission at Week 54, with similar proportions in LD and HD groups (Fig. 1A). Clinical remission rates at Week 54 for patients categorised by weight, age, anti-TNF exposure, and baseline corticosteroid use are shown in Fig. 1B-E. Forty-two of 121 (34.7%) patients achieved clinical remission at Week 14. At Week 54, 27/93 (29.0%) patients achieved sustained clinical remission. Anti-VDZ antibodies occurred in 7/120 (5.8%) VDZ-exposed patients, including neutralizing antibodies in 4 (3.3%); similar VDZ serum trough levels were observed across weight groups. In the safety population, 103/120 (85.8%) patients had treatment emergent adverse events (TEAEs), including 15/120 (12.5%) related to VDZ. Twenty-five of 468 (5.3%) TEAEs were serious. Five (4.2%) patients had serious VDZ-related TEAEs. Seven (5.8%) patients had TEAEs leading to VDZ discontinuation (most common: UC worsening, n = 3; infection, n = 3). Conclusion LD and HD VDZ IV were effective for children and adolescents with UC, including those with prior anti-TNF or corticosteroid failure. Similar rates were observed in adult patients with UC.2 VDZ was well tolerated, with no new safety signals identified.

We propose a new definition of inconspicuous consumption as an individual disposition and present an instrument for measuring this variable. The article describes the successive stages of the construction of the Inconspicuous Consumption Scale (ICS). The initial set of test items was generated using the method of competent judges - qualitative and quantitative evaluation using CVR Lawshe. Next, an exploratory factor analysis was carried out using data obtained from a sample of 690 participants. In the first step, parallel analysis and the maximum average partial (MAP) criterion were conducted, while in the next step, we again performed exploratory hierarchical factor analysis using maximum likelihood ML with the promax rotation. Confirmatory structure was performed on data collected from 497 respondents (confirmatory factor analysis CFA using the robust ML estimator with the Satorra-Bentler correction).The results of a preliminary selection of items and exploratory and confirmatory factor analyses have led to the development of an instrument which measures four factors that make up the global ICS: Knowledge, Services, Experiences, and Subtle Brand Signals. Reliability and validity studies carried out in Poland in a sample of 1,330 respondents show that the ICS has satisfactory psychometric properties. We have assumed that inconspicuous consumption (IC) consists of deliberate avoidance of visibility and investments directly aimed at improving the quality of life and caring for the environment, both from a local and global perspective. Treated as an individual, relatively enduring disposition in the area of consumer behavior, it appears to be a useful construct for explainingh changes in the area of consumer behavior.