Linking obesity, obesity-related diseases, Mediterranean style-diet and gut microbiota in pediatrics

The worldwide prevalence of overweight and obesity among children and adolescents has risen dramatically. Obesity is a complex and multifactorial condition associated with an increased risk of multiple comorbidities, like diabetes, arterial hypertension, dyslipidemia, cardiovascular diseases and cancer. Most of them have been already described since pediatric age. However, precocious biomarkers for identifying "high risk" subjects to an unhealthy metabolic profile are lacking, especially in pediatrics. Thus, one of the aims of this Ph.D. project was to investigate the development of obesity-related diseases in obese children and adolescents, identifying precocious biomarkers that could allow early detection and promote prevention strategies. Besides, we reported that insulin resistance, metabolic syndrome, and hyperuricemia correlated with cardiovascular dysfunction in pediatric obesity, Furthermore, we identified novel metabolic risk factors, in particular high-normal estimated glomerular filtration rate and haptoglobin phenotypes. The fundamental cause of overweight and obesity is an energy imbalance between calories consumed and calories expended. Certainly, the diet plays a key role and is a crucial variable for a healthy life. A rapidly growing number of studies, in recent years, support the hypothesis that the Mediterranean style-diet has beneficial effect. However, the urbanization of people living in the Mediterranean area modified lifestyle choices deviating to a "Western diet" richer in saturated fat, refined grains, simple carbohydrates and processed foods. Thus, we also almed to describe the adherence to the Mediterranean style-diet in children and adolescents, assessing the potential effect of healthier behaviours. In nothern Italy, we described poor food quality which replaced the Mediterranean dietary pattern in children and adolescents, in particular among younger children. Moreover, in a systematic review, we supported skipping breakfast as an easy marker of the risk of overweight and obesity and metabolic-related diseases. Besides, increasing evidence especially reported the involvement of the gut microbiota in the dysmetabolism associated with obesity. For this reason, exploring the role of the gut microbiota in the development of childhood obesity was another outcome of this Ph.D. project, for potentially revealing new strategies for obesity prevention and treatment. Our first baseline findings correlated gut microbiota to dietary pattern and adherence to the Mediterranean style-diet. This suggested that dietary intervention would have enormous potential in modulating the microbial composition and promoting a more health-associated metabolic profile. However, few data are nowadays available concerning pediatrics, so this relationship awaits further studies. Most of the above-mentioned results were published on international peer-reviewed scientific journals, hoping to contribute to the current knowledge on the crosstalk between obesity, obesity-related diseases, Mediterranean style-diet and gut microbiota. Futhermore, during the Ph.D. project the GOOD-DAY Trial was designed and realized (ID NCT03154255). Although COVID-19 pandemic temporary stopped it, further results are awaited in the next months.