As part of the LIMIT project, the oral presentation delivered at the ECO2025 Congress, titled "Maternal Weight and Delivery Mode Shape the Neonatal Gut Microbiota: Findings from the LIMIT Cohort Study at Delivery," reported on an investigation into how maternal factors and delivery mode influence the composition of the neonatal gut microbiota. Analysis was conducted on 155 meconium samples, considering variables such as pre-pregnancy BMI, gestational weight gain, delivery mode, and environmental exposures. Although no individual factor showed a significant effect on microbial diversity (Adonis PERMANOVA R² = 0.003–0.018, p > 0.05), clustering analyses using PAM and Silhouette methods identified distinct microbial profiles. These profiles did not strongly correlate with any specific maternal characteristics, suggesting a complex interplay of multiple influences on early gut microbiota development. The findings indicate that neonatal gut microbiota composition at birth is shaped by a combination of interacting factors rather than isolated variables, underscoring the multifactorial nature of microbial colonization in the early neonatal period.

As part of the MATER project, the results of the recent systematic review titled “Folic acid supplementation in European women of reproductive age and during pregnancy with excessive weight: a systematic review” were presented during the poster session. The review highlighted that Neural tube defects (NTDs), severe congenital malformations linked to maternal folate deficiency, pose a particularly high risk for women with excess weight. Women with obesity tend to have lower plasma folate levels and respond less effectively to the standard folic acid dose (0.4 mg/day) due to increased metabolic demands and chronic low-grade inflammation. For this group, the World Health Organization (WHO) recommends a higher folic acid dose of 5 mg, to be taken before conception and during the first trimester of pregnancy. However, the data from the review reveal that adherence to these recommendations remains low (only 4–9.5% of pregnant women with obesity), with supplementation often started too late to effectively prevent NTDs. Furthermore, the majority (61%) started supplementation after conception, highlighting that European pregnant women are not particularly adherent to recommendations during the period of greatest need. The review emphasizes the urgent need to standardize folic acid supplementation guidelines across European countries. In particular, women of childbearing age with excess weight should be closely monitored through assessments of serum folate, red blood cell folate, and homocysteine levels. This would allow the development of tailored supplementation protocols to effectively reduce the occurrence of NTDs.

Findings drawn from the LIMIT prospective cohort study, were presented during a poster pitch session entitled ”Maternal Lifestyle and Gestational Weight Gain: Findings from Correspondence Analysis”. The analysis highlighted that inadequate gestational weight gain (GWG) is linked to adverse maternal and neonatal outcomes, including preterm birth and low birth weight. Identifying key determinants of GWG is essential for improving maternal-infant health. This study applied correspondence analysis (CA) to explore relationships between maternal characteristics and GWG deviations, using baseline data from 162 women in the LIMIT prospective cohort. CA revealed two main dimensions explaining GWG variability. Dimension 1 (71.0% inertia) was strongly associated with excess GWG and correlated with pre-pregnancy overweight and poor adherence to the Mediterranean diet. Dimension 2 (59.5% inertia) aligned with adequate GWG and healthier behaviors such as higher vegetable intake. Profiles linked to excess GWG included lower education, smoking, high meat consumption, and pre-pregnancy mothers with overweight or obesity. Moderate Mediterranean diet adherence showed some association with low GWG, while underweight and obese women were more frequently associated with adequate GWG. These results highlight maternal lifestyle factors, especially diet quality, as critical determinants of GWG. Excess GWG correlates with unhealthy behaviors, whereas adequate GWG aligns with healthier lifestyle patterns. The findings support integrating nutritional counseling and physical activity promotion into prenatal care, improving access to maternal health services, and increasing awareness about healthy behaviors in women of reproductive age. Addressing these factors may optimize GWG and improve health outcomes for mothers and their children.

The LIVELY project (MuLtidimensional school-based and family Involved interVentions, to promote a hEalthy and sustainable LifestYle for the childhood obesity primary prevention) was conducted from October 2023 to October 2024 at the public primary school “Luigi Cadorna” in Milan, led by Istituto Mario Negri and the Laboratory of Dietetics and Clinical Nutrition, University of Pavia. It aimed to assess overweight/obesity prevalence in children, identify contributing family factors, and implement a multidimensional educational intervention promoting healthy, sustainable lifestyles. The program included age-appropriate lessons, games, and creative activities focused on nutrition and lifestyle, with summary materials shared with families. A total of 227 children from 14 classes (mean age 8.9±1.2 years, 48% male) participated. Overweight/obesity affected 24% of males and 23% of females, with central obesity present in 35% and 36%, respectively. BMI z-scores, waist-to-height ratios, and abdominal circumferences varied by ethnicity, with higher values in Hispanic and African children. From baseline to post-intervention, adherence to the Mediterranean diet remained stable, while water intake and both scheduled (66.1% to 71.4%) and unscheduled (82.1% to 85.6%) physical activity increased; screen time remained unchanged. Most children (55%) enjoyed the activities, 89% wanted the project repeated, and 83.3% of parents reported a “very positive” impact on their child’s health. Teachers overwhelmingly supported the initiative (93.3%). At follow-up, over half of the students passed an educational questionnaire, indicating improved knowledge. The project underscored the burden of obesity in a multiethnic school context and demonstrated the feasibility and impact of a reproducible, multidisciplinary approach to childhood obesity prevention.

The AUT-MENU study is a bicentric intervention led by the Laboratory of Dietetics and Clinical Nutrition of the University of Pavia and the Research Centre for Food and Nutrition (CREA) of Rome. The main objective of the AUT-MENU project is to improve meal acceptance in individuals with Autism Spectrum Disorder (ASD), a population often characterized by low dietary diversity due to Food Selectivity (FS), which can lead to malnutrition, including obesity and/or micronutrient deficiencies. A secondary goal is to assess the effectiveness of a nutrition education course for parents and caregivers in reducing FS. The study is being conducted in three care centers (located in Pavia and Milan) and one secondary school in Rome, involving approximately 200 participants with ASD aged 3 to 35 years. The research includes two phases: an observational phase (T0) and an intervention phase (T1). During T0, biographical data, clinical characteristics, and dietary habits of participants are collected. Based on these findings and current nutritional guidelines for individuals with ASD, targeted menus are developed and introduced. In the T1 phase, the same assessment tools used at baseline will be applied to evaluate the impact of the intervention. Between T0 and T1, a nutrition education course for caregivers will be implemented, accompanied by pre- and post-course questionnaires to assess changes in nutritional knowledge. As of September 2024, enrollment was completed in the care centers of Pavia and Milan, with 74 participants recruited. In Rome, the enrollment phase has not yet started, but activities are expected to follow the same structure as in the northern sites. The study is expected to provide valuable insights into strategies for improving meal acceptance in individuals with ASD, particularly through the implementation of tailored menus in institutional catering settings such as care centers and schools.

Preliminary findings of the FACILITY project “Feeding the Family: the Intergenerational Approach to Fight Obesity” have been presented during the poster session, marking a significant step forward in the ongoing research. Preliminary analysis of participants (36 children/adolescent) in the FACILITY project highlights a high prevalence of obesity and severe obesity among children and adolescents involved. Lifestyle assessment revealed suboptimal adherence to the Mediterranean Diet, with dietary quality tending to decline with age. Sleep patterns were generally inadequate, with only a small proportion of participants meeting recommended standards. Increased screen time was associated with reduced sleep duration, underscoring the impact of digital exposure on rest quality. Although many participants reported engaging in physical activity, those not meeting international guidelines presented with higher levels of excess weight. These preliminary results point to widespread unhealthy lifestyle habits in children with excessive weight, including poor diet, insufficient sleep, and excessive screen use. The findings underline the importance of early, targeted interventions in nutrition and screen-time management. Future phases of the project will broaden the scope to include maternal influences, aiming to better understand the complex factors contributing to childhood obesity.