Nutritional evaluation and intervention

Nutritional surveillance is central to the care of all children because of the national propensity for childhood obesity and metabolic complications. Sound nutritional advice should be given at the earliest times in life, even prenatally, as healthy nutritional practices instituted at an early age are likely to be the most sustainable over the life course. The assessment of body mass index should be a routine part of clinical care and other body composition methods, such as waist circumference and regional skinfolds, and should be employed to ascertain compartmentalization of body fat with a focus on central adiposity. A critical assessment of dietary intake is necessary to identify eating patterns and choices that are amenable to change. The 24-h, multiple-pass food recall method is the most reliable, but all methods are fraught with technical flaws. Biochemical indicators including cardiometabolic risk profile, inflammatory biomarkers, and micronutrient levels, including vitamins D, E, and iron, should be routinely measured. Treatment is aimed primarily at lifestyle modifications that advocate sound nutritional practices with weight loss or weight maintenance in the growing child kept in mind. However, nutritional interventions are unlikely to be effective when instituted in isolation. A multidisciplinary management strategy that addresses nutritional, lifestyle, psychological, and pharmacological approaches is essential to promote the most optimal nutrition to prevent and treat the metabolic syndrome in childhood.