Today, the prevalence of obesity in the pediatric population has increased dramatically. Acute appendicitis (AA) is the most common surgical condition among pediatric patients. We aimed to investigate the impact of obesity on postoperative outcomes in terms of operative time (OT), length of stay (LOS), surgical site infection (SSI), overall complications, adverse events, and mortality in children undergoing appendectomy for acute appendicitis. An extensive search of the literature in PubMed and Google Scholar was conducted to evaluate the outcomes of normal weight (NW), overweight (OW), and obese (OB) children who underwent appendectomy. Although no statistically significant differences were noted in perioperative outcomes and overall postoperative complications between OW/OB and NW children in the majority of the included studies, prolonged OT and LOS and SSI were found in some studies. Moreover, no differences in terms of readmissions and ED visits were recorded. We conclude that the impact of obesity on postoperative outcomes for children undergoing appendectomy for AA is unclear, and, therefore, no safe conclusions can be drawn with the currently available data. Due to the lack of high-quality studies, further research is required to optimize the surgical approach and prevent unwarranted complications.

Background: Elemental or amino-acid-based formulas play a crucial role in pediatric nutrition, offering a therapeutic alternative when human milk is poorly tolerated or in specific disease states. Mostly used in various cases of allergy, maldigestion, or malnutrition, elemental formulas serve as a special therapeutic regimen in clinical practice to promote growth and development. Methods: This narrative review briefly surveys the literature of the past decade available on PubMed, Scopus, and Google Scholar, encompassing original research, review articles, and position papers. Results: The indications for using elemental formulas in pediatric clinical practice extend beyond cow’s milk allergy to conditions such as eosinophilic esophagitis, intestinal failure, Crohn’s disease, hepatic failure, chronic pancreatitis, and various neurological and other malnutrition-related disorders. Conclusions: Elemental formulas are associated with potential health benefits for pediatric patients in certain conditions, either as a first-line feeding option or under conditional use. Despite their drawbacks, they are regarded as a therapeutic tool with numerous indications, requiring careful implementation by a multidisciplinary team of healthcare experts. Future expert guidelines, including dosage, timing, and long-term effects of elemental diets, are needed for pediatric clinical practice.

Objective: The olive oil–based Mediterranean ketogenic diet (MedKD) may support patients with drug‐resistant epilepsy (DRE) or neurometabolic disorders by integrating ketogenic therapy with the cardiometabolic and neuroprotective advantages of the Mediterranean diet. This study assessed alterations in gut microbiota composition and short‐chain fatty acids (SCFAs) in Greek pediatric epilepsy patients under a 3‐month MedKD. Methods: Patients eligible for ketogenic diet therapy and one parent per patient as controls were enrolled. An olive oil–based KD aligned with Mediterranean principles was initiated during a 5–7‐day hospital stay. Anthropometric, nutritional, biochemical and clinical data were recorded at baseline and after 3 months. Fecal samples were collected from patients at both time points, and parents provided a single baseline sample. Microbiota composition was analyzed using 16S rRNA gene next‐generation sequencing, and SCFAs were quantified via gas chromatography. Written informed consent was obtained from all parents. The study was registered at ClinicalTrials.gov (NCT05898438). Results: The study enrolled 18 pediatric/adolescent patients (aged 2.5–15.5 years) and 17 parents at baseline (T1). After 3 months (T2), 13 patient–parent pairs completed follow‐up. MedKD adherence was high, with mean ketone levels of 2.6 mmol/L and a clinical response in 85% of patients. Anthropometric measurements improved, and lipid changes were modest. No significant α‐diversity differences were detected between patients and parents at T1 or between T1 and T2 in patients, whereas β‐diversity differed significantly between parents and patients at baseline. Epilepsy‐associated genera were more abundant in patients. At T2, patients exhibited shifts including increased members of Eggerthellaceae and decreased Lachnospira and Bifidobacterium . Major SCFAs remained stable, with increases limited to minor protein‐derived SCFAs. Significance: The MedKD was associated with high adherence, efficacy, and anthropometric improvements, along with modest effects on the lipid profile. Microbial and SCFA changes reflected both the epilepsy‐related milieu and potential influences of the diet's high olive oil content.

The ketogenic diet (KD) has long been used in the treatment of drug-resistant epilepsy, demonstrating significant beneficial health effects. Various modifications of the KD have been introduced as alternatives to the classical, more restrictive form, aiming to improve patient’s adherence while maintaining therapeutic efficacy. Among these adaptations, the Mediterranean ketogenic diet (MedKD) has been primarily implemented in populations in the Mediterranean region. The MedKD integrates elements of the traditional Mediterranean diet, with olive oil as the primary fat source, leveraging its unique properties. This narrative review examines the possible connections between olive oil and the mechanisms of KD, proposing the extra virgin olive oil-rich MedKD as a healthier option with the potential for reduced adverse effects.

Intestinal-failure-associated liver disease (IFALD) is a common complication of prolonged parenteral nutrition (PN). Risk factors for IFALD include clinical features, as well as medical interventions, and its management was initially based on the decrease or interruption of parenteral nutrition while increasing enteral nutrition. However, the tolerance of full enteral nutrition in children with intestinal failure may require prolonged intestinal rehabilitation over a period of years. As a consequence, infants unable to wean from PN are prone to develop end-stage liver disease. We describe the case of an infant receiving long-term PN who was diagnosed with IFALD wherein we were able to reverse IFALD by switching lipid emulsions to fish oil monotherapy. A systemic review of case reports and case series on reversing IFALD using fish oil lipid emulsion follows the case description.