Children with Cerebral Palsy (CP) encounter substantial nutritional challenges that impair their health and quality of life. Despite the importance of nutrition in managing CP and the recognition of physiological, behavioral, and social causes of malnutrition, research on the effectiveness of individualized nutritional interventions developed and supported by multidisciplinary teams is scarce. The study will evaluate the impact of an individualized nutritional intervention developed and supported by a multidisciplinary team on the anthropometric outcomes and overall health of children with CP. A single-center, randomized controlled trial, conducted at the Medical University of Varna, Bulgaria, will enroll 100 children aged 2–12 years and diagnosed with CP. Participants will be randomly assigned to either an intervention group, receiving comprehensive structured dietary assessment and individualized nutrition plan developed by a multidisciplinary team of experts, or to a standard care group. Outcomes assessed will focus on anthropometric measures of nutritional status, but also include health outcomes, child development and clinical assessments, and quality of life indicators. Ethical approval for this study has been obtained from the Medical Ethics Committee at the Medical University of Varna (Protocol No. 134 dated 20.07.2023). This study will assess the benefits of a multidisciplinary, individualized nutritional intervention for children with CP. The findings will have implications for clinical guidelines and interventions aiming to improve their care and quality of life.

Aim: This study aims to explore the prevalence of vitamin D deficiency (VDD) among children with cerebral palsy (CP) and autism spectrum disorder (ASD) in Bulgaria, while analyzing associated demographic, nutritional, and biochemical factors. Materials and methods: A cross-sectional study was conducted in Northeastern Bulgaria, involving 95 children (59 with CP and 36 with ASD). Vitamin D status was assessed using biochemical markers and categorized as deficient (<20 ng/mL), insufficient (20-29 ng/mL), or normal (≥30 ng/mL). Statistical comparisons were performed to identify differences across groups. Results: VDD was prevalent in 29.4% of children with CP and 15.8% of those with ASD, with no significant intergroup differences (p=0.492). Demographic analysis revealed significant gender (p<0.001) and ethnic differences (p=0.006). Children with VDD exhibited lower height-for-age Z scores (p=0.002), weight-for-age Z scores (p=0.021), albumin levels (p<0.001), and lymphocyte counts (p=0.011). Normal ferritin levels alongside reduced transferrin and serum iron suggested protein synthesis deficits rather than depleted iron stores. Conclusion: This study, which is the first in Bulgaria to address vitamin D deficiency in children with autism spectrum disorder and cerebral palsy, emphasizes the necessity of tailored interventions and nutritional support. The findings emphasize the role of biological and sociocultural factors in the prevalence of VDD, contributing valuable insights into pediatric health in moderate-climate regions.

Background: Allergic diseases in early childhood are influenced by genetic predisposition and modifiable early-life exposures, including epigenetic mechanisms. Understanding the interplay between environmental factors and allergy development in children with atopic heredity is critical for prevention strategies. Objective: To investigate the associations between selected early-life environmental exposures and the development of allergic conditions in children with a positive family history of atopy. Methods: A cross-sectional study was conducted among 120 children aged 2 years (±5 months) with atopic heredity, recruited at the Medical University of Varna, Bulgaria (2017–2020). Data on sociodemographic background, prenatal exposures, birth mode, feeding practices, pet contact, daycare attendance, and infectious burden were collected via structured questionnaires and medical records. Allergic outcomes (food allergy and atopic dermatitis) were physician-confirmed. Statistical analyses included t-tests and chi-square tests. Results: Food allergy was diagnosed in 23.3% and atopic dermatitis in 21.7% of participants. Formula feeding was significantly more common in children with food allergy (66.7% vs. 38.1%; p = 0.020). A lower maternal pregnancy experience score was significantly associated with both food allergy (p = 0.021) and overall allergic outcomes (p = 0.004). Indoor smoking was more common in households of non-allergic children (p = 0.034). Children with food allergy had significantly more rhinopharyngitis episodes (p = 0.014) and longer infection duration. Higher gastroenteritis frequency and hospitalization rates were also noted in food-allergic children. Conclusions: In children with atopic heredity, early formula feeding, prenatal maternal stress, and infection burden were associated with increased risk of allergic conditions. This study underscores the importance of early-life psychosocial and environmental influences, possibly mediated by epigenetic mechanisms, in the development of childhood allergies. These findings highlight novel targets for early prevention and warrant further longitudinal research.

Background/Objectives: Iron plays an important role in cognitive, behavioral, and motor development. This study aims to assess the iron nutritional status of Bulgarian children with cerebral palsy (CP) and autism spectrum disorder (ASD), focusing on iron deficiency (ID) and its impact on children’s development. We hypothesized that children with CP and ASD suffer from iron deficiency. Methods: The cross-sectional study includes 95 children from northeastern Bulgaria. Data were collected in two periods (2017–2018 and 2023–2024). Demographic questionnaires, food frequency questionnaires, and laboratory tests for hemoglobin, serum iron, serum ferritin, serum albumin, and CRP were conducted. Anthropometric measurements were evaluated. The Gross Motor Function Classification System scale was used to assess motor function in children with CP. Statistical analysis was performed using Jamovi software, ver. 2.6.44, with a significance level of p < 0.05. Results: Of the 95 children, 62.1% had CP and 37.9% had ASD. Most children had normal hemoglobin and serum iron levels, but 62.7% of those with CP and 36.8% of those with ASD had low serum ferritin levels, indicating latent ID. A higher proportion of children with CP than those with ASD consumed meat daily, while fish was more commonly consumed by children with ASD. Anthropometric data showed delayed growth and lower height-for-age scores in children with CP. Conclusions: The study identifies latent ID in children with CP and ASD. An evaluation of dietary habits highlights the need for interventions to improve nutritional status and development. The observed deficiencies emphasize the need for regular monitoring and targeted dietary programs for children in these groups.

Purpose: To investigate aspects of insulin resistance in children with autism. Material/Methods: In January 2024, the search was conducted using three bibliographic databases: PubMed, Scopus, Google Scholar, and Mendeley. The objective of the search was to find relevant sources on metabolic diseases Insulin resistance (IR) in Autism spectrum disorders (ASD) from 2016 to 2023. The search technique involved using the terms and keywords: "(IR OR Insulinopathie) AND (child OR toddler OR adolescent OR school age) AND (ASD OR Autism)." The two independent reviewers (RB and AT) systematically conducted the data extraction process. Results: There is no conclusive evidence that prenatal insulin resistance is a risk factor for the onset of autism. Poor eating habits, lack of physical activity, presence of other medical conditions, and use of medications can contribute to increased obesity rates in children with ASD, leading to potential health issues like diabetes, insulin problems, and heart disease. Some experts highlight the metabolic risks, specifically insulin resistance, associated with prescribing antipsychotic drugs to children with autism. Risperidone causes a notable increase in weight and serum triglyceride levels, even when used briefly. Teenagers with autism spectrum disorder demonstrate increased HOMA-IR levels, possibly indicating decreased glucose utilization in certain areas of the brain. Conclusion: Understanding how insulin resistance affects peripheral metabolism and the CNS could lead to extensive research to enhance the neuropsychological development of children with autism and have implications for public health.

Background/Objectives: Autism Spectrum Disorder (ASD) is characterized by social communication challenges and repetitive behaviors. Children with ASD often exhibit selective eating habits that may result in nutritional deficiencies and exacerbate developmental issues. While food frequency questionnaires (FFQs) are effective for dietary assessment, the links between food preferences, ASD severity, and developmental outcomes remain underexplored, particularly in Bulgaria. This study examines these relationships using validated tools. Methods: The present report constitutes a pilot, hypothesis-generating substudy of the broader NutriLect project. This substudy involved 49 children aged 2–12 years diagnosed with ASD. Dietary patterns were evaluated with a modified FFQ, while ASD severity and developmental profiles were assessed using the Childhood Autism Rating Scale, Second Edition (CARS-2) and the Developmental Profile 3 (DP-3). Results: Among 49 ASD children (mean age = 6.89 ± 2.15 years; 86% boys), 73.4% consumed grains/potatoes daily. Only 34.7% met combined fruit and vegetable recommendations. Only 36.7% met the recommendation for daily milk or other dairy product consumption. Fish was consumed at least twice weekly by only 22,4%. Furthermore, children with more severe autism were approximately 9.4 times more likely to consume grains daily (χ² = 14.319, p = 0.006). Logistic regression analyses indicated that higher cognitive scores were strongly associated with lower grain (OR ≈ 0.044) and other dairy products consumption (OR ≈ 0.337), yet with greater fish intake (OR ≈ 3.317). In contrast, better communication skills corresponded to increased milk consumption (OR ≈ 5.76), and higher physical development scores predicted more frequent egg consumption (OR ≈ 4.40). Conclusions: The pronounced preference for grain and meat products, which are frequently ultra-processed, and avoidance of nutrient-dense foods in children with severe ASD symptoms underscore the need for tailored dietary interventions. These interventions must address sensory sensitivities, nutritional inadequacies, and the risks that selective nutrition can have on the nutritional status and development of the children.