Myocardial function, mechanics and work by echocardiography in adolescents with severe obesity.

Introduction: Obesity and its metabolic complications can impact the heart's structure and function in childhood, although demonstrating this impact has been challenging. New echocardiographic parameters such as left atrial strain (LAε) and left ventricular strain (LVε), as well as myocardial work (MW), could reveal subclinical alterations in cardiac function. Objective: The aim is to evaluate the feasibility of these parameters in adolescents with severe obesity and explore their associations with body fat, metabolic comorbidities, and physical capacity. Methods: This is a cross-sectional study in adolescents with obesity who underwent echocardiography with analysis of LAε, LVε and MW using speckle tracking. Feasibility and association with anthropometry, body fat percentage, comorbidities and cardiopulmonary test were analyzed. Results: Twenty adolescents were recruited, 13 (65%) were males, median age 14.2 (interquartile range: 12.9-14.9) years old. The median Z-score for BMI (zBMI) was +3.03 (2.87-3.14), 14 (70%) had severe obesity (zBMI ≥+3), 12 (60%) body fat ≥95th percentile, 9 (45%) high blood pressure (HBP) and 8 (40%) metabolic syndrome. The analysis of the echocardiographic parameters was feasible in 95% (LAε) and 100% (LVε and MW). LVε was lower in adolescents with vs. without metabolic syndrome: 17.8% (17.5-19.3%) vs. 19.3% (18.3-20.3%), P = 0.046; and with vs. without HBP 17.8% (17.5-18.6%) vs. 19.7% (18.4-20.3%), P = 0.02. Those with body fat ≥95th percentile had lower LAε and MW parameters, without association with cardiopulmonary test. Conclusion: Echocardiographic evaluation of LAε, LVε and MW is feasible in adolescents with severe obesity. A higher proportion of body fat and the presence of comorbidities are associated with alterations in these new echocardiographic functional parameters suggesting myocardial impact of higher metabolic compromise.

Assessment of a consensus definition of obesity and metabolic health phenotypes in children at different pubertal stages.

Not all individuals with obesity develop metabolic complications, which has brought about the concepts of metabolically healthy and unhealthy obesity (MHO/MUO). However, inconsistent definitions of these conditions have limited their understanding. We assessed whether a recently-proposed consensus definition for MHO/MUO correlates with adiposity and reflects metabolic risk parameters during puberty. Low-middle income children from the Growth and Obesity Cohort Study (Santiago, Chile) were included (n = 949; 1692 visits at Tanner (T)2, T4 and/or one-year post menarche (1YPM)). Anthropometry, body composition and metabolic parameters were compared between MUO and MHO, and also in children without obesity. The risk for presenting MUO phenotype was significantly elevated with higher waist-height ratio (T2), zBMI (T2, T4), trunk fat, and C-reactive protein (T4). Elevated cardiometabolic indices were important predictors of the "unhealthy" phenotype allocation in children with or without obesity. Our observations suggest that the consensus definition in children at T2, T4 and 1YPM reflects metabolic risk and central obesity. Metabolic health phenotype allocation by this equation enables easy detection of risk factors that call for action to prevent long-term metabolic derangements in children with obesity and, importantly, also those without obesity.

Educación alimentaria nutricional: Estrategias para mejorar la adherencia al plan dietoterapéutico

RESUMEN La educación alimentaria nutricional es la combinación de estrategias educativas, acompañadas de apoyos ambientales, diseñadas para facilitar la adopción voluntaria de elecciones alimentarias que conducen a un estado óptimo de salud y bienestar. La educación alimentaria nutricional tiene tres componentes: 1) motivación, 2) acción y 3) ambiente. Para elegir la técnica de educación adecuada para cada persona, se deben considerar las características psicoemocionales individuales, especialmente las motivaciones para el cambio y el tipo de personalidad, ya que ambos han mostrado ser buenos predictores de la conducta alimentaria. Dentro de los recursos educativos posibles de utilizar para realizar la educación en alimentación nutricional se encuentran indicaciones verbales, material escrito, uso de internet, dispositivos portátiles, aplicaciones de teléfonos inteligentes, e incluso la clase de cocina. La evidencia demuestra que la educación alimentaria nutricional impacta favorablemente la adherencia a las intervenciones nutricionales, lo cual a la vez se ve reflejado en efectos positivos en la salud.

ABSTRACT Food and nutrition education is the combination of educational strategies, accompanied by environmental supports designed to facilitate voluntary adoption of food choices conducive of health and well-being. It has a motivational phase, an action phase, and an environmental component. To choose the right educational technique for each patient, their individual psychoemotional characteristics must be considered; especially what their motivations for change are, as well as their personality type, because both are good predictors of food behavior. Among the resources that can be used to perform nutrition education are verbal indications, written material, the internet, mobile devices, smartphone applications, and even the kitchen as a place for education. Evidence shows that nutrition education has a favorable impact on diet adherence in different conditions that have an important nutritional component, such as celiac disease, inflammatory bowel disease, diabetes and obesity, which at the same time produces positive health outcomes.

Profesionalismo en el nutricionista: ¿Qué es y cómo incorporarlo en la formación de pregrado?

RESUMEN El profesionalismo es un pilar fundamental en la formación y ejercicio profesional de un nutricionista que implícitamente se ha incluido y desarrollado en los estándares de práctica. Recientemente se ha intentado establecer una terminología común para su definición, esta se basa en cuatro aspectos centrales: a) atributos personales como empatía, autoconciencia e inteligencia emocional, b) comunicación interpersonal, tanto con pares, otros profesionales de la salud y usuarios, c) actuar centrado en la práctica, que considera el entorno laboral en cuanto a las leyes y normativas que rigen el actuar profesional y 4) compromiso con el aprendizaje permanente, como el proceso de reflexión y autoevaluación del propio trabajo. Para garantizar un actuar profesional, la enseñanza del profesionalismo debe ser considerada de manera formal en el plan curricular, implementando distintas técnicas educativas y evaluaciones correspondientes que permitan la adquisición de conocimientos y habilidades necesarias. En el proceso formativo cobra especial relevancia el contexto y ambiente en el que se desempeñan los estudiantes para un óptimo uso de recursos.

ABSTRACT Professionalism is a fundamental aspect in the training and professional practice of a dietitian that has been implicitly included and developed in standards of practice. However, recently, an attempt to establish a common terminology for its definition has been made. The concept of professionalism is based on four central aspects: a) personal attributes such as empathy, self-awareness and emotional intelligence, b) interpersonal communication, both with peers, other health professionals and users, c) approach to practice, which considers the laws and regulations that govern professional actions, and 4) commitment to lifelong learning, such as the process of reflection and self-evaluation. To guarantee professionalism in dietitians, the teaching of professionalism must be considered formally in the plan of study, implementing different educational techniques and corresponding evaluations that guarantee the acquisition of necessary knowledge and skills. In the training process, the context and environment in which students work is especially relevant for an optimal use of resources.