Body fat at pubertal genital stage 2: a comparison between Spanish and Mexican boys.

BACKGROUND/OBJECTIVES: To compare body fat mass at the same stage of pubertal maturation, genital stage 2 (G2), in a Spanish and in a Mexican sample of boys. SUBJECTS/METHODS: Data from Spain (n=177) were from a previous longitudinal clinical follow-up and data from Mexico (n=91) from a cross-sectional study. Subjects were grouped according to the presence of G2 at similar ages. Spanish sample was divided into boys with G2 at age 12 (n=60), 13 (n=74) and 14 (n=43). In Mexican sample, 23 boys were at G2 at 12 years, 38 at age 13 and 30 at 14 years. Height, weight, upper arm circumference and four skinfold thicknesses were recorded. Genital development was assessed (Tanner scale). Sum of four skinfolds (SUM), body mass index (BMI), percentage of body fat (%BF) and extremity/trunk skinfold ratio (ETR=(triceps+biceps)/(subscapular+suprailiac)) was calculated. RESULTS: When comparing subjects with different ages at G2 from the same country, or with the same age at G2 from different countries, no significant differences were found in adiposity variables (%BF, SUM), nor in BMI. Nevertheless, there were differences in body fat distribution: ETR was higher in Spanish boys (P<0.001), because of their greater triceps skinfold thickness (P=0.013), and due to the greater trunk fat stores in Mexican boys (P<0.01, subscapular and suprailiac skinfolds). CONCLUSIONS: There is a subcutaneous fat mass store characteristic of G2 in boys, which is not only independent of age, but is also observable in two different populations.

Onset of puberty at eight years of age in girls determines a specific tempo of puberty but does not affect adult height.

AIMS: To analyse the effect of early puberty (onset between 7.5 and 8.5 y) on pubertal growth and adult height in girls, and the implications of this effect for the age limit for normal onset of puberty. METHODS: Longitudinal study in Reus (Spain) of 32 girls with early puberty until they reached adult height. Data from these girls were compared with longitudinal data from girls (116) from the same population with normal onset at 10 (n = 37), 11 (n = 47), 12 (n = 19) and 13 (n = 13)y. We analysed height, target height, adult height, pubertal height increase, duration of pubertal growth, age at menarche and time to menarche. RESULTS: The adult height of girls with early puberty (160.9 +/- 5.4cm) was similar to that of girls with onset at later ages (p = not significant). In these girls, puberty lasted 5.4 +/- 0.7 y and the mean growth during puberty was 31.1 +/- 3.5 cm. As the age of onset of puberty increases, the duration of puberty and mean growth during puberty progressively decreased (p < 0.001). Girls with early puberty reached menarche at a mean age of 10.9 +/- 1.0 y, 3.2 +/- 0.9 y after onset of puberty, and this time span was greater than in the other groups. CONCLUSION: Girls with onset of puberty at 8 y show all the compensatory phenomena related to height at onset, pubertal duration and height increase during puberty. These phenomena cause their adult height to be similar to that of girls who begin puberty at the age of 10 to 13 y.

Long-Term GH therapy: epidemiology and auxologic outcome.

OBJECTIVES: Epidemiologic and auxologic characteristics of patients treated with GH during childhood and adolescence and entered in a national registry in Catalonia were studied between 1988 and 1997. At the end of 1997, prevalence was 53.2 treatments/100,000 inhabitants aged 0-14 years. Maximum annual incidence rates were observed in 1990 and 1991 (34.0-35.6 cases/100,000 inhabitants aged 0-14 years). STUDY DESIGN: Analysis of treatments terminated in 1993 (n = 548) revealed, for the three principal reasons for cessation of treatment ('near-final height', 'adequate height but further growth potential', and 'poor growth response'), that males began and ended treatment at older ages with a better auxologic situation in SDS than girls at the beginning and end of therapy in the first two subgroups, with a similar duration of therapy. Severe GH deficiency (GHD) [both multiple pituitary hormone deficiency (MPHD) and the most severe isolated GHD (IGHD-A)] was more frequent in the group ending treatment at 'near-final height', whereas cessation of therapy because of 'poor growth response' was more frequent in the group with 'other causes of short stature' and no demonstrable GHD by routine tests. In the near-final height group, after excluding Turner's syndrome, MPHD and GHD cases secondary to brain tumors and GH deficiencies associated with malformative syndromes, positive linear correlations were observed between HSDS at the end of treatment and HSDS at the beginning, predicted adult height SDS (PAHSDS) and target height SDS (THSDS). Multiple regression analysis showed that in this group of patients, 41.4% of the variability in HSDS increment can be explained by the equation: HSDS increment = -0.33 + 0.29 THSDS - 0.68 HSDS at the beginning of treatment. RESULTS: The outcome showed a reasonable use of GH, since good-response cases generally continued treatment until final height whereas therapy was suspended in doubtful cases.

Age of pubertal onset affects the intensity and duration of pubertal growth peak but not final height.

This paper analyzed the intensity and duration of height growth during puberty in boys and girls in relation to rhythm of maturation. A longitudinal clinical follow-up between ages of 10 and 20 years, was carried out in a sample of 251 children grouped according to age at pubertal onset: boys (genital stage 2) at the ages of 11 (n = 28), 12 (n = 38), 13 (n = 42), and 14 (n = 27); and girls (breast stage 2) at the ages of 10 (n = 37), 11 (n = 47), 12 (n = 19), and 13 (n = 13). Height was measured annually. Testicular volume and genital development were assessed in boys, and breast development was assessed in girls. There were significant differences (P < 0.001) in height at the age of pubertal onset among maturity groups. Late maturers were taller than early maturers (r = 0.49, P < 0.001 for girls; r = 0.38, P < 0.001 for boys). However, final heights did not differ according to age of onset in either sex. In boys, later onset of puberty was associated with a smaller pubertal height gain (r = -0.60, P < 0.001) and a shorter period of pubertal growth (r = -0.61, P < 0.001). Equally in girls, earlier onset of puberty was associated with a greater pubertal height gain (r = -0.68, P < 0.001) and a longer period of pubertal growth (r = -0.59, P < 0.001). In conclusion, age of pubertal onset does not affect final height attained in both sexes, since there is an inverse compensatory phenomenon in both sexes between height at pubertal onset and the intensity and duration of pubertal growth.

[Treatment with LHRH analogues in girls with precocious puberty does not improve final height. Longitudinal study compared with a control group]. / El tratamiento con análogos de la LHRH en la pubertad avanzada de la niña no modifica la talla final. Estudio longitudinal frente a un grupo control.

BACKGROUND: We analysed the effectiveness of therapy with LHRH analogues in girls with a puberty onset at age 8 years. PATIENTS AND METHOD: We performed a non-randomised clinical study of 32 girls with advanced puberty. These included 16 treated with triptorelin LHRH analogue(3.75 mg/month during 1 year) and 16 control subjects. We carried out anthropometric measurements and determined the pubertal height growth (gain in height from the puberty onset up to the final height) and the pubertal duration (time in years from the puberty onset up to the age at which final height is attained). RESULTS: Treatment with LHRH analogue delayed the menarche age (11.5 [1.46]vs 10.37 [0.67] years of age; p = 0.03), led to an involution in secondary sexual characteristics and a temporary decrease ingrowth rate, and delayed skeletal maturation. However, pubertal duration, pubertal height growth and final height were all similar in both groups. In addition, no significant differences in body fat mass were observed. CONCLUSIONS: Treatment with LHRH analogues in advanced puberty modifies pubertal development, without modifying pubertal duration or pubertal height growth. Furthermore, this treatment does not improve final height.

Food and nutritional profile of high energy density consumers in an adult Mediterranean population.

OBJECTIVE: To test if an adult Mediterranean population consumes different food volumes while spontaneously ingesting diets of different energy density and to estimate which are the food and nutritional profiles of these diets. DESIGN: A cross-sectional study of food consumption. SETTING: Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus. SUBJECTS: Five hundred and seventy two adult individuals (25 65 y) randomly selected from the population census of Reus. INTERVENTION: 24 hour recall method for 3 non-consecutive days including one holiday. The population was classified into three groups of differing energy densities by simple linear regression analysis. Means were compared by ANOVA. RESULTS: Both sexes consume similar food volumes across the different levels of energy density. High energy density consumers ingest significantly more red meat, olive oil, sweet cereals, cereals and sugars and less reduced fat milk, green vegetables and fruit compared to low energy density consumers. Male and female high energy density consumers show a significantly higher consumption of energy (1686 kJ and 2200 kJ, respectively) (P < 0.001), a 5.2% (P < 0.001) and 2.3% (P < 0.05) respectively higher energy intake derived from fat and a 1.3% (P < 0.05) and 1.3% (P < 0.05) respectively higher energy intake derived from saturated fatty acids compared to low energy density consumers. CONCLUSIONS: Our adult Mediterranean population normally consumes similar food volumes, independently of the energy density ingested. High energy dense diets in our population could represent an important health risk because they are excessively rich in energy, fats and saturated fatty acids.

[Food intake, dietary habits and nutritional status of the population of Reus (X): Evolution of the diet and the contribution of macronutrients to energy intake (1983-1999) by age and sex]. / Consumo, hábitos alimentarios y estado nutricional de la población de Reus (X): Evolución de la ingestión alimentaria y de la contribución de los macronutrientes al aporte energético (1983-1999), según edad y sexo.

BACKGROUND: To study the evolution of the diet and the nutritional intake between 1983 and 1999, by age and sex. SUBJECTS AND METHODS: We performed a series of analysis of the food intake on a representative sample of the population of Reus (aged 10-69 years). Dietary intake was estimated using the 24-hours recall method. In 1999 the sample size was 839 individuals, 41% of them having taken part in the studies since 1983. Results are shown as mean (standard deviation). RESULTS: In 1999, the energy intake was 2524 (582) kcal in men aged 35-44 years (n = 57), and 1827 (490) kcal in women (n = 95) (p < 0.001 between sexes). The energy intake decreases with age (significant trend [p < 0.001] between 15-69 years) and it is higher in men than in women in all the age groups studied. When comparing similar age groups, we observe that this energy intake has not changed significantly since 1983. Between 1983 and 1999 the contribution of the macronutrients to the total energy intake has become more similar between ages and sexes. In 1999, in men aged 35-44 years a 15.6% of the energy came from proteins, 42% from fat and 42.5% from carbohydrates; in women of the same age: a 17.3% of the energy came from proteins, 42.4% from fat and 40.3% from carbohydrates). During this period we observed, however, remarkable changes in the diet which imply the increasing participation of the dairy products, vegetables and meat in the energy intake, or the significant decrease of the role of tubers, eggs and visible fat. CONCLUSIONS: Our population maintains an energy intake without significant changes, and it presents a trend towards a progressive uniformity of the nutritional balance between the different ages and sexes, although there are significant changes in some components of the diet.

Puberty begins with a characteristic subcutaneous body fat mass in each sex.

OBJECTIVE: To observe whether there exists a characteristic body fat mass at pubertal onset. DESIGN: Longitudinal clinical follow-up (between ages of 10 and 15 y) with an annual visit in a sample of 469 children. They were grouped according to age of purbertal onset: boys with pubertal onset at the ages of 11 (n=59), 12 (n=88), 13 n=89) and 14 y (n=46), and girls with pubertal onset at the age of 10 (n=68), 11 (n=66), 12 (n=37) and 13 (n=16). METHODS: Height, weight, upper arm circumference and four skinfold thicknesses were recorded annually. In boys testicular volume index was measured, and genital development was assessed on the Tanner scale; in girls mammary development was measured also using the Tanner scale. The sum of four skinfolds, body mass index, upper arm fat estimate and percentage body fat were calculated. RESULTS: Boys presented a positive relation between the age of pubertal onset and body mass index (P<0.001), which was not observed in girls. Body mass index thus varied according to the onset of puberty in boys (P<0.001), but not in girls. The sum of four skinfolds, the upper arm fat estimate index and the percentage of body fat mass did not differ according to age of pubertal onset either in girls (P=NS) or in boys (P=NS). The characteristic adiposity of the puberty onset is progressively acquired during the previous years in all the groups. CONCLUSIONS: Puberty seems to begin with a characteristic subcutaneous body fat mass that is independent of the age of onset. This study supports the hypothesis of a close link between maturation and the development of an energy store in the form of adipose tissue in both sexes.

Energy density of the diet, food volume and energy intake by age and sex in a healthy population.

OBJECTIVE: To assess the changes in energy intake (EI), food intake volume (FV) and energy density (ED) related to age and gender in a population in the Mediterranean area of Spain, and to determine the different role of FV and ED on the consecution of the adequate EI throughout lifespan. SUBJECTS: One thousand and eighty-eight individuals (1-65 y) randomly selected from the population census. DESIGN: Cross-sectional study in which food intake was quantified by 24 h dietary recall, three non-consecutive days. Height and weight measurements were taken in 885 individuals. RESULTS: EI, FV and ED increased progressively (P < 0.001) between 1-2 y and 10-12 y of age in both sexes. At 1-2 y the EI is 5.8+/-1.5 MJ/d, FV 1195+/-275 g/d and ED 4.8+/-0.9 kJ/g. Between 1-2 and 3-4 y, coinciding with an EI that increased up to 7.2+/-1.5 MJ/d, there was an increase in ED up to 6.1+/-0.8 kJ/g (P < 0.001), while the FV did not vary significantly. At the start of puberty, between 7-9 and 10-12 y, when the EI increased to 9.7+/-0.9 MJ/d (P < 0.001) in males, the ED rose to 7.1+/-0.9 kJ/g (P < 0.001) while the FV did not vary significantly. At this age, a significant difference between the genders was observed in the EI (P = 0.04), and in the ED (P = 0.02) but not, as yet, in the FV. During adulthood, a significant trend towards decrease (P < 0.001 in both sexes) was observed in EI and ED. However, FV decreased significantly only in females. CONCLUSIONS: The changes in energy intake that were observed with respect to age and gender were accommodated-for by changes in the ED of the diet rather than by variations in food volume intake. Autoregulation of the ED of the diet, sufficient for energy intake requirement changes, appears to be an essential human capacity for efficient nutrition.

[Nutrition surveys of Spanish school-age children: analysis of the period 1984-1994]. / Encuestas alimentarias en los niños españoles de edad escolar: análisis del período 1984-1994.

OBJECTIVE: To review available data on the usual dietary intake of school-age Spanish children, by analyzing the nutritional surveys carried out during the period 1984-1994. METHODS: Systematic and comprehensive search of surveys with dietary data in Spanish children aged 6 to 16 years collected during the period 1984-1994 and published after January 1997. The search of bibliographic databases (MEDLINE, IME, ISBN and Teseo), was completed with an extensive search of the gray literature and of unpublished studies through contact with public and private institutions which may fund such studies. The quality of the original surveys was assessed, and the data of the studies fulfilling pre-established quality requirements were summarized and tabulated. RESULTS: We located 65 nutritional surveys in children and adolescents performed between 1984 and 1994, which generated 91 documents. Most surveys (76.9%) were local, while 18.5% of them studied provinces or regions and 3.1% studied more than one region. Only 4 studies (6.2%) met the quality requirements, but the methods or the presentation of the results of these surveys were too heterogeneous. In spite of that, the available data tends to show a certain lack of balance of macronutrient intakes in relation to the usual dietary recommendations. CONCLUSIONS: Available data on nutritional intake of Spanish school-age children during 1984-1994 were too heterogeneous to be comparable, even if the analysis was restricted to high-quality surveys. Furthermore, there are no repeated surveys monitoring changes in intake in representative samples of children performed during the study period. This should be taken into account in future research endeavours which should contemplate a well defined sampling framework and the appropriate methodology to assure the proper interpretation of the eventual results.

[Testosterone treatment of delayed puberty: a longitudinal study in relation to a control group]. / Tratamiento con testosterona en la pubertad diferida: estudio longitudinal en relación a un grupo control.

OBJECTIVE: Delayed puberty is a very common clinical situation that affects a great number of adolescents. We analyzed the effects that testosterone therapy produces in this situation, including the start of puberty and, therefore, lessening the psychological effects that this delay causes. PATIENTS AND METHODS: We carried out a longitudinal study, in which we followed the growth and maturation of 32 boys from the age of 14 to 19 years. The sample was divided into a control group (n = 17) and a treatment group (n = 15). The treatment group received 50 mg/month of testosterone enantate depot during 6 months. None of the subjects, neither in the control group nor in the treatment group, had started puberty or if so, they had started it in an insufficient way for their age. RESULTS: The boys treated with testosterone developed a greater growth velocity compared to the control group during the first year of observation (9.07 +/- 1.11 cm/year vs 6.9 +/- 1.76, respectively, p < 0.0001). They had a higher increment in the muscular area of the arm (p < 0.005) and pubertal stage G changes occurred more quickly. On the other hand, the growth of the testicular volume was similar in both groups. At 19 years of age, no significant difference between the groups was observed in any of the clinical parameters studied. CONCLUSIONS: Treatment wit testosterone at the dose used promotes a significant response that leads to the start of puberty, but without stopping the maturation of the hypothalamic-pituitary axis that is produced in normal puberty, allowing a normal testicular evolution. The treatment does not show any long-term effects. It is, therefore, an effective treatment of delayed puberty.

Implications of the weaning pattern on macronutrient intake, food volume and energy density in non-breastfed infants during the first year of life.

OBJECTIVES: To evaluate the implications of the patterns of weaning on the intake of macronutrients, energy intake, food volume and the energy density in healthy infants in the Mediterranean area of Spain. SUBJECTS AND STUDY DESIGN: Cross-sectional study of 120 clinically-healthy, non-breastfed infants at the ages of 4, 6, 9 and 12 months randomly recruited from three pediatric out-patient clinics. Nutrition data were obtained from the infant's food preparer using the 24-hour dietary recall method. RESULTS: Energy intake/kg body weight was within the recommended daily allowance and did not vary significantly with age (423 kJ/kg body weight at 4 months and 443.7 kJ/kg at 12 months). There was a progressive decrease in the intake volume (p < 0.001) in which carbohydrate-rich foodstuffs were the major factors, and an increase in the energy density (p < 0.001) in which the protein-rich items were the principal contributors. Lipid intake diminished progressively (p < 0.01) to a nadir of 26.4% of energy intake at 9 months of age. In each of the meals there was a tendency towards a progressive increase in energy intake with age. This increase was achieved by a significant increase in energy density (p < 0.001 in all meals, except dinner p < 0.05). Conversely, the intake volume of breakfast, lunch and dinner remained essentially unchanged between 6 and 12 months while that of the mid-evening meal decreased markedly. CONCLUSION: Increased energy requirements for growth is achieved, mainly, by an increase in the energy density rather than the intake volume during food-item diversification in the non-breastfed infant. Cereals were the central food item in the weaning diet in our study sample and which adequately compensates, in terms of energy requirement, for the early reliance on the lipids contained in milk.

The duration of puberty in girls is related to the timing of its onset.

OBJECTIVE: To observe the time lapse between the start of puberty and the advent of menarche in groups of girls maturing at different ages. SUBJECTS: A sample of 163 girls subgrouped by pubertal onset at 9 (n = 22), 10 (n = 53), 11 (n = 54), 12 (n = 27), and 13 (n = 7) years of age. DESIGN: Clinical follow-up from 10 to 17 years of age. METHODS: Onset of puberty was defined by the combined observation of mammary development on the Tanner scale and the height curve. The date of menarche was recorded (month and year), and the time lapse was expressed as a function of the date of birth. RESULTS: In the overall study sample, the duration of puberty was 1.96 +/- 0.06 years. For the subgroups of girls starting puberty at 9, 10, 11, 12, and 13 years of age, the time lapse to menarche was 2.77 +/- 0.16, 2.27 +/- 0.16, 1.78 +/- 0.08, 1.44 +/- 0.10, and 0.65 +/- 0.09 years, respectively (p < 0.001). The correlation coefficient (r) between the onset of puberty and its duration was r = -0.62 (p < 0.001), and that of age of pubertal onset versus age of menarche was r = 0.66 (p < 0.001). CONCLUSION: The duration of puberty in girls depends on the timing of its onset; the earlier the onset of puberty the longer its duration.

[Consumption, dietary habits and nutritional status of the Reus (IX) population. Evolution of food consumption, energy and nutrient intake and relationship with the socioeconomic and cultural level, 1983-1993]. / Consumo, hábitos alimentarios y estado nutricional de la población de Reus (IX). Evolución del consumo de alimentos, du su participación en la ingestión de energía y nutrientes y de su relación con el nivel socioeconómico y cultural entre 1983 y 1993.

BACKGROUND: Mediterranean diet (a greater intake of olive oil, cereals, legumes, fruits and vegetables), is related to a lower prevalence of some associated diseases. The aim of the study was to observe in a Spanish population the evolution of dietary intake, whether there could be changes in the contribution of different kinds of food in energy intake, and the importance of socioeconomic and cultural factors which could influence this phenomenon. METHODS: Dietary intake was evaluated using the 24 hours recall method in a representative sample (n = 941, age range = 10-69) of a Reus population (Spain). This longitudinal study consisted of 70% of the sample studied in 1983 using identical methodology. RESULTS: From 1983 to 1993, we observed a significant increment of lactic derivatives (50.0%), vegetables (12.5%) and fruit intake (10.6%), and a significant decrease in tubercles (-56%), eggs (-15.6%), sugars (-13.0%), milk (-9.2%), and cereal (-7.6%) intake. Meat, fish, and visible fat intake remained unchanged. The intake of the 9 groups of food was different for men and women along this time period. We observed an increment in animal sources to our diet, primarily because of an increment in lactic derivative intake and a decrease in tubercles intake. Differences observed in 1983 between social classes related to different kinds of nutrients had nearly disappeared in 1993. Medium and high social classes followed very similar diets. However, the group of population with lowest socioeconomic status had a lower intake of energy and nutrients. CONCLUSIONS: Our diet consisted of the main characteristics of the typical mediterranean diet, although we observed a decrease in cereal intake and an increase in food of animal origin. Differences observed in 1983 related to dietary habits and nutritional profile between medium and high social classes, disappeared in 1993. However, there exists a small group of people of low social class which had a lower intake of energy and other nutrients.

[Food consumption, habits, and nutritional status of the population of Reus (VIII). Evolution of energy and nutrient intake from 1983 to 1993]. / Consumo, hábitos alimentarios y estado nutricional de la población de Reus (VIII). Evolución de la ingestión de energía y nutrientes entre 1983 y 1993.

BACKGROUND: Nutritional characteristics of the mediterranean diet, with a high intake of complex carbohydrates, fibre, monounsatured fatty acids and vegetables, are related to a lower prevalence of some nutritional associated diseases. The aim of our study was to perform a longitudinal analysis of the evolution of food intake in a mediterranean population in order to observe its influence on the energy and nutritional intake and their balance. The latter could have some effects on health status. METHODS: Dietary intake was evaluated using the 24 hours recall method in a representative sample (n = 941, age range = 10-69) of a Reus population. This longitudinal study consisted of 70% of the samples studied in 1983 using identical methodology. RESULTS: During this decade (1983-1993), energy intake decreased significantly 180 kcal/day for men and 158 kcal/day for women, carbohydrates being the main cause for this drop (132 and 84 kcal/day less for men and women, respectively). Protein intake decreased significantly in both sexes, 5.6% for men and 8.0% for women. However, the evolution of fat intake was different for men (no changes) and for women (a significant decrease of 5.7%). Saturated and monounsatured fatty acids did not show significant changes in this decade. Cholesterol intake decreased significantly in both sexes. Energy percents obtained from lipids, saturated and monounsaturated fatty acids significantly increased. However, in absolute values very little changes in fat intake in both sexes were observed. CONCLUSIONS: The dietary pattern evolved to a lower energy intake with an increment of the percentage of dietary lipids, but this feature was did not reflect a greater fat intake in absolute values. Moreover, the main characteristics of the typical mediterranean diet (which is basically different to the usual diet of other non mediterranean european countries mainly due to its richness in monounsaturated fatty acids) did not change in the period analyzed.

Biopsychopathologic risk profile of adolescents with eating disorder symptoms.

The aim of this study is to determine whether there is a psychological and somatic pattern for adolescents with eating symptomatology. The Eating Attitudes Test (Garner & Garfinkel, 1979) and other psychological instruments to evaluate self-esteem (SEI, Battle, 1981), personality (EPQ-J, Eysenck & Eysenck, 1984), school abilities (AAT, Thurstone & Thurstone, 1986), anxiety (STAIC, Spielberger, 1973) and symptoms of depression (CDI, Kovacs, 1983) were used in a sample of 515 adolescents between 13 and 14 years of age. Prevalence of risky eating attitudes was 12.4% for the girls and 8.3% for the boys. In general, a low level of self-esteem and a high level of anxiety were the most important predictors of eating symtomatology, but there were differences between genders. Girls with eating symptomatology exhibited a profile with more psychopathological traits. Heavy and corpulent subjects, boys or girls, form a group with a high risk of eating disorder. This suggests that the conjunction of psychological and somatic factors at the beginning of adolescence can be a useful marker for early intervention.

A longitudinal study of depression in an urban Spanish pubertal population.

Depression characteristics were investigated in 507 adolescents using a two-stage longitudinal study design. The three-year longitudinal study started when the girls and boys were 11 and 12 years, respectively. In the initial (screening) phase the Children's Depression Inventory (CDI) was used to select subjects for phase-II of the study in which the Children's Depression Rating Scale-Revised (CDRS-R) interview was used. The caseness definition of Major Depression (MD) and Dysthymia (D) was based on the DSM-III-R criteria. Pubertal development was assessed by Tanner's staging. Estimated prevalence of Major Depression in the female sample for each increasing year of age was 2.2%, 2.7% and 4.1%. In the male sample the prevalence for the three years was 0.9%, 0.3% and 0.6%. There was no relation to age. The estimated mean prevalence of Dysthymia was 1.4% in girls and 0.8% in boys. No association between pubertal development and depression was found. Longitudinal data support the notion of chronic depression in early adolescence.

Growth retardation in children receiving long-term total parenteral nutrition: effects of ornithine alpha-ketoglutarate.

We evaluated the effect of ornithine ketoglutarate (OKG) in reversing abnormal growth in six prepubertal children receiving total parenteral nutrition (TPN) for 5-10 y. They were 1-4 SDs below their expected 50th percentile for height. The energy and nitrogen intakes were unchanged from 8 mo before the beginning of the study until its completion. Two consecutive periods of 5 mo each were studied. OKG (15 g) was added to the parenteral solution during the first period (OKG+) but not during the second period (OKG-). Height velocity (HV) increased (P < 0.05) from a median of 3.8 cm/y to 6.45 cm/y (range 1.8-6.7) during the OKG+ period, and decreased (P < 0.05) to a median of 3.65 cm/y in the OKG- period. Plasma concentrations of insulin-like growth factor 1 (IGF1), glutamine, and glutamate increased (P < 0.05) during the OKG+ period. Variations of IGF1 concentrations correlated with HV variations (r = 0.82, P < 0.005) during both periods. This study demonstrates that OKG is associated with statural growth acceleration and increased IGF1 concentrations.

Influence of adiposity on the thermic effect of food and exercise in lean and obese adolescents.

To determine the effect of adiposity on adolescent energy expenditure compartments, basal energy expenditure (BEE) together with the thermic effect of food at rest and during post-exercise recovery were compared in eight lean (BMI < 25 kg/m2) and eight obese (BMI > 27 kg/m2) 15-year-old adolescent males at the same stage of pubertal development. Both groups were of equivalent fat-free mass. Continuous energy expenditure was measured by open circuit indirect calorimetry for periods of up to three hours following: (i) an overnight fast; (ii) a test meal; and (iii) moderate exercise after a further serving of the test meal. Repeat baseline measurements were taken on the following day. Absolute basal energy expenditure was higher in obese than in lean subjects. No significant differences were observed between groups in relation to BEE per kg total fat free-mass. Thermogenesis was significantly greater in the lean relative to the obese group under resting conditions (61.1 +/- 8.9 vs. 41.4 +/- 5.1 kcal/3h; P < 0.05) and in the post-exercise period (69.4 +/- 6.3 vs. 49.0 +/- 5.6 kcal/3h; P < 0.05). Of the body composition parameters, percentage fat mass was the best predictor of the thermic effect of food at rest (R = -0.53; P = 0.03) and post-exercise recovery (R = -0.61; P = 0.012). The results indicated that: (i) even when lean and obese adolescents are comparable with respect to fat-free mass, thermogenesis is blunted in obese subjects; and (ii) the best body composition predictor of thermogenesis in adolescents is percentage fat mass.