cMetS Based on Z-Scores as an Accurate and Efficient Scoring System to Determine Metabolic Syndrome in Spanish Adolescents.

The definition of metabolic syndrome (MetS) based on dichotomous cut-off points is efficient in the adult population. However, to date, there is no international consensus on how to define MetS in the pediatric population. For that reason, a continuous MetS score (cMetS) has been proposed for the pediatric population. However, despite multiple attempts, cMetS has not been fully validated as there is no agreement about the most accurate score to calculate it. The purpose of the present study was to compare the validity of different scores (three siMS scores, z-score, principal components analysis (PCA), the sum of PCA, and confirmatory factor analysis) to calculate cMetS and determine MetS in Spanish adolescents. There were 981 subjects, ranging 11-16 years old, recruited for this cross-sectional study. Seven different approaches to pediatric cMetS scores were calculated. All cMetS scores calculated strongly correlated with each other, especially siMS scores. The area under the curve obtained from receiving operating characteristic curves was particularly elevated for z-scores 0.81 (95% CI: 0.784-0.838), showing a specificity of 64.4%. Our study shows that cMetS based on z-scores is accurate and efficient to be used for research instead of the dichotomized definition of MetS in adolescents; and cMetS based on siMS scores is useful for clinical practice.

Stricter Adherence to Dietary Approaches to Stop Hypertension (DASH) and its Association with Lower Blood Pressure, Visceral Fat, and Waist Circumference in University Students.

How diet affects blood pressure (BP) in young adults has not been studied in sufficient depth. For this purpose, we analyzed adherence to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and BP in Spanish university students. The sample population of our cross-sectional study consisted of 244 subjects (18-31 years old), who were in good health. Measurements were taken of their systolic and diastolic BP. A food frequency questionnaire and 72 h food record were used to assess their dietary intake in the previous year. The resulting DASH score was based on foodstuffs that were emphasized or minimized in the DASH diet. Analysis of covariance adjusted for potential confounding factors showed that the mean values for systolic BP, visceral fat rating, and waist circumference (WC) of the subjects in the upper third of the DASH score were significantly lower than those of the subjects in the lower third (for systolic BP: mean difference -4.36 mmHg, p = 0.004; for visceral fat rating: mean difference -0.4, p = 0.024; for waist circumference: mean difference -3.2, p = 0.019). Stricter adherence to the DASH dietary pattern led to a lower BP, visceral fat rating, and WC values in these university students. Nevertheless, further prospective studies are needed to confirm these results.

Unhealthy Lifestyle and Nutritional Habits Are Risk Factors for Cardiovascular Diseases Regardless of Professed Religion in University Students.

To date, few studies have evaluated the possible association between religion and nutritional habits, lifestyle and cardiovascular risk in the university population. This study identified differences in the eating habits of Christian and Muslim university students and determined a possible association between the impact of religion on their lifestyles and the parameters related to cardiovascular risk. A cross-sectional study was performed with a sample population of 257 students (22.4 ± 4.76 year) at the campus of the University of Granada in Melilla (Spain). An anthropometric evaluation and a dietary assessment were performed. Blood pressure was also measured. There was a higher prevalence of overweight (29.1%) among Christian university students. The prevalence of pre-hypertension was similar between Christians and Muslims (48.3%) but was higher among Christian males (74.5%). Christian students presented higher levels of visceral fat. Students of both religions ingested carbohydrates, saturated fatty acids and total cholesterol, proteins, sodium and alcohol in excess. Significant positive correlations were found between food energy, sweets, snacks, soft drinks and body mass index (BMI) in both sexes and between the consumption of sausages-fatty meats and the systolic blood pressure (SBP) and body adiposity index (BAI) variables. Muslim students were less likely to consume alcohol (odds ratio [OR] = 7.88, 95% confidence interval [CI] = 4.27, 14.54). Christian and Muslim students presented improvable lifestyles and intake patterns. The high intake of saturated fatty acids, total cholesterol, sodium and alcohol in Christian students could lead to the early development of cardiovascular disease.

Need of improvement of diet and life habits among university student regardless of religion professed.

At present, few studies have assessed the possible influence of culture and religion on healthy eating habits among the university population. The aim of this study was to identify differences in healthy and eating habits among university students of different religions. A cross-sectional study was performed with a sample population of 257 students (22.4 ± 4.76 y) at the campus of the University of Granada in Melilla (Spain). The quality of diet was assessed by the Healthy Eating Index (HEI) and the adherence to the Mediterranean diet by a validated score (MDS). There were a higher prevalence of overweight in Christian boys and girls compared to Muslims. Muslim students omit breakfast and dinner more often than Christians. Significant differences in sodium intake (p < 0.001) were observed among boys of Christian and Muslim faith, with significantly higher intakes in Christians. In contrast, a higher cholesterol intake (p = 0.038) was observed in Muslim girls compared to Christians. Regarding alcohol intake, its consumption being much higher among students of Christian faith. Likewise, there were no significant differences in the quality of the diet as assessed by HEI, this being of poor, together with a low adherence to the Mediterranean diet in both groups. Muslim university students have a lower risk of drinking alcohol (OR = 7.88, 95% CI = 4.27, 14.54). Few differences were found between girls and boys in both religions although the Mediterranean Diet Score was lower for girls. In conclusion, Melilla university students eat low quality foods and have little adherence to the Mediterranean diet regardless of the religion professed or gender, although Christians tend to drink more alcohol and to smoke more cigarettes and Muslims skip some meals.

Influence of Biochemical and Anthropometric Factors on the Presence of Insulin Resistance in Adolescents.

BACKGROUND: Insulin resistance plays a determinant role in the development of metabolic syndrome in adolescents. The objective of the present study was to determine the influence of factors commonly associated with insulin resistance in a sample of adolescents. METHODS: This cross-sectional study included 976 adolescents from southeast Spain. Anthropometric and biochemical measurements were performed, and insulin resistance was assessed using the homeostasis model assessment-insulin resistance (HOMA-IR). RESULTS: Subjects with abnormal HOMA-IR values had significantly higher body mass index (BMI), body fat content, waist circumference, and systolic blood pressure (BP) than those with normal values. Furthermore, levels of glucose, insulin, glycosylated hemoglobin, total cholesterol, triglycerides, low-density lipoprotein-cholesterol, homocysteine, nonesterified fatty acids, and ceruloplasmin were higher in subjects with abnormal HOMA-IR values. Multivariate logistic regression analysis showed the highest odds ratio (OR) for BMI and that combinations of BMI with body fat content or systolic BP can increase the risk of insulin resistance 7-fold. DISCUSSION: Anthropometric indicators have different levels of influence on the risk of insulin resistance in adolescents, and a combination of two of these indicators is enough to increase the risk 7-fold. Since the highest OR was observed for BMI, the greatest effort should be directed to reducing this parameter in adolescents. An adequate understanding by nursing personnel of factors associated with insulin resistance is a key factor in the prevention of this pathophysiological condition and its complications in adolescents.

[Life style and monitoring of the dietary intake of students at the Melilla campus of the University of Granada]. / ESTILO DE VIDA Y SEGUIMIENTO DE LA INGESTA DIETÉTICA EN ESTUDIANTES DEL CAMPUS DE LA UNIVERSIDAD DE GRANADA EN MELILLA.

INTRODUCTION: University students represent a social group at risk, from the nutrionally point of view because they usually have inappropiate nutritional habits and lifestyle. OBJECTIVE: Analize the students' lifestyle from the Campus of University of Granada in Melilla. Analize the evolution of the eating habits of these students during the academic year 2013-2014. METHODS: A longitudinal study was carried out during the academic year 2013-2014, the lifestyle was evaluated and, in a ongoing way, the eating habits in a representative sample of 257 students, 90 men (35%) and 167 women (65%), all of them from the campus of University of Granada in Melilla. RESULTS: The results get worst as the academic year progresses and they are characterized by a significant reduction (p < 0.001) of carbohydrates intake as well as a significant increase (p < 0.001) of the lipido and proteína intake, especially, rich in saturated fat and a low-fiber diet. CONCLUSIONS: The population studied shows a sedentary lifestyle. As the academic year progresses, the students' eating habits get worst distance from the Mediterranian Diet pattern with the consequent risk at the development of cardiovascular diseases and metabolism disorder. So, it is necesary to get into these results in order to identify the influential factors in their eating habits and take the appropiate actions.

Introducción: los estudiantes universitarios representan un colectivo social en riesgo desde el punto de vista nutricional, ya que a menudo mantienen estilos de vida y hábitos nutricionales inapropiados. Objetivos: analizar el estilo de vida de los alumnos del Campus de la Universidad de Granada en Melilla. Analizar la evolución de los hábitos alimentarios de los estudiantes del campus durante el curso académico 2013-2014. Material y método: se realizó un estudio longitudinal durante el curso académico 2013-2014 en el cual, a su inicio, se evaluó el estilo de vida y, de forma continuada los hábitos nutricionales de un grupo representativo de 257 estudiantes, 90 chicos (35%) y 167 chicas (65%), todos ellos del campus de la Universidad de Granada en la Ciudad Autónoma de Melilla (norte de África). Resultados: los hábitos nutricionales empeoran a medida que avanza el curso académico, caracterizándose por una reducción significativa (p < 0.001) en la ingesta de carbohidratos, así como por una elevación significativa (p < 0.001) en la ingesta proteica y lipídica, siendo especialmente rica en grasas saturadas y baja en fibra. Conclusiones: la población estudiada posee un estilo de vida eminentemente sedentario. A medida que avanza el curso académico, los hábitos nutricionales de los estudiantes empeoran, alejándose del patrón de alimentación mediterráneo con el consiguiente riesgo de desarrollar enfermedades metabólicas y cardiovasculares. De estos resultados se desprende la necesidad de continuar profundizando a fin de identificar los factores que influyen en sus hábitos nutricionales y establecer las medidas correctoras oportunas.

Metabolic syndrome in Spanish adolescents and its association with birth weight, breastfeeding duration, maternal smoking, and maternal obesity: a cross-sectional study.

PURPOSE: The metabolic syndrome (MetS) in adolescents is a growing problem. The objectives were to verify the association among early predictors such as birth weight, breastfeeding, maternal weight status, smoking during pregnancy, and the development of MetS. METHODS: A cross-sectional study was performed of 976 children and adolescents, 10-15 years of age, at schools in the provinces of Granada and Almeria (Spain). For this purpose, we analyzed the physical characteristics as well as the biochemical markers of the participants with a view to ascertaining the prevalence of the MetS. Relevant data were also extracted from the clinical histories of their mothers. RESULTS: It was found that 3.85% of the female subjects and 5.38% of the male subjects in the sample population suffered from MetS. In both sexes, there was an association between birth weight and positive MetS diagnosis (OR 1.27). For both males and females, there was an inverse association between the length of time that they had been breastfed and positive MetS diagnosis (OR1-3 months 3.16; OR4-6 months 1.70; OR(>6 months) 0.13). There was also a significant association between maternal weight (OR(overweight )30.79; OR(obesity) 49.36) and cigarette consumption during pregnancy (OR 1.47) and the subsequent development of MetS in the children of these mothers. CONCLUSIONS: Those subjects born with a higher than average birth weight had a greater risk of developing MetS in childhood and adolescence. Breastfeeding children for longer than 6 months protected them from MetS in their early years as well as in their teens. Other risk factors for MetS were maternal smoking during pregnancy as well as maternal overweight and obesity.

Influence of age and religious fasting on the body composition of Muslim women living in a westernized context.

INTRODUCTION: Currently there is some controversy to whether Ramadan fasting leads to changes in the nutritional status and body composition of females who observe this practice. Furthermore, recent research suggest that age may be an important factor that affects anthropometric values and body composition just before and at the end of Ramadan. The aim of our study was to analyze the effects of Ramadan fasting, as modulated by age, on the nutritional status and body composition of a group of Muslim female subjects living in a westernized context. MATERIAL AND METHODS: A longitudinal study was carried out of 62 Berber Muslim females of ages ranging from 18 to 61 in the North African city of Melilla (Spain). The nutritional status was evaluated by anthropometry and their body composition studied by means of bioimpedance scales. These evaluations were performed before fasting began and again in the last week of Ramadan. RESULTS: The intermittent fasting produced important changes in the nutritional status and body composition of the female subjects. More specifically, there was a significant reduction (p=0.000) in total body weight values, BMI, body fat percentage measured by bioimpedance, and hip circumference (p=0.008). Significant differences were found (p=0.000) in anthropometric values and body composition before and at the end of Ramadan, depending on age. CONCLUSIONS: All the subjects experienced significant changes in nutritional status and body composition at the end of Ramada. These changes were more pronounced in the group of women over thirty years of age. .

Introducción: Actualmente existe controversia acerca de si la práctica del Ramadán implica, o no, cambios en el estado nutricional y composición corporal en las mujeres que lo practican. Asimismo, estudios recientes sugieren que la edad puede constituir un factor influyente en los valores antropométricos y de composición corporal antes y al final del Ramadán. El objetivo de nuestro estudio fue analizar los efectos del ayuno practicado durante el Ramadán sobre el estado nutricional y la composición corporal en un grupo de mujeres que viven en un contexto occidentalizado, así como el efecto de la variable edad. Material y Métodos: Se llevó a cabo un estudio longitudinal con 62 mujeres, bereberes y musulmanas, de edades comprendidas entre los 18 a 61 en la ciudad norteafricana de Melilla (España). El estado nutricional se evaluó mediante antropometría y el estudio de la composición corporal, a través de bioimpedancia. Estas evaluaciones se realizaron antes del inicio del ayuno y la última semana de Ramadán. Resultados: El ayuno intermitente produce cambios importantes en el estado nutricional y en la composición corporal de las mujeres. Observándose una reducción significativa (p=0.000) en los valores del peso corporal total, índice de masa corporal, porcentaje de grasa corporal medida por bioimpedancia, y circunferencia de la cadera (p=0.008). Se encontraron diferencias significativas (p=0.000) en los valores antropométricos y de composición corporal, antes y al final del Ramadán, en función de la edad. Conclusiones: Se observaron cambios significativos en el estado nutricional y en la composición corporal en todas las mujeres al finalizar el Ramadán. Estos cambios fueron más acusados en el grupo de mujeres mayores de treinta años.

[Evaluation of the nutritional status, insulin resistance and cardiovascular risk in a population of adolescents in the cities of Granada and Almeria (Spain)]. / Valoración del estado nutricional, resistencia insulínica y riesgo cardiovascular en una población de adolescentes de la ciudades de Granada y Almería.

OBJECTIVES: The first objective of this study was to evaluate the nutritional status and insulin resistance index in a population of adolescents as calculated by Homeostatic Model Assessment (HOMA). The second objective was to establish correlations between the nutritional status of the subjects, the possible existence of insulin resistance, and the risk of high blood pressure. POPULATION SAMPLE AND METHODOLOGY: The sample was composed of 1001 adolescents, 9-17 years of age, from 18 schools in the provinces of Granada and Almeria. Their nutritional status was determined by means of anthropometric evaluation. For the metabolic study, a blood sample was collected from each subject by venipuncture. An analysis was performed of the basal glucose and insulin levels as well as the Homeostatic Model Assessment- Insulin Resistance (HOMAIR) index. Also evaluated were the levels of glycosylated haemoglobin (HbA1c), serum lipoprotein (a), and non-esterified fatty acids (NEFAs). Insulin resistance was calculated with the formula, proposed by Matthews et al. (1985) : HOMA-IR = (insulin[mmol/L] x glucose[mU/L])/22.5. RESULTS: The evaluation of the nutritional status of the subjects reflected a progressive increase in the values of anthropometric variables as the nutritional status of the subjects worsened. The results of this study showed, regardless of age and gender, 85.01% of the subjects were of normal weight, whereas 9.99% were overweight, and 4.99% were obese. The metabolic study reflected that in comparison to normal-weight and overweight students, obese students had significantly higher serum levels (p < 0,0001) of HbA1c, basal insulin, basal glycemia, basal NEFA, lipoprotein (a), and HOMA-IR. CONCLUSIONS: Obesity was found to be a serious health problem in the population of adolescents studied, especially given the high cardiovascular risk that is characteristic of this condition. As reflected in the results of this study, obesity led to the premature development of metabolic disorders, which generally do not appear until adulthood.

Objetivos: Los objetivos de este estudio fueron evaluar el estado nutricional e índice de resistencia insulínica mediante HOMA en una población de adolescentes, así como establecer correlaciones entre el estado nutricional de los sujetos, la existencia o no de resistencia a la acción insulínica y el riesgo de padecer hipertensión arterial. Muestra y metodología: Una población de 1001 adolescentes de entre 9 y 17 años de edad, pertenecientes a 18 centros educativos de las provincias de Granada y Almería. Se realizó una valoración completa del estado nutricional de los alumnos mediante antropometría. Para el estudio metabólico, se practicó una extracción sanguínea mediante punción venosa a cada alumno, analizando glucosa basal, insulina basal, índice HOMAIR. Además, se valoró hemoglobina glicosilada (HBA1c), niveles séricos de lipoproteína (a) y ácidos grasos de cadena larga (NEFA). Para el cálculo del índice de resistencia a la insulina, se utilizó el modelo matemático propuesto por Matthews (Homeostasis Model Assessment - HOMAIR), aplicando la fórmula HOMAIR = (insulina x glucosa)/22,5. Resultados: La valoración del estado nutricional reveló un progresivo incremento en los valores de las variables antropométricas a medida que el estado nutricional de los sujetos empeoraba, describiéndose una prevalencia de normopeso del 85,01%, frente a una tasa de sobrepeso del 9,99% y de obesidad del 4,99% para ambos sexos y con independencia de la edad. El estudio metabólico evidenció niveles séricos significativamente más elevados (p < 0,0001) de HBA1c, insulina basal, glucemia basal, NEFA basal, lipoproteína (a) y HOMA IR entre adolescentes con obesidad frente a aquellos otros en situación de normopeso o sobrepeso. Conclusiones: La obesidad constituye un grave problema de salud entre la población de adolescentes estudiada, determinado el desarrollo precoz de trastornos metabólicos, hasta ahora propios de la etapa adulta circunstancia ésta alarmante si consideramos el riesgo cardiovascular que ello implica.

[C-reactive protein as a biochemical marker of cardiovascular risk]. / Proteína-C reactiva como marcador bioquímico de riesgo cardiovascular.

OBJECTIVES: The first objective of this study was to analyze the metabolic profile of the population to be studied. The second one was to ascertain whether there was a significant association between the nutritional status of the subjects and the serum level of C-reactive protein. Finally, the third objective was to discover whether there was a correlation between C-reactive protein serum levels and waist to hip ratio values. SAMPLE AND METHODOLOGY: The sample was composed of 1001 adolescents, 9-17 years of age, from 18 schools in the provinces of Granada and Almeria. Their nutritional status was determined by means of anthropometric evaluation. For the metabolic study, a blood sample was collected from each subject by venipuncture. An analysis was performed of C-reactive protein, basal glycemia, ceruloplasmin, glycated hemoglobin (HBA1c), basal insulin, serum levels of lipoprotein (a), and non-esterified fatty acids (NEFA). RESULTS: The biochemical study reflected a normal metabolic profile with serum levels of C-reactive protein, basal glycemia, ceruloplasmin, glycated hemoglobin, basal insulin, lipoprotein (a) and non-esterified fatty acids slightly higher in the male subjects. The results of our studied showed that there was a statistically significant association (p < 0.05; F = 3.701) between the nutritional status of the subjects and serum levels of C-reactive protein. A statistically significant association (F = 9.008; p < 0.005) was also found between serum levels of C-reactive protein and waist to hip ratio values. CONCLUSIONS: The C-reactive protein associated either with nutritional status or the waist to hip ratio is an effective biochemical marker of cardiovascular risk among the population of adolescents in our study.

Resumen: Objetivos: Los objetivos de este estudio fueron analizar el perfil metabólico de la población de estudio. En segundo lugar, verificar una asociación significativa entre el estado nutricional de los sujetos y los niveles séricos de proteína-C reactiva. Por último, comprobar la existencia de una correlación entre los niveles séricos de proteína-C reactiva y los valores del índice de cintura-cadera. Muestra y metodología: Una población de 1001 adolescentes de entre 9 y 17 años de edad, pertenecientes a 18 centros educativos de las provincias de Granada y Almería. Se evaluó el estado nutricional de los alumnos mediante antropometría. Para el estudio metabólico, se practicó una extracción sanguínea mediante punción venosa a cada alumno, analizando proteína-C reactiva, glucemia basal, ceruloplasmina, hemoglobina glicosilada (HBA1c), insulina basal, niveles séricos de lipoproteína (a) y ácidos grasos de cadena larga (NEFA). Resultados: El estudio bioquímico evidenció un perfil metabólico normal, destacando niveles séricos de proteína-C reactiva, glucemia basal, ceruloplasmina, hemoglobina glicosilada, insulina basal, lipoproteína (a) y ácidos grasos libres ligeramente superiores en chicos. Se encontró una asociación estadísticamente significativa (p.