Waist circumference and abdominal volume index are the strongest anthropometric discriminators of metabolic syndrome in Spanish adolescents.

BACKGROUND: Waist circumference has been suggested as predictor for metabolic syndrome (MetS) in adolescents but it has not been compared with newly proposed anthropometric indexes. This study aimed to disclose the capacity of ten classic and novel anthropometric indexes to discriminate by the presence of MetS in this young population. MATERIALS AND METHODS: A cross-sectional study was performed on 981 adolescents (13.2 ± 1.2 years) randomly recruited from eighteen schools in south-east Spain. Body fat percentage (BF%), abdominal volume index (AVI), body roundness index (BRI), body mass index (BMI), body adiposity index (BAI), body adiposity index for paediatrics (BAIp), conicity index (C-Index), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and body shape index (ABSI) were measured and calculated. Receiver-operator curves (ROC) were created to determine the discriminatory capacity of these anthropometric parameters for MetS. RESULTS: The prevalence of MetS was 7.0% for boys and 6.1% in girls. Participants with MetS had significantly higher levels of blood pressure and plasma levels of lipids, glucose and insulin. All anthropometric indexes were elevated in MetS individuals compared to the non-MetS group. AVI and WC showed the highest AUC values (0.83 for boys and 0.86 for girls). In contrast, according to ROC analyses, no anthropometric index was capable of discriminating the components of MetS (hypertension, hypertriglyceridemia, hyperglycaemia and low-HDL levels), except for abdominal obesity. CONCLUSION: We suggest the use of WC and AVI, with the cut-off points presented herein, for the discrimination between adolescents with or without MetS.

Analysis of lifestyle and bone mineralization in a population of Spanish young adults.

OBJECTIVE: To analyze the environmental factors (nutritional status, levels of physical activity and nutritional habits) and their possible association with bone mass in a population of young adults. METHODS: The study population consisted of 200 subjects (117 women and 83 men) aged between 18 and 25 years (mean age 20.4 years ±2.2 years). Body composition parameters were measured by an electronic balance (TANITA BC-418MA), nutritional habits were estimated by 72-h dietary recall, level of physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) and bone mass was measured by ultrasonography at the calcaneus. RESULTS: There were significant differences in bone mass values ​​according to gender (p= 0.013). Despite the fact that 70% of the subjects had a body mass index (BMI) within the normal range, 20% had overweight or obesity. 49% of the individuals had a moderate level of physical activity, although women had lower levels of physical activity than men (17.9% vs 8.4%). Most diets among young adults were hyperprotic, hyperlipidic and low-carbohydrates, with low-calcium and fiber intakes and high-phosphorus. Analysis of bone mass according to BMI showed higher values ​​as the weight category rises, with significant differences in women. Higher values ​​of bone mass were shown as the level of physical activity was higher, showing significant differences in males. CONCLUSION: Our results show that BMI and level of physical activity are significantly associated with bone health in a population of young adults, suggesting the relevance of promoting healthy lifestyles as a strategy for the early prevention of osteoporosis.

OBJETIVO: Analizar los factores ambientales (estado nutricional, nivel de actividad física y hábitos nutricionales) y su posible relación con los niveles de masa ósea en una población de adultos jóvenes. MÉTODOS: La población de estudio estuvo constituida por 200 sujetos (117 mujeres y 83 hombres) de edades comprendidas entre 18 y 25 años (edad media 20.4 años ± 2.2 años). La composición corporal se evaluó con balanza electrónica (TANITA BC-418MA), la valoración de los hábitos nutricionales mediante Recordatorio de 72 h, el nivel de actividad física a través del Cuestionario Internacional de Actividad Física (IPAQ) y la masa ósea mediante ultrasonografía en el calcáneo. RESULTADOS: Existen diferencias estadísticamente significativas en los valores de masa ósea en función del sexo (p= 0.013). A pesar de que el 70% de los sujetos presentaron un índice de masa corporal (IMC) dentro de los límites de la normalidad, un 20% padece sobrepeso y obesidad. El 49% de los individuos tenian un nivel moderado de actividad física, aunque las mujeres presentaron niveles más bajos de actividad física que lo varones (17.9% vs 8.4%). Las dietas mayoritarias entre los adultos jóvenes son hiperprotéicas, hiperlipídicas y bajas en hidratos de carbono, observándose una ingesta baja de calcio y fibra y alta en fósforo. El análisis de la masa ósea en función de IMC mostró valores mayores conforme asciende la categoría ponderal, existiendo diferencias significativas en mujeres. Igualmente, se muestran valores más altos de masa ósea conforme mayor es el nivel de actividad física, evidenciando diferencias significativas en los varones. CONCLUSIÓN: Nuestros resultados muestran que el índice de masa corporal y el nivel de actividad física se asocian significativamente con la salud ósea en una población de adultos jóvenes, evidenciando la importancia del fomento de estilos de vida saludables como estrategia para la prevención temprana de la osteoporosis.

Grip Strength Moderates the Association between Anthropometric and Body Composition Indicators and Liver Fat in Youth with an Excess of Adiposity.

Paediatric non-alcoholic fatty liver disease (NAFLD) is considered the most common early driver of chronic liver disease. The aim of this study was to examine whether grip strength moderates the association between anthropometric and body composition parameters and controlled attenuation parameter (CAP), an indicator of fat deposits in the liver, in children and adolescents with excess of adiposity. A total of 127 adolescents (67% girls) aged between 11 and 17, attending two public schools in Bogotá (Colombia), who had an axiological evaluation of obesity were included in this study. A grip strength test was assessed as an indicator of muscular strength, and cardiorespiratory fitness by maximal oxygen uptake was assessed using the 20 m shuttle-run test. Waist circumference (WC), waist-to-height ratio (WHtR), fat mass, and visceral adipose tissue (VAT) (cm³) were included as anthropometric and body composition measures. CAP was determined with a FibroScan® 502 Touch device (Echosens, Paris, France). The anthropometric and body composition parameters including WC, WHtR, fat mass, and VAT were positively associated with the CAP (range ß = 0.423 to 0.580), slightly reduced after being adjusted for handgrip strength/weight. The Johnson-Neyman technique revealed a significant inverse relationship between WC, WHtR, VAT, and CAP when grip strength normalized by body mass was above but not equal to or below 0.475 (8.1% of the sample), 0.469 (8.9% of the sample), and 0.470 (8.5% of the sample), respectively. In conclusion, grip strength adjusted by body mass, has a moderating effect on the association between anthropometric and body composition parameters (including WC, WHtR, and VAT) and CAP in in children and adolescents with excess of adiposity, suggesting the importance of promoting muscular strength during paediatric population in order to prevent NAFLD.

Analysis of lifestyle and bone mineralization in a population of Spanish young adults / Análisis de los estilos de vida y la mineralización ósea en una población de adultos jóvenes españoles

Abstract Objective: To analyze the environmental factors (nutritional status, levels of physical activity and nutritional habits) and their possible association with bone mass in a population of young adults. Methods: The study population consisted of 200 subjects (117 women and 83 men) aged between 18 and 25 years (mean age 20.4 years ±2.2 years). Body composition parameters were measured by an electronic balance (TANITA BC-418MA), nutritional habits were estimated by 72-h dietary recall, level of physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) and bone mass was measured by ultrasonography at the calcaneus. Results: There were significant differences in bone mass values ​​according to gender (p= 0.013). Despite the fact that 70% of the subjects had a body mass index (BMI) within the normal range, 20% had overweight or obesity. 49% of the individuals had a moderate level of physical activity, although women had lower levels of physical activity than men (17.9% vs 8.4%). Most diets among young adults were hyperprotic, hyperlipidic and low-carbohydrates, with low-calcium and fiber intakes and high-phosphorus. Analysis of bone mass according to BMI showed higher values ​​as the weight category rises, with significant differences in women. Higher values ​​of bone mass were shown as the level of physical activity was higher, showing significant differences in males. Conclusion: Our results show that BMI and level of physical activity are significantly associated with bone health in a population of young adults, suggesting the relevance of promoting healthy lifestyles as a strategy for the early prevention of osteoporosis.

Resumen Objetivo: Analizar los factores ambientales (estado nutricional, nivel de actividad física y hábitos nutricionales) y su posible relación con los niveles de masa ósea en una población de adultos jóvenes. Métodos: La población de estudio estuvo constituida por 200 sujetos (117 mujeres y 83 hombres) de edades comprendidas entre 18 y 25 años (edad media 20.4 años ± 2.2 años). La composición corporal se evaluó con balanza electrónica (TANITA BC-418MA), la valoración de los hábitos nutricionales mediante Recordatorio de 72 h, el nivel de actividad física a través del Cuestionario Internacional de Actividad Física (IPAQ) y la masa ósea mediante ultrasonografía en el calcáneo. Resultados: Existen diferencias estadísticamente significativas en los valores de masa ósea en función del sexo (p= 0.013). A pesar de que el 70% de los sujetos presentaron un índice de masa corporal (IMC) dentro de los límites de la normalidad, un 20% padece sobrepeso y obesidad. El 49% de los individuos tenian un nivel moderado de actividad física, aunque las mujeres presentaron niveles más bajos de actividad física que lo varones (17.9% vs 8.4%). Las dietas mayoritarias entre los adultos jóvenes son hiperprotéicas, hiperlipídicas y bajas en hidratos de carbono, observándose una ingesta baja de calcio y fibra y alta en fósforo. El análisis de la masa ósea en función de IMC mostró valores mayores conforme asciende la categoría ponderal, existiendo diferencias significativas en mujeres. Igualmente, se muestran valores más altos de masa ósea conforme mayor es el nivel de actividad física, evidenciando diferencias significativas en los varones. Conclusión: Nuestros resultados muestran que el índice de masa corporal y el nivel de actividad física se asocian significativamente con la salud ósea en una población de adultos jóvenes, evidenciando la importancia del fomento de estilos de vida saludables como estrategia para la prevención temprana de la osteoporosis.

Comparison of Bioelectrical Impedance Analysis, Slaughter Skinfold-Thickness Equations, and Dual-Energy X-ray Absorptiometry for Estimating Body Fat Percentage in Colombian Children and Adolescents with Excess of Adiposity.

Dual-energy X-ray absorptiometry (DXA) has been considered a reference method for measuring body fat percentage (BF%) in children and adolescents with an excess of adiposity. However, given that the DXA technique is impractical for routine field use, there is a need to investigate other methods that can accurately determine BF%. We studied the accuracy of bioelectrical impedance analysis (BIA) technology, including foot-to-foot and hand-to-foot impedance, and Slaughter skinfold-thickness equations in the measurement of BF%, compared with DXA, in a population of Latin American children and adolescents with an excess of adiposity. A total of 127 children and adolescents (11⁻17 years of age; 70% girls) from the HEPAFIT (Exercise Training and Hepatic Metabolism in Overweight/Obese Adolescent) study were included in the present work. BF% was measured on the same day using two BIA analysers (Seca® 206, Allers Hamburg, Germany and Model Tanita® BC-418®, TANITA Corporation, Sportlife Tokyo, Japan), skinfold measurements (Slaughter equation), and DXA (Hologic Horizon DXA System®, Quirugil, Bogotá, Columbia). Agreement between measurements was analysed using t-tests, Bland⁻Altman plots, and Lin's concordance correlation coefficient (ρc). There was a significant correlation between DXA and the other BF% measurement methods (r > 0.430). According to paired t-tests, in both sexes, BF% assessed by BIA analysers or Slaughter equations differ from BF% assessed by DXA (p < 0.001). The lower and upper limits of the differences compared with DXA were 6.3⁻22.9, 2.2⁻2.8, and -3.2⁻21.3 (95% CI) in boys and 2.3⁻14.8, 2.4⁻20.1, and 3.9⁻18.3 (95% CI) in girls for Seca® mBCA, Tanita® BC 420MA, and Slaughter equations, respectively. Concordance was poor between DXA and the other methods of measuring BF% (ρc < 0.5). BIA analysers and Slaughter equations underestimated BF% measurements compared to DXA, so they are not interchangeable methods for assessing BF% in Latin American children and adolescents with excess of adiposity.

AKAP11 gene polymorphism is associated with bone mass measured by quantitative ultrasound in young adults.

Background: Due to the increased prevalence of osteoporosis and direct health care cost of osteoporosis-related fractures, there is a growing interest in identifying genetic markers associated with osteoporosis phenotypes in order to develop genetic screening strategies. We aimed to analyze the possible associations between calcaneal Quantitative ultrasound (QUS), a valuable screening tool for assessing bone status in clinical practice, and ZBTB40 (rs7524102, rs6426749), SP7 (rs2016266) and AKAP11 (rs9533090) genes. Methods: A cross-sectional study was conducted on 550 healthy individuals of Caucasian ancestry (381 females and 169 males, median age 20.46±2,69). Bone mass was assessed through QUS to determine broadband ultrasound attenuation (BUA, dB/MHz). Single-nucleotide polymorphisms (SNPs) in ZBTB40 (rs7524102, rs6426749), SP7 (rs2016266) and AKAP11 (rs9533090) were selected as genetic markers and genotyped using TaqMan OpenArray® technology. Results: Linear regression analysis revealed that rs7524102 and rs6426749 in ZBTB40, and rs9533090 in AKAP11 were significantly associated with the calcaneal QUS parameter after adjustments for age, sex, weight, height, physical activity, and calcium intake (p=0.038, p=0.012 and p=0.008, respectively). After applying the Bonferroni correction for multiple testing (p=0.012), only the association of rs9533090 in AKAP11 remained significant. Conclusion:AKAP11 gene (rs9533090) influences QUS trait in a population of Caucasian young adults. The rs9533090 SNP may be considered a factor affecting peak bone mass acquisition.

The RSPO3 gene as genetic markers for bone mass assessed by quantitative ultrasound in a population of young adults.

Ultrasound bone mass measurement has been postulated as a valuable bone-health assessment tool for primary care. The aim of this study was to analyse the possible relationship between the SPTBN1, RSPO3, CCDC170, DKK1, GPATCH1, and TMEM135 genes, with calcaneal quantitative ultrasound (QUS) in a population of young adults. These genes were first associated with broadband ultrasound attenuation (BUA) in the GEFOS/GENOMOS study. A cross-sectional study was conducted on 575 individuals (mean age 20.41 ± 2.69). Bone mass at the right calcaneus was estimated by QUS. Six single-nucleotide polymorphisms (SNPs) in SPTBN1 (rs11898505), RSPO3 (rs7741021), CCDC170 (rs4869739), DKK1 (rs7902708), TMEM135 (rs597319), and GPATCH1 (rs10416265) were selected as genetic markers based on their previous association with calcaneal QUS. After adjusting for multiple confounding factors, the only significant association with QUS in our population was found for the rs7741021 SNP in the RSPO3 gene (P = 0.006) using the dominant model of inheritance. This suggests the possible implication of the RSPO3 gene in bone mass acquisition during early adulthood.

The Effect of Exercise Training on Mediators of Inflammation in Breast Cancer Survivors: A Systematic Review with Meta-analysis.

Several sources of evidence indicate that exercise during and after breast cancer could positively modulate the tumor microenvironment. This meta-analysis aimed to determine the effects of exercise training on mediators of inflammation in breast cancer survivors. We searched for randomized controlled trials published from January 1990 to March 2014. An inverse variance method of meta-analysis was performed using a random effects model in the presence of statistical heterogeneity. Eight high-quality trials (n = 478) were included. Exercise improved the serum concentrations of IL6 [weighted mean difference (WMD) = -0.55 pg/mL; 95% confidence interval (CI), -1.02 to -0.09], TNFα (WMD = -0.64 pg/mL; 95% CI, -1.21 to -0.06), IL8 (MD = -0.49 pg/mL; 95% CI, -0.89 to -0.09), and IL2 (WMD = 1.03 pg/mL; 95% CI, 0.40 to 1.67). No significant differences were found in the serum concentrations of C-reactive protein (WMD = -0.15; 95% CI, -0.56 to 0.25) or IL10 (WMD = 0.41; 95% CI, -0.18 to 1.02). Exercise training positively modulates chronic low-grade inflammation in women with breast cancer, which may impact upon carcinogenic mechanisms and the tumor microenvironment. These findings align with the other positive effects of exercise for breast cancer survivors, reinforcing the appropriateness of exercise prescription in this population. Cancer Epidemiol Biomarkers Prev; 25(7); 1009-17. ©2016 AACR.

A Cross-Sectional Study of the Association of VDR Gene, Calcium Intake, and Heel Ultrasound Measures in Early Adulthood.

The acquisition of a high adult peak bone mass (PBM) is considered an important determinant of osteoporotic risk later in life. Genetic and environmental factors determine optimal PBM acquisition in early adulthood. The aim of this study was to test the association of vitamin D receptor (VDR) gene polymorphisms and dietary calcium intake with the bone mass of young adults. The study population comprised a total of 305 individuals (mean age 20.41; SD 2.36) whose bone mass was assessed through heel ultrasound [quantitative ultrasound measurements (QUS)] measurements (BUA, dB/MHz). The FokI G/A, rs9729 G/T, and TaqI G/A polymorphisms were selected as genetic markers of VDR. A significant difference in BUA values was observed according to gender (females 82.96; SD 15.89 vs. males 97.72; SD 16.50; p < 0.00001). The mean dietary calcium intake of the study group (827.84 mg/day; SD 347.04) was lower than the dietary reference intake for young adults (1000 mg/day) and had no association with BUA. None of the three VDR polymorphisms tested showed an association with BUA. Similarly, the analysis of VDR 3' haplotypes, estimated using rs9729 and Taq1 as tag SNPs, did not reveal any significant association with QUS traits. Our results confirm the existence of different heel QUS for women and men, as well as a tendency towards low calcium consumption by young adults, and they also suggest that the VDR gene does not play a major role in the genetic determination of QUS parameter in early adulthood.

Social stress increases cortisol and hampers attention in adolescents with excess weight.

OBJECTIVE: To experimentally examine if adolescents with excess weight are more sensitive to social stress and hence more sensitive to harmful effects of stress in cognition. DESIGN AND METHODS: We conducted an experimental study in 84 adolescents aged 12 to 18 years old classified in two groups based on age adjusted Body Mass Index percentile: Normal weight (n=42) and Excess weight (n=42). Both groups were exposed to social stress as induced by the virtual reality version of the Trier Social Stress Task--participants were requested to give a public speech about positive and negative aspects of their personalities in front of a virtual audience. The outcome measures were salivary cortisol levels and performance in cognitive tests before and after the social stressor. Cognitive tests included the CANTAB Rapid Visual Processing Test (measuring attention response latency and discriminability) and the Iowa Gambling Task (measuring decision-making). RESULTS: Adolescents with excess weight compared to healthy weight controls displayed increased cortisol response and less improvement of attentional performance after the social stressor. Decision-making performance decreased after the social stressor in both groups. CONCLUSION: Adolescents who are overweight or obese have increased sensitivity to social stress, which detrimentally impacts attentional skills.

[Effectiveness of educational interventions conducted in latin america for the prevention of overweight and obesity in scholar children from 6-17 years old; a systematic review]. / Efectividad de las intervenciones educativas realizadas en América Latina para la prevención del sobrepeso y obesidad infantil en niños escolares de 6 a 17 años: una revisión sistemática.

INTRODUCTION: Overweight and obesity are serious public health problem, which is specially among children populations. OBJECTIVE: To determine the effectiveness of educational interventions conducted in Latino America for the prevention of overweight and obesity in scholar children from 6 to 17 years old. Metodology: MEDLINE, LILACS and EMBASE were searched between february and may 2014 to retrieve randomized controlled trials and longitudinal studies that evaluated the effects of educational interventions intended to retrieve randomized controlled trials and longitudinal studies aiming to prevent overweight and obesity among Latinoamerican children. Risk of bias was evaluated using the PEDro scale and the CASPe tool. RESULTS: Twenty one studies were included (n=12,092). Different types of educational interventions were identified, such as nutritional campaigns, physical activity practice and environmental changes. Mixed approaches combining nutritional campaigns, physical activity promotion and enviromental changes were the most effective interventions, since their results produced the largest improvements in the overweight and obesity of children. None evidence of reporting bias was observed. CONCLUSION: Educational interventions performed in the educational environment that combined an adequate nutrition and the promotion of physical activity practice, are more effective for preventing overweight and obesity in Latino American children, although familiar interventions are also encouraged approach, associated with better responses on the behavioral change in scholar children.

Introducción: El sobrepeso y la obesidad representan un serio problema de salud pública, de orden creciente en la población infantil. Objetivo: Determinar la efectividad de las intervenciones educativas realizadas en América Latina para la prevención del sobrepeso y la obesidad en niños escolares de 6 a 17 años. Metodología: Las bases de datos MEDLINE, LILACS y EMBASE fueron consultadas entre febrero y mayo de 2014 para identificar estudios controlados aleatorizados y estudios longitudinales que evaluaran los efectos de intervenciones educativas dirigidas a la prevención del sobrepeso y la obesidad en niños latinoamericanos. El riesgo de sesgo y la calidad metodológica se evaluó con la escala de PEDro y el instrumento CASPe. Resultados: Veintiún estudios fueron incluidos (n=12,092). Se identificaron diferentes tipos de intervenciones, tales como estrategias nutricionales, promoción de la práctica de actividad física y cambios en el entorno. Las intervenciones mixtas, que combinaron cambios nutricionales con la promoción de actividad física, fueron las más efectivas, pues sus resultados evidenciaron cambios positivos en las variables asociadas al sobrepeso y obesidad infantil. No se observaron evidencias de sesgo de publicación. Conclusión: Las intervenciones realizadas en el ámbito escolar que combinan la nutrición adecuada y la promoción de la práctica de actividad física son efectivas en la prevención del sobrepeso y la obesidad infantil en escolares latinoamericanos, aunque se deben incorporar intervenciones en el ambiente familiar para permitir un abordaje integral, asociado con mayores respuestas sobre el cambio comportamental de los escolares.

[Analysis of food intake and dietary habits in a population of adolescents in the city of Granada (Spain)]. / Análisis de la ingesta alimentaria y hábitos nutricionales en una población de adolescentes de la ciudad de Granada.

OBJECTIVES: The main research objective was to analyze the intake of macronutrients and micronutrients in a population of adolescents. The purpose of the study was to verify a significant correlation between the habit of breafasting at home each morning and the nutritional status of the sample population. SAMPLE AND METHODOLOGY: The sample population was composed of 100 adolescents, 12-15 years of age, who attended two public secondary schools in the city of Granada. The study conducted was descriptive, cross-sectional, and multi-centered, and involved a comprehensive evaluation of the nutritional status of the subjects by using anthropometry. The analysis of food intake and dietary habits was based on a 72-hour record of the subjects' food intake. The protocol used had previously been elaborated and validated by the research team. RESULTS: For all subjects, the energy intake was found to be higher than the recommended dietary allowance (RDA). The female subjects had a mean protein intake of 16% in regards to total calorific value (TCV). In the case of the male subjects, the mean protein intake was 15%. The mean consumption of fats was 106.1 for the male subjects, whereas for the females, it was 110.4 grams. The females were found to ingest more carbohydrates at a rate of 297.4 grams per day in comparison to the male subjects, whose rate of carbohydrate ingestion was 251 grams per day. The ingestion of minerals varied in both sexes though in all cases it was lower than the RDA. However, the male subjects had a calcium and zinc intake higher than the RDA for these minerals. The vitamin intake was varied and balanced in both male and female subjects, and covered the requirements for both age and sex. Regarding the variable, breakfast, a significant relation was found (p < 0.0001) between the dietary habit of breakfasting at home before going to school and the nutritional status of the students. CONCLUSIONS: The results of this study showed that an optimal nutritional and health status requires a balanced food intake and healthy dietary habits.

Objetivos: Los objetivos de este estudio fueron realizar un análisis de la ingesta de macronutrientes y micronutrientes en una población de adolescentes. En segundo lugar, verificar una correlación significativa entre el hábito de desayunar a diario en casa y el estado nutricional de dicha población. Muestra y metodología: La población de estudio estaba compuesta por 100 adolescentes de entre 12 y 15 años de edad, pertenecientes a 2 centros educativos públicos de la ciudad de Granada. Estudio descriptivo, transversal y multicéntrico en el que se llevó a cabo una valoración completa del estado nutricional de los alumnos mediante antropometría. Para el análisis de la ingesta alimentaria y hábitos nutricionales se utilizó un registro alimentario de 72 horas, específicamente elaborado y validado por el equipo investigador. Resultados: La ingesta energética fue superior en ambos sexos a la recomendada por la RDA. Se encontró una ingesta proteica media en chicas del 16% respecto del valor calórico total (VCT) y de un 15% del VCT en varones. Se evidenció un consumo medio de grasas de (106,1 gramos) en chicos, frente a los 100,4 gramos en chicas. Éstas ingerían más carbohidratos, destacando una ingesta media de 279,4 gramos/día frente a los 251 gramos/día ingeridos en varones. La ingesta de minerales fue variable en ambos sexos, siendo inferior a las recomendaciones de la RDA en chicas. En los varones resaltó una ingesta de calcio y zinc por encima de dichas recomendaciones. El aporte vitamínico fue variado y equilibrado en ambos sexos, cubriendo los requerimientos para edad y sexo. Respecto de la variable desayuno, se encontró una relación significativa (p < 0,0001) entre el hábito de desayunar en casa, antes de ir al instituto y el estado nutricional de los alumnos. Conclusiones: Un óptimo estado nutricional y de salud implica necesariamente mantener una alimentación equilibrada en sus nutrientes y unos hábitos nutricionales saludables.

Influencia del estado nutricional, niveles hormonales séricos e historia familiar de cáncer en el desarrollo del cáncer de mama / Influence of nutritional status, hormones serum levels, and family history on breast cancer development

Background: Several studies have analyzed the relation between obesity and the hormonal imbalances generated by overweight and a family history of breast cancer. All of these factors are potentially implicated in the early development of breast cancer. Aim: To verify the existence of a significant relation between the nutritional status of breast cancer patients, their hormone serum levels (estrogens, prolactin, and progesterone), and the existence of a family history of breast cancer. Material and Methods: Retrospective data was collected from clinical records of524 women diagnosed with breast cancer in a Spanish hospital. Results: There was a positive association between estrogen, progesterone and prolactin serum levels and body mass index. The elevations in hormone levels occurred earlier in life among women with a family history of breast cancer. A two way ANOVA found a significant association between progesterone and prolactin levels with the age at diagnosis of breast cancer. Conclusions: Extreme serum levels of these hormones appear to be related to the early development of breast cancer, which in turn is influenced by the existence of a family history of cancer among those women with normal or average hormone levels.

[Influence of nutritional status, hormones serum levels, and family history on breast cancer development]. / Influencia del estado nutricional, niveles hormonales séricos e historia familiar de cáncer en el desarrollo del cáncer de mama.

BACKGROUND: Several studies have analyzed the relation between obesity and the hormonal imbalances generated by overweight and a family history of breast cancer. All of these factors are potentially implicated in the early development of breast cancer. AIM: To verify the existence of a significant relation between the nutritional status of breast cancer patients, their hormone serum levels (estrogens, prolactin, and progesterone), and the existence of a family history of breast cancer. MATERIAL AND METHODS: Retrospective data was collected from clinical records of 524 women diagnosed with breast cancer in a Spanish hospital. RESULTS: There was a positive association between estrogen, progesterone and prolactin serum levels and body mass index. The elevations in hormone levels occurred earlier in life among women with a family history of breast cancer. A two way ANOVA found a significant association between progesterone and prolactin levels with the age at diagnosis of breast cancer. CONCLUSIONS: Extreme serum levels of these hormones appear to be related to the early development of breast cancer, which in turn is influenced by the existence of a family history of cancer among those women with normal or average hormone levels.

[Fatty liver and its clinical management in obese adolescents]. / Esteatosis hepática y su manejo clínico en el adolescente obeso.

Liver steatosis, also called non-alcoholic fatty liver, is characterized by a pathological fat accumulation in the liver, leading to liver damage in the form of inflammation and fibrosis. These histological features are similar to those in alcoholic hepatitis. Obesity is known to be the most common cause of simple steatosis in the preadolescent and adolescent population with a consequent serious health risk. The aim of this study was to provide an update on the concepts, pathophysiology and clinical management of hepatic steatosis secondary to obesity at an early age.

Selective alterations within executive functions in adolescents with excess weight.

Increasing evidence underscores overlapping neurobiological pathways to addiction and obesity. In both conditions, reward processing of preferred stimuli is enhanced, whereas the executive control system that would normally regulate reward-driven responses is altered. This abnormal interaction can be greater in adolescence, a period characterized by relative immaturity of executive control systems coupled with the relative maturity of reward processing systems. The aim of this study is to explore neuropsychological performance of adolescents with excess weight (n = 27, BMI range 24-51 kg/m(2)) vs. normal-weight adolescents (n = 34, BMI range 17-24 kg/m(2)) on a comprehensive battery of executive functioning tests, including measures of working memory (letter-number sequencing), reasoning (similarities), planning (zoo map), response inhibition (five-digit test (FDT)-interference and Stroop), flexibility (FDT-switching and trail-making test (TMT)), self-regulation (revised-strategy application test (R-SAT)), and decision-making (Iowa gambling task (IGT)). We also aimed to explore personality traits of impulsivity and sensitivity to reward. Independent sample t- and Z Kolmogorov-Smirnov tests showed significant differences between groups on indexes of inhibition, flexibility, and decision-making (excess-weight participants performed poorer than controls), but not on tests of working memory, planning, and reasoning, nor on personality measures. Moreover, regression models showed a significant association between BMI and flexibility performance. These results are indicative of selective alterations of particular components of executive functions in overweight adolescents.

Neuropsychological consequences of alcohol and drug abuse on different components of executive functions.

Several studies have shown alterations in different components of executive functioning in users of different drugs, including cannabis, cocaine and heroin. However, it is difficult to establish a specific association between the use of each of these drugs and executive alterations, since most drug abusers are polysubstance abusers, and alcohol is a ubiquitous confounding factor. Moreover, in order to study the association between consumption of different drugs and executive functioning, the patterns of quantity and duration of drugs used must be considered, given the association between these parameters and the executive functioning alteration degree. Based on the multicomponent approach to executive functions, the aims of the present study were: (i) to analyse the differential contribution of alcohol versus cocaine, heroin and cannabis use on executive functions performance; and (ii) to analyse the contribution made by the severity of the different drugs used (quantity and duration patterns) on these functions in a sample of polysubstance abusers that requested treatment for cannabis-, cocaine- or heroin-related problems. We administered measures of fluency, working memory, analogical reasoning, interference, cognitive flexibility, decision-making and self-regulation to two groups: 60 substance-dependent individuals (SDIs) and 30 healthy control individuals (HCIs). SDIs had significantly poorer performance than HCIs across all of the executive domains assessed. Results from hierarchical regression models showed the existence of common correlates of the use of alcohol, cannabis and cocaine on verbal fluency and decision-making; common correlates of quantity of cannabis and cocaine use on verbal working memory and analogical reasoning; common correlates of duration of cocaine and heroin use on shifting; and specific effects of duration of cocaine use on inhibition measures. These findings indicate that alcohol abuse is negatively associated with fluency and decision-making deficits, whereas the different drugs motivating treatment have both generalized and specific deleterious effects on different executive components.

Bad news for the patient and the family? The worst part of being a health care professional.

In Spain, there is a general tendency to conceal the prognosis from a terminally ill patient. We conducted grounded-theory-based, phenomenological, qualitative research on this using a final sample of 42 in-depth interviews with doctors and nurses from different fields. We found that most health professionals believe that although patients don't ask questions, they know what is happening to them. Many professionals feel bad when communicating bad news. In hospitals, doctors take responsibility for doing so. The attitudes of professionals are influenced by their sense of responsibility and commitment to the principle of patient autonomy, as well as to the level of their agreement with the cultural context. The tacit agreement of silence makes communication impossible: the patient does not ask questions, the health professional does not want to be interrogated, and family members don't talk about the disease and want health professionals to follow their example. This situation is detrimental to patients and their families and leads to suffering, low levels of satisfaction, and feelings of guilt and helplessness. Health care professionals must acquire the means and the skills for communicating bad news.