[Family environment, physical activity and sedentarism in preadolescents with childhood obesity: ANOBAS case-control study]. / Ambiente familiar, actividad física y sedentarismo en preadolescentes con obesidad infantil: estudio ANOBAS de casos-controles.

OBJECTIVE: The aim of this study is to compare the levels of physical activity and sedentary behaviours in children with obesity and normal weight through accelerometer measures, and analyze the family environment related to physical activity. DESIGN: Case-control study. LOCATION: A health center and colleges of the Community of Madrid. PARTICIPANTS: A total of 50 obese children between 8 and 12 years of age (P > 97) and their mothers were matched by age, sex and socioeconomic status of their parents (1: 1) with 50 children with normopeso (GN; P < 85). MAIN MEASUREMENTS: Physical activity levels were measured by accelerometer (ActiGraph GT3X), levels of physical activity of the primary caregiver were measured through physical activity questionnaire (IPAQ) and the environment in relation to the physical activity was measured by the Home Environment Scale (HES-S). RESULTS: The group GO showed less vigorous physical activity than their peers in the GN group. Vigorous physical activity in the GO group was associated with modeling and parental policies regarding physical activity. A multiple regression analysis revealed that 21% of the variance of weight status of children was explained by sex, vigorous physical activity and maternal body mass index. CONCLUSIONS: The levels of vigorous physical activity and the family environment differ between children with obesity and normal weight. Therefore, it is important to continue working on the awareness of illness and the promotion of healthy habits from Primary Care and the school and institutional context.

[Waist-to-height ratio is an indicator of metabolic risk in children]. / Índice cintura-estatura como indicador de riesgo metabólico en niños.

INTRODUCTION: Abdominal fat, particularly visceral, is associated with a high risk of metabolic complications. The waist-height ratio (WHtR) is used to assess abdominal fat in individuals of all ages. OBJECTIVE: To determine the ability of the waist-to-height ratio to detect metabolic risk in mexican schoolchildren. PATIENTS AND METHOD: A study was conducted on children between 6 and 12 years. Obesity was diagnosed as a body mass index (BMI) ≥ 85th percentile, and an ICE ≥0.5 was considered abdominal obesity. Blood levels of glucose, cholesterol and triglycerides were measured. The sensitivity, specificity, positive predictive and negative value, area under curve, the positive likelihood ratio and negative likelihood ratio of the WHtR and BMI were calculated in order to identify metabolic alterations. WHtR and BMI were compared to determine which had the best diagnostic efficiency. RESULTS: Of the 223 children included in the study, 51 had hypertriglyceridaemia, 27 with hypercholesterolaemia, and 9 with hyperglycaemia. On comparing the diagnostic efficiency of WHtR with that of BMI, there was a sensitivity of 100% vs. 56% for hyperglycaemia, 93 vs. 70% for cholesterol, and 76 vs. 59% for hypertriglyceridaemia. The specificity, negative predictive value, positive predictive value, positive likelihood ratio, negative likelihood ratio, and area under curve were also higher for WHtR. CONCLUSIONS: The WHtR is a more efficient indicator than BMI in identifying metabolic risk in mexican school-age.

[Childhood obesity prevention from a community view]. / La prevención de la obesidad infantil desde una perspectiva comunitaria.

The percentage of failure and relapse in the treatment of obesity is high. Where possible, the preferred strategy for preventing obesity is to modify eating habits and lifestyles. This article aims to provide a framework for evidence on the most effective interventions for addressing childhood obesity, both from a prevention point of view, as well as reducing it, when it is already established. After a review of the scientific literature, the issues that must be considered both in the universal and selective prevention of childhood obesity are presented. Also, in light of the controversy over the tools for measuring and controlling the problem, some clarification is provided on the criteria. Finally, the approach to the prevention of overweight and obesity with a community perspective is separated, with two short protocols being offered with diagrams of the basic procedure to follow.

Predictors of adherence to follow-up and treatment success in childhood obesity.

INTRODUCTION: Management of childhood obesity, based upon behavioural, physical activity and dietary guidance, usually achieves limited success and is hindered by a high attrition rate. The identification of potential predictors of either weight loss or early weight management attrition could help develop personalised management plans in order to improve patient outcomes. PATIENTS AND METHODS: We conducted a retrospective study in a cohort of 1300 patients with obesity managed in speciality clinics for up to 5 years with outpatient conservative treatment. We studied the family background and personal characteristics (demographic, behavioural, psychosocial, anthropometric and metabolic) of patients who dropped out before completing the first year of the programme and patients who achieved significant weight loss, with a separate analysis of patients who achieved substantial reductions in weight compared to the rest of the cohort. RESULTS: The mean age of the patients in the cohort was 10.46 years (SD, 3.48) the mean BMI z-score 4.01 (SD, 1.49); 52.8% of the patients were male, 53.3% were prepubertal, 75.8% were Caucasian and 19% Latin. We found a higher proportion of Latinla ethnicity and compulsive eating in the group of patients with early attrition from the weight management follow-up. In the group of patients with substantial weight loss, a greater proportion were male, there was a higher frequency of dietary intake control at home and obesity was more severe, and the latter factor was consistently observed in patients who achieved substantial weight loss at any point of the follow-up. CONCLUSIONS: Some family and personal characteristics in childhood obesity are associated with an increased risk of early withdrawal from follow-up or a greater probability of successful outcomes; however, the predictive value of these variables is limited.

Prevalence of obesity and related factors in schoolchildren aged 3 to 4 years.

OBJECTIVE: To describe the prevalence of obesity and analyse possible differences in it according to sociodemographic characteristics, diet, physical activity, screen use and family perception of the weight and dietary habits of schoolchildren aged 3 to 4 years in Barcelona. METHODS: We conducted a cross-sectional study in a representative sample of schools selected based on the socioeconomic status (SES) of the corresponding neighbourhood and school ownership. We selected 101 schools in Barcelona and recruited pupils aged 3 to 4 years during the 2016-17 academic year (n = 2936 children). Anthropometric measurements were taken in each participant. Family members completed a questionnaire on eating habits, physical activity, sleeping hours, screen use and the family's perception of the child's weight and diet. The primary variable was the body mass index (BMI) for age and sex, subsequently categorised as normal weight, overweight or obese. RESULTS: Approximately 7.0% of girls and 7.1% of boys aged 3 to 4 years presented obesity. The prevalence of obesity (8.3%) was higher in neighbourhoods of lower SES compared to those of higher SES (5.2%; p = .004). Parents of children with obesity reported that the child had some excess weight or excess weight in 46.9% of cases, 3.9% indicated the child's weight was appropriate and 0.9% that the child was a little underweight or underweight (p < .001). DISCUSSION: The prevalence of obesity in children aged 3 to 4 years is high. There are social and geographical inequalities, and obesity was more prevalent in areas of lower SES. A large percentage of the families of children with obesity do not consider that the child's weight is excessive.

Soluble receptor for advanced glycation end-products (sRAGE) in childhood obesity: association with gene expression of RAGE and cardiometabolic markers.

Introduction: Introduction: advanced glycation end-products (AGEs) interact with the receptor for AGEs (RAGE). Full-length RAGE is associated with intracellular signal transduction, and soluble-RAGE (sRAGE) lacks the transmembrane and cytoplasmic domains, acting as a competitive inhibitor of AGEs-RAGE binding. sRAGE levels in healthy children are associated with cell surface expression of RAGE. However, the expression of RAGE has not been explored in childhood obesity. Objective: the study aim was to evaluate the sRAGE levels and the gene expression of RAGE in children and its association with cardiometabolic markers. Methods: this is a cross-sectional study with 6-11-year children, 20 with overweight and 20 with obesity. Anthropometric measurements included waist circumference (cm) (WC), neck circumference (NC), weight (kg), fat mass (%), trunk fat (kg), muscular mass (kg), height (cm), and body mass index (BMI) (kg/m2). Blood samples following an overnight fast were collected to measure glucose (mg/dl) and lipid profile with colorimetric methods. sRAGE was determined in serum using the enzyme-linked immunosorbent assay (ELISA). Quantitative reverse transcription (RT-qPCR) was performed to analyze RAGE transcripts in peripheral blood mononuclear cells isolated by Ficoll®-Hypaque. Results: we found higher RAGE (p = 0.0315) and lower sRAGE (p = 0.0305) levels in the obesity group. sRAGE level showed a negative correlation with RAGE (r = -0.35) and BMI (r = -0.24), and positive with HDL-cholesterol (r = 0.29). Regression analysis suggests that HDL-C and RAGE levels are predictors of sRAGE levels. Conclusions: expression of RAGE is associated with lower sRAGE levels in childhood obesity. Moreover, obese children show higher cardiometabolic risk markers, and a positively associated with sRAGE.

Introducción: Introducción: los productos finales de glicación avanzada (AGE) interactúan con el receptor de AGE (RAGE). El RAGE de longitud completa está asociado con la transducción de señales intracelulares y el RAGE soluble (sRAGE) carece de los dominios transmembrana y citoplásmico, actuando como un inhibidor competitivo de la unión de AGE-RAGE. Los niveles de sRAGE en niños sanos están asociados con la expresión de RAGE en la superficie celular. Sin embargo, la expresión de RAGE no se ha explorado en la obesidad infantil. Objetivo: el objetivo del estudio fue evaluar los niveles de sRAGE y la expresión génica de RAGE en niños y su asociación con marcadores cardiometabólicos. Métodos: se trata de un estudio transversal con niños de seis a once años, 20 con sobrepeso y 20 con obesidad. Las medidas antropométricas incluyeron la circunferencia de la cintura (cm) (CC), la circunferencia del cuello (NC), el peso (kg), la masa grasa (%), la grasa del tronco (kg), la masa muscular (kg), la altura (cm) y el índice de masa corporal (IMC) (kg/m2). Se tomaron muestras de sangre después de una noche de ayuno para medir glucosa (mg/dl) y el perfil de lípidos con métodos colorimétricos. Los sRAGE se determinaron en suero utilizando un ensayo inmunoabsorbente ligado a enzimas (ELISA). Se realizó una transcripción inversa cuantitativa (RT-qPCR) para analizar los transcritos de RAGE en células mononucleares de sangre periférica aisladas por Ficoll®-Hypaque. Resultados: encontramos niveles más altos de RAGE (p = 0,0315) y más bajos de sRAGE (p = 0,0305) en el grupo de obesidad. El nivel de sRAGE mostró una correlación negativa con RAGE (r = -0,35) e IMC (r = -0,24), y positiva con el colesterol HDL (r = 0,29). El análisis de regresión sugiere que los niveles de HDL-C y RAGE predicen los niveles de sRAGE. Conclusiones: la expresión de RAGE se asocia con niveles más bajos de sRAGE en la obesidad infantil. Además, los niños obesos muestran marcadores de riesgo cardiometabólico más elevados y una asociación positiva con sRAGE.

[Childhood obesity risk index (IROBIC) for small administrative areas in Chile]. / Índice de riesgo de obesidad infantil (IROBIC) para áreas administrativas pequeñas en Chile.

Introduction: Introduction: although the prevalence of childhood obesity (CO) is high globally, there are no composite indices to estimate territorial aspects associated with its risk Objective: to develop an obesity risk index (IROBIC) for small administrative units, called "comunas" in Chile Methods: we used 2019 data from public sources on children under 10 years living in "comunas" of the two largest regions. IROBIC includes 16 indicators standardized for each "comuna" and grouped together into four domains, determined by principal component analysis (health, socio-economic, built-in and educational environments). IROBIC was calculated as a weighted geometric mean. Differences in obesity risk between the 10 and 5 "comunas" with the highest and lowest IROBIC and of each domain, were calculated with the disparity ratio. Results: in spite of the poorest "comunas" having the highest IROBIC, when its value and that for each domain were considered, we observed that the effect of inequality could be mitigated. The 10 and 5 "comunas" with the highest IROBIC have a 2.41 and 4.05 higher risk of CO compared to those with the lowest values Conclusions: IROBIC is a useful tool for monitoring the risk of CO and its factors from a territorial perspective.

Introducción: Introducción: a pesar de la alta prevalencia de la obesidad infantil (OI) globalmente, no existen índices compuestos para estimar los aspectos territoriales asociados al riesgo de OI. Objetivo: elaborar un índice de riesgo de OI (IROBIC) para unidades administrativas pequeñas (comunas) de Chile Métodos: se utilizaron datos de 2019 de fuentes públicas con información de menores de 10 años de todas las comunas de las 2 regiones más grandes. El IROBIC incluye 16 indicadores estandarizados por comuna y agrupados en cuatro dimensiones, determinadas por análisis de componentes principales (salud, socio económica, entornos comunal y educacional). Se determinó el IROBIC mediante una media geométrica ponderada y posteriormente se calcularon las diferencias entre las 10 y 5 comunas con mayores y menores IROBIC y de cada dimensión, con el coeficiente de disparidad Resultados: aun cuando los mayores IROBIC se obtuvieran en comunas más vulnerables, su valor total y el de cada dimensión, mostraron que es posible amortiguar los efectos de la desigualdad sobre la OI. Las 10 y 5 comunas con mayor IROBIC presentan un riesgo, 2,41 y 4,05 veces mayor que las de menor valor, respectivamente. Conclusiones: el IROBIC puede monitorear el riesgo de OI ­y factores asociados­ desde una perspectiva territorial.

[Application of WHO 2015 nutritional profile model for the reduction of added sugars in children's dairy]. / Aplicación del modelo de perfiles nutricionales OMS 2015 para la reducción de azúcares añadidos en lácteos infantiles.

Introduction: In the last 20 years we have doubled obesity rates. In Spain, 67 % of the population does not have an adequate weight and 40 % of the child population suffers from obesity or overweight. This leads to serious diseases. To avoid this, a national plan to fight obesity is required, with prevention and therapeutic strategies so as not to continue increasing these data in 2030. Among the factors that cause childhood obesity are poor eating habits as well as a lack of physical activity and excessive use of screens. In addition, there is a significant social gap. Childhood obesity especially affects families with lower purchasing power (54 %) who do not have access to a healthy diet or the necessary tools or knowledge to promote health to their sons and daughters through food. The World Health Organization (WHO) Regional Office for Europe developed a nutrient profile model in 2015, specifically for the purpose of restricting the marketing of foods aimed at children. This model is considered by the scientific community as a reference tool when it comes to establish policies and improvements in favor of public health, in order to provide families with access to food with a better profile and nutritional value.

Introducción: En los últimos 20 años hemos duplicado las tasas de obesidad. Un 67 % de la población no tiene un peso adecuado y el 40 % de la población infantil sufre obesidad o sobrepeso en España. Esto deriva en graves enfermedades. Para evitarlo, es necesario un plan nacional de lucha contra la obesidad, con estrategias de prevención y terapéuticas para no seguir incrementando estos datos en 2030. Entre los factores causantes de la obesidad infantil se encuentran los malos hábitos de alimentación, además de la falta de actividad física y un uso excesivo de pantallas. Además, existe una brecha social importante. La obesidad infantil afecta especialmente a familias con menor poder adquisitivo (el 54 %), que no tienen acceso a una alimentación saludable ni las herramientas necesarias o el conocimiento para promover la salud a sus hijos e hijas a través de la alimentación. La Oficina Regional de la Organización Mundial de la Salud (OMS) para Europa desarrolló un modelo de perfil de nutrientes en 2015, específicamente a efectos de restringir la comercialización de alimentos dirigida a los niños, un modelo que se plantea desde la comunidad científica como una herramienta de referencia a la hora de establecer políticas y mejoras en pro de la salud pública, con el fin de facilitar a las familias el acceso a alimentos con un mejor perfil y valor nutricional.

[Impact of attend to day care associated with healthy weight in infants and preschoolers]. / Impacto del cuidado infantil en guarderías asociado con peso saludable en lactantes y preescolares.

Background: Being overweight affects millions of infants and preschoolers in the world, affecting their quality and life expectancy. Exposure to day care centers may play an important role in preventing unhealthy weight (UW). Objective: To point out the prevalence and association of day care exposure and other factors associated with UW in infants and preschoolers. Methods: An analytical cross-sectional study was carried out. Infant population aged 6-47 months without comorbidities that compromised their nutritional status were included, and those with formal childcare different from the selected day care were excluded. Exposure to day care, and other factors (perinatal, physical activity, nutritional, and familiar) were evaluated. A z score > 1 SD was considered UW. Prevalence, odds ratios (OR), 95% confidence intervals (95%CI) and adjusted RM by low birth weight, initiation of complementary feeding, consumption of sugary drinks, daytime naps, maternal nutritional status, and family income quintile through logistic regression. Results: The overall prevalence of UW was 17.84% (95%CI: 14.93-21.16), 11.84 (95%CI: 8.54-16.14) for children exposed to day care, and 23.78% (95%CI: 19.21-29.02) in unexposed infant population, showing significant differences between both prevalences (p < 0.001). The adjusted OR for UW presentation was 0.39 (95% CI: 0.23-0.66). Conclusions: Exposure to IMSS day care has shown to be a possible protective environment against the development of a UW.

Introducción: el sobrepeso afecta a millones de lactantes y preescolares en el mundo afectando su calidad y esperanza de vida. La exposición a guarderías puede jugar un papel importante para prevenir un peso no saludable (PNS). Objetivo: indicar la prevalencia y la asociación de la exposición a guarderías y otros factores asociados con el PNS en lactantes y preescolares. Métodos: se realizó un estudio transversal analítico. Se incluyó población infantil de 6-47 meses sin comorbilidades que comprometieran su estado nutricional y se excluyeron a aquellos con un cuidado infantil formal diferente al de las guarderías seleccionadas. Se evaluó la exposición a guardería, y otros factores (perinatales, actividad física, nutricionales, y familiares). Se consideró PNS una puntuación z > 1 DE. Se obtuvieron prevalencias, razones de momios (RM), intervalos de confianza del 95% (IC95%) y RM ajustadas por edad, bajo peso al nacer, inicio de la alimentación complementaria, consumo de bebidas azucaradas, siestas diurnas, estado nutricional materno y quintil de ingreso familiar a través de regresión logística. Resultados: la prevalencia general de PNS fue de 17.84% (IC95%:14.93-21.16), 11.84 (IC95%: 8.54-16.14) para la población infantil expuesta a guarderías, y 23.78% (IC95%: 19.21-29.02) en no expuestos, mostrando diferencias significativas entre ambas prevalencias (p < 0.001). La RM ajustada para la presentación de PNS fue de 0.39 (IC95%: 0.23-0.66) para exposición a guardería. Conclusiones: la exposición a guarderías IMSS mostró ser un posible ambiente protector contra el desarrollo de un PNS.

Relationship between eating habits, sleep patterns and physical activity and the degree of obesity in children and adolescents.

INTRODUCTION: Childhood obesity is an extremely prevalent pathology and, in order to be able to address it, it is necessary to understand the factors that influence on its genesis and maintenance. We hypothesise that the timing of meals and sleep, the regularity of these throughout the week and a sedentary lifestyle influence the degree of obesity. MATERIAL AND METHODS: We included children and adolescents with obesity who attended a first check-up visit at the Childhood Obesity Unit between January 2018 and February 2020. The data were obtained from a questionnaire on food (36-h intake, frequency of consumption, eating times and habits) and sleep. RESULTS: The degree of obesity was influenced to a greater extent by later meal times and the distribution of calories throughout the day (less at breakfast, more at dinner) than by the total number of calories ingested. In addition, a lower consumption of vegetables was related to a higher degree of obesity. The difference between the hours of sleep at weekends and on weekdays correlated positively with a higher degree of obesity. Finally, the anthropometric data correlated negatively with the number of hours of physical activity. Almost half of the children did not exercise after school. CONCLUSION: In the approach to childhood obesity, it is necessary to include recommendations on the regularity of meal and sleep times, as well as the distribution of calories throughout the day. Additionally, it is necessary to encourage the practice of physical exercise.

Prevalence of overweight and obesity in Aragón and variations according to health determinants.

INTRODUCTION: Childhood obesity is a serious global health problem that is continuously increasing worldwide. Many studies suggest that socioeconomic factors are related to the development of obesity. The objective of our study was to analyse the prevalence of overweight and obesity in Aragón, calculated applying the World Health Organization (WHO) growth standards, and to study its association with socioeconomic factors. MATERIAL AND METHODS: We collected data for the entire paediatric population of Aragón aged 2-14 years. We classified each child as normal weight, overweight or obese based on the body mass index. We calculated prevalences by province and basic health care zone. To analyse differences in relation to social inequalities, we used the Aragón deprivation index as an indicator of socioeconomic status. RESULTS: The final sample consisted of 161 335 children aged 2-14 years, 51% male and 49% female. The overall prevalence of excess weight was 31.1% (17.7% overweight and 13.3% obesity) and was significantly higher in boys. We found a high frequency of under-recording in health records (65%). There was a direct association between the deprivation index and the prevalence of obesity and overweight throughout Aragón, with a significant strong correlation in urban areas, where socioeconomic factors explained up to 66.4% of obesity and 48.9% of body weight excess. CONCLUSIONS: In Aragón, the prevalence of obesity and excess weight is high and associated with low family socioeconomic status.

Genetic risk score for common obesity and anthropometry in Spanish schoolchildren.

IntroductionCommon or non-syndromic obesity is a complex polygenic trait conditioned by biallelic or single-base polymorphisms called SNPs (Single-Nucleotide Polymorphisms) that present an additive effect and act synergistically. Most genotype-obese phenotype association studies include body mass index (BMI) or waist-to-height ratio (WtHR), and very few introduce a broad anthropometric profile. ObjectiveTo verify whether a genetic risk score (GRS) developed from 10 SNPs is associated with the obesity phenotype assessed from anthropometric measures indicative of excess weight, adiposity and fat distribution. Material and methodsA series of 438 Spanish schoolchildren (6-16 years old) were evaluated anthropometrically (weight, height, waist circumference, skinfold thickness, BMI, WtHR, body fat percentage [%BF]). Ten SNPs were genotyped from saliva samples, generating a GRS for obesity, establishing genotype-phenotype association. ResultsSchoolchildren categorised as obese by BMI, ICT and %BF had higher GRS than their non-obese peers. The prevalence of overweight and adiposity was higher in subjects with a GRS above the median. Similarly, between 11 and 16 years of age, all anthropometric variables presented higher averages. ConclusionsGRS estimated from the 10 SNPs can be a diagnostic tool for the potential risk of obesity in Spanish schoolchildren and could be useful from the preventive perspective.

Overweight and obesity in the Mexican school-age population from 2015 to 2019.

Introduction: Objectives: to analyze the changes of Ow+Ob in a cohort with four years of evolution of students from Mexico elementary schools and to evaluate its association with socio-demographic factors. Methods: information comes from a nutritional surveillance system of 52,545 elementary schools, with weight and height measurements from 2,008,474 children from six to eleven years old. A follow-on panel longitudinal analysis was performed from 2015 to 2019 in a dynamic cohort with three measurements. Ow+Ob prevalences were obtained; through a logistic regression with random effects, odds ratios (OR) were calculated, adjusting by sociodemographic characteristics (p < 0.05). Results: between 2015 and 2019, positive OR were observed for Ow+Ob development in 2017-2018 (OR = 1.02) and 2018-2019 (OR = 1.06). Students from the northern and southern regions of the country showed a greater probability of suffering Ow+Ob (OR = 1.58 and 1.64) when compared with the center. Attending to community or indigenous schools was a protective factor (OR = 0.54) whereas attending to a private school increased the risk (OR = 1.75). Adjusted Ow+Ob prevalences showed an accelerated increasing trend in males through all the periods. Conclusions: in Mexico, obesity in school children is a growing problem related to sociodemographic factors, therefore, urgent actions are needed for its restraining.

Introducción: Introducción: México se sitúa dentro de los primeros lugares a nivel mundial en cuanto a sobrepeso y obesidad en escolares, con una prevalencia del 38,2 %. Objetivo: analizar los cambios de sobrepeso y obesidad (Sob+Ob) durante cuatro años en una cohorte de alumnos de escuelas primarias en México y evaluar su asociación con factores sociodemográficos. Métodos: la información proviene de un sistema de vigilancia nutricional en escolares. Se realizó un análisis longitudinal de panel con seguimiento a través de una corte dinámica de tres mediciones realizadas entre 2015 y 2019. Se obtuvieron las prevalencias de Sob+Ob a través de una regresión logística con efectos aleatorios y se calcularon razones de momios (OR), ajustando por características sociodemográficas. Resultados: entre 2015 y 2019 se observaron OR positivos para el desarrollo de Sob+Ob, 2017-2018 (OR = 1,02) y 2018-2019 (OR = 1,06). Los estudiantes de las regiones norte y sur del país mostraron una mayor probabilidad de sufrir Sob+Ob (OR = 1,58 y 1,64) en comparación con el centro. La asistencia a escuelas comunitarias o indígenas fue un factor protector (OR = 0,54), mientras que la asistencia a una escuela privada aumentó el riesgo (OR = 1,75). Las prevalencias ajustadas de Sob+Ob demostraron una tendencia creciente acelerada en los hombres a lo largo de todos los periodos. Conclusiones: en México, la obesidad en escolares es un problema creciente relacionado con factores sociodemográficos, por lo que se requieren acciones urgentes para su contención.

Association between recreational screen time and excess weight and obesity assessed with three sets of criteria in Spanish residents aged 2-14 years.

INTRODUCTION AND OBJECTIVE: Studies that assess the association between excess weight and screen time in childhood and adolescence are methodologically heterogeneous, and few studies have analysed the exposure to smartphones and tablets. Our study aimed to assess the association between daily recreational screen time and excess weight (overweight+obesity) and obesity in children aged 2-14 years residing in Spain using different sets of standards. METHODS: We conducted a cross-sectional study using data from the 2017 Spanish National Health Survey (N=4528). We assessed the prevalence of overweight and obesity applying the criteria of the World Health Organization (WHO), International Obesity Task Force (IOTF), and Orbegozo 2011 study. We categorised daily recreational screen time in minutes as 0-59, 60-119, 120-179, and ≥180. We calculated crude and adjusted prevalence ratios (aPR) of excess weight and obesity based on the daily minutes of recreational screen time with the corresponding 95% confidence intervals (95%CI). Moreover, we calculated crude and adjusted change (aΔ) in the expected number of fulfilled excess weight/obesity criteria based on the minutes of daily recreational screen time with the corresponding 95% CI. We adjusted the association analyses for potential confounders. RESULTS: We found that spending 180min or more a day of recreational screen time was associated with an increase in the adjusted prevalence of excess weight (e.g. Orbegozo 2011 aPR≥180, 1.20; 95% CI, 1.02-1.42) and of obesity (e.g. IOTF aPR≥180, 1.41; 95% CI, 1.06-1.86) as well as an increase in the adjusted number of fulfilled criteria for excess weight (aΔ≥180, 1.18; 95% CI, 1.06-1.31). CONCLUSIONS: Longer periods of recreational screen time were associated with excess weight and obesity in children aged 2-14 years. Cohort studies are required to confirm these findings, as this may be a determinant of health in children.

Prevalence and risk factors associated with different comorbidities in obese children and adolescents.

INTRODUCTION: Different obesity-related comorbidities already present in childhood, such as: vitamin D deficiency, impaired carbohydrate metabolism, dyslipidaemia, arterial hypertension and non-alcoholic steatohepatitis. In this study, we aim to analyse the prevalence of comorbidities and to determine the predictive factors that affect these comorbidities. MATERIAL AND METHODS: Anthropometric, demographic and biochemical variables were collected from obese patients between six and 18 years of age. Subsequently, a statistical analysis was performed to describe the characteristics of the patients and the prevalence of comorbidities, as well as their predictive factors. RESULTS: A total of 158 obese children (76 boys and 82 girls) with a mean age at diagnosis of 12.48 years and a BMI Z-score of +3.24 SDS were included. The most prevalent comorbidities were vitamin D deficiency (64.2%), insulin resistance (45.1%), dyslipidaemia (32.2%), hyperuricaemia (18.5%) and arterial hypertension (15%). Age, BMI Z-score, percentage of fat mass and male sex have been found to be predictors of these comorbidities. CONCLUSION: Obese children and adolescents have a high prevalence of comorbidities. Once the diagnosis of obesity has been established, it would be very useful to identify early those patients with a higher risk of comorbidities, knowing their relationship with sex, age, BMI Z-score, percentage of fat mass and pubertal stage.

[Quality of food products announced on television before and after the plan to improve their composition, 2017-2020]. / Calidad de productos alimentarios anunciados por televisión antes y después del plan para mejorar su composición, 2017-2020.

OBJECTIVE: To compare the nutritional quality of the foods and beverages advertised on television in Spain, before and after the plan to improve their composition. METHOD: DTT broadcasts of the more popular channels were recorded in children's hours. Every advertised products in commercial breaks were registered and their nutritional data collected. We compared the distribution of frequencies by food categories and their adherence to the nutritional standards of the World Health Organization in 2017 and 2020. RESULTS: In 256h of broadcasting we identified 173 products (78 in 2017 and 95 in 2020). The most advertised products were chocolates (26.9% in 2017 and 22.1% in 2020). 76.3% of the products advertised were unhealthy (76.9% in 2017 vs. 75.8% in 2020; p=0.86). CONCLUSIONS: The nutritional profile of the foods and drinks advertised on television, mostly unhealthy, did not change after the implementation of the plan to improve their composition. A regulation is needed to protect children from food advertising.

Effects of physical activity on quality of life in overweight and obese children.

INTRODUCTION: Background: in recent years the prevalence of obesity in infants, children, and adolescents has increased alarmingly, which may affect their health, educational level, and quality of life. Objectives: the aim of this study was to determine whether a program with physical activity and nutritional recommendations may improve health-related quality of life (HRQL) in overweight and obese children. Material and methods: the design of this study was that of a randomized clinical trial (RCT). The sample consisted of 54 children with a median age of 10.65 years, all of them overweight or obese. They were divided into a study (SG) and a control (CG) group, with 27 children each. The study group received physical activity and nutritional advice, while the control group only received theoretical-practical sessions on nutrition during 9 months. Families participated in the workshops on nutritional recommendations in both groups. Results: there was a significant difference in fat percentage before and after the intervention in the study group compared to the children who did not engage in sports activity. In the SF-10 quality-of-life perception questionnaire, statistically significant differences in both the physical and mental components may be seen at the end of the study between both groups (p < 0.001). Conclusions: an educational intervention with physical activity based on play and nutritional advice improved quality of life in overweight and obese children. Family involvement is vital for children to improve their life habits, and achieve favorable results in the reduction of overweight and obesity.

INTRODUCCIÓN: Introducción: en los últimos años, la prevalencia de la obesidad en los bebés, niños y adolescentes ha aumentado de forma alarmante, lo que podría afectar a su salud, nivel educativo y calidad de vida. Objetivos: el objetivo de este estudio fue determinar si un programa con actividad física y recomendaciones nutricionales puede mejorar la calidad de vida relacionada con la salud (CVRS) en niños con sobrepeso y obesidad. Material y métodos: el diseño de este estudio fue el de un ensayo clínico aleatorizado (ECA). La muestra consistió en 54 niños de 10,65 años de edad mediana con sobrepeso u obesidad. Se dividieron en grupos de estudio (SG) y de control (CG), ambos con 27 niños. El grupo de estudio recibió actividad física y asesoramiento nutricional mientras que el grupo de control solo recibió las sesiones de nutrición teórico-prácticas durante 9 meses. Las familias participaron en los talleres sobre recomendaciones nutricionales en ambos grupos. Resultados: hubo una diferencia significativa en el porcentaje de grasa antes y después de la intervención en el grupo de estudio en comparación con los niños que no participaron en la actividad deportiva. En el cuestionario de calidad de vida SF-10 se puede observar que existen diferencias estadísticamente significativas en los componentes físicos y mentales al final del estudio entre ambos grupos (p < 0,001). Conclusiones: una intervención educativa con actividad física basada en el juego y asesoramiento nutricional mejoró la calidad de vida de estos niños obesos y con sobrepeso. La participación familiar es vital para que los niños mejoren sus hábitos de vida y logren resultados favorables en la reducción del sobrepeso y la obesidad.

[Cardiovascular Health School Program (PESCA). Methodology and initial results: 2018-2020]. / Programa Escolar de Salud Cardiovascular (PESCA). Metodología y primeros resultados: 2018-2020.

INTRODUCTION: Introduction: despite the fact that 40 % of children in Spain, ages 6 to 9, are overweight or obese, and 2/3 of them are at risk of developing cardiovascular disease, there is a lack of protocolized efficient interventions to fight this important health problem. The PESCA project aims to reduce the prevalence of overweight and obesity with a transversal model focused on a school intervention, but also involving families and primary care doctors, to increase the quantity and quality of physical activity (PA) and improve eating habits. Methods: a 5-step protocol was carried out at schools: 1) family and personal background questionnaire for children; 2) body mass index (BMI); 3) bioimpedance corporal composition (BIA); 4) hand grip dynamometry (DIN); and 5) medical physical examination. As a result, each subject received a medical report about his/her diagnosis of body weight and composition and cardiovascular health, and also recommendations to improve eating habits and increase physical activity. Results: in the first two years of PESCA, the weekly time of physical activity has significantly increased among participants (up to 20.12 %; p < 0.001). In addition, the prevalence of overweight/obesity has significantly declined in both girls and children under 6 years of age (35.78 % and 58.92 %; p < 0.05, respectively). Conclusion: the school, pediatrician, and family working together on a transversal intervention has shown effectiveness in reducing the lack of diagnosis and prevalence of overweight and obesity in children.

INTRODUCCIÓN: Introducción: el 40 % de los niños entre los 6 y 9 años en España presentan exceso de peso infantil (EPI). Más de 2/3 padecerán enfermedad cardiovascular en la vida adulta. Aun así, no existe un modelo protocolarizado de acción con el que combatir, de forma eficaz, el problema. El objetivo del programa PESCA es la reducción de la prevalencia del EPI a través de un modelo transversal de actuación que, tomando como centro la red escolar y su profesorado, implique a las familias y la red de atención primaria de salud para actuar mediante la mejora cualitativa y cuantitativa de la actividad física (AF) y los hábitos de alimentación. Métodos: el protocolo incluye 5 pasos que se realizan en el centro escolar: 1) cuestionario de antecedentes personales y familiares de cada alumno; 2) índice de masa corporal (IMC); 3) bioimpedancia de composición corporal (BIA); 4) dinamometría de mano (DIN), y 5) exploración física facultativa. Como resultado, cada sujeto participante recibe un informe facultativo con su diagnostico individualizado de peso corporal y salud cardiovascular, y recomendaciones de mejora en cuanto a AF y hábitos de alimentación. Resultados: en los dos primeros años del programa se ha objetivado un aumento del tiempo semanal dedicado a la AF entre los sujetos participantes (hasta un 20,12 %; p < 0,001) y un descenso significativo en la prevalencia del EPI en las niñas y los menores de 6 años (35,78 % y 58,92 %; p < 0,05, respectivamente). Conclusión: la actuación transversal de colegio, pediatra y familia permite disminuir tanto el déficit diagnóstico de la obesidad y el sobrepeso infantiles como su prevalencia.

[Framing of childhood obesity in Spanish lay press]. / Encuadre mediático de la obesidad infantil en las noticias de prensa generalista en España.

OBJECTIVE: To explore the frame, individual or collective, of childhood obesity in the main Spanish lay media. METHOD: Analysis of a convenience sample of 132 publications regarding childhood obesity (August 2016-September 2018). Descriptive analysis about approach, measures and causes of obesity and food industry influence in the development of the publication. RESULTS: 47% of the publications presented an individual approach. 54% included eating and physical activity as cause. 29% of the measures propose a healthy environment and 27% individual recommendations. Individual frame was present in 77% of the news influenced by the industry. CONCLUSION: Publications on childhood obesity of the main Spanish lay press reveal a predominance of the individual approach to the problem. This majority perception may condition the development and implementation of public health policies or interventions.

[Map of school nutritional policies in Spain]. / Mapa de las políticas nutricionales escolares en España.

OBJECTIVE: To systematically describe the school nutritional policies of the 17 autonomous communities of Spain. METHOD: Through a search of bibliographic databases, web pages and other official information systems, 183 documents of interest were identified. Information was systematically collected with the SNIPE (school nutrition index of programme effectiveness) questionnaire, adapted to Spain, and validated by reference staff of the regional government's health and education ministries. RESULTS: The main objective of the policies is to prevent obesity and improve the nutrition of schoolchildren. The 17 autonomous communities cover the school canteen service, 11 cafeteria and vending machines, and 9 the breakfast service. All communities use the Consensus Document on School Food as a reference for the content of the menu and the nutritional quality of the products offered at the school; however, only 4 of them have regulated these aspects. The evaluation of policy objectives ranges from 58.8% of the autonomous communities for food supply to 5.9% for rotation and menu quality. CONCLUSION: Although all the autonomous communities have standards for the school menu, the standards for the rest of the food supply vary across them; also, evaluation of objectives is scarce and only 4 communities have approved mandatory regulations. Nutritional standards should be reviewed according to current scientific knowledge and enacted by law, in compliance with the current legislation (Act 17/2011).