Leptin Receptor Gene Variant rs11804091 Is Associated with BMI and Insulin Resistance in Spanish Female Obese Children: A Case-Control Study.

Leptin is an endocrine hormone that has a critical role in body weight homoeostasis and mediates its effects via the leptin receptor (LEPR). Common polymorphisms in the genes coding leptin receptors have been associated with metabolic abnormalities. We assessed the association of 28 LEPR polymorphisms with body mass index (BMI) and their relationship with obesity-related phenotypes, inflammation and cardiovascular disease risk biomarkers. A multicentre case-control study was conducted in 522 children (286 with obesity and 236 with normal-BMI). All anthropometric, metabolic factors and biomarkers were higher in children with obesity except apolipoprotein (Apo)-AI, cholesterol, high-density lipoprotein cholesterol (HDL-c), and adiponectin, which were lower in the obesity group; and glucose, low-density lipoprotein cholesterol (LDL-c), and matrix metalloproteinase-9 that did not differ between groups. We identified the associations between rs11208659, rs11804091, rs10157275, rs9436303 and rs1627238, and BMI in the whole population, as well as the association of rs11804091, rs10157275, and rs1327118 with BMI in the female group, although only the rs11804091 remained associated after Bonferroni correction (p = 0.038). This single nucleotide polymorphisms (SNP) was also associated with insulin (p = 0.004), homeostasis model assessment for insulin resistance (HOMA-IR) (p = 0.006), quantitative insulin sensitivity check index (QUICKI) (p = 0.005) and adiponectin (p = 0.046) after adjusting for age, Tanner stage and BMI. Our results show a sex-specific association between the rs11804091 and obesity suggesting an influence of this SNP on insulin resistance.

A Continuous Metabolic Syndrome Score Is Associated with Specific Biomarkers of Inflammation and CVD Risk in Prepubertal Children.

BACKGROUND/AIMS: We aimed to evaluate the use of a continuous metabolic syndrome (MetS) score and to assess the associations of this score with risk biomarkers of inflammation, endothelial damage and cardiovascular disease (CVD) in prepubertal children. METHODS: A total of 677 prepubertal children (295 obese, 146 overweight, and 236 normal-weight) were recruited. MetS traits, markers of inflammation, endothelial damage and CVD risk were measured, and a continuous MetS score was calculated, consisting of the sum/5 of the standardised scores of the MetS components. RESULTS: The continuous MetS score was significantly associated with active plasminogen activator inhibitor-1 (r = 0.406, p < 0.001), adiponectin (r = -0.212, p < 0.001), resistin (r = 0.263, p < 0.001), C-reactive protein (r = 0.254, p < 0.001), tumour necrosis factor alpha (r = 0.120, p = 0.003), myeloperoxidase (r = 0.188, p < 0.001) and sE-selectin (r = 0.278, p < 0.001). Children in the normal-weight, overweight and obese groups with MetS totalled 0 (0%), 1 (0.7%) and 24 (8.7%), respectively, whereas the at-risk children identified using the continuous MetS score in each group totalled 2 (0.85%), 17 (11.6%) and 167 (56.6%), respectively. CONCLUSIONS: The association of the continuous MetS score with specific risk biomarkers of inflammation, endothelial damage and CVD supports its use in the early identification of children at increased risk of metabolic dysfunction.

Waist-to-height ratio, inflammation and CVD risk in obese children.

OBJECTIVE: To evaluate the association between waist-to-height ratio (WHtR) and specific biomarkers of inflammation, CVD risk and endothelial dysfunction in prepubertal obese children. DESIGN: Prospective, multicentre case-control study matched by age and sex. SETTING: Children were recruited between May 2007 and May 2010 from primary-care centres and schools in three cities in Spain (Cordoba, Santiago de Compostela and Zaragoza). SUBJECTS: Four hundred and forty-six (223 normal weight and 223 obese) Caucasian prepubertal children aged 6-12 years. RESULTS: WHtR was higher in the obese than in the normal-weight children. Blood pressure, waist circumference, weight, height, insulin, plasma lipids, leptin, resistin, abnormal neutrophil and monocyte counts, C-reactive protein, IL-6, IL-8, TNF-α, myeloperoxidase, soluble intercellular adhesion molecule-1, selectin and plasminogen activator inhibitor-1 levels were higher in the obese than in the normal-weight group. Adiponectin and HDL-cholesterol were lower and glucose and metalloproteinase-9 showed no differences. Resistin, TNF-α and active plasminogen activator inhibitor-1 were associated with WHtR, a sensitive indicator of central obesity. CONCLUSIONS: Our results lead to the hypothesis that changes in biomarker levels of insulin resistance, inflammation and CVD risk before puberty might induce metabolic consequences of obesity in obese children before reaching adulthood.

Influence of FTO variants on obesity, inflammation and cardiovascular disease risk biomarkers in Spanish children: a case-control multicentre study.

BACKGROUND: Variants in the FTO gene have been associated with obesity in children, but this association has not been shown with other biomarkers. We assessed the association of 52 FTO polymorphisms, spanning the whole gene, with obesity and estimated the influence of these polymorphisms on anthropometric, clinical and metabolic parameters as well as inflammation and cardiovascular disease (CVD) risk biomarkers among Spanish children. METHODS: A multicentre case-control study was conducted in 534 children (292 obese and 242 with normal-BMI). Anthropometric, clinical, metabolic, inflammation and CVD risk markers were compared using the Student's t-test for unpaired samples. The genotype relative risk was assessed by comparing the obese and normal-BMI group, calculating the odds ratio. The association of each SNP with phenotypic parameters was analysed using either logistic or linear regression analysis. RESULTS: All anthropometric, clinical and metabolic factors as well as inflammatory and CVD risk biomarkers were higher in the obese than in the normal-BMI group, except adiponectin and HDL-c that were lower, and glucose, LDL-c, and metalloproteinase-9 that did not show difference. Four polymorphisms (rs9935401, rs9939609, rs9928094 and rs9930333) were positively associated with obesity and in linkage disequilibrium between each other; the haplotype including the risk alleles of these polymorphisms showed a high risk for obesity. The rs8061518 was negatively associated with obesity and the haplotype including this SNP and rs3826169, rs17818902 and rs7190053 showed a decreased risk for obesity. Additionally, the rs8061518 was associated with weight, diastolic blood pressure, insulin, homeostatic model assessment of insulin resistance, leptin, and active plasminogen inhibitor activator-1 after sex and age adjustment; however, after an additional BMI adjustment, this polymorphism remained associated only with leptin. CONCLUSIONS: We validated the previous reported association of genetic variability in intron 1 of the FTO gene with the risk of obesity and found no association with other related traits in this region of the gene. We have observed strong statistical evidence for an association of rs8061518 in intron 3 of the gene with decreased risk of obesity and low concentration of leptin.

Impact of Dietary Isoflavone Supplementation on the Fecal Microbiota and Its Metabolites in Postmenopausal Women.

Isoflavones are metabolized by components of the gut microbiota and can also modulate their composition and/or activity. This study aimed to analyze the modifications of the fecal microbial populations and their metabolites in menopausal women under dietary treatment with soy isoflavones for one month. Based on the level of urinary equol, the women had been stratified previously as equol-producers (n = 3) or as equol non-producers (n = 5). The composition of the fecal microbiota was assessed by high-throughput sequencing of 16S rRNA gene amplicons and the changes in fatty acid excretion in feces were analyzed by gas chromatography. A greater proportion of sequence reads of the genus Slackia was detected after isoflavone supplementation. Sequences of members of the family Lachnospiraceae and the genus Pseudoflavonifractor were significantly increased in samples from equol-producing women. Multivariable analysis showed that, after isoflavone treatment, the fecal microbial communities of equol producers were more like each other. Isoflavone supplementation increased the production of caproic acid, suggesting differential microbial activity, leading to a high fecal excretion of this compound. However, differences between equol producers and non-producers were not scored. These results may contribute to characterizing the modulating effect of isoflavones on the gut microbiota, which could lead to unravelling of their beneficial health effects.

Use of high throughput amplicon sequencing and ethidium monoazide dye to track microbiota changes in an equol-producing menopausal woman receiving a long-term isoflavones treatment.

This work describes the impact of long term consumption of an isoflavone-rich dietary daily supplement on the composition and diversity of the faecal microbiota of a menopausal, equol-producing woman. Sequencing of 16S rDNA amplicons was performed on faecal samples taken at 0, 1, 3 and 6 months of treatment. Additionally, and for comparative purposes, ethidium monoazide (EMA) was used to avoid detection of DNA from dead bacteria. Members of two genera of the family Coriobacteriaceae (Eggerthella and Collinsella) were found in greater proportions at all sampling points during isoflavone supplementation. Different genera of the family Ruminococcaceae (e.g., Ruminococcus and Faecalibacterium), as well as members of the family Lachnospiraceae (Coprococcus) also underwent significant increases. For this last genus a positive correlation with the levels of equol excretion in urine was found. Currently bacterial strains known to be involved in isoflavone metabolism and equol production have been assigned to these taxa. The use of EMA dye allowed us to unravel those bacterial gut linages (e.g., Lachnospiraceae) that were more susceptible to damage. Our study contributes to the identification of microorganisms possibly involved in the production of isoflavone-desirable metabolites (such as equol), which could ultimately be isolated and further used as probiotics by people who cannot naturally benefit from isoflavones.

[Lung function reference values in children and adolescents aged 6 to 18 years in Galicia]. / Valores de referencia de función respiratoria en niños y adolescentes (6-18 años) de Galicia.

OBJECTIVE: It is well known that lung function reference values differ between populations, hence the apparent importance of establishing such values. The aim of this study was to develop prediction equations for spirometry for healthy children and adolescents in Galicia, Spain. POPULATION AND METHODS: We studied children and adolescents aged 6 to 18 years from randomly selected schools in 14 municipalities in Galicia. Spirometric values were measured following the protocols established by the American Thoracic Society in 1987, with real-time monitoring of flow-volume curves. The prediction equations were derived using multivariate linear regression. RESULTS: We developed equations to predict the main spirometry parameters for this age group according to sex, height, and weight. Mean spirometry values in relation to height were higher for boys than for girls, except in the 140-160 cm range, where they were higher for girls. Equations published in other studies in similar populations gave different predictions, ranging from an underestimation of forced midexpiratory flow rate (FEF(25%-75%)) by 16% in comparison to ours to an overestimation of peak expiratory flow (PEF) rate by 15% for an average boy. For a girl, the corresponding differences ranged from an underestimation of FEF(25%-75%) by 17% to an overestimation of PEF by 19%. CONCLUSIONS: These results support the importance of using population-specific prediction equations to establish lung function reference values.

[Parental smoking and lung function in healthy children and adolescents]. / Tabaquismo parental y función pulmonar en niños y adolescentes sanos.

OBJECTIVE: The debate continues on the effect of passive smoking on nonsmokers. The effect of parental smoking on the lung function of children varies considerably according to geographic area, source of passive smoking, and sex. The objective of this study was to evaluate the effect of parental smoking on the lung function of children. POPULATION AND METHODS: A cross-sectional study was performed on a sample of the population of healthy children and adolescents between 6 and 18 years of age in Galicia. Subjects were selected by means of 2-stage cluster sampling grouped by sex and age. RESULTS: Approximately 56% of the children were exposed to the tobacco smoke of one of their parents. Children whose fathers were smokers presented a 40% higher risk of reduced forced expiratory flow at 75% of forced vital capacity (FEF75%) and a 30% higher risk of reduced FEF25%-75%. Children whose mothers were smokers presented a 30% higher risk of reduced forced expiratory volume in the first second and a 40% higher risk of reduced FEF50%. There was a 60% increase in risk of reduced FEF75%. The fact that both parents smoked did not appear to increase the risk of reduced lung function. CONCLUSIONS: Parental smoking has a considerable effect on the lung function of children and adolescents. Smoking by either the mother or the father has a decisive influence. The fact that this effect is independent of the growth of the child and that the obstructive effect is located principally in the distal airways appears to confirm the hypothesis that this effect is produced after birth.

Quality of life in patients with functional dyspepsia: a prospective 1-year follow-up study in Spanish patients.

BACKGROUND AND AIMS: The natural history of functional dyspepsia is not well known. We prospectively assess the quality of life and severity of symptoms in a group of Spanish patients with functional dyspepsia. PATIENTS AND METHODS: One hundred and twelve consecutive patients with functional dyspepsia, according to Rome II criteria, were prospectively followed up for 1 year. All patients completed symptom (Dyspepsia Questionnaire and the Gastrointestinal Symptoms Rating Scale) and quality of life [the Psychological General Well-Being (PGWB) Index and the General Health Questionnaire (GHQ)] questionnaires every 3 months. Only free antacid consumption was permitted during the study period. RESULTS: The group was made up of 81 women and 31 men with a mean age of 45 +/- 17 years; 66% of patients were infected with Helicobacter pylori, and ulcer-like dyspepsia (53%) was the predominant subgroup. At baseline, quality of life scores were low (PGWB, 87.1 +/- 17.6 and GHQ, 20.6 +/- 11.8), but these values gradually improved during the year of follow-up (PGWB, 107.7 +/- 1.1 and GHQ, 8.9 +/- 0.4). Digestive symptoms also decreased. In the multivariate analysis, the anxiety score on the PGWB index (Wald, 5.2; P = 0.02) and smoking status (Wald, 4.3; P = 0.04) were predictors of end quality of life. At baseline, patients with a high level of anxiety had a very reduced quality of life, although their symptom scores were similar to other patients. CONCLUSION: Quality of life is reduced in patients with functional dyspepsia. Some improvement in quality of life together with a decrease in the severity of symptom scores was seen during the 1 year of follow-up. We believe that both the reassurance of negative endoscopy and the scheduling of visits to the doctor favourably influence the quality of life.

[Prevalence of obesity in Spain: results of the SEEDO 2000 study]. / Prevalencia de la obesidad en España: resultados del estudio SEEDO 2000.

BACKGROUND AND OBJECTIVE: Obesity is a major public health problem in developed countries. It is of key importance to ascertain its magnitude and to identify main groups at risk. In this paper the prevalence of obesity in Spanish adult population aged 25-60 is estimated, based on measured height and weight. SUBJECTS AND METHOD: Pooled-analysis of regional cross-sectional nutrition surveys performed on representative random population samples. Randomly selected 9,885 free living subjects aged 25-60 years respondents of population nutritional surveys carried out in eight Spanish regions (Andalucía, Balearic Islands, Basque Country, Canary Islands, Catalunya, Galicia, Madrid and Valencia) between 1990 to 2000. Weight and height were measured on each individual by trained observers following standardised procedures and measuring instruments. The samples were pooled together and weighted according to the distribution of Spanish adult population aged 25-60 years. Obesity was defined as body mass index (BMI) >= 30 kg/m2. The protocol used in each survey was in accordance to the recommendations of the Spanish Society for the study of Obesity (SEEDO) to estimate the prevalence of obesity in population studies. RESULTS: The prevalence of obesity in Spanish adult population was 14.5% (95% CI, 13.93-15.07%), significantly higher among women 15.75% (95% CI, 14.89-16.61%), than men 13,39% (95% CI, 11.84-14.94%) (*2 = 12.470; p = 0.000). Prevalence of obesity significantly increased with age in men and women. The highest rates were estimated for the age group older than 55 years, both among males and females, 21.58% (95% CI, 18.68-24.48%) and 33.9% (95% CI, 32.73-35.07%), respectively. CONCLUSION: Obesity is a health problem which affects an important proportion of the Spanish adult population. Considering its potential impact on Public Health, it would be required to design and implement effective strategies aimed at the early detection of subjects at risk and the provision of adequate treatment, as well as to establish suitable preventive programmes.

Intestinal microbiota in health and disease: role of bifidobacteria in gut homeostasis.

The pool of microbes inhabiting our body is known as "microbiota" and their collective genomes as "microbiome". The colon is the most densely populated organ in the human body, although other parts, such as the skin, vaginal mucosa, or respiratory tract, also harbour specific microbiota. This microbial community regulates some important metabolic and physiological functions of the host, and drives the maturation of the immune system in early life, contributing to its homeostasis during life. Alterations of the intestinal microbiota can occur by changes in composition (dysbiosis), function, or microbiota-host interactions and they can be directly correlated with several diseases. The only disease in which a clear causal role of a dysbiotic microbiota has been demonstrated is the case of Clostridium difficile infections. Nonetheless, alterations in composition and function of the microbiota have been associated with several gastrointestinal diseases (inflammatory bowel disease, colorectal cancer, or irritable bowel syndrome), as well as extra-intestinal pathologies, such as those affecting the liver, or the respiratory tract (e.g., allergy, bronchial asthma, and cystic fibrosis), among others. Species of Bifidobacterium genus are the normal inhabitants of a healthy human gut and alterations in number and composition of their populations is one of the most frequent features present in these diseases. The use of probiotics, including bifidobacteria strains, in preventive medicine to maintain a healthy intestinal function is well documented. Probiotics are also proposed as therapeutic agents for gastrointestinal disorders and other pathologies. The World Gastroenterology Organization recently published potential clinical applications for several probiotic formulations, in which species of lactobacilli are predominant. This review is focused on probiotic preparations containing Bifidobacterium strains, alone or in combination with other bacteria, which have been tested in human clinical studies. In spite of extensive literature on and research into this topic, the degree of scientific evidence of the effectiveness of probiotics is still insufficient in most cases. More effort need to be made to design and conduct accurate human studies demonstrating the efficacy of probiotics in the prevention, alleviation, or treatment of different pathologies.

Association of genetic polymorphisms for glutathione peroxidase genes with obesity in Spanish children.

BACKGROUND/AIMS: Altered expression and activity of the antioxidant enzymes glutathione peroxidases (GPXs) have been observed in obesity in human and animal studies. We aimed to study 59 single nucleotide polymorphisms (SNPs) for GPX1-7 genes and to characterize their association with prepubertal childhood obesity and its associated biomarkers. METHODS: This case-control study included 193 obese and 191 normal-weight prepubertal Spanish children, in whom anthropometry, biochemical parameters, adipokines, antioxidant enzyme erythrocyte activities and biomarkers of oxidative stress, inflammation and cardiovascular risk were measured. The genotype analysis was performed in the Illumina platform. PLINK and SPSS were used for statistical analyses. RESULTS: We found SNPs rs757228 and rs8103188 (GPX4) to be negatively associated and rs445870 (GPX5) and rs406113 (GPX6) to be positively associated with obesity in children. The variant rs2074451 (GPX4) increased GPX activity in erythrocytes. Although we did not find significant differences in erythrocyte GPX activity between obese and normal-weight children, GPX activity was found to be positively and significantly correlated with blood pressure, adipocyte fatty acid-binding protein and high-sensitivity C-reactive protein. CONCLUSIONS: The GPX variants rs757228, rs8103188, rs445870 and rs406113 were associated with prepubertal childhood obesity. However, erythrocyte GPX activity was not altered in obese prepubertal Spanish children.

Are catalase -844A/G polymorphism and activity associated with childhood obesity?

Catalase (CAT) is a peroxisomal antioxidant enzyme that is up-regulated upon oxidative stress. Previous studies have found associations between some single nucleotide polymorphisms (SNPs) located in the CAT promoter region in a variety of metabolic diseases. This is the first study that analyzes the association between erythrocyte CAT activity and candidate CAT SNPs with childhood obesity. The association study showed a significant positive association of the promoter variant -844A/G with childhood obesity and biomarkers of obesity such as weight, body mass index (BMI), BMI Z-Score, and adipocyte fatty acid-binding protein, along with a tendency toward significance with insulin resistance biomarkers. In addition, CAT erythrocyte activity was found to be significantly lower in obese children, and it was significantly correlated with obesity and insulin resistance biomarkers. No association was found between erythrocyte CAT activity and the SNP -844A/G. However, further in vitro and in vivo studies are needed to fully understand the role of CAT activity and SNPs in the development of insulin resistance in the setting of obesity. We hypothesize that CAT plays a role in early metabolic complications of obesity.

Influence of variants in the NPY gene on obesity and metabolic syndrome features in Spanish children.

Variants in the neuropeptide Y (NPY) gene have been associated with obesity and its traits. The objective of the present study was to evaluate the association of single nucleotide polymorphisms (SNPs) in the NPY gene with obesity, metabolic syndrome features, and inflammatory and cardiovascular disease (CVD) risk biomarkers in Spanish children. We recruited 292 obese children and 242 normal-body mass index (BMI) children. Height, weight, BMI, waist circumference, clinical and metabolic markers, adipokines, and inflammatory (PCR, IL-6, IL-8 and TNF-α) and CVD risk biomarkers (MPO, MMP-9, sE-selectin, sVCAM, sICAM, and PAI-1) were analyzed. Seven SNPs in the NPY gene were genotyped. The results of our study indicate that anthropometric measurements, clinical and metabolic markers, adipokines (leptin and resistin), and inflammatory and CVD risk biomarkers were generally elevated in the obese group. The exceptions to this finding included cholesterol, HDL-c, and adiponectin, which were lower in the obese group, and glucose, LDL-c, and MMP-9, which did not differ between the groups. Both rs16147 and rs16131 were associated with the risk of obesity, and the latter was also associated with insulin resistance, triacylglycerols, leptin, and HDL-c. Thus, we confirm the association of rs16147 with obesity, and we demonstrate for the first time the association of rs16131 with obesity and its possible impact on the early onset of metabolic syndrome features, mainly triacylglycerols, in children.

Myeloperoxidase is an early biomarker of inflammation and cardiovascular risk in prepubertal obese children.

OBJECTIVE: Obesity is associated with a state of chronic low-grade inflammation. Myeloperoxidase (MPO) plays an important role in the initiation and progression of acute and chronic inflammatory diseases, such as cardiovascular disease (CVD). The objectives of the current study were to evaluate plasma MPO levels in prepubertal obese children and to determine whether MPO could be an early biomarker of inflammation and CVD risk. RESEARCH DESIGN AND METHODS: In a prospective multicenter case-control study paired by age and sex of 446 Caucasian prepubertal children ages 6-12 years, 223 normal-weight and 223 obese children were recruited. Blood pressure, waist circumference, weight, and height were measured. In addition to MPO, glucose, insulin, metabolic lipid parameters, oxidized low-density lipoproteins, adiponectin, leptin, resistin, C-reactive protein (CRP), interleukin 6, tumor necrosis factor α, matrix metalloproteinase-9 (MMP-9), and plasminogen activator inhibitor 1 were determined. RESULTS: We found that MPO was elevated in prepubertal obese children and that this enzyme was associated with such proinflammatory and cardiovascular risk biomarkers as CRP, MMP-9, and resistin. Insulin resistance calculated by the homeostatic assessment model was the best predictor of MPO. CONCLUSIONS: MPO is an early biomarker of inflammation associated with CVD risk in obese children at the prepubertal age.

Body composition and respiratory function in healthy non-obese children.

BACKGROUND: The purpose of the present paper was to evaluate the role that body composition plays in lung function, among healthy children and adolescents. METHODS: Cross-sectional study was undertaken using sex- and age-stratified sampling among healthy children and adolescents aged 6-18 years. Spirometry was performed on every child who fulfilled inclusion criteria. Fat mass (FM) and fat-free mass (FFM) were calculated from triceps skinfold thickness and arm circumference. Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) and 95% confidence intervals (95%CI) between low pulmonary function (PF) of schoolchildren and body composition expressed in FM and FFM. Calculations of OR imply that the outcome is dichotomous (low PF/normal PF), therefore those children who had parameters of pulmonary function below the 25th percentile were classed as cases and the rest of the subjects were considered as controls. RESULTS: A total of 2408 children were included; 1270 (53%) of them were male and 1138 (47%), female. Among boys the increase of FFM was associated with an increase of forced expiratory volume in 1 s (FEV1). Among girls the increase of FFM was associated with an increase of FEV1, forced vital capacity, and peak expiratory flow. The increase in FM was associated with a decrease of spirometric parameters in both genders, with a stronger effect among boys. CONCLUSIONS: The present study confirms the negative effect of body fat on the PF of children and adolescents, even though obese subjects were excluded. The effect is different between boys and girls.

Causas y consecuencias de la opulencia en la edad pediátrica / Causes and consecuenses of opulence at pediatric age

El sobrepeso y la obesidad se han convertido en un problema serio y causa alarmante de aumento de la morbimortalidad en la población general. Además la existencia de una asociación clara entre el riesgo de enfermedad cardiovascular, cáncer, diabetes y obesidad ha llevado a la Organización Mundial de la Salud a declarar la existencia de una epidemia de obesidad a nivel mundial. Las causas de sobrepeso son complejas e incluyen factores ambientales, familiares y genéticos. Nuestro estilo de vida moderno permite un mayor acceso a todo tipo de alimentos incluyendo los alimentos de alto contenido energético y por otro lado nos proporciona una vida cotidiana con baja actividad física. También podemos incluir hábitos tóxicos muy implantados en nuestra sociedad como son el consumo de tabaco y alcohol, que suponen asociados a la obesidad un marcado aumento del riesgo de enfermedad. Los marcadores genéticos asociados a la obesidad representa un importante reto para el futuro y hasta el momento tan sólo unos pocos genes parecen tener un efecto importante sobre la obesidad. En esta revisión resumimos de forma actualizada estos aspectos centrándonos en la población infantil y juvenil. También proponemos una serie de medidas preventivas para reducir este problema actuando sobre la conducta tóxica de consumo de tabaco y alcohol en la juventud asociándolo con una importante educación dietética y la promoción de la actividad física ya en los niños y adolescentes