Influence of the interaction between the adiponectin G276T polymorphism and body mass index on lipid levels in healthy children.

Adiponectin is an adipose tissue-specific hormone which is inversely associated with metabolic alterations related to atherosclerosis. Polymorphisms in the adiponectin gene (AdipoQ) have been related to low adiponectin levels as well as several cardiovascular risk factors, but this association remains controversial. In our study we investigated the relationship between the AdipoQ T45G (rs: 2241766) and G276T (rs: 1501299) polymorphisms and adiponectin concentrations, blood pressure, and lipid and insulin levels, in a population-based sample of 12- to 16-year-old children. The study included 815 healthy Spanish children (388 boys and 427 girls). Plasma glucose and lipid levels were determined by standard methods. Insulin concentrations were measured by RIA, and serum adiponectin levels were determined by ELISA. The AdipoQ T45G and AdipoQ G276T polymorphisms were determined by TaqMan(®) allelic discrimination assays. ANOVA or t test allowed for comparison of the studied parameters across genotypes or genotype groups, respectively. A linear regression analysis was performed to examine the independent relationships of the lipid variables with BMI (body mass index), AdipoQ G276T polymorphism and the interaction between the two. When independently comparing the effect of these polymorphisms in normal-weight and overweight children, we observed that overweight boys carriers of the minor allele T had significantly lower TC, LDL-C and apo A-I levels than non-carriers, but these differences were not apparent in normal-weight boys. Furthermore, linear regression analysis demonstrated that interaction between the BMI and the AdipoQ G276T polymorphism is a significant factor explaining the variations of TC and LDL-C levels. To our knowledge, this is the first study to report an association between the AdipoQ G276T polymorphism and lipid levels in overweight boys alone, thereby suggesting that the influence of the AdipoQ polymorphisms on cardiovascular risk factors may be dependent on BMI.

Influence of the leptin G-2548A polymorphism on leptin levels and anthropometric measurements in healthy Spanish adolescents.

Polymorphisms in the leptin gene (LEP) have been associated with leptin levels and obesity in some studies in adults though this link has scarcely been investigated in children. In our study, we examined the relationship of the LEP G-2548A polymorphism with leptin levels, anthropometric variables and body composition in a population-based sample of pubescent children. Our study included 880 healthy schoolchildren (419 males and 461 females), 12-16 years of age. Plasma leptin levels were determined by ELISA. The LEP polymorphism was determined by allelic discrimination TaqMan assay. Male carriers of the AA genotype had significantly lower plasma leptin levels than GA (p < 0.008) and GG (p < 0.001) carriers and significantly lower mean hip circumference (HC) values than GG carriers (p = 0.04). In girls, leptin levels were also lower in A-allele carriers than in GG carriers, and BMI and HC were significantly lower in AA carriers as compared with GG carriers. In addition, the frequency of the A allele was significantly lower (chi(2): 4.58, p = 0.032) in the OW-obese than in the NW group. In conclusion, the LEP G-2548A polymorphism is associated with variations in leptin levels, BMI and HC in Spanish pubertal children, and evidence suggests a link between the G allele and presence of overweight in girls.

Sex hormone-binding globulin levels and metabolic syndrome and its features in adolescents.

BACKGROUND: Low levels of sex hormone-binding globulin (SHBG) are associated with obesity, insulin resistance, and metabolic syndrome (MS) in men and women, and it has been suggested that SHBG could be a useful marker for MS risk. OBJECTIVE: The aim of this study was to analyze the relationship of SHBG levels with MS and its components in Spanish adolescents. METHODS: The sample population of this cross-sectional study was comprised of 386 male and 429 female adolescents, aged 12-16 yr. Anthropometric parameters and blood pressure (BP) were measured. Total cholesterol, high-density lipoprotein (HDL)-cholesterol, insulin, glucose, and SHBG levels were determined. The pediatric International Diabetes Federation (IDF) definition was used to classify adolescents for MS. RESULTS: SHBG levels were lower in adolescents with MS or with some MS features. More than 90% of the abdominally obese adolescents were in the lowest and medium SHBG tertiles. In girls, BP was significantly higher in the lowest SHBG tertile than in the two others, whereas in boys BP levels were significantly higher in the lowest and medium tertiles than in the highest one. Insulin levels and homeostasis model assessment (HOMA) index were also significantly higher in the lowest SHBG tertile than in the two others. CONCLUSIONS: The associations of SHBG with MS and its components, such as abdominal obesity, high BP or insulin levels, are already present in normal adolescents. This may suggest the possibility of using SHBG levels as a biomarker for MS risk in adolescents as well as adults.

Leptin and adiponectin levels in pubertal children: relationship with anthropometric variables and body composition.

BACKGROUND: Adipocytokines play an important role in controlling energy homeostasis, and in various metabolic processes related to obesity. The aim of this study was to describe serum leptin and adiponectin concentrations in a sample of pubertal Spanish children and to evaluate their association with anthropometric parameters and body composition. METHODS: The study included 833 pubertal boys and girls. Serum leptin and adiponectin concentrations were determined by ELISA. RESULTS: Leptin concentrations were significantly higher (p<0.0001) in obese or overweight (OW) children compared with children with normal weight (NW). Adiponectin was significantly lower (p<0.01) in obese or OW girls compared with girls of NW, although these findings were not the same for boys. Weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist to hip ratio were significantly correlated (p<0.01) with leptin concentrations in both genders. Correlation of leptin with fat mass and % fat mass was strong, particularly in boys. The association of adiponectin concentrations with anthropometric variables was weaker in both genders. No significant correlations were found between adiponectin concentrations and fat mass or % fat mass. CONCLUSIONS: In summary, our study showed that, in pubertal children, leptin is related to weight, BMI, WC and HC and correlates even more strongly with % fat mass. However, adiponectin was weakly related to anthropometric variables and was not correlated with body fat.

Fat intake influences the effect of the hepatic lipase C-514T polymorphism on HDL-cholesterol levels in children.

Polymorphisms in the hepatic lipase gene have been associated with variability in plasma HDL-C concentrations, but contradictory results have been reported regarding the effect of diet on this association in adults. In our study, we examined whether dietary fat intake modified the association between lipid levels and the C-514T polymorphism in the hepatic lipase gene (LIPC C-514T) in prepubescent children. The LIPC C-514T polymorphism was determined by PCR and restriction analysis in 1260 healthy school children, aged 6-8. Information on the children's nutrient intake was obtained by means of a validated food frequency questionnaire. We found that regardless of gender, carriers of the minor allele had significantly higher apo A-I levels compared to noncarrier subjects. The effect of the polymorphism, however, was modified by dietary fat intake. In boys, the presence of the LIPC C-514T polymorphism was associated with significantly higher HDL-C among children within the highest tertiles of total, saturated, monounsaturated, or polyunsaturated fat intake. Apo A-I levels were significantly higher in carriers of the LIPC C-514T polymorphism, but only among boys who consumed high total as well as monounsaturated fat and among girls who consumed high total, saturated, monounsaturated, and polyunsaturated fat. Our data show that dietary fat intake modifies the effect of the LIPC C-514T polymorphism on plasma HDL-C and apo A-I levels in prepubescent children, being associated with higher levels of HDL-C and apo A-I only when fat intake is high. This significant gene-nutrient interaction could help to explain inter-individual variations in the plasma lipid response to fat intake.

Relationship of NEFA concentrations to RBP4 and to RBP4/retinol in prepubertal children with and without obesity.

BACKGROUND: The regulation of adipose tissue metabolism in early childhood obesity is not well understood. Insulin levels are higher and insulin resistance seems to be present in prepubertal children with obesity but, differing from their behavior in adults with obesity, non-esterified fatty acid (NEFA) concentrations are not increased. Retinol-binding protein (RBP)-4 concentration is associated with obesity and insulin resistance conditions, but the means of this relationship remain unclear, and few studies have taken retinol values into account to evaluate it. OBJECTIVE: To analyze the relationship between RBP4 concentration and lipolytic products in plasma in 141 prepubertal children aged 6 to 8 years, with and without obesity. METHODS: Plasma glucose, insulin, triacylglycerols, NEFA, glycerol, leptin, RBP4, and retinol were analyzed in obese and in their normal-weight counterparts. Homeostatic model assessment, quantitative insulin sensitivity check index, and fasting glucose to insulin ratio were calculated as indicators of insulin resistance. RESULTS: Fasted plasma NEFA concentrations were lower in children with obesity than in their normal weight counterparts, despite leptin, insulin resistance indices, RBP4, retinol, and RBP4/retinol (an index of free-RBP4) being higher. NEFA and glycerol concentrations were inversely correlated with RBP4/retinol in children with obesity but not in those without obesity. In normal weight children, total RBP4 correlated negatively with NEFA and glycerol concentrations and positively with insulin and homeostasis model assessment for insulin resistance. These results indicate that a low saturation of RBP4 with retinol, which implies a higher concentration of free-RBP4, may preserve the antilipolytic function of insulin in adipose tissue in children with obesity. CONCLUSION: Our findings suggest that, in prepubertal children with obesity and insulin resistance, the amount of RBP4/retinol correlates with the antilipolytic response of the adipose tissue to insulin rather than the total RBP4 concentration.

The serum levels of the EGF-like homeotic protein dlk1 correlate with different metabolic parameters in two hormonally different children populations in Spain.

BACKGROUND: The Dlk1 gene encodes for dlk1, a transmembrane protein belonging to the EGF-like repeat-containing family. Dlk1 has been shown to act as a regulator of adipogenesis. Fc-dlk1 transgenic mice show a decrease in adipose tissue and glucose tolerance, hypertriglyceridaemia and lower insulin sensitivity. Dlk1-deficient mice show growth retardation, increased serum lipid metabolites and develop obesity. These data advocate for a role of dlk1 in the maintenance of lipid homeostasis, and suggest that dlk1 levels may influence the development of cardiovascular disease. AIM AND METHODS: In this study, we analysed whether dlk1 serum levels could be indicative of the different hormonal or metabolic status shown by two Spanish children populations (6-8 years-old), Orense and Murcia. We determined dlk1 serum levels by ELISA assay, using an antibody raised against the recombinant protein, and performed a correlation analysis against measurements of several hormonal and biochemical parameters in samples from 494 subjects. RESULTS: We found a statistically significant positive correlation between serum levels of dlk1 and those of glucose (P < 0.05), total cholesterol (P < 0.01) and high-density lipoprotein-cholesterol (HDL-C) (P < 0.01) in children from Murcia, but not from Orense's population, where dehydroepiandrosterone-sulphate (DHEA-S) levels were significantly higher (P < 0.01) and dlk1 correlated positively with insulin (P < 0.01), homeostasis model assessment (HOMA) (P < 0.01) and free fatty acids (FFA) (P < 0.05). CONCLUSIONS: dlk1 serum levels appear related to the anabolic status of the children in association with changes in the levels of DHEA-S, which have been associated with hyperinsulinaemia and diabetes. Monitoring dlk1 levels may be important to evaluate the metabolic and hormonal stage of child development.

[Serum folate levels in adolescent population in Madrid, Spain]. / Folato sérico en población adolescente de la Comunidad de Madrid.

BACKGROUND AND OBJECTIVE: Serum folate concentrations in children are essential to establish values which allow to compare different regions or countries, and raise the possibility of fortifying diet with group B vitamins and folic acid as a secondary prevention against cardiovascular diseases. SUBJECTS AND METHOD: A cross-sectional epidemiological study was performed to assess serum folate levels in school children, aged 13-15 years, in Madrid. Folate and vitamin B12 determinations were determined in blood samples of fasting children. Genotype C677T of methylentetrahydrofolate reductase (MTHFR) enzyme was determined by polymerase chain reaction. RESULTS: Average folate levels obtained in our study were 7.83 nmol/l (95% confidence interval, 7.42 to 8.23 nmol/l). Median was 6.89 nmol/l (interquartilic range: 5.30 to -9.30 nmol/l). No statistically significant differences were found by gender, age or presence of menstruation. Serum folate concentration decreased significantly with the mutation of the C677T genotype for MTHFR. Prevalence of deficits of folate (< 5.3 nmol/l) was 23.8% and raised significantly with the mutation of the C677T genotype for MTHFR: 18.8% for CC, 20.4% for CT, and 46.7% for TT. This effect was mainly observed in girls after menstruation. CONCLUSIONS: Homozygosis mutation in C677T genotype of the enzyme MTHFR induces lower folate levels, mainly in girls after menstruation. 5.3 nmol/l is proposed as a threshold to define deficient serum folate levels in the Spanish adolescent population.

Dehydroepiandrosterone sulfate (DHEA-S) distribution in Spanish prepuberal children: relationship with fasting plasma insulin concentrations and insulin resistance.

BACKGROUND: The aim of this study was to analyze dehydroepiandrosterone sulfate (DHEA-S) levels in a population-based sample of Spanish prepuberal children and to investigate the relationship between DHEA-S and insulin. METHODS: 854 (440 boys and 414 girls) randomly selected prepuberal children were included in our study after a sampling. Children were 6 to 8 years old and were classified for the analysis in half-year intervals. DHEA-S and insulin levels were measured. RESULTS: DHEA-S levels increase significantly with age during prepuberty reaching the maximum level of DHEA-S for this period at 7.5 years old in girls and 8 years old in boys. Girls have significantly higher log DHEA-S levels than boys, except at the age of 8, where the levels are similar (median: 41.7 nmol/l girls and 41.1 nmol/l boys). DHEA-S correlates positively and significantly with weight, height, and BMI in all age intervals but the correlation between DHEA-S and insulin and HOMA is present only at the age of 6.5 in boys and 8 in girls. CONCLUSIONS: We report data about the distribution of DHEA-S in the Spanish prepuberal population. The maximum level of DHEA-S in this prepuberal period was reached before in girls than in boys, with girls having higher DHEA-S levels than boys until the end of this period. We found an important association between DHEA-S levels and weight, height and BMI but an inconsistent association of DHEA-S with insulin and HOMA.

Metabolic adaptation in the crew of the Hesperides on their Antarctic journey.

AIMS: We studied the metabolic changes that took place in the crew of the Hesperides vessel in their 2001-2002 Antarctic journey, comparing two periods differing in diet and physical activity. METHODS AND RESULTS: Lipid profile, vitamin and hormone levels were analyzed in 17 subjects who completed the study in its two phases. In phase I the participants spent 47 days sailing with hard work and rough seas, and the diet was rich in fat and poor in fresh foods. In this phase, glucose decreased and HDL-cholesterol, apo-AI, and TSH increased. Plasma retinol and alpha-tocopherol levels remained stable, gamma-tocopherol, alpha-carotene and beta-carotene significantly decreased, and lycopene significantly increased. Phase II lasted 49 days including a 7-day long stop in port. This meant that a more varied diet was available and fresh foods were present in the hold. There was also less extreme physical activity. The metabolic pattern changed direction, glucose rose, HDL-cholesterol and apo-AI decreased and the levels of the vitamins that dropped in phase I started to increase. Lycopene significantly decreased. CONCLUSION: Contrary to popular beliefs about navigation at extreme latitudes, the metabolic changes described may be explained by the intense physical activity in a cold environment and a high-fat diet poor in fresh products.

Influence of apolipoprotein E genotype on fat-soluble plasma antioxidants in Spanish children.

BACKGROUND: Apolipoprotein (apo) E is a major determinant of plasma lipid concentrations, which in turn influence the plasma concentrations of various fat-soluble vitamins. OBJECTIVE: We aimed to analyze the effect of APOE genotype on fat-soluble antioxidant concentrations in children. DESIGN: A total of 926 healthy boys and girls aged 6-8 y were selected from 4 cities in Spain. APOE genotyping was carried out, and plasma concentrations of lipids, apolipoproteins, and lipid-soluble antioxidants were measured. RESULTS: Plasma lipid concentrations were strongly influenced by APOE genotype. The mean plasma concentration of alpha-tocopherol was 21.3 micromol/L, which is one of the highest values ever reported for a population of children. Although plasma concentrations of alpha-tocopherol, gamma-tocopherol, lycopene, and alpha-carotene varied significantly between subjects with different APOE genotypes, most of these differences disappeared after adjustment for lipoprotein-related covariates. Nevertheless, tocopherol concentrations remained elevated in individuals with the E2/2 genotype. Multivariate regression analysis showed interactions of APOE genotype with triacylglycerol and apo B in determining alpha-tocopherol concentrations. When subjects were stratified according to major apo E groups, apo B appeared to be the most important predictor of alpha-tocopherol concentrations in all groups, whereas triacylglycerol was identified only in carriers of the E2 allele. CONCLUSIONS: The association between APOE genotype and lipophilic antioxidant concentrations is dependent mainly on the effect of the polymorphism on lipoprotein concentrations. However, triacylglycerol plays a role in determining the variability of alpha-tocopherol concentrations in E2 carriers only. This suggests that the alpha-tocopherol content in each lipoprotein class varies according to APOE genotype.

epsilon3epsilon4 genotype as risk factor of myocardial infarction in middle-aged people in Spain.

Apolipoprotein E (apoE) plays an important role in lipid metabolism. Its epsilon4 allele has been consistently associated with lipoprotein disorders but its connection to myocardial infarction (MI) is controversial. Because epsilon4 frequency decreases with age we thought that the contradictory results in different studies could be due to the wide age range of the subjects included. To test our hypothesis, ApoE genotyping was performed in 474 MI cases and an analysis was performed by percentiles of age. The frequencies of epsilon3epsilon4 genotype and epsilon4 allele in the MI group as a whole (subjects aged 31 to 92) were not significantly different from those in our area general population. However, significant differences were observed when comparing by group of age. The frequencies decreased as age increased. The epsilon3epsilon4 and epsilon4 frequencies were significantly higher in MI subjects aged 31 to 56 than in subjects over 74. The epsilon3epsilon4 genotype prevalence in an age and sex matched control group of subjects aged 31 to 56 was significantly lower than in the 31-56 year-old MI group. In conclusion, our data shows different epsilon3epsilon4 and epsilon4 frequencies depending on the age range of the subjects with MI, being significantly higher in the middle-aged group. This finding may help explain the discrepancies between studies analyzing association between apoE genotype and MI, and emphasizes the idea of considering apoE genotype for prevention at early age.

Insulin and HOMA in Spanish prepubertal children: relationship with lipid profile.

OBJECTIVE: The effects of insulin or insulin resistance on the lipid profile seem to change with age. The aim of this study was to analyze insulin levels and an insulin resistance index and to investigate the relationship between these and the lipid profile in a population-based sample of Spanish prepubertal children. METHODS: 1048 (524 boys and 524 girls) randomly selected prepubertal children were studied. Children were 6 to 8 years old with a mean age of 6.7. Plasma lipid, FFA and insulin levels were measured. The homeostatic model assessment (HOMA) was calculated as an indicator of insulin resistance. RESULTS: When analyzing percentile values of insulin, HOMA and FFA by sex, we observed that girls had significantly higher insulin concentrations than boys (except at the 10th percentile) and significantly higher FFA (except at the 90th percentile) with no significant differences between sexes for HOMA. Multivariate regression analyses showed that insulin was positively associated with glucose, triglycerides and apoB in boys but not in girls, and negatively associated with FFA in both genders. CONCLUSIONS: We report here data about the distribution of insulin in the Spanish prepubertal population. The higher levels of insulin in prepubertal girls could indicate that girls start to be more insulin resistant than boys at this age, although other manifestations of insulin resistance are not yet detectable.

Effects of dehydroepiandrosterone-sulfate on the Apo E genotype influence on plasma lipid levels in prepubertal children.

Gender differences in the apolipoprotein (apo) E genotype effect on plasma lipid levels reported in adults have also been found in pre-pubertal children. In adults, the difference seems to be due to the influence of sexual hormones. The reason why this difference exits between pre-pubertal girls and boys, for whom those sexual hormones are not different, is unclear. However, there is an important difference in Dehydroepiandrosterone-sulfate (DHEA-S) levels between pre-pubertal boys and girls. To evaluate the influence of DHEA-S on apo E genetic determinants of plasma lipids levels in pre-pubertal children we measured plasma DHEA-S in 1045 healthy children (534 males and 511 females) 6 to 8 years old in which a different apoE influence on lipid levels had been reported between girls and boys. Our observations demonstrate that the extent of the lipid increasing or decreasing effects associated with each allele were modulated by DHEA-S. DHEA-S increases the hypolipemic effect of the epsilon2 allele and decreases the hyperlipemic effect of the epsilon4 allele. In conclusion, the interaction of apo E genotype and DHEA-S may represent a critical determinant of TC, LDL-C and apo B levels in children at the prepuberal age.

Consistently high plasma high-density lipoprotein-cholesterol levels in children in Spain, a country with low cardiovascular mortality.

Coronary heart disease (CHD) mortality is relatively low in Spain compared with other developed countries and has remained low despite an apparent increase in mean plasma cholesterol concentration in adults over the last several years. It is accepted that pathologic processes related to arteriosclerosis development begin in childhood and seem to be related to the presence of cardiovascular risk factors at this age. High-density lipoprotein-cholesterol (HDL-C) levels in children have been inversely correlated with the incidence of coronary heart disease in the different countries studied. Childhood plasma lipoprotein profile might contribute to the low coronary heart disease mortality in Spain. Thus, we analyzed data on lipid levels over time in schoolchildren in Spain in the last decade. Plasma lipid levels were analyzed in prepuberal children (6 to 8 years) in 3 school-based surveys performed by our group in Madrid in 1987, 1993, and 1999. A significant increase in plasma total cholesterol (P < .05) and low-density lipoprotein-cholesterol (LDL-C) (P < .01) levels in prepuberal children was observed over the last decade. However, the mean concentration of plasma HDL-C remained stable and very high. These high levels of plasma HDL-C in Spanish school children may help to explain why the coronary heart disease mortality rate in Spain is low compared with that in other developed countries.

[Intervention program to improve secondary prevention of myocardial infarction. Results of the PRESENTE (early secondary prevention) study]. / Programa de intervención para mejorar la prevención secundaria del infarto de miocardio. Resultados del estudio PRESENTE (PREvención SEcuNdaria TEmprana).

INTRODUCTION AND OBJECTIVES: Secondary prevention measures for myocardial infarction are inadequate. In Spain, the earlier PREVESE studies provided preliminary data. The aim of this study was to document the results of a simple intervention program for secondary prevention, implemented during the hospital stay. PATIENTS AND METHODS: We included 4174 patients (mean age 63.7 years, 73% men) discharged from 110 hospitals after myocardial infarction. Lipid profile was determined during the first 24 h after admission, and before discharge patients and relatives were informed about the disease and its prevention, and were given printed informative materials. The patients were seen again 6 months later. RESULTS: After 6 months, 82.9% of the patients were examined and 10% were lost to follow-up. Mean blood pressure, weight and body mass index of the sample were lower, and lifestyle variables had improved. At discharge 87% were prescribed statins, 59.4% beta blockers, 51.2% ACE inhibitors and angiotensin blockers, and 94.1% antiplatelet drugs. These prescriptions were still being used 6 months later. There were substantial improvements in lipid values. CONCLUSIONS: The implementation of a simple intervention program for patients with myocardial infarction and their relatives, and the determination of lipid levels within 24 hours of admission, improved the secondary prevention measures at discharge and during the 6-month follow-up period. Acceptance of the program among the patients was good.

[New data on secondary prevention of myocardial infarction in Spain. Results of the PREVESE II study]. / Nuevos datos sobre la prevención secundaria del infarto de miocardio en España. Resultados del estudio PREVESE II.

Introduction and objectives. The PREVESE Study reported the situation of secondary prevention after myocardial infarction in Spain. Similar surveys conducted in Europe have also shown that the implementation of secondary prevention is not adequate. The aim of this second PREVESE study was to compare the situation in Spain four years after the first study.Patients and method. We included retrospectively 2,054 patients discharged after myocardial infarction from 74 Spanish hospitals. We studied the available information recorded in medical records after discharge, the prevalence of risk factors, procedures performed, and medical treatment before admission and at discharge. We compared the data collected with those from the first PREVESE study because the data collection methodology was similar.Results. The information recorded in the hospital medical records was satisfactory in relation to the most important risk factors (hypertension 94.8%; dyslipidemia and diabetes 97.9%; and smoking 89.2%). Compared with the previous study, there was a significant decrease in the percentage of smokers (46.1 vs. 35.4%). The echocardiogram was performed more frequently (60.1 vs. 85.6%) and there were also significant differences related to drug treatment at discharge, with an important increase in the prescription of beta-blockers (33.5 vs. 45.1%), ACE inhibitors (32.5 vs. 46.4%), and lipid-lowering drugs (6.7 vs 30.5%).Conclusions. This study shows some improvement in the management of myocardial infarction patients after a four-year period, mainly due to more prescription of cardioprotective drugs at hospital discharge.

[Dietary variety and diversity of Spanish children: Four Provinces Study]. / Variedad y diversidad de la dieta de los niños españoles: Estudio Cuatro Provincias.

BACKGROUND AND OBJECTIVE: Diet variety is claimed for ensuring a healthy eating. Our objective was to analyze the relationship between the variety and diversity of the diet and its nutritional quality among Spanish children. SUBJECTS AND METHOD: Cross-sectional study where information on food and nutrition was obtained through a food frequency questionnaire. The sample included 1,112 children aged 6-7 years from 4 cities. Children were selected by random cluster-sampling in schools and stratified by sex and socioeconomic level. We calculated a diet variety index (DVI)--count of food items--and a diet diversity index (DDI)--count of food groups. To measure the overall diet quality, the Healthy Eating Index (HEI-f) was used. RESULTS: The percentage of children eating less than one daily food serving varied between 0% for the grain and 11.3% for the fruit groups. Diet variety and diversity were positively associated with the intake of fiber, vitamines B6 and E and folic acid, and the percentage of caloric intake resulting from polyinsaturated fatty acids and carbohydrates. In contrast, intakes of lipis and saturated fatty acids, vitamine C, sodium and calcium were all negatively associated with diet variety and diversity. Although both DVI and DDI were possitively associated with the HEI-f, the results from a regression model showed that it was only DDI that contributed significantly to the model fitting (p < 0.001). CONCLUSIONS: These results support the goodness of a varied diet that includes ingredients from different food groups and, at the same time, maintains the energy energy within recomended levels.

Plasma non-esterified fatty acid levels in children and their relationship with sex steroids.

OBJECTIVE: Puberty is associated with decreased insulin sensitivity. Sexual hormones have been related with the onset of insulin resistance, but their relationship with non-esterified fatty acids (NEFA) remains unexplored. The aim of this study was to evaluate circulating NEFA levels in population-based samples of prepubertal children and adolescents and to analyze the association of NEFA with obesity, insulin resistance, and sexual hormones in adolescents. EXPERIMENTAL: The studied population included 854 randomly selected 6-8-year-old children and 822 children aged 12-16years. NEFA levels were determined using a commercial kit. Testosterone and estradiol levels were determined by RIA, and insulin and sex hormone binding protein by IRMA. HOMA was calculated as an indicator of insulin resistance. RESULTS: NEFA levels were lower in adolescents than in 6-8-year-old children, and decreased progressively with age between 12-year-olds and 16-year-olds. No significant differences in NEFA levels were observed between obese and non-obese adolescents. NEFA were not correlated with insulin or HOMA in 12-16-year-old girls, and appear negatively correlated with these variables in boys. Insulin and HOMA were negatively correlated with SHBG levels in both sexes adjusting by age but NEFA levels were not. CONCLUSIONS: NEFA levels decrease with age in adolescents and are not significantly increased in obese children, supporting the fact that the decreased insulin sensitivity at this age is not affecting NEFA metabolism. Although SHBG is related to insulin and HOMA independently of age in both sexes, SHBG levels are not associated with NEFA.

Relationship of adiponectin with metabolic syndrome components in pubertal children.

OBJECTIVE: Adiponectin is an adipose tissue-derived adipocytokine which appears in decreased concentrations in obese patients and in several processes related to cardiovascular disease, such as type 2 diabetes or metabolic syndrome. The aim of this study was to analyze the relationship between adiponectin and components of metabolic syndrome (lipid profile, blood pressure, insulin and insulin resistance) in pubertal Spanish children. METHODS: The population-based sample included 810 healthy children (382 boys and 428 girls) 12-16 years of age. Anthropometric parameters and blood pressure were measured. Lipid levels were determined by standard methods, and insulin and adiponectin concentrations were measured by ELISA. Insulin resistance index was assessed by HOMA-IR. RESULTS: Adiponectin levels were negatively correlated with insulin and HOMA in both boys and girls, and remained significant after adjustment for BMI z-score in girls. After this adjustment, adiponectin maintained a positive correlation with HDL-cholesterol and HDL-phospholipids in both genders, and correlated with triglycerides in girls. Multiple linear regression analysis showed that, after adjustment for BMI z-score, adiponectin accounted for 15.8% of the variation of HDL-cholesterol in girls and for 5% of its variation in boys; meanwhile, it accounted for 15.8% and 12.7% of the variation of HDL-phospholipids in girls and boys, respectively. CONCLUSIONS: Adiponectin levels in 12- to 16-year-old children appear to be more strongly related to better lipid profile and insulin sensitivity in girls than in boys. Our study shows, for the first time to our knowledge, a significant positive correlation between adiponectin and HDL-phospholipids in pubertal children.