Age, maturation and serum lipid parameters: findings from the German Health Survey for Children and Adolescents.

BACKGROUND: Recommendations on preventive lipid screening among children and adolescents remain controversial. The aim of the study was to assess age and puberty-related changes in serum lipids, including total cholesterol (TC), and high-density (HDL-C) and non-high-density lipoprotein cholesterol (Non-HDL-C). METHODS: Using cross-sectional data from the National Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS 2003-2006; N = 13,676; 1-17 years), changes in distributions of serum lipids were visualized according to sex, age and maturation. Youth aged 10-17 years were classified as prepubescent, early/mid-puberty, and mature/advanced puberty. Multiple linear regressions were used to quantify the impact of pubertal stage on serum lipid levels, adjusted for potential confounding factors. RESULTS: Among children 1-9 years mean serum lipid measures increased with age, with higher mean TC and Non-HDL-C among girls than boys. Among children 10-17 years, advanced pubertal stage was independently related to lower lipid measures. Adjusted mean TC, HDL-C and Non-HDL-C was 19.4, 5.9 and 13.6 mg/dL lower among mature/advanced puberty compared to prepubescent boys and 11.0, 4.0 and 7.0 mg/dL lower in mature/advanced puberty compared to prepubescent girls. CONCLUSIONS: Lipid concentrations undergo considerable and sex-specific changes during physical growth and sexual maturation and significantly differ between pubertal stages. Screening recommendations need to consider the fluctuations of serum lipids during growth and sexual maturation.

Trace-back and trace-forward tools developed ad hoc and used during the STEC O104:H4 outbreak 2011 in Germany and generic concepts for future outbreak situations.

The Shiga toxin-producing Escherichia coli O104:H4 outbreak in Germany in 2011 required the development of appropriate tools in real-time for tracing suspicious foods along the supply chain, namely salad ingredients, sprouts, and seeds. Food commodities consumed at locations identified as most probable site of infection (outbreak clusters) were traced back in order to identify connections between different disease clusters via the supply chain of the foods. A newly developed relational database with integrated consistency and plausibility checks was used to collate these data for further analysis. Connections between suppliers, distributors, and producers were visualized in network graphs and geographic projections. Finally, this trace-back and trace-forward analysis led to the identification of sprouts produced by a horticultural farm in Lower Saxony as vehicle for the pathogen, and a specific lot of fenugreek seeds imported from Egypt as the most likely source of contamination. Network graphs have proven to be a powerful tool for summarizing and communicating complex trade relationships to various stake holders. The present article gives a detailed description of the newly developed tracing tools and recommendations for necessary requirements and improvements for future foodborne outbreak investigations.

The double burden of malnutrition and its risk factors in school children in Tunja.

Undernutrition and overnutrition are relevant Public Health problems in Colombia. We conducted a nutritional survey in the municipality of Tunja to quantify the problem in order to guide government interventions and serve as baseline for future evaluations. Schoolchildren were randomly selected among all private and public schools. Information on health status, socioeconomic and demographic characteristics of their families was collected using questionnaires, which also included the Colombian Household Food Security Scale. Anthropometric measurements of 1168 schoolchildren (5 to 19 years old) were obtained, analyzed with WHO Anthro-Plus, and associated with the mentioned variables by further statistic analysis. The overall prevalences of stunting, thinness and overweight were 11.3%, 1.7% and 17.6%, respectively. The highest prevalence of stunting was found in rural areas (23%). Children from rural areas, attending public schools and in female-headed households had higher risks of stunting. Overweight reached a percentage of 26.9% in children attending private schools, where the risk of overweight was double than in public ones. Within the studied households 48.6% had some level of food insecurity. In Tunja the prevalence of undernutrition was low, which could be an effect of government nutrition programs. However, it continues to be a problem in vulnerable population groups, mainly in rural areas. On the other hand, the rising prevalence of overweight, following the trend of countries in nutritional transition, is a new Public Health problem which should be addressed. Periodic controls are also needed to evaluate the impact of government nutrition programs on the nutritional status of the children.

Dietary Patterns in Adolescent Obesity as Predictors of Long-Term Success Following an Intensive Inpatient Lifestyle Programme.

(1) Background: Lifestyle interventions for adolescents with obesity show minor long-term effects on anthropometric parameters. The persistence of dietary changes after obesity inpatient rehabilitation has not been sufficiently investigated. (2) Objectives: To analyse dietary patterns in German adolescents with obesity as predictors of long-term success following an intensive inpatient lifestyle programme regarding food choices as well as body weight and comorbidities. (3) Methods: Food consumption data of 137 German adolescents with obesity aged 10-17 years were collected by a nutrition interview. Cluster analysis was used to group the participants according to their food consumption. Dietary patterns, changes in body weight and insulin resistance were compared over a 2-year-period. (4) Results: Three dietary patterns were identified. Big Eaters (n = 32) consume high amounts of total sugar and meat, Moderate Eaters (n = 66) have a diet comparable to the national average, and Snackers (n = 39) have a particularly high consumption of total sugar. Big Eaters and Snackers significantly reduced the consumption of total sugar. Among Moderate Eaters, no persistent changes were observed. (5) Conclusion: Weight reduction interventions can induce long-lasting changes in the diet of adolescents with obesity. Therefore, the success of a weight reduction intervention should not be determined by weight reduction only.

Eating behaviour and its association with social living conditions and weight status among adolescent girls: results of the cross-sectional Berlin School Children's Cohort study.

OBJECTIVE: To capture a more holistic picture of eating behaviour by investigating the impact of the social living conditions and weight status of parents and daughters on food consumption frequency, the context of meals and daily portion sizes. DESIGN: Cross-sectional Berlin School Children's Cohort study. SETTING: A total of sixty-nine schools in Berlin (3 400 000 inhabitants, eastern Germany) participated in the present study. SUBJECTS: A total of 1519 girls aged 11-14 years were selected. Bi- and multivariate analyses were performed to examine the impact of age, migration background, socio-economic status (SES), parental education, family situation and the weight status of parents and daughters on three different eating behaviour scores according to nutritional recommendations. RESULTS: For the three dependent eating behaviour variables, different patterns of influencing factors emerged. Multivariate regression (model 1) revealed that low and middle SES, two-parent migration background and older age were significant risk factors. Meal context was also significantly influenced by living with a single parent. Similar results were obtained for the daily portion size scores and maternal overweight status was the most influential. Model 2 succeeded in showing that, within the composite variable of family SES, mothers' level of education was the dominant component. CONCLUSIONS: SES as a whole, and especially the component of mothers' level of education and two-parent migration background, was the strongest risk factor for an unfavourable eating pattern among adolescent girls. The results clearly indicated preventive potential. Using three different measures of eating behaviour simultaneously provided an in-depth understanding of general patterns and potential risk factors.

Operationalizing multimorbidity and autonomy for health services research in aging populations--the OMAHA study.

BACKGROUND: As part of a Berlin-based research consortium on health in old age, the OMAHA (Operationalizing Multimorbidity and Autonomy for Health Services Research in Aging Populations) study aims to develop a conceptual framework and a set of standardized instruments and indicators for continuous monitoring of multimorbidity and associated health care needs in the population 65 years and older. METHODS/DESIGN: OMAHA is a longitudinal epidemiological study including a comprehensive assessment at baseline and at 12-month follow-up as well as brief intermediate telephone interviews at 6 and 18 months. In order to evaluate different sampling procedures and modes of data collection, the study is conducted in two different population-based samples of men and women aged 65 years and older. A geographically defined sample was recruited from an age and sex stratified random sample from the register of residents in Berlin-Mitte (Berlin OMAHA study cohort, n = 299) for assessment by face-to-face interview and examination. A larger nationwide sample (German OMAHA study cohort, n = 730) was recruited for assessment by telephone interview among participants in previous German Telephone Health Surveys. In both cohorts, we successfully applied a multi-dimensional set of instruments to assess multimorbidity, functional disability in daily life, autonomy, quality of life (QoL), health care services utilization, personal and social resources as well as socio-demographic and biographical context variables. Response rates considerably varied between the Berlin and German OMAHA study cohorts (22.8% vs. 59.7%), whereas completeness of follow-up at month 12 was comparably high in both cohorts (82.9% vs. 81.2%). DISCUSSION: The OMAHA study offers a wide spectrum of data concerning health, functioning, social involvement, psychological well-being, and cognitive capacity in community-dwelling older people in Germany. Results from the study will add to methodological and content-specific discourses on human resources for maintaining quality of life and autonomy throughout old age, even in the face of multiple health complaints.

An Integrated Understanding of the Molecular Mechanisms of How Adipose Tissue Metabolism Affects Long-term Body Weight Maintenance.

Lifestyle-based weight loss interventions frequently demonstrate long-term inefficiency and weight regain. Identification of underlying mechanisms and predictors to identify subjects who will benefit from lifestyle-based weight loss strategies is urgently required. We analyzed 143 adults of the randomized Maintain trial (Maintain-Adults) after intended weight loss to identify mechanisms contributing to the regulation of body weight maintenance. Unbiased RNA sequencing of adipose and skeletal muscle biopsies revealed fatty acid metabolism as a key pathway modified by weight loss. Variability of key enzymes of this pathway, estimates of substrate oxidation, and specific serum acylcarnitine (AC) species, representing a systemic snapshot of in vivo substrate flux, predicted body weight maintenance (defined as continuous or dichotomized [< or ≥3% weight regain] variable) 18 months after intended weight loss in the entire cohort. Key results were confirmed in a similar randomized controlled trial in 137 children and adolescents (Maintain-Children), which investigated the same paradigm in a pediatric cohort. These data suggest that adaption of lipid utilization in response to negative energy balance contributes to subsequent weight maintenance. Particularly a functional role for circulating ACs, which have been suggested to reflect intracellular substrate utilization, as mediators between peripheral energy stores and control of long-term energy homeostasis was indicated.

Mean High-Dose l-Thyroxine Treatment Is Efficient and Safe to Achieve a Normal IQ in Young Adult Patients With Congenital Hypothyroidism.

Context: The optimal levothyroxine (LT4) dose to treat congenital hypothyroidism (CH) remains unclear, with debate over whether higher starting doses (>10 µg/kg) are necessary and safe for a normal intelligence quotient (IQ). Objective: To examine psychomotor, metabolic, and quality of life (QoL) outcomes in patients with CH treated with a mean high initial LT4 dose. Design, settings, participants: A cross-sectional cohort study of patients with CH identified in the Berlin newborn screening program from 1979 to 2003; 76 patients with CH (mean age, 18 years; mean initial LT4 dose, 13.5 µg/kg) and 40 siblings completed the study. Main outcome measures: Psychomotor (Wechsler Intelligence Test, CNS Vital Signs), QoL (short form-36 Health Survey), anthropometric (body mass index, height), and metabolic (intima media thickness, laboratory parameters) outcomes were compared with those of healthy siblings. Mean values and percentage of episodes of elevated thyroxine (T4) and tri-jod-thyronin (T3) and suppressed thyrotropin (TSH) before age 2 years were analyzed. A meta-analysis of CH treatment studies was performed. Results: There were no significant differences in IQ, QoL, or other outcome measures in patients with CH compared with controls. Most T4 levels were high before age 2 years and during subsequent testing, but mean T3 and TSH levels remained normal. The meta-analysis showed a significant IQ difference in severe vs mild CH cases only when treatment started with an LT4 dose <10 µg/kg. Conclusions: High initial LT4 dosing was effective and safely achieved optimal cognitive development in patients with CH, including those severely affected. Supranormal T4 values during infancy were not associated with impaired IQ in adolescence.

Effects of a combined dietary, exercise and behavioral intervention and sympathetic system on body weight maintenance after intended weight loss: Results of a randomized controlled trial.

BACKGROUND: Lifestyle based weight loss interventions are hampered by long-term inefficacy. Prediction of individuals successfully reducing body weight would be highly desirable. Although sympathetic activity is known to contribute to energy homeostasis, its predictive role in body weight maintenance has not yet been addressed. OBJECTIVES: We investigated, whether weight regain could be modified by a weight maintenance intervention and analyzed the predictive role of weight loss-induced changes of the sympathetic system on long-term weight regain. DESIGN: 156 subjects (age > 18; BMI ≥ 27 kg/m2) participated in a 12-week weight reduction program. After weight loss (T0), 143 subjects (weight loss > 8%) were randomized to a 12-month lifestyle intervention or a control group. After 12 months (T12) no further intervention was performed until month 18 (T18). Weight regain at T18 (regainBMI) was the primary outcome. Evaluation of systemic and tissue specific estimates of sympathetic system was a pre-defined secondary outcome. RESULTS: BMI was reduced by 4.67 ±â€¯1.47 kg/m2 during the initial weight loss period. BMI maintained low in subjects of the intervention group until T12 (+0.07 ±â€¯2.98 kg/m2; p = 0.58 compared to T0), while control subjects regained +0.98 ±â€¯1.93 kg/m2 (p < 0.001 compared to T0). The intervention group regained more weight than controls after ceasing the intervention (1.17 ±â€¯1.34 vs. 0.57 ±â€¯0.93 kg/m2) until T18. Consequently, BMI was not different at T18 (33.49 (32.64; 34.33) vs. 34.18 (33.61; 34.75) kg/m2; p=0.17). Weight loss-induced modification of urinary metanephrine excretion independently predicted regainBMI (R2 = 0.138; p < 0.05). The lifestyle intervention did not modify the course of urinary metanephrines after initial weight loss. CONCLUSIONS: Our lifestyle intervention successfully maintained body weight during the intervention period. However, no long-term effect could be observed beyond the intervention period. Predictive sympathetic activity was not persistently modified by the intervention, which may partially explain the lack of long-term success of such interventions.

Cardiac device implantations in obese patients: Success rates and complications.

BACKGROUND: Obesity is associated with increased complications and potentially worse outcomes for various cardiac interventions. This study analyzed the success rate and complication rates associated with implantation of cardiac implantable electronic devices (CIEDs) in obese patients. HYPOTHESIS: Success rates are lower and complication rates higher in obese patients. METHODS: Consecutive patients undergoing CIED implantation between 2011 and 2015 in our hospital were included. Patients were categorized into obese and nonobese groups according to body mass index (BMI); cutoff was 30 kg/m2 . Patient characteristics, complication rates, procedural duration, and fluoroscopy data were compared between the 2 groups. RESULTS: A total of 965 patients (mean age, 69.0 ± 12.9 years; 67% male) were included. Of these, 249 (25.8%) patients were classified obese and 716 (74.2%) nonobese. Mean BMI was 34.7 ± 4.7 kg/m2 vs 25.1 ± 3.0 kg/m2 , respectively. There was no difference in procedural success rates between the 2 groups (97.2% vs 97.1%, respectively). Major complications were significantly lower in the obese group compared with the nonobese group (11 [4.4%] vs 62 [8.7%]; P < 0.05). Procedural duration and fluoroscopy duration were not different between the 2 groups, but the total dose-area product was significantly higher in obese patients vs nonobese patients (4012 ± 5416 cGcm2 vs 2692 ± 5277 cGcm2 ; P < 0.005). CONCLUSIONS: CIED implantation can be safely and effectively achieved in patients with BMI >30 kg/m2 . However, total radiation dose was significantly higher in the obese group, emphasizing that efforts should be made to reduce radiation exposure in these patients.

Hormonal regulatory mechanisms in obese children and adolescents after previous weight reduction with a lifestyle intervention: maintain - paediatric part - a RCT from 2009-15.

BACKGROUND: Weight loss improves cardiovascular risk factors and "quality of life". Most therapeutic approaches fail to induce a sustained weight loss and most individuals undergo weight regain. In this paper the comprehensive design of the "MAINTAIN" study, all assessments as well as the one year lifestyle intervention will be outlined in detail. METHODS/DESIGN: One-center randomized controlled trial with seven assessment time points conducted 2009-2015. For the randomization eight groups were distinguished in a list to allocate intervention or control group: Females and males either pre-pubertal or pubertal and with a BMI-SDS under or over 2.5. SETTING: Weight loss at a residential weight reduction programme Berlin/Brandenburg and intervention at a paediatric outpatient clinic; PARTICIPANTS: 137 children and adolescents (10 to 17 years). INTERVENTION: PARTICIPANTS were randomized after an initial weight loss at a residential weight reduction programme and allocated to intervention (n=65) and control (n=72) conditions. The intervention group received an one-year group multi-professional lifestyle intervention with monthly meetings at the paediatric outpatient obesity clinic. The control group had a free living phase for one year and both groups 48 months follow up. MAIN OUTCOME MEASURES: PARTICIPANTS who are engaged in monthly intervention meetings will benefit in terms of a sustained weight maintenance. The primary aim is to describe the dynamic of hormonal and metabolic mechanisms counter-balancing sustained weight loss during puberty and adolescence. The secondary aim is to investigate the effect of an intensive family based lifestyle intervention during the weight maintenance period on the endogenous counter-regulation as well as on health related quality of life. The third aim is to establish predictors for successful weight maintenance and risk factors for weight regain in obese children and adolescents. DISCUSSION: Weight maintenance after induced weight loss is one of the most important therapeutic challenges as long as most patients fail to maintain their weight loss. MAINTAIN is the first paediatric RCT addressing in parallel to a RCT in obese adults the course of weight regain after induced weight loss and is embedded in an experimental research consortium in order to also address several molecular mechanisms of weight regain. TRIAL REGISTRATION: ClinicalTrials NCT00850629, first registration 17 February 2009, verified January 2012, Paediatric part of the interventional study. Ethic proposal approved at 08.04.2009.

Weight Loss Partially Restores Glucose-Driven Betatrophin Response in Humans.

CONTEXT: Recently a potential role of betatrophin was shown in the postprandial switch from lipid to glucose metabolism. OBJECTIVE: The objective of the study was to analyze whether obesity is associated with altered postprandial betatrophin response and whether this could be restored by weight loss. Design, Setting, Participants, and Intervention: Oral glucose load was performed in 12 lean individuals at baseline as well as in 20 obese subjects before and after a 12-week structured weight-loss program at an endocrinology research center. Euglycemic hyperinsulinemic clamps were performed in the obese cohort. The effect of insulin and different glucose concentrations on betatrophin expression were analyzed in 3T3-L1 adipocytes. MAIN OUTCOME MEASURE: Circulating betatrophin levels during a glucose challenge were measured. RESULTS: The betatrophin level decreases after an oral glucose intake (P < .001). This correlates with the increase of glucose levels (r = -0.396; P < .05). Hyperinsulinemia results in an increase of betatrophin. In vitro experiments in 3T3-L1 adipocytes confirmed that insulin and low glucose concentration increases betatrophin expression, whereas a further elevation of glucose levels blunts this effect. Obese subjects are characterized by lower fasting betatrophin (600.6 ± 364.4 vs 759.5 ± 197.9 pg/mL; P < .05) and a more pronounced betatrophin suppression during the glucose challenge. The impaired betatrophin response in obese subjects is restored after weight loss and is comparable with lean individuals. CONCLUSIONS: Obesity is associated with increased betatrophin suppression after an oral glucose load, which is driven by increased hyperglycemia. Given the metabolic properties of betatrophin, this may indicate that betatrophin is tightly linked to obesity-associated metabolic disturbances. In line with such an assumption, weight loss almost completely eliminated this phenomenon.

ANP system activity predicts variability of fat mass reduction and insulin sensitivity during weight loss.

INTRODUCTION: In weight loss trials, a considerable inter-individual variability in reduction of fat mass and changes of insulin resistance is observed, even under standardized study conditions. The underlying mechanisms are not well understood. Given the metabolic properties of the atrial natriuretic peptide (ANP) system, we hypothesized that ANP signaling might be involved in this phenomenon by changes of ANP secretion or receptor balance. Therefore, we investigated the impact of systemic, adipose and myocellular ANP system on metabolic and anthropometric improvements during weight loss. METHODS: We comprehensively investigated 143 subjects (31 male, 112 female) before and after a 3 month-standardized weight loss program. The time course of BMI, fat mass, insulin sensitivity, circulating mid-regional proANP (MR-proANP) levels as well as adipose and myocellular natriuretic receptor A (NPR-A) and C (NPR-C) mRNA expression were investigated. RESULTS: BMI decreased by -12.6±3.7%. This was accompanied by a remarkable decrease of adipose NPR-C expression (1005.0±488.4 vs. 556.7±465.6; p<0.001) as well as a tendency towards increased adipose NPR-A expression (4644.7±946.8 vs. 4877.6±869.8; p=0.051). Weight loss induced changes in NPR-C (ΔNPR-C) was linked to relative reduction of total fat mass (ΔFM) (r=0.281; p<0.05), reduction of BMI (r=0.277; p<0.01), and increase of free fatty acids (ΔFFA) (r=-0.258; p<0.05). Basal NPR-C expression and weight loss induced ΔNPR-C independently explained 22.7% of ΔFM. In addition, ΔMR-proANP was independently associated with improvement of insulin sensitivity (standardized ß=0.246, p<0.01). DISCUSSION: ANP receptor expression predicted the degree of weight loss induced fat mass reduction. Our comprehensive human data support that peripheral ANP signalling is involved in control of adipose tissue plasticity and function during weight loss. (Funded by the Deutsche Forschungsgemeinschaft (KFO281/2), the Berlin Institute of Health (BIH) and the German Centre for Cardiovascular Research (DZHK/BMBF); ClinicalTrials.gov number: NCT00850629).

Long-term lanreotide treatment in six patients with congenital hyperinsulinism.

BACKGROUND: Medical treatment is a substantial therapeutic measure to achieve glycemic control and prevent hypoglycemic brain damage without surgery in patients with congenital hyperinsulinism (CHI). However, only few drugs are available and even fewer are approved as a medical therapy to maintain normal blood glucose levels. The established therapies are demanding for caregivers and complicated by different side effects such as gastrointestinal symptoms, hypertrichosis, and obesity. Therefore, it is important to develop new strategies to improve blood glucose control. METHODS: We report the use of the very-long-acting somatostatin analogue lanreotide autogel in 6 patients with CHI over a mean duration of 40.8 months. Blood glucose levels before and after the start and dosage titration of lanreotide in these patients are compared. RESULTS: In 3 of 6 patients, switching to lanreotide raised mean blood glucose levels and reduced individually as well as overall the risk for hypoglycemic episodes (odds ratio 0.38) significantly. CONCLUSION: Lanreotide autogel can be used as an alternative pharmacological treatment and may be beneficial in conservatively treated patients with CHI.

Associations between media consumption habits, physical activity, socioeconomic status, and glycemic control in children, adolescents, and young adults with type 1 diabetes.

OBJECTIVE: To evaluate the relationship between media consumption habits, physical activity, socioeconomic status, and glycemic control in youths with type 1 diabetes. RESEARCH DESIGN AND METHODS: In the cross-sectional study, self-report questionnaires were used to assess media consumption habits, physical activity, and socioeconomic status in 296 children, adolescents, and young adults with type 1 diabetes. Clinical data and HbA(1c) levels were collected. Risk factors were analyzed by multiple regression. RESULTS: Youths with type 1 diabetes (aged 13.7 ± 4.1 years, HbA(1c) 8.7 ± 1.6%, diabetes duration 6.1 ± 3.3 years) spent 2.9 ± 1.8 h per day watching television and using computers. Weekly physical activity was 5.1 ± 4.5 h. Multiple regression analysis identified diabetes duration, socioeconomic status, and daily media consumption time as significant risk factors for glycemic control. CONCLUSIONS: Diabetes duration, socioeconomic status, and daily media consumption time, but not physical activity, were significant risk factors for glycemic control in youths with type 1 diabetes.

The double burden of malnutrition and its risk factors in school children in Tunja

Undernutrition and overnutrition are relevant Public Health problems in Colombia. We conducted a nutritional survey in the municipality of Tunja to quantify the problem in order to guide government interventions and serve as baseline for future evaluations. Schoolchildren were randomly selected among all private and public schools. Information on health status, socioeconomic and demographic characteristics of their families was collected using questionnaires, which also included the Colombian Household Food Security Scale. Anthropometric measurements of 1168 schoolchildren (5 to 19 years old) were obtained, analyzed with WHO Anthro- Plus, and associated with the mentioned variables by further statistic analysis. The overall prevalences of stunting, thinness and overweight were 11.3%, 1.7% and 17.6%, respectively. The highest prevalence of stunting was found in rural areas (23%). Children from rural areas, attending public schools and in female-headed households had higher risks of stunting. Overweight reached a percentage of 26.9% in children attending private schools, where the risk of overweight was double than in public ones. Within the studied households 48.6% had some level of food insecurity. In Tunja the prevalence of undernutrition was low, which could be an effect of government nutrition programs. However, it continues to be a problem in vulnerable population groups, mainly in rural areas. On the other hand, the rising prevalence of overweight, following the trend of countries in nutritional transition, is a new Public Health problem which should be addressed. Periodic controls are also needed to evaluate the impact of government nutrition programs on the nutritional status of the children.

La doble carga de la malnutrición y sus factores de riesgo en Tunja, Colombia. La malnutrición es un problema de Salud Pública relevante en Colombia. Realizamos una encuesta nutricional en el municipio de Tunja para cuantificar el problema, guiar intervenciones gubernamentales y servir de base a futuras evaluaciones. Para ello seleccionamos aleatoriamente escolares entre todas las escuelas públicas y privadas y recogimos información sobre su salud y características socioeconómicas y demográficas de sus hogares con cuestionarios, incluyendo la Escala Colombiana de Seguridad Alimentaria en el Hogar. Obtuvimos así medidas antropométricas de 1168 escolares (entre 5 y 19 años) que analizamos con WHO-AnthroPlus y relacionamos con las variables mencionadas mediante análisis estadístico. La prevalencias de bajo peso, delgadez y sobrepeso fueron 11,3%, 1,7% y 17,6%, respectivamente. La prevalencia más alta de bajo peso se encontró en áreas rurales (23%). Niños de áreas rurales, escuelas públicas y en hogares con mujeres como cabeza de familia presentaron mayor riesgo de bajo peso. Encontramos sobrepeso en el 26,9% de los niños en escuelas privadas, donde el riesgo de sobrepeso doblaba al de las públicas. De los hogares estudiados, un 48,6% presentaban inseguridad alimentaria. Encontramos por tanto una prevalencia baja de déficit nutricional, que podría ser resultado de los programas de nutrición gubernamentales. Sin embargo este problema continúa existiendo en poblaciones vulnerables, especialmente en zonas rurales. Por otro lado la creciente prevalencia de sobrepeso, siguiendo la tendencia de los países en transición nutricional, es un nuevo problema de Salud Pública a tratar. Para controlar la malnutrición es fundamental establecer controles periódicos para valorar el impacto de los programas nutricionales.