Effectiveness of different exercises and stretching physiotherapy on pain and movement in patellofemoral pain syndrome: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of proprioceptive neuromuscular facilitation combined with exercise, classic stretching physiotherapy intervention, and educational intervention at improving patient function and pain in patients with patellofemoral pain syndrome. DESIGN: Randomized, controlled, blind trial over four months. SETTING: Urban population, Spain. PARTICIPANTS: Patients undergoing primary care for retropatellar pain. INTERVENTION: Subjects were allocated on three different treatment options: a proprioceptive neuromuscular facilitation and aerobic exercise group, a classic stretching group, and a control treatment were applied over four months under the supervision of a physiotherapist. MAIN OUTCOME: Knee Society Score, pain reported (Visual analogue scale) and knee range of motion. Assessments were completed at baseline and after four months. RESULTS: 74 patients were enrolled in the study and distributed between groups. Both the proprioceptive neuromuscular facilitation and classic stretching group showed significant changes in all variables after four months intervention (p < 0.001). The difference in mean Kujala knee score changes between groups (classic stretching group vs. proprioceptive neuromuscular facilitation group vs. control group) at four months was -24.05 (95% confidence interval (CI) -30.19, -17.90), p ≤ 0.001; vs. -39.03 (95% confidence interval (CI) -42.5, -35.5), p ≤ 0.001; vs. -0.238 (95% confidence interval (CI) -1.2, 0.726), p = 0.621, respectively. CONCLUSIONS: A proprioceptive neuromuscular facilitation intervention protocol combined with aerobic exercise showed a better outcome than a classic stretching protocol after four months.

Genetic association analysis of vitamin D receptor gene polymorphisms and obesity-related phenotypes.

Vitamin D has been established as a key factor in the development of obesity through the vitamin D receptor (VDR). The aim of this study was to investigate the contribution of the VDR gene to obesity-related phenotypes in a population of Caucasian young adults. The study population consisted of 701 healthy Spanish young adults (mean age 20.41±2.48). Three single-nucleotide polymorphisms (SNPs) of VDR (TaqI, BsmI and FokI) were selected as genetic markers. Body composition measurements including weight, body mass index (BMI), fat mass (FM), percentage of fat mass (PFM), fat-free mass (FFM) and visceral fat level (VFL) were analysed. Differences in obesity traits across the genotypes were determined using analysis of covariance (ANCOVA). The FokI polymorphism showed a significant association with PFM across the whole population after adjusting for age and sex (p=0.022). Age-adjusted analysis revealed an association between body weight and the TaqI and BsmI SNPs in males (p=0.033 and p=0.028, respectively). However, these positive findings did not remain significant after applying the Bonferroni correction for multiple testing. Our findings suggest that VDR genetic variants are unlikely to play a major role in obesity-related phenotypes in a population of Caucasian young adults.

LMS tables for waist circumference and waist-height ratio in Colombian adults: analysis of nationwide data 2010.

BACKGROUND/OBJECTIVES: Indices predictive of central obesity include waist circumference (WC) and waist-to-height ratio (WHtR). These data are lacking for Colombian adults. This study aims at establishing smoothed centile charts and LMS tables for WC and WHtR; appropriate cutoffs were selected using receiver-operating characteristic analysis based on data from the representative sample. SUBJECTS/METHODS: We used data from the cross-sectional, national representative nutrition survey (ENSIN, 2010). A total of 83 220 participants (aged 20-64) were enroled. Weight, height, body mass index (BMI), WC and WHtR were measured and percentiles calculated using the LMS method (L (curve Box-Cox), M (curve median), and S (curve coefficient of variation)). Receiver operating characteristics curve analyses were used to evaluate the optimal cutoff point of WC and WHtR for overweight and obesity based on WHO definitions. RESULTS: Reference values for WC and WHtR are presented. Mean WC and WHtR increased with age for both genders. We found a strong positive correlation between WC and BMI (r=0.847, P< 0.01) and WHtR and BMI (r=0.878, P<0.01). In obese men, the cutoff point value is 96.6 cm for the WC. In women, the cutoff point value is 91.0 cm for the WC. Receiver operating characteristic curve for WHtR was also obtained and the cutoff point value of 0.579 in men, and in women the cutoff point value was 0.587. A high sensitivity and specificity were obtained. CONCLUSIONS: This study presents first reference values of WC and WHtR for Colombians aged 20-64. Through LMS tables for adults, we hope to provide quantitative tools to study obesity and its complications.

[Regulation of dietary intake and energy balance: factors and mechanisms involved]. / Regulación de la ingesta alimentaria y del balance energético: factores y mecanismos implicados.

UNLABELLED: The regulation of energy intake is a vital process in the body as possible to maintain a balance between the amount of energy stored as body fat and the catabolism of the same. OBJECTIVE: The objective of this study was to analyze the main factors involved in regulating food intake, energy balance and pathophysiology. METHODS: We searched Medline and Ebsco of articles published in English and Spanish in the period between January 2009 and January 2012. Search terms were "food intake", "energy balance", "regulation", "nutritional homeostasis." RESULTS: There were a total of 198 scientific studies, of which only 70 met the requirements of the search. All studies consulted agree on the importance of gastrointestinal hormones modulating agents as primary energy homeostasis. Such a modulatory effect on appetite and satiety is mediated by direct action on the hypothalamus or the nucleus of the solitary tract at the brainstem (autonomic nervous system). Only ghrelin has been linked to the start of the intake considering a major orexigenicas signals studied in animal models and humans. DISCUSSION: The regulation of food intake and energy balance is an extremely complex process whose operation and balance is made possible by the action of various endocrine signals of the gastrointestinal tract.

[Monogenic human obesity: role of the leptin-melanocortin system in the regulation of food intake and body weight in humans]. / Obesidad monogénica humana: papel del sistema leptina-melanocortina en la regulación de la ingesta de alimentos y el peso corporal en humanos.

Human obesity is a disorder of multifactorial origin in which genetic and environmental factors are involved. To understand the mechanisms regulating energy intake and fat accumulation in the body, it is important to study the genetic alterations causing monogenic obesity. Most of the genes involved in monogenic obesity are associated with the leptin-melanocortin system; hence the importance of studying this system by analysing natural mutations in mice. Previous studies have described mutations in leptin and its receptor, proopiomelanocortin and prohormone convertase 1 associated with human obesity of monogenic origin. The aim of this study is to provide an updated review of the main characteristics and functioning of the leptin-melanocortin system, and its implications and potentialities in regulating food intake and body weight.

[Analysis of the nutritional state of school children in different districts of the province of Granada (Spain)]. / Análisis del estado nutricional en escolares; estudio por áreas geográficas de la provincia de Granada (España).

BACKGROUND: In Spain the prevalence of obesity shows a north-south distribution. In the province of Granada its distribution is unknown. OBJECTIVES: (1) To study the prevalence of overweight and obesity in a sample population of school children and adolescents from different districts in the province of Granada. (2) To verify whether there are significant differences, depending on the district where the students reside. (3) To find a possible correlation between the nutritional state of the students and that of their parents. METHODS: The population sample was composed of 977 school children and adolescents from 9 to 17 years of age, attending 13 public elementary schools and high schools in the city and province of Granada (Spain). In this analytical and multicentric study, the nutritional state of the subjects was evaluated by means of anthropometric measurements. Furthermore, data were collected by means of questionnaire to discover whether the respondents had a family history of overweight or obesity. RESULTS: We found a high prevalence of overweight and obesity among the studied population. In girls, the greater prevalence of both overweight and obesity ranged from 12 to 14 years of age. In boys, there was an increase in the prevalence of overweight at twelve years of age. Regarding obesity, their rates were significantly lower than those described among girls. There were statistically significant differences for weight (F = 4,154; p = 0,003) but not for height (F = 1,928; p =0,105). But for the variable BMI was statistically significant difference (F = 5.037; P < 0.001) between the studied geographical areas. The results showed that the nutritional state of students with a family history of obesity was significantly worse (p < 0.01). DISCUSSION: A high prevalence of obesity was found in the sample, especially among the girls. There exists a geographical distribution pattern, possibly derived from the socioeconomic characteristics of each area in the province. The existence of a family history of obesity is an important factor that can determine whether the child will also become obese in the future.

[Anthropometric study and evaluation of the nutritional status of a population school children in Granada; comparison of national and international reference standards]. / Estudio antropométrico y valoración del estado nutricional de una población de escolares de Granada; comparación con los estándares nacionales e internacionales de referencia.

Recent studies show an alarming increase in levels of overweight and obesity among children and adolescents. The main objectives of this research were the following: (i) to carry out an anthropometric evaluation of the nutritional status and body composition of school children in the city and province of Granada; (ii) to compare the nutritional status of this population sample with national and international reference standards. The results obtained in this study showed that the general prevalence of overweight in both sexes was 22.03% and that 9.12% of the children were obese. Statistically significant differences were found between the variable, weight for age and sex (p < 0.05) and the variable, height for age and sex (p < 0.05). Regarding the body mass index, no statistically significant differences were found for the variable, sex (p = 0.182). This contrasted with the variable, age, which did show statistically significant differences (p < 0.05). As a conclusion, the results of our study highlighted the fact that these anthropometric values were much higher than national and international reference standards.

[Obesity and seric levels of strogens; the importance of early development of breast cancer]. / Obesidad y niveles séricos de estrógenos; importancia en el desarrollo precoz del cáncer de mama.

Many studies have analyzed the possible association between the development of obesity and hormone levels, as well as their relation with the early development of breast cancer. As part of this study, we performed a retrospective collection of data from the clinical histories of 524 women in Granada (Spain), who had been diagnosed with breast cancer. The objectives were to verify an association between the nutritional state of the women and their age at breast cancer diagnosis as well as a possible relation between their nutritional state and seric levels of estrogens. The results obtained in this study show that obesity and the levels of certain hormones, such as estrogens, are closely associated with the early development of breast cancer.

[Overweight and obesity as a prognosis factor of desmotivation in children and adolescents]. / Sobrepeso y obesidad como factor pronóstico de la desmotivación en el niño y el adolescente.

Spain has become the country in the European Union with the fourth highest number of overweight and obese children. This condition directly affects physical health as well as mental health. The objective of this research study was to evaluate motivational aspects in one group of obese or overweight adolescents and another group of normal-weight adolescents. For this purpose a descriptive observational study was carried out in an educational institution in Guadix (Granada). The universe was composed of 200 children of ages 10 to 14. A sample of 24 children was selected by means of proportional random sampling with an error of 0.19, and was divided into the following groups (i) 12 normal-weight children; (ii) 12 obese children. Motivation was measured by means of the School Motivation Analysis Test (SMAT), a multidimensional measuring instrument based on Cattell's dynamic model of motivation and emotions. Our study evaluated five motivational parameters: TAO (total autism-optimism), TGI (total general information), TIN (total integration), TPI (total personal interest), and TCO (total conflict). Our results showed that for each of the SMAT variables, the overweight and obese children obtained an average value of 4.5 in contrast to the normal-weight children, who obtained an average value of 5.9. This indicates that overweight and obese children have low motivational states and a higher level of frustration. They also tend to distort reality by alleging the existence of obstacles that prevent them from achieving their goals.

[Risk factors for metabolic syndrome in a population with sleep apnea; evaluation in a population of Granada; the Granada study]. / Factores de riesgo para el síndrome metabólico en una población con apnea del sueño; evaluación en un grupo de pacientes de Granada y provincia; estudio GRANADA.

INTRODUCTION: The Metabolic Syndrome is one of the first health problems in the public health of the century. It's consider that the beginning of the syndrome is determined by numerous factors that developed two main metabolic disturbances: the insulin resistance and the central obesity. This relationship is concentrating the scientific world. As the cause-effect relationship has to be answered, the epidemiologic research has focused on without results. MATERIAL AND METHODS: 1,016 subjects were recruited in the sleep disorders laboratory in San Cecilio Hospital with sleep apnea suspicion. RESULTS: Significant correlation (p < 0,001) was found between sleep apnea severity and nocturnal saturation values and the different metabolic disturbances related to the metabolic syndrome (Hypertension, Diabetes and obesity). By the contrary, we doesn't found significant differences between No-Sleep apnea group and moderate sleep apnea group in the majority of the variables. CONCLUSIONS: Subjects with sleep apnea have significantly more possibilities to develop metabolic syndrome, and cardiovascular pathology. These subjects had to be evaluated in this sense to reduce the impact associated to this pathology.

[Analysis of the nutritional state and body composition of school children in Granada (Spain)]. / Análisis del estado nutricional y composición corporal de una población de escolares de Granada.

The objective of this study was to first determine the nutritional state of a sample population of school children, and then analyze the distribution pattern of their subcutaneous fat layer. The sample was composed of 977 school children from the city and province of Granada (Spain). All of the children (524 girls and 452 boys) were 9-17 years of age. To study their nutritional state and the distribution of the subcutaneous fat layer, they were given a complete anthropometric evaluation, which included measuring their weight, height, body mass index, skin folds, and body perimeters. The results obtained showed a 23.01% prevalence of overweight in the female subjects and 20.81% in the male subjects. Furthermore, the female subjects had an obesity prevalence of 12.70% in comparison to the male subjects, whose obesity prevalence was 4.98%. The distribution pattern of subcutaneous fat was found to be mainly located in the central part of body. The high percentage of overweight and obesity along with the development of a central fat distribution pattern (neck, chest, and abdomen) in these school children is clear evidence of potential cardiovascular risk.

[Influence of family environment of the development of obesity and overweight in a population of school children in Granada (Spain)]. / Influencia del entorno familiar en el desarrollo del sobrepeso y la obesidad en una población de escolares de Granada (España).

According to recent research, eating behaviour should be understand as a cyclical and interactive process in which parental eating habits cause children to develop specific eating strategies as well as their own eating habits. Needless to say, this interactive process is reflected and has a direct impact on the nutritional indicators of the children in a family. The objectives of this study were the following: (i) to verify the existence of a significant association between the educational level of parents and the nutritional state of children in the same family; (ii) to discover if there is a direct relation between the nutritional state of children and the person that decides the menu and/or prepares family meals; (iii) to determine if there is a link between the nutritional state of children and the time that they spend on sedentary leisure activities. The sample population was composed of 718 school children and adolescents, 9-17 years of age, who A descriptive, transversal, and multicentric study was performed that evaluated the nutritional state of the entire sample by using anthropometric techniques to assess weight, height, and body mass index.

[Obesity and its relation with markers of inflammation and erythrocyte fatty acids in a group of overweight adolescents]. / Obesidad y su relación con marcadores de inflamación y ácidos grasos de eritrocito en un grupo de adolescentes obesos.

There is a general consensus that obesity is an eminently inflammatory process. This is justified by alterations observed in obese patients, which affect the secretion of certain cytokines such as ceruloplasmin, leptin, adiponectin, and interleukin-6 (IL-6), among others. In a parallel way, other research has also pointed out alterations in the composition of fatty acids in the erythrocyte membrane of overweight adults. The results obtained in our study confirm the existence of a significant correlation between the serum levels of some of the cytokines studied and the nutritional state of the sample studied. This means that for the population of children evaluated in our study, the serum concentrations of these biomolecules can be an important tool for the prediction of cardiovascular risk when they become adults. Furthermore significant differences were found regarding the composition of saturated fatty acids in the erythrocyte membrane.

[Comparative study of the effectiveness of body mass index and the body-fat percentage as methods for the diagnosis of overweight and obesity in children]. / Estudio comparativo de la eficacia del índice de masa corporal y el porcentaje de grasa corporal como métodos para el diagnóstico de sobrepeso y obesidad en población pediátrica.

The World Health Organization (WHO) regards obesity as one of the most serious public health problems in the world that can affect young children and adolescents. Accordingly, a major priority is to find ways to more effectively study and analyze the various methods used to diagnose and evaluate the nutritional state of the pediatric and adolescent population. The nutritional indicators currently employed for this purpose are the body mass index and body-fat percentage. However, there is a certain controversy related to the body-fat percentage since it tends to overestimate overweight and obesity. The main objectives of this study were the following: (i) to determine the prevalence of overweight and obesity in a population of primary and secondary school children between 9-17 years of age at 13 educational centers in the city and province of Granada; (ii) to verify possible differences regarding the accuracy of the body mass index and the body-fat percentage in the diagnosis of overweight and obesity.

[Ceruloplasmin and its clinical relevance as an indactor of cardiovascular risk factor in a school population of Granada]. / Ceruloplasmina y su importancia clínica como factor indicador del riesgo cardiovascular en una población de escolares de Granada.

Also known as ferroxidase ceruloplasmin, belongs to the family of inflammation-sensitive proteins, and its main function to transport copper in the blood. Although, in addition to this transport function, at present, there are numerous studies that have attempted to use the determination of serum concentrations as a predictive indicator of cardiovascular risk in patients who are overweight or obese. The results of this study confirm the existence of a significant correlation between serum ceruloplasmin and nutritional status of the subjects, which means that for the population of students assessed, serum levels of this protein are an important predictor the risk of cardiovascular disease.

[Obesity and its implication in breast cancer]. / Obesidad y su implicación en el cáncer de mama.

Obesity and breast cancer are two very frequent pathologies in the world today, which have a strong impact on society. Various research studies have tried linking the two. For this purpose, data was collected from the medical histories of 524 women who had been diagnosed and treated for breast cancer from January 2009 to September 2010. The objectives of the study were to find and verify a possible association between the nutritional state of these women and their age when they were diagnosed with the tumour (p < 0.0001) as well as a statistically significant association (p < 0.0001) between the age of the first menstruation and the nutritional state of the patients. The results obtained showed that obesity was closely related to breast cancer.

[Prevalence of nutritional overweight and obesity and hypertension as well as their relationship with anthropometric indicators in a population of students in Granada and its provinces]. / Prevalencia de sobrepeso y obesidad nutricional e hipertensión arterial y su relación con indicadores antropométricos en una población de escolares de Granada y su provincia.

INTRODUCTION: Several authors have found correlations between anthropometric parameters and blood pressure levels in overweight and obese subjects. This paper is an update on the potential of these parameters as a tool for predicting cardiovascular risk. AIMS: to estimate the prevalence of overweight and obesity. Second verify the existence of a significant correlation between the main anthropometric indicators and the blood pressure levels. SAMPLE: The population consisted of 977 children and adolescents between 9 and 17 years of age belonging to 13 schools in the province of Granada and city. METHODOLOGY: anthropometric evaluation in which they were assessed six skinfolds, waist circumference, hip and determination of blood pressure in three consecutive occasions. The anthropometric assessment phase began in March 2008 lasted until April 2009. RESULTS: We found that the prevalence of overweight in girls varied between 18.3% and 32.2%. For its part, the prevalence among boys was between 10.9% and 26.1%. Regarding the prevalence of obesity, the girls had similar rates between 4.5% and 15.1%. Among boys the prevalence of obesity was similar, and found rates between 4.7% and 12.6%. Of all the parameters measured, body mass index and waist circumference were the anthropometric indicators that showed a better correlation to blood pressure. CONCLUSIONS: BMI and WC are useful anthropometric indicators to predict cardiovascular risk in non adults.

[Study of the serum levels of leptin, ceruloplasmin and lipoprotein (a) as indicators of cardiovascular risk in a population of adolescents in Granada (Spain)]. / Estudio de los niveles séricos de leptina, ceruloplasmina y lipoproteína (a) como indicadores del riesgo cardiovascular en una población de adolescentes de Granada (España).

Numerous studies have focused on establishing a relation between the serum values of biomolecules such as leptin, ceruloplasmin, and lipoprotein (a), and the nutritional state and levels of diastolic and systolic blood pressure in subjects with problems of overweight or obesity. However, in many cases, the results obtained have not been conclusive. The results of our study confirm the existence of a statistically significant association between the serum levels of these biomolecules, the nutritional state of the subjects, and levels of diastolic and systolic blood pressure. For the population of overweight and obese adolescents studied, the evaluation of the serum concentrations of these biomolecules was found to be an important instrument that could be used to identify those subjects with an elevated risk of suffering cardiovascular disorders basically derived from a hypertensive status.

[Obesity in a school children population from Granada: assessment of the efficacy of an educational intervention]. / Obesidad de una población de escolares de Granada: evaluación de la eficacia de una intervención educativa.

OBJECTIVES: The objective of this research was to study the prevalence of obesity and excess weight in a population of school children and adolescents, and to verify the effectiveness of an educational intervention, as reflected in the variation of their body mass index values. MATERIALS: The population sample was composed of 977 school children and adolescents from 9 to 17 years of age, belonging to 13 public elementary schools and high schools in the city and province of Granada (Spain). METHODOLOGY: This longitudinal cohort study was analytical, muticentric, and observational. It was carried out in three phases. The first phase involved the evaluation of the nutritional state of the sample population by means of anthropometric measurements (weight, height, body mass index, six skin folds and four body perimeters) as well as arterial blood pressure. The second phase entailed an educational intervention focusing on good nutritional habits and physical exercise. The third and final phase evaluated the effectiveness of the intervention. RESULTS: A higher obesity prevalence (15.1%) was found in school girls between 12 and 13. In the case of boys, obesity prevalence was lower up to age 13 though afterwards, it progressively increased (12.6%). The educational intervention produced an important reduction in body mass index values in both sexes though this reduction was more significant in young females. CONCLUSIONS: There is a currently an alarming increase in obesity and overweight prevalence among the population evaluated in this study. The significant reduction in body mass index values resulting from this research confirmed the effectiveness of the educational intervention to reduce excess weight.

[Breast feeding: an effective method to prevent breast cancer]. / Lactancia materna: un método eficaz en la prevención del cáncer de mama.

INTRODUCTION: Breast cancer is the most common gynecological tumor in young women in Western countries. Its profound implications for health and an increasingly early age of diagnosis have been carefully analyzed its causes and possible preventive measures, making their study in a primary goal of epidemiological research. SAMPLE AND METHODS: We reviewed medical records pertaining to 504 female patients aged 19 to 91 years. All of them were diagnosed and treated for breast cancer between 2003-2008 at the Hospital Universitario "San Cecilio" of Granada (Spain). RESULTS: We found a significant correlation (p = 0.001) between the age of cancer diagnosis, length of breastfeeding, and the existence of personal and family history for cancer. By contrast, there were no statistically significant differences test (t-test) between the average age of diagnosis of cancer and having had offspring or not (t = 0.559, p = 0.576). CONCLUSIONS: Breastfeeding for periods of longer than six months, not only provides children with many health benefits, but may also protect the mother from serious diseases, such as breast cancer.