Good practice criteria for childhood obesity prevention in kindergartens and schools-elaboration, content and use.

Background: In accordance with the policy actions that address childhood overweight and obesity at European level and as a contribution to the EU Action Plan on Childhood Obesity 2014-20, a Joint Action on Nutrition and Physical Activity (JANPA) was established. As part of JANPA work package 6, an evaluation framework to identify good practices, targeting childhood obesity prevention in kindergartens and schools, was developed. This article describes the WP 6 JANPA framework of good practice criteria and its development, compares it to other frameworks and discusses its potential for future use. Methods: Based on the analysis of scientific literature, a set of 47 potential good practice criteria was drafted, that was then revised and complemented through a series of online Delphi consultations. Results: A final list of 48 good practice criteria (9 of which were rated as core criteria) was developed and grouped into three categories: intervention characteristics (n = 17), implementation (n = 17) and monitoring and evaluation (n = 14). Conclusion: The identified JANPA framework of good practice criteria complements the existing frameworks by focussing on kindergarten- and school-based initiatives and provides guidance for evaluators, programme planners and decision makers bearing in mind that a one-size-fits-all approach is inadequate. To ensure the effectiveness of future practices, programme planners should endeavour to meet at least the nine JANPA core criteria.

[Hungarian Diet and Nutritional Status Survey 2014. I. Nutritional status of the Hungarian adult population]. / Országos Táplálkozás és Tápláltsági Állapot Vizsgálat 2014. I. A magyar felnott lakosság tápláltsági állapota.

INTRODUCTION AND AIM: The Hungarian Diet and Nutritional Status Survey examines the obesity prevalence, dietary habits and, since 2014, physical activity in Hungarian adults in every 5 years. METHOD: The survey provides national data representative by age and gender, based on anthropometric measurements and international standards. RESULTS: In 2014, nearly two-thirds of adults were overweight or obese. 28.2% of men and 31.5% of women were obese. Prevalence of morbid obesity were 2.6% and 3.3% in men and women, respectively. Abdominal obesity was more prevalent among women than men (55% vs. 38%), and the rate was increasing with age in both genders. In elderly, 55% of men and almost 80% of women were abdominally obese. CONCLUSION: In conclusion, the prevalence of overweight, obesity, and abdominal obesity is high in Hungarian adults. In order to tackle obesity, we need to obtain representative and measured data, which form the basis of targeted interventions and the assessment of their impact. Orv. Hetil., 2017, 158(14), 533-540.

[Hungarian Diet and Nutritional Status Survey - OTÁP2014. III. Macroelement intake of the Hungarian population]. / Országos Táplálkozás és Tápláltsági Állapot Vizsgálat ­ OTÁP2014. III. A magyar lakosság makroelem-bevitele.

INTRODUCTION AND AIM: The Hungarian Diet and Nutritional Status Survey examined the dietary habits of the Hungarian adult population. The aim of the study is to present the macroelement intake of the population. METHOD: The study represents the macrolement intake of the population with age 18 or over on the day of 31 December 2013, of those who are non-institutionalised. RESULTS: Salt intake decreased compared to the findings of the previous study in 2009 but it is still extremely high (15.9 g in men and 11.2 g in women). The potassium intake is below the recommendation, which together with a high sodium intake increases the risk of high blood pressure. Calcium intake in the youngest age group reached the recommendations, whereas the intake in the oldest age group was well below the references. Magnesium intake complied with the recommendation, the intake of phosphorus however exceeded it. High sodium intake still represents substantial public health risk. CONCLUSION: The reduction that occured in the population's salt intake since 2009 demonstrates the effectiveness of implemented prevention programs, cooperation with the industry and public awareness campaigns. Orv Hetil. 2017; 158(17): 653-661.

[Hungarian Diet and Nutritional Status Survey - The OTAP2014 study. V. Vitamin intake of the Hungarian population]. / Országos Táplálkozás- és Tápláltsági Állapot Vizsgálat ­ OTÁP2014. V. A magyar lakosság vitaminbevitele.

INTRODUCTION AND AIM: The Hungarian Diet and Nutritional Status Survey was implemented on a sub-sample of the European Health Interview Survey. In this paper, the authors present the data on the vitamin intake of the Hungarian population. METHOD: The survey represents the vitamin intake of the Hungarian non-institutionalised adult population of 18 years and older. There are significant differences between men's and women's vitamin intake. RESULTS: The intake of all water-soluble vitamins except for vitamin C is higher in men than in women, and the difference between the genders regarding the intake of vitamin E and D is significant. The intake of vitamin B1, B2, B6, B12, niacin and vitamin C is in line with the recommendations, however, there is an unfavourable decrease in the intake of vitamin A and ß-carotene in the case of men compared to the previous survey. Vitamin D and folic acid intakes are critically low, particularly in the elderly, and mainly in case of vitamin D. The population's intake of panthotenic acid and biotin did not reach the recommendations. CONCLUSION: In order to reach the dietary reference intakes and to prevent deficiencies, it is necessary to inform the population and to make healthy food choices available. Orv Hetil. 2017; 158(33): 1302-1313.

[Hungarian Diet and Nutritional Status Survey - OTÁP2014. II. Energy and macronutrient intake of the Hungarian population]. / Országos Táplálkozás és Tápláltsági Állapot Vizsgálat ­ OTÁP2014. II. A magyar lakosság energia- és makrotápanyag-bevitele.

INTRODUCTION AND AIM: The aim of the study was to assess and monitor the dietary habits and nutrient intake of Hungarian adults. METHOD: Three-day dietary records were used for dietary assessment, the sample was representative for the Hungarian population aged ≥18ys by gender and age. RESULTS: The mean proportion of energy from fat was higher (men: 38 energy%, women: 37 energy%), that from carbohydrates was lower (men: 45 energy%, women: 47 energy%) than recommended, the protein intake is adequate. CONCLUSION: Unfavorable change compared to the previous survey in 2009 was the increase of fat and saturated fatty acid energy percent in women, the decrease in fruit and vegetable consumption, which explains the decreased fiber intake. An increasing trend in added sugar energy percent in each age groups of both genders was observed compared to 2009. Interventions focusing on the promotion of fruit and vegetable consumption and decreasing of saturated fat and added sugar intake are needed. Orv. Hetil., 2017, 158(15), 587-597.

[Hungarian Diet and Nutritional Status Survey - The OTAP2014 study. IV. Microelement intake of the Hungarian population]. / Országos Táplálkozás és Tápláltsági Állapot Vizsgálat ­ OTÁP2014. IV. A magyar lakosság mikroelem-bevitele.

INTRODUCTION AND AIM: The Hungarian Diet and Nutritional Status Survey examined the dietary habits of the Hungarian population. This publication presents the microelement intake. METHOD: The survey represents the microelement intake of the Hungarian non-institutionalised adult population of 18 years and older. RESULTS: While the intake of iron, copper and manganese corresponded with the recommendations in males, in females it was insufficient. The iron intake of women in their reproductive age (9.8 mg/d) stayed well below the recommendation, thus representing a high health risk. In comparison to earlier Hungarian data chromium intake decreased significantly in both sexes (men p = 0.000, women p = 0.008) and the zinc intake of men (9.6 mg/d) decreased below recommended. CONCLUSION: Since the consumption of whole grain products with high microelement content in Hungary is very low, it would be favourable to increase the proportion of these foods in the diet. In case of women it is also necessary to increase the consumption of food groups (e.g. meat, fruits) contributing to the iron intake. Furthermore, communication of adequate nutrition, and the availability of healthy foods is essential for the entire population. Orv Hetil. 2017; 158(21): 803-810.

WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6-9-year-old children from school year 2007/2008 to school year 2009/2010.

BACKGROUND: The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. METHODS: Using cross-sectional nationally representative samples of 6-9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses. RESULTS: At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 - 31% of boys and 5 - 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change in mean BMI (range: from -0.4 to +0.3) and BMI-for-age Z-scores (range: from -0.21 to +0.14) varied statistically significantly across countries. The highest significant decrease in BMI-for-age Z-scores was found in countries with higher absolute BMI values and the highest significant increase in countries with lower BMI values. The highest significant decrease in overweight prevalence was observed in Italy, Portugal and Slovenia and the highest significant increase in Latvia and Norway. CONCLUSIONS: Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation.

[Present and future of genotype-based personalized nutrition]. / A genetikaiprofil-alapú, személyre szabott táplálkozás jelene és jövoje.

After the completion of the Human Genome Project, the era of providing personalized dietary advice based on an individual's genetic profile seemed near. Since then more than a decade has passed and the pace of development has been slower than expected. Genotyping single nucleotide polymorphisms which may determine susceptibility to multifactorial diseases is cheaper and more accessible than it was ten years ago. However, few of them are supported by such solid scientific evidence which would justify their use for personalized dietary advice. The future of genotype-based personalized nutrition depends on whether a sufficient amount of gene-diet-disease interactions are identified and scientifically confirmed.

[Evaluation of the LightCycler® SeptiFast test in newborns and infants with clinical suspicion of sepsis]. / Evaluación de la técnica LightCycler® SeptiFast en recién nacidos y lactantes con sospecha de sepsis.

INTRODUCTION: Neonatal sepsis is a significant cause of morbidity and mortality. Early diagnosis and prompt antimicrobial therapy are crucial for a favorable outcome of the newborn child. Blood culture, the current "gold standard" method for diagnosing bloodstream infections, has a low sensitivity in newborns. We evaluated the multiplex real-time PCR LightCycler(®) SeptiFast (LC-SF) for detection of bloodstream infections in newborns, compared with conventional blood culture. METHODS: A total of 42 blood samples were obtained from 35 subjects presenting with a febrile episode and hospitalized in neonatal intensive care unit at Hospital Universitario Virgen de las Nieves. Two samples were collected during each febrile episode in order to carry out LC-SF assay and blood culture, respectively. RESULTS: Sensitivity and specificity of 79% and 87%, respectively, compared with clinical diagnosis, were obtained for LC-SF. Contamination rate of blood cultures was 16.7%, mainly due to coagulase-negative staphylococci (CoNS) and viridans groups of streptococci. Contamination rate of LC-SF by CoNS was 2.4%. Concordance between LC-SF and blood culture was moderate (kappa index: 0.369). LC-SF demonstrated a higher concordance (kappa index: 0.729) with the final clinical diagnosis than blood culture (kappa index: 0.238). CONCLUSION: LC-SF assay could be a useful diagnostic tool, along with a conventional blood culture, in newborn, for confirming or ruling out those cases that blood culture could not determine, shortening the time to result to 7 hours.

Biochar of animal origin: a sustainable solution to the global problem of high-grade rock phosphate scarcity?

Phosphorus (P) is an essential element for all living organisms. However, in soil-plant systems, this nutrient is the most limiting, leading to frequent applications of soluble P fertilisers. Their excessive use provokes alterations in the natural P cycle, soil biodiversity and ecological equilibrium and is the main reason for the eutrophication of water, with consequences on food safety. Biotechnology offers a number of sustainable solutions that can mitigate these problems by using various waste materials as a source of P and, on the other hand, their solubilisation by selected micro-organisms. This review present results on the solubilisation of animal bone char with high phosphate content by micro-organisms to produce organic acids such as lactic acid, citric acid and itaconic acid. All experiments were performed under conditions of liquid submerged and solid state fermentation processes. Freely suspended and immobilised cells of the corresponding microbial cultures were employed using substrates characterised by low cost and abundance. Other alternative technologies are discussed as well in order to stimulate further studies in this field, bearing in mind the progressive increase in P fertiliser prices based on high global P consumption and the scarcity of rock phosphate reserves.

[Hungarian diet and nutritional status survey -- the OTAP2009 study. I. Nutritional status of the Hungarian population]. / Országos Táplálkozás- és Tápláltsági Állapot Vizsgálat - OTÁP2009. I. A magyar lakosság tápláltsági állapota.

UNLABELLED: Obesity is a leading public health problem, but representative data on measured prevalence among Hungarian adults has been missing since the late eighties. AIM AND METHOD: Joining in European Health Interview Survey the aim of the OTAP2009 study was to provide data representative by age and gender on the prevalence of obesity and abdominal obesity among Hungarian adults based on their measured anthropometric data. RESULTS: Participation rate was 35% (n = 1165). Data shows that nearly two-thirds of adults are overweight or obese. 26.2% of men and 30.4% of women are obese. Prevalence of morbid obesity is 3.1% and 2.6% in men and women, respectively. Abdominal obesity is more prevalent among women than men (51.0% vs. 33.2%), and rate is increasing parallel with age in both gender. In elderly, 55% of men and almost 80% of women are abdominally obese. CONCLUSIONS: Besides interventions of population level for tackling obesity, individual preventive measures are indispensable.

[Hungarian Diet and Nutritional Status Survey -- the OTAP2009 study. III. Vitamin intake of the Hungarian population]. / Országos Táplálkozás és Tápláltsági Állapot Vizsgálat - OTÁP2009. III. A magyar lakosság vitaminbevitele.

UNLABELLED: For the healthy status the adequate intake of vitamins is essential. AIM AND METHOD: The Hungarian Diet and Nutritional Status Survey - joining to the European Health Interview Survey - studied the dietary habits of the Hungarian population. This work presents the vitamins intake. RESULTS: The intake of all water soluble vitamins, vitamin E and D were significantly higher in men than in women. Favourable phenomena were the increased ß-carotene and vitamin C intakes in men and women compared to the earlier data. Intakes of vitamin C, B1-, B2-, B6- and B12, and niacin meet the recommendations. Crucially low intakes of vitamin D and folate were calculated in both genders, particularly in the elders, mainly in case of vitamin D. Imperfect intakes of panthotenic acid and biotin were also observed. CONCLUSIONS: For maintaining the adequate vitamin supply and for prevention of vitamin deficiency, diversified nutrition, information of the population on the basic principles of healthy nutrition and availability of healthy food are essential.

[Hungarian Diet and Nutritional Status Survey -- the OTAP2009 study. II. Energy and macronutrient intake of the Hungarian population]. / Országos Táplálkozás és Tápláltsági Állapot Vizsgálat - OTÁP2009. II. A magyar lakosság energia- és makrotápanyag-bevitele.

UNLABELLED: The Hungarian Diet and Nutritional Status Survey is the fourth in the row of the Hungarian national dietary surveys conducted by the Institute for Food and Nutrition Science. AIMS: The present study was performed to provide valid, up-to-date data on energy and nutrient intakes and dietary habits of the Hungarian adult population. METHODS: The energy and nutrient intakes were calculated on validated three-day dietary records of a representative sample by age and gender of the Hungarian population aged ≥ 18 ys. RESULTS: The energy percentage of fat was too high (39 E% for men and 36 E% for women), that of carbohydrate was too low (45 E% for men and 48 E% for women), whereas that of protein met the recommendation (15 E% for men and 15 E% for women). CONCLUSIONS: Reduction of the nutritional risk factors would greatly reduce the mortality and morbidity rates of nutrition-related diseases.

[Hungarian Diet and Nutritional Status Survey -- the OTAP2009 study. V. Intake of microelements in the Hungarian population]. / Országos Táplálkozás és Tápláltsági Állapot Vizsgálat - OTÁP2009. V. A magyar lakosság mikroelem-bevitele.

UNLABELLED: For a healthy status the adequate intake of microelements is vital. AIM AND METHOD: The Hungarian Diet and Nutritional Status Survey - joining to the European Health Interview Survey - studied the dietary habits of the Hungarian population. The present paper demonstrates the microelement intake. RESULTS: While the intake of iron, copper and zinc was sufficient in males, it was deficient in females according to the Hungarian recommendations. Especially women in their reproductive age ingested iron below the recommendation, thus representing a health risk. In comparison to earlier Hungarian data, zinc and chromium intake decreased unfavorable. CONCLUSIONS: Since in Hungary the consumption of the whole grain products with high trace element content is traditionally low, as also reflected in the present study, it would be desirable to increase the contribution of these foods in the diet in order to enhance the intake of microelements.

[Hungarian Diet and Nutritional Status Survey - the OTAP2009 study. IV. Macroelement intake of the Hungarian population]. / Országos Táplálkozás és Tápláltsági Állapot Vizsgálat - OTÁP2009. IV. A magyar lakosság makroelem-bevitele.

UNLABELLED: The adequate intake of minerals is basically important for healthy nutrition. AIM AND METHOD: The Hungarian Diet and Nutritional Status Survey - joining to the European Health Interview Survey - studied the dietary habits of the Hungarian population. The present publication describes the macroelement intake. RESULTS: The salt intake is unusually high (17.2 g in men and 12.0 g in women), the potassium intake remains well below the recommendation. These factors substantially increase the risk of cardiovascular diseases including high blood-pressure. The calcium intake stays below the recommendation except in the youngest males, the oldest men and women are at risk from this point of view. While magnesium intake suited the recommendation, the intake of phosphorus exceeded it twice. CONCLUSIONS: Focusing on marcroelements, high sodium/salt intake represents the highest public health risk. The implementation of STOP SALT! National Salt Reducing Programme, i.e. decrease the salt content of processed food and provide proper information to the population about excessive salt consumption, should result in a beneficial change of salt intake and ameliorate the public health conditions.

[The NADYA-SENPE Home Enteral Nutrition Registry in Spain: years 2018 and 2019]. / Registro del Grupo NADYA-SENPE de Nutrición Enteral Domiciliaria en España: años 2018 y 2019.

INTRODUCTION: Aim: to present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2018 and 2019. Material and methods: from January 1, 2018 to December 31, 2019 the home enteral nutrition registry was recorded, and afterwards a further descriptive and analytical analysis was done. Results: in 2018, 4756 active patients were registered and the prevalence was 101.79 patients per one million inhabitants; in 2019 there were 4633 patients with a prevalence of 98.51 patients per one million inhabitants. They originated in 46 hospitals: 51.3 % were male, and median age was 71.0 years in both periods. The most frequent diagnosis was a neurological disorder that presents with aphagia or severe dysphagia - 58.7 % and 58.2 %, respectively. The main cause of episode termination was death. A total of 116 pediatric patients were registered in 2018 and 115 in 2019. Females represented 57.8 % and 59.1 %, respectively, in each of the periods. Median age at the beginning of HEN was 5 and 7 months. The most commonly recordered diagnostic group (42.2 % and 42.6 %) was included within the other pathologies group, followed by neurological disorders that present with aphagia or severe dysphagia in 41.4 % and 41.7 % of children. The route of administration was gastrostomy in 46.6 % and 46.1 %, respectively, in each of the periods. Conclusions: the NED registry of the NADYA-SENPE group continues to operate uninterruptedly since its inception. The number of registered patients and the number of participating hospitals remained stable in the last biennium analyzed.

INTRODUCCIÓN: Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) de los años 2018 y 2019 del Grupo NADYA-SENPE. Material y métodos: se recopilaron los pacientes introducidos en el registro desde el 1 de enero al 31 de diciembre de 2018 y en las mismas fechas para 2019, procediendo al análisis descriptivo y analítico de los datos. Resultados: en el año 2018 se registraron 4756 pacientes activos con una tasa de prevalencia de 101,79 pacientes/millón de habitantes; en 2019 fueron 4633 con una tasa de prevalencia de 98,51 pacientes/millón de habitantes. Procedían de 46 hospitales. Fueron el 51,3 % los varones registrados y la edad mediana fue de 71,0 años en ambos periodos. El diagnóstico más frecuente fue el de enfermedad neurológica que cursa con afagia o disfagia severa (58,7 % y 58,2 %), respectivamente. La causa principal de finalización de los episodios fue el fallecimiento. Los pacientes pediátricos registrados fueron 116 en 2018 y 115 en 2019. Las niñas representaron el 57,8 % y 59,1 %, respectivamente, en cada uno de los periodos. La edad mediana de inicio de la NED fue de 5 y 7 meses. El grupo diagnóstico más registrado (42,2 % y 42,6 %) se englobó dentro del grupo de otras patologías, seguido de la enfermedad neurológica que cursa con afagia o disfagia severa de los niños (41,4 % y 41,7 %). Se alimentaban a través de gastrostomía el 46,6 % y 46,1 %, respectivamente, en cada uno de los periodos. Conclusiones: el registro de NED del grupo NADYA-SENPE sigue operativo de forma ininterrumpida desde sus inicios. El número de pacientes registrados y el de hospitales participantes permanece estable en el último bienio analizado.

Reliable identification and quantification of anabolic androgenic steroids in dietary supplements by using gas chromatography coupled to triple quadrupole mass spectrometry.

The aim of the present research was the identification and quantification of specific anabolic androgenic steroids (AASs) and other sterane structured compounds in dietary supplements (DSs). The adulteration of DSs by these compounds is of a particular concern in athletes, because it might lead to a positive doping result. The research was focused on the optimization of a highly sensitive and selective GC-based analytical strategy using triple quadrupole MS as detector. Chromatographic method and multiple reaction monitoring (MRM) transitions of 28 target compounds were optimized. Sample clean-up was carried out by using a solid phase extraction (SPE) procedure, while the derivatization of AASs was performed by using N-methyl-N-(trimethylsilyl)-trifluoroacetamide (MSTFA). The method was validated, and the following parameters were investigated: linearity range, limit of detection, accuracy, and precision expressed in terms of intra-day precision. The calibration curves were evaluated by using regression model and resulting in a good determination coefficients (R2 ≥ 0.9912). The residuals were scattered randomly around zero. The limits of detection (LODs) were lower than 7.0 ng g-1 or ng ml-1 . The accuracy assessment was evaluated in different forms of DSs characterized by high sample-to-sample variability (liquid, powder, tablet, capsule, protein, and herbal-based). Intra-day assay precision was in all cases lower than 20%. The developed analytical method was successfully applied to the analysis of 67 commercially available dietary supplements. In five cases, one or more steroid-type compounds were found in the concentration of 5 ng g-1 -100 µg g-1 , which might result adverse analytical findings in athletes.

Therapy and prevention of obesity: nutrition, physical activity and medical treatment / Az elhízás kezelése és megelozése: táplálkozás, testmozgás, orvosi lehetoségek.

Összefoglaló. Az elhízás és következményes megbetegedései fontos népegészségügyi problémát jelentenek hazánkban is. Kezelése komoly szakmai kihívás, ugyanakkor prevenciója eredményesebb lehet. Az elhízott betegekkel leggyakrabban találkozó háziorvosok, más szakorvosok és egészségügyi szakemberek részérol nagy igény van egy viszonylag rövid, áttekintheto, naprakész gyakorlatias útmutatóra. A különbözo orvosszakmai társaságokban tevékenykedo, évtizedes szakmai tapasztalatokkal rendelkezo szerzok összefoglalják tudományosan megalapozott, bizonyítékokon alapuló ismereteiket. Az elhízás kezelését lépcsozetesen célszeru megkezdeni, elotte felmérve a beteg motivációját, általános állapotát, lehetoségeit. A szerzok leírják az energiaszükséglet meghatározásával, az étrenddel és a fizikai aktivitás megtervezésével kapcsolatos alapveto szempontokat. Felsorolják a hazánkban elérheto gyógyszereket és metabolikus sebészeti beavatkozásokat, az életmódi támogatás igényét. Az elhízás megelozésében az élet elso 1000 napjának táplálkozása, a késobbiekben a szüloi minta a meghatározó. Sok kihasználatlan lehetosége van a háziorvosok, a lakóközösségek, az állami szervek koordinált együttmuködésének, helyi kezdeményezéseknek. Az elhízás betegségként való meghatározása egyaránt igényel egészségpolitikai és kormányzati támogatást, az elhízottak ellátására szakosodott multidiszciplináris centrumok számának és kompetenciájának növelését. Orv Hetil. 2021; 162(9): 323-335. Summary. Obesity and related morbidities have a high public health impact in Hungary. The treatment is a challenge, but prevention seems more effective. General practitioners, other specialists and health care professionals who are treating obese persons require short, summarized, updated and practical guideline. Hungarian medical professionals of different scientific societies, having decennial practices, are summarizing their evidence-based knowledge. Obesity management requires step by step approach, evaluating previously the general health condition, motivation and options of the patients. The measurement of energy requirement, planning of diet and physical activities, available surgical methods and medications are described in detail with life style and mental support needed. The most important period in the prevention of obesity is the first 1000 days from conception. Other significant factors are the life style habits of the parents. Proper obesity prevention requires better coordination of primary health care, community and governmental activities. Obesity should be defined as morbidity, therefore stronger governmental support and more health-policy initiatives are needed, beside increasing number and developing of multidisciplinary centres. Orv Hetil. 2021; 162(9): 323-335.

The prognostic value of toxin B and binary toxin in Clostridioides difficile infection.

To study the association between detection of the Clostridioides difficile gene encoding the binary toxin (CDT) and direct detection of toxinB (TcdB) from feces with the appearance of serious disease, complications, or recurrence in a prospective series of cases. A total of 220 confirmed cases were included, using a two-step algorithm: an initial study to detect the enzyme, glutamate dehydrogenase (GDH), followed, in cases of positivity, by detection of the tcdB. tcdB-positive patients were investigated for the presence of CDT and TcdB. Outcome variables were severe disease, the modified Illinois C. difficile infection (CDI) prognostic risk index (ZAR score), the appearance of complications (need for colectomy, CDI-related death, or toxic megacolon) and recurrence. Patients who tested positive for the presence of TcdB in feces were found to have greater disease severity than those who tested negative, with a ZAR score of 35.4% vs. 23% (p = .048), a higher recurrence rate (14.6% vs. 5.9%, p = .032), and a tendency for higher number of complications (20.7% vs. 11.5%), although without reaching statistical significance (p = .053). When presence of CDT was analyzed, higher frequencies of severe disease (39.2% vs. 21.2%, p = .005), complications and recurrence (21.6% vs. 10.9%, p = .037 and 14.9% vs. 5.8%, p = .029; respectively) were observed in patients where CDT was detected. TcdB and CDT act as prognostic markers of the appearance of serious disease, complications or recurrence in cases of CDI. Simultaneous detection of both markers, TcdB and CDT, had a greater impact on the prognosis than when they were detected separately.