Leche enriquecida con esteroles vegetales como estrategia para conseguir una disminución de la trigliceridemia en la infancia; ensayo clínico doble ciego, aleatorizado y controlado / Low-fat, fermented milk enriched with plant sterols, a strategy to reduce hypertriglyceridema in children, a double-blind, randomized placebo-cotrolled trial

Introducción: en estos últimos años, paralelamente a la epidemia de obesidad, se ha producido un aumento de las dislipemias en la población pediátrica. En estas dislipemias es posible que los triglicéridos sanguíneos también tengan un papel importante. Los esteroles vegetales se han mostrado eficaces en el tratamiento de la hipercolesterolemia, pero no de la hipertrigliceridemia. Nuestro objetivo en este estudio es determinar la eficacia de la leche enriquecida en fitoesteroles para la disminución de la hipertrigliceridemia en la población infantil. Población y método: se diseñó un ensayo clínico, controlado, aleatorizado, y doble ciego, con leche desnatada enriquecida con esteroles vegetales y leche desnatada no enriquecida. Se incluyeron 67 pacientes pediátricos. Resultados: tras la ingesta observamos diferencias en la trigliceridemia final entre la leche desnatada enriquecida con esteroles vegetales y la leche desnatada no enriquecida con esteroles. El efecto atribuible a la ingesta de la leche enriquecida con fitosteroles vegetales fue de una disminución de 5,88 mg/dl. Conclusión: concluimos que la leche enriquecida con esteroles vegetales (2,24 gr de esteroles vegetales al día) podría constituir una estrategia adecuada para el tratamiento de la hipertrigliceridemia en pacientes pediátricos (AU)

Introduction: in the last few years, as the rate of childhood obesity has been rising, there has been a parallel increase in the incidence of dislipemia in the pediatric population, in which blood triglycerids might play an important role. Plant sterols have been shown to be useful in the treatment of hypercholesterolemia, but not of hypertrygliceridemia. Our study focusses on determining the efficacy of phytosterol-supplemented milk for the treatment of hypertriglyceridemia in children. Study Population and Method: we designed a double-blind, randomized, controlled clinical trial on 67 pediatric patients. The treatment group received low-fat, phytosterol-supplemented milk and the control group received low-fat conventional milk. Results: we observed differences in triglyceridemia between the phytosterol-supplemented group and the non-supplemented group. The effect attributable to the intake of milk supplemented with plant sterols was a reduction of triglyceridemia of 5.88 mg/dl compared with the control group. Conclusion: we conclude that phytosterol-supplemented milk (2.24 gr of plant sterols daily) might be an adequate tool in the management of hypertriglyceridemia in pediatric patients (AU)

[LOW-FAT, FERMENTED MILK ENRICHED WITH PLANT STEROLS, A STRATEGY TO REDUCE HYPERTRIGLYCERIDEMA IN CHILDREN, A DOUBLE-BLIND, RANDOMIZED PLACEBO-COTROLLED TRIAL]. / LECHE ENRIQUECIDA CON ESTEROLES VEGETALES COMO ESTRATEGIA PARA CONSEGUIR UNA DISMINUCIÓN DE LA TRIGLICERIDEMIA EN LA INFANCIA; ENSAYO CLÍNICO DOBLE CIEGO, ALEATORIZADO Y CONTROLADO.

INTRODUCTION: in the last few years, as the rate of childhood obesity has been rising, there has been a parallel increase in the incidence of dislipemia in the pediatric population, in which blood triglycerids might play an important role. Plant sterols have been shown to be useful in the tratment of hypercholesterolemia, but not of hypertrygliceridemia. Our study focusses on determining the efficacy of phytosterol-supplemented milk for the treatment of hypertriglyceridemia in children. Study Population and Method: we designed a double- blind, randomized, controlled clinical trial on 67 pediatric patients. The treatment group received low-fat, phytosterol-supplemented milk and the control group received low-fat conventional milk. RESULTS: we observed differences in triglyceridemia between the phytosterol-supplemented group and the non-supplemented group. The effect attributable to the intake of milk supplemented with plant sterols was a reduction of triglyceridemia of 5.88 mg/dl compared with the control group. CONCLUSION: we conclude that phytosterol-supplemented milk (2.24 gr of plant sterols daily) might be an adequate tool in the management of hypertriglyceridemia in pediatric patients.

Introducción: en estos últimos años, paralelamente a la epidemia de obesidad, se ha producido un aumento de las dislipemias en la población pediátrica. En estas dislipemias es posible que los triglicéridos sanguíneos también tengan un papel importante. Los esteroles vegetales se han mostrado eficaces en el tratamiento de la hipercolesterolemia, pero no de la hipertrigliceridemia. Nuestro objetivo en este estudio es determinar la eficacia de la leche enriquecida en fitoesteroles para la disminución de la hipertrigliceridemia en la población infantil. Población y método: se diseñó un ensayo clínico, controlado, aleatorizado, y doble ciego, con leche desnatada enriquecida con esteroles vegetales y leche desnatada no enriquecida. Se incluyeron 67 pacientes pediátricos. Resultados: tras la ingesta observamos diferencias en la trigliceridemia final entre la leche desnatada enriquecida con esteroles vegetales y la leche desnatada no enriquecida con esteroles. El efecto atribuible a la ingesta de la leche enriquecida con fitosteroles vegetales fue de una disminución de 5,88 mg/dl. Conclusión: concluimos que la leche enriquecida con esteroles vegetales (2,24 gr de esteroles vegetales al día) podría constituir una estrategia adecuada para el tratamiento de la hipertrigliceridemia en pacientes pediátricos.

Television viewing time and risk of eating disorders in Spanish adolescents: AVENA and AFINOS studies.

BACKGROUND: Effective preventive interventions for both eating disorders and obesity in adolescence should be focused on shared risk factors. We analyzed the association between television (TV) viewing time and the risk of eating disorders, as well as the potential role of obesity in this association. METHODS: The sample consisted of a total of 3458 Spanish adolescents, aged 13-18.5 years, from the Food and Assessment of the Nutritional Status of Adolescents (AVENA) and Physical Activity as a Preventive Measure of the Development of Overweight, Obesity, Allergies, Infections, and Cardiovascular Risk Factors in Adolescents (AFINOS) studies. Adolescents' TV time was assessed by self-report. Body mass index was calculated and the adolescents were classified into non-overweight and overweight-obesity. The risk of eating disorders was evaluated using the SCOFF questionnaire. RESULTS: Adolescents who watched TV >1 h/day had a higher risk for eating disorders, compared with those adolescents who watch TV <1 h/day. Also, overweight-obese adolescents had a higher risk for eating disorders than those who were non-overweight. Analyses across groups of TV viewing time and weight status showed similar trends, so that the higher the time spent in TV viewing, the higher the risk of eating disorders, regardless of weight status. CONCLUSIONS: TV viewing time might be a focal point for prevention of both eating disorders and obesity in adolescence.

Immigrant status, acculturation and risk of overweight and obesity in adolescents living in Madrid (Spain): the AFINOS study.

Prior studies have identified a link between length of residence and overweight (including obesity) in immigrant populations. However, this link has not been confirmed in Europe. This study compares overweight prevalences in native Spanish and immigrant adolescents living in the Madrid region (Spain), and whether length of residence affects the risk of immigrant adolescents being overweight. The study population was a representative sample of adolescents aged 13-17 years (n = 2,081, 1,055 girls) who lived in Madrid. Data were collected from November 2007 to February 2008 through a cross-sectional survey in which self-reported height and weight were used to calculate BMI. Overall, no significant difference was detected in overweight risk between the Spanish and immigrant adolescents. However, immigrant adolescents residing in Spain for 6 years or under did show a higher overweight risk than both the Spanish adolescents (OR 1.57) and immigrants who had lived in Spain for longer than 6 years (OR 1.98). Changes in lifestyle associated to a longer duration of residence in Spain seems to have a slightly protective effect on the risk of being overweight in immigrant adolescents.

Length of residence and risk of eating disorders in immigrant adolescents living in Madrid; the AFINOS study / Tiempo de residencia y riesgo de trastornos de conducta alimentaria en adolescentes inmigrantes residentes en Madrid; estudio AFINOS

Objectives: This study was designed to compare the risk of having an eating disorder (ED) among immigrant and native adolescents living in Madrid and to determine the possible influence of length of residence (LOR) on the risk of the immigrants. Methods: A cross-sectional survey was conducted from november 2007 to february 2008 in a representative sample of adolescents aged 13 to 17 years (n = 2,077, 1,052 girls) living in the Madrid region. Data were collected using the Spanish version of the SCOFF Eating Disorders Questionnaire. Further factors considered were country of birth, LOR and several biological, sociodemographic, lifestyle and health-related variables. Results: According to the three logistic regression models constructed, female immigrant adolescents on the whole showed a greater ED risk (OR = 1.95; 95%CI 1.29- 2.95; p = 0.001) than native adolescents. Moreover, the likelihood of ED was higher among female immigrants living in Spain for < 6 years than for Spanish native females (OR = 2.44; 95%CI 1.42-4.18; p = 0.001), while no significant differences were found when female natives were compared with female immigrants living in this country for ≥ 6 years. Similarly, no differences were observed in the ED risk recorded for male native and immigrant adolescents, both as a whole and by length of residence in Spain. Conclusions: The immigrant status and the length of Spanish residence are relevant factors in regard to the ED risk in adolescents living in Madrid (AU)

Objetivos: Este estudio fue diseñado para comparar el riesgo de trastornos de conducta alimentaria (TCA) entre adolescentes nativos e inmigrantes residentes en Madrid, así como para determinar la posible influencia del tiempo de residencia en el riesgo de los inmigrantes. Métodos: Se llevó a cabo un estudio transversal durante el periodo comprendido entre noviembre 2007 y febrero 2008 sobre una muestra representativa de adolescentes residentes en Madrid, con edades de entre 13 y 17 años (n = 2.077, 1.052 mujeres). Los datos se recogieron usando la versión española del cuestionario SCOFF para la detección de trastornos alimentarios. Otros factores considerados fueron el país de nacimiento, el tiempo de residencia y diversas variables biológicas, socio-demográficas, relativas a estilo de vida y la salud. Resultados: Según los tres modelos de regresión logística construidos, las mujeres adolescentes inmigrantes en conjunto mostraron un mayor riesgo de TCA (OR = 1,95; 95%CI 1,29-2,95; p = 0,001) que las nativas. Además, la probabilidad de sufrir TCA fue mayor entre las adolescentes inmigrantes con una residencia en España < 6 años que en las nativas (OR = 2,44; 95%CI 1,42-4,18; p = 0,001), mientras que no se encontraron diferencias entre las adolescentes nativas y las inmigrantes con un tiempo de residencia ≥ 6 años. No se observaron diferencias en el riesgo de TCA entre los adolescentes varones nativos y los inmigrantes, tanto en conjunto como según tiempo de residencia. Conclusiones: La condición de inmigrante y el tiempo de residencia son factores relevantes a la hora de considerar el riesgo de TCA en adolescentes residentes en Madrid (AU)

Adherence to dietary recommendations among Spanish and immigrant adolescents living in Spain; the AFINOS study / Adherencia a las recomendaciones nutricionales entre adolescentes españoles e inmigrantes residentes en España; estudio AFINOS

Objectives: This study compares the adherence of immigrant and Spanish adolescents residing in the Madrid region (Spain) to national dietary recommendations. The factors compared were the consumption of items from the eight basic food groups (vegetables, fruits, bread/cereals, meat, eggs, fish, legumes and milk/dairy products), including the excessive or deficient consumption of eggs, meat and fish. In addition, the evaluation of excessive sweet foods or soft drinks in the diet was also considered. Subsequently, the influence of length of residence on dietary habits was examined. Materials and methods: Self-reported data were collected in a cross-sectional survey conducted over the period November 2007 to February 2008. The study participants were a representative sample of adolescents aged 13 to 17 years (n=2081, 1055 girls) living in the Madrid region. Participants were recruited from secondary schools (grades 7th to 10th) randomly selected according to the geographic distribution of adolescents in the region. Results: Immigrant adolescents showed a greater likelihood of not fulfilling recommendations for the consumption of meat, fish, eggs, legumes, bread/cereals, and milk/dairy products. Their diets were also more likely to lack sufficient fish and they also consumed more eggs and more sweet foods and soft drinks than their native counterparts. Spanish adolescents were more likely not to meet recommendations for the intake of vegetables. Length of residence weakly affected dietary habits, with both negative and positive effects observed. Conclusion: The likelihood of not fulfilling dietary recommendations was higher among the immigrant adolescents with the exception of the intake of fruits and vegetables (AU)

Objetivos: Este estudio compara la adherencia a las recomendaciones nutricionales de adolescentes inmigrantes y españoles residentes en la Comunidad de Madrid, España. Se comparó el consumo de ocho grupos principales de alimentos (verduras, frutas, pan/cereales, carne, huevos, pescado, legumbres, leche/derivados lácteos) incluyendo el consumo excesivo y deficiente de huevos, carne y pescado. También fue valorado el consumo excesivo de dulces y bebidas azucaradas. Posteriormente se analizó la influencia del tiempo de residencia en España sobre los mencionados hábitos de dieta. Material y método: Se llevó a cabo un estudio transversal en el que fueron recogidos datos auto-reportados durante el periodo comprendido entre Noviembre 2007 y Febrero 2008. Se obtuvo una muestra representativa de adolescentes con edades comprendidas entre 13 y 17 años (n=2081, 1055 mujeres) residentes en la Comunidad de Madrid. Los participantes pertenecían a centros de enseñanza secundaria seleccionados aleatoriamente según la distribución geográfica de los adolescentes en la región. Resultados: Los inmigrantes adolescentes presentaron una mayor probabilidad de no cumplir las recomendaciones nutricionales para el consume de carne, pescado, legumbres, pan/cereales y leche/derivados, de consumir una cantidad insuficiente de pescado y más dulces y bebidas azucaradas que sus compañeros españoles. Los adolescentes españoles mostraron una mayor probabilidad de no cumplir con la recomendación establecida para verduras. El tiempo de residencia afectó débilmente los hábitos de dieta, asociando aspectos tanto positivos como negativos. Conclusiones: La probabilidad de no cumplir las recomendaciones nutricionales fue mayor entre los adolescentes inmigrantes con excepción del consumo de frutas y verduras (AU)

Adherence to dietary recommendations among Spanish and immigrant adolescents living in Spain; the AFINOS study.

OBJECTIVES: This study compares the adherence of immigrant and Spanish adolescents residing in the Madrid region (Spain) to national dietary recommendations. The factors compared were the consumption of items from the eight basic food groups (vegetables, fruits, bread/cereals, meat, eggs, fish, legumes and milk/dairy products), including the excessive or deficient consumption of eggs, meat and fish. In addition, the evaluation of excessive sweet foods or soft drinks in the diet was also considered. Subsequently, the influence of length of residence on dietary habits was examined. MATERIALS AND METHODS: Self-reported data were collected in a cross-sectional survey conducted over the period November 2007 to February 2008. The study participants were a representative sample of adolescents aged 13 to 17 years (n=2081, 1055 girls) living in the Madrid region. Participants were recruited from secondary schools (grades 7th to 10th) randomly selected according to the geographic distribution of adolescents in the region. RESULTS: Immigrant adolescents showed a greater likelihood of not fulfilling recommendations for the consumption of meat, fish, eggs, legumes, bread/cereals, and milk/dairy products. Their diets were also more likely to lack sufficient fish and they also consumed more eggs and more sweet foods and soft drinks than their native counterparts. Spanish adolescents were more likely not to meet recommendations for the intake of vegetables. Length of residence weakly affected dietary habits, with both negative and positive effects observed. CONCLUSION: The likelihood of not fulfilling dietary recommendations was higher among the immigrant adolescents with the exception of the intake of fruits and vegetables.

Objetivos: Este estudio compara la adherencia a las recomendaciones nutricionales de adolescentes inmigrantes y españoles residentes en la Comunidad de Madrid, España. Se comparó el consumo de ocho grupos principales de alimentos (verduras, frutas, pan/cereales, carne, huevos, pescado, legumbres, leche/derivados lácteos) incluyendo el consumo excesivo y deficiente de huevos, carne y pescado. También fue valorado el consumo excesivo de dulces y bebidas azucaradas. Posteriormente se analizó la influencia del tiempo de residencia en España sobre los mencionados hábitos de dieta. Material y método: Se llevó a cabo un estudio transversal en el que fueron recogidos datos auto-reportados durante el periodo comprendido entre Noviembre 2007 y Febrero 2008. Se obtuvo una muestra representativa de adolescentes con edades comprendidas entre 13 y 17 años (n=2081, 1055 mujeres) residentes en la Comunidad de Madrid. Los participantes pertenecían a centros de enseñanza secundaria seleccionados aleatoriamente según la distribución geográfica de los adolescentes en la región. Resultados: Los inmigrantes adolescentes presentaron una mayor probabilidad de no cumplir las recomendaciones nutricionales para el consume de carne, pescado, legumbres, pan/cereales y leche/derivados, de consumir una cantidad insuficiente de pescado y más dulces y bebidas azucaradas que sus compañeros españoles. Los adolescentes españoles mostraron una mayor probabilidad de no cumplir con la recomendación establecida para verduras. El tiempo de residencia afectó débilmente los hábitos de dieta, asociando aspectos tanto positivos como negativos. Conclusiones: La probabilidad de no cumplir las recomendaciones nutricionales fue mayor entre los adolescentes inmigrantes con excepción del consumo de frutas y verduras.

The association between birthplace in different regions of the world and cardiovascular mortality among residents of Spain.

The objective of this study is to estimate the association of birthplace with mortality from cardiovascular diseases in residents of Spain by analysing immigrant populations that are unlikely to have adopted health-related attitudes and behaviours of the host country. Data from the population register and cause of death register were used for the period 2001-2005. The study included people aged 20-64 years. Age-adjusted mortality from cardiovascular diseases--and from ischaemic heart disease, cerebrovascular disease and hypertension-related disease--according to birthplace were estimated and compared with those for the native Spanish population by mortality rate ratios. Compared with the native Spanish population, residents who came from Eastern Europe, Sub-Saharan Africa and South Asia had a higher risk of mortality from most of the cardiovascular diseases analysed. Women from North Africa and the Caribbean also had a higher risk of cardiovascular mortality. A higher risk of mortality from ischemic heart disease was observed in persons from the Middle East, and from cerebrovascular disease in those from Eastern Asia. Compared with the native Spanish population, residents from South America and Eastern Asia had a lower risk of mortality from ischemic heart disease. This pattern of mortality from cardiovascular diseases in residents of Spain who have come from different regions of the world is very similar to the findings of studies in other countries, and probably reflects the burden of disease in the countries of origin.

Plantago ovata consumption and colorectal mortality in Spain, 1995-2000.

BACKGROUND: Consumption of Plantago ovata may protect against colorectal cancer. To test this hypothesis, an ecological study was performed to determine mortality rates and distribution of colorectal cancer, and the consumption and distribution of P ovata, in different provinces in Spain. The putative association between P ovata consumption and mortality from colorectal cancer was then evaluated. METHODS: We conducted a comparative ecological study of Spanish provinces, with colorectal cancer mortality as the dependent variable and per capita consumption of P ovata by province and year as the independent variable. Associations were analyzed by calculating Spearman's correlation coefficients and a Poisson multiple regression model. RESULTS: Consumption of P ovata tended to be inversely correlated with mortality from colorectal cancer. In the Poisson regression analysis this tendency remained and reached statistical significance for the top quintile of P ovata consumption in the adjusted analysis (P = 0.042). CONCLUSIONS: Our results show an inverse trend between the consumption of P ovata and colorectal cancer mortality. We recommend additional observational studies of individuals, in order to better control confounding factors.

[Association of income with use of and access to health services in Spain at the beginning of the XXI century]. / Asociación de los ingresos económicos con la utilización y la accesibilidad de los servicios sanitarios en España al inicio del siglo XXI.

OBJECTIVE: To estimate the association of household income and provincial income with visits to general practitioners and specialists and with hospitalization and to determine whether waiting times to access these services vary with both economic variables. METHOD: Data from the 2001 National Health Survey were used. The association was estimated by sex- and age-adjusted odds ratios; in the case of per capita income, odds ratios were also adjusted for household income. Percentiles and the geometric mean of waiting times in each health service were estimated and the statistical significance of their association with both economic variables was evaluated. RESULTS: Subjects with the lowest household income showed the highest frequency of visits to general practitioners and hospitalization, although they waited longer for hospital admission. Subjects with the lowest household income also showed the lowest frequency of specialist visits: the odds ratio in the lowest income quartile with respect to the highest income quartile was 0.73 (95% CI: 0.62-0.87). However, when only visits to specialists working in the public system were analyzed, the lowest frequency of visits was observed in subjects with the highest household income. No differences were found in health services utilization or in waiting times according to provincial income. CONCLUSIONS: The frequency of specialist visits according to household income shows a different pattern from that observed for visits to general practitioners and hospitalizations. The longest waiting times for admission to hospital were observed in subjects with the lowest household income.

Decreasing socioeconomic inequalities and increasing health inequalities in Spain: a case study.

OBJECTIVES: We examined the evolution of income inequalities and health inequalities in Spain from the time of the country's entry into the European Union. METHODS: We estimated distributions of provincial income and household income, relations of provincial income with mortality and disability, and relations of household income with disability in 1984-1986 and 1999-2001. RESULTS: Inequalities in average provincial income and household income were lower in 2000 than in 1985. Differences in mortality and disability according to income were greater in 2000 than in 1985, in both absolute and relative terms, except for differences in mortality among individuals aged 25 to 44 years. In most cases, differences in mortality from leading causes of death and differences in major types of disabilities were also greater in 2000. CONCLUSIONS: Our results show that redistribution of income might achieve greater social justice but probably does not lead to reduced health inequalities, despite observed improvements in material circumstances as well as in most health indicators among disadvantaged population groups.

Long-term use of oral contraceptives increases the risk of miscarriage.

In this prospective, case-control study, a step-wise logistic regression model was used to examine the relationship between the consumption of oral contraceptives before pregnancy and the potential increase in the risk of miscarriage. Consumption of oral contraceptives for more than 2 years before pregnancy is associated with a higher risk of miscarriage.

Risk factors for low birth weight: a review.

Low birth weight (LBW) is one of the main predictors of infant mortality. The global incidence of LBW is around 17%, although estimates vary from 19% in the developing countries (countries where it is an important public health problem) to 5-7% in the developed countries. The incidence in Spain in the decade 1980-1989 was about 5.7%. LBW is generally associated with situations in which uterine malnutrition is produced due to alterations in placental circulation. There are many known risk factors, the most important of which are socio-economic factors, medical risks before or during gestation and maternal lifestyles. However, although interventions exist to prevent many of these factors before and during pregnancy, the incidence of LBW has not decreased.