Autoimmune Thyroiditis and Vitamin D.

Hashimoto's thyroiditis (HT) is marked by self-tissue destruction as a consequence of an alteration in the adaptive immune response that entails the evasion of immune regulation. Vitamin D carries out an immunomodulatory role that appears to promote immune tolerance. The aim of this study is to elaborate a narrative review of the relationship between vitamin D status and HT and the role of vitamin D supplementation in reducing HT risk by modulating the immune system. There is extensive literature confirming that vitamin D levels are significantly lower in HT patients compared to healthy people. On the other hand, after the supplementation with cholecalciferol in patients with HT and vitamin D deficiency, thyroid autoantibody titers decreased significantly. Further knowledge of the beneficial effects of vitamin D in the prevention and treatment of autoimmune thyroid diseases requires the execution of additional randomized, double-blind, placebo-controlled trials and longer follow-up periods.

Dental caries in children and vitamin D deficiency: a narrative review.

Dental caries represents one of the most prevalent health problems in childhood. Numerous studies have assessed that vitamin D deficiency is highly related to dental caries in primary and permanent teeth in children. The aim of this study is to elaborate a narrative review about proposed mechanisms by which vitamin D deficiency interacts with dental caries process in children. Vitamin D deficiency during pregnancy may cause intrauterine enamel defects, and through childhood is accompanied by insufficient activity of antibacterial peptides, decreased saliva secretion, and a low level of calcium in saliva.  Conclusion: In conclusion, vitamin D deficiency would increase the risk of caries in the primary and/or permanent dentition. Relationship between vitamin D deficiency and dental caries is evident enough for vitamin D deficiency to be considered as a risk factor for dental caries in children. Optimal levels of vitamin D throughout pregnancy and childhood may be considered an additional preventive measure for dental caries in the primary and permanent dentition.

Vitamin D deficiency in adolescents with obesity-Altered metabolism or environmental factors? / Deficiencia de vitamina D en adolescentes con obesidad: ¿alteración metabólica o factores ambientales?

Introduction: obesity childhood is related to vitamin D deficiency. The aim of this study was to compare vitamin D status between adolescentswith obesity living in an urban area and in a rural area. We hypothesized that environmental factors would be decisive in reducing the bodycontent of vitamin D in patients with obesity.Methods: a cross-sectional clinical and analytical study (calcium, phosphorus, calcidiol and parathyroid hormone) was carried out in a group of259 adolescents with obesity (BMI-SDS > 2.0), 249 adolescents with severe obesity (BMI-SDS > 3.0) and 251 healthy adolescents. The placeof residence was categorized as urban or rural. Vitamin D status was defined according to the US Endocrine Society criteria.Results: vitamin D deficiency was significantly higher (p < 0.001) in severe obesity (55 %) and obesity groups (37.1 %) than in the control group(14 %). Vitamin D deficiency was more frequent in severe obesity (67.2 %) and obesity groups (51.2 %) living in urban areas than in those livingin rural areas (41.5 % and 23.9 %, respectively). The patients with obesity living in urban residence did not present significant seasonal variationsin vitamin D deficiency in contrast to those patients with obesity living in rural residence.Conclusions: the most probable mechanism for vitamin D deficiency in adolescents with obesity, rather than altered metabolic is the environmentalfactors (sedentary lifestyle and lack of adequate sunlight exposure). (AU)

Introducción: la obesidad está relacionada con la deficiencia de vitamina D. El objetivo del presente estudio fue comparar el estado de vitaminaD entre adolescentes con obesidad con residencia urbana y rural. Se hipotetiza que los factores ambientales serían determinantes en la reduccióndel contenido corporal de vitamina D en pacientes con obesidad.Métodos: estudio transversal clínico y analítico (calcio, fósforo, calcidiol y PTH) en un grupo de 259 adolescentes con obesidad (IMC-SDS >2,0), 249 adolescentes con obesidad severa (IMC-SDS > 3,0) y 251 adolescentes sanos. El estado de vitamina D se definió de acuerdo con loscriterios de la Sociedad Americana de Endocrinología.Resultados: la deficiencia de vitamina D fue superior (p < 0,05) en los grupos de obesidad severa (55 %) y obesidad (37,1 %) respecto al grupode control (14 %). La prevalencia de deficiencia de vitamina D fue superior (p < 0,05) en los grupos de obesidad severa (67,2 %) y obesidad(51,2 %) con residencia urbana respecto a los que vivían en áreas rurales (41,5 % y 23,9 %, respectivamente). Los pacientes con obesidad yobesidad severa con residencia urbana no presentaban variaciones estacionales en la deficiencia de vitamina D en contraste con los pacientescon residencia rural.Conclusiones: el mecanismo más probable para la deficiencia de vitamina D en adolescentes con obesidad, más que alteraciones metabólicas,serían los factores ambientales (sedentarismo y falta de exposición solar adecuada). (AU)

Pregnancy, Breastfeeding, and Vitamin D.

Exclusive breastfeeding is considered the ideal food in the first six months of life; however, paradoxically, vitamin D content in human breast milk is clearly low and insufficient to obtain the recommended intake of 400 IU daily. This article summarizes the extraordinary metabolism of vitamin D during pregnancy and its content in human breast milk. The prevalence of hypovitaminosis D in pregnant women and/or nursing mothers and its potential maternal-fetal consequences are analyzed. The current guidelines for vitamin D supplementation in pregnant women, nursing mothers, and infants to prevent hypovitaminosis D in breastfed infants are detailed. Low vitamin D content in human breast milk is probably related to active changes in human lifestyle habits (reduced sunlight exposure).

Vitamin D deficiency in adolescents with obesity - Altered metabolism or environmental factors?

Introduction: Introduction: obesity childhood is related to vitamin D deficiency. The aim of this study was to compare vitamin D status between adolescents with obesity living in an urban area and in a rural area. We hypothesized that environmental factors would be decisive in reducing the body content of vitamin D in patients with obesity. Methods: a cross-sectional clinical and analytical study (calcium, phosphorus, calcidiol and parathyroid hormone) was carried out in a group of 259 adolescents with obesity (BMI-SDS > 2.0), 249 adolescents with severe obesity (BMI-SDS > 3.0) and 251 healthy adolescents. The place of residence was categorized as urban or rural. Vitamin D status was defined according to the US Endocrine Society criteria. Results: vitamin D deficiency was significantly higher (p < 0.001) in severe obesity (55 %) and obesity groups (37.1 %) than in the control group (14 %). Vitamin D deficiency was more frequent in severe obesity (67.2 %) and obesity groups (51.2 %) living in urban areas than in those living in rural areas (41.5 % and 23.9 %, respectively). The patients with obesity living in urban residence did not present significant seasonal variations in vitamin D deficiency in contrast to those patients with obesity living in rural residence. Conclusions: the most probable mechanism for vitamin D deficiency in adolescents with obesity, rather than altered metabolic is the environmental factors (sedentary lifestyle and lack of adequate sunlight exposure).

Introducción: Introducción: la obesidad está relacionada con la deficiencia de vitamina D. El objetivo del presente estudio fue comparar el estado de vitamina D entre adolescentes con obesidad con residencia urbana y rural. Se hipotetiza que los factores ambientales serían determinantes en la reducción del contenido corporal de vitamina D en pacientes con obesidad. Métodos: estudio transversal clínico y analítico (calcio, fósforo, calcidiol y PTH) en un grupo de 259 adolescentes con obesidad (IMC-SDS > 2,0), 249 adolescentes con obesidad severa (IMC-SDS > 3,0) y 251 adolescentes sanos. El estado de vitamina D se definió de acuerdo con los criterios de la Sociedad Americana de Endocrinología. Resultados: la deficiencia de vitamina D fue superior (p < 0,05) en los grupos de obesidad severa (55 %) y obesidad (37,1 %) respecto al grupo de control (14 %). La prevalencia de deficiencia de vitamina D fue superior (p < 0,05) en los grupos de obesidad severa (67,2 %) y obesidad (51,2 %) con residencia urbana respecto a los que vivían en áreas rurales (41,5 % y 23,9 %, respectivamente). Los pacientes con obesidad y obesidad severa con residencia urbana no presentaban variaciones estacionales en la deficiencia de vitamina D en contraste con los pacientes con residencia rural. Conclusiones: el mecanismo más probable para la deficiencia de vitamina D en adolescentes con obesidad, más que alteraciones metabólicas, serían los factores ambientales (sedentarismo y falta de exposición solar adecuada).

Vitamin D and Parathyroid Hormone during Growth Hormone Treatment.

Background. There is some controversy concerning a potential interaction between vitamin D and PTH and the GH/IGF-1 axis. The goal of this study is to assess vitamin D and PTH status in children with GH deficiency at diagnostic and during treatment with rhGH. Methods. Longitudinal and descriptive study in 110 patients, aged 3.3−9.1 years, with GH deficiency (GHD group) treated with rhGH. At diagnosis and after 12, 24, 36, and 48 months of treatment, a clinical (height, weight, and bone age) and laboratory (phosphorus, calcium, calcidiol, PTH, IGF-1) evaluation was performed. Concurrently, 377 healthy children, aged 3.8−9.7 years, were enrolled and constituted a control group. Vitamin D status was stated in accordance to the U.S. Endocrine Society criteria. Results. No significant differences were found in the prevalence of vitamin D deficiency among control (11.43%) and GHD (13.6%) groups at the moment of diagnosis, remaining without significant changes at 12 (12.9%), 24 (14.6%), 36 (13.1%), and 48 months (13.3%) of treatment. There were not any significant differences in serum levels of calcium, phosphorus, and calcidiol, but a steady increase (p < 0.001) in PTH was detected. Conclusions. Prepubertal patients with GH deficient do not appear to have a higher risk of vitamin D deficiency than healthy subjects, and with treatment with rhGH, no changes in the organic content of vitamin D were observed although a significant increase in PTH levels was detected.

Changes in body composition and cardiometabolic risk factors in relation to the reduction in body mass index in adolescents with obesity.

Introduction: Introduction: there are controversial data in relation to the reduction in body mass index standard deviation score (BMI-SDS) needed to improve adiposity in the pediatric population with obesity. The aim of this work was to determine the minimum variation in BMI-SDS required to improve the values of adiposity markers and cardiometabolic risk factors in growing adolescents with obesity. Methods: a longitudinal study consisting of clinical evaluation (waist circumference, waist-to-height ratio, fat mass index, and blood pressure) and blood testing (insulin resistance and lipid profile) was conducted in 350 adolescents with obesity (152 boys and 198 girls) aged 10.2-14.3 years who went through a combined intervention (12 months). Results: a decrease in SDS-BMI ≤ 0.5 was not associated with any significant improvement in the clinical features and blood testing recorded. A decrease in BMI-SDS > 0.5, and especially if > 1.0, was linked to a significant improvement in adiposity markers. A decrease in BMI-SDS > 0.5 was associated with a significant improvement in insulin resistance, and a decrease in BMI-SDS > 1.0 was associated with a significant decrease in the percentage of patients who showed high values of systolic blood pressure, HOMA-IR, and lipid profile Conclusions: improvement in body composition, insulin resistance, and lipid profile can be observed with reductions in BMI-SDS ≥ 0.5 in obese adolescents, while extended benefits are obtained by losing at least 1.0 BMI-SDS.

Introducción: Introducción: los datos en relación con la reducción del índice de masa corporal (IMC-SDS) necesario para mejorar la adiposidad en la población pediátrica con obesidad son controvertidos. El objetivo de este trabajo es determinar la variación mínima del IMC-SDS necesaria para mejorar los valores de los marcadores de adiposidad y los factores de riesgo cardiometabólico en adolescentes obesos. Métodos: estudio longitudinal clínico (perímetro de cintura, índice cintura-estatura e índice de masa grasa y presión arterial) y analítico (HOMA-R y perfil lipídico) realizado en 350 adolescentes con obesidad (152 niños y 198 niñas) de entre 10,2 y 14,3 años de edad que completaron una intervención combinada (12 meses). Resultados: una disminución en el índice de masa corporal (SDS-BMI) ≤ 0,5 no se asoció con ninguna mejora significativa de las características clínicas y analíticas registradas. Una disminución del IMC-SDS > 0,5, y especialmente si > 1,0, se relacionó con una mejora significativa de los marcadores clínicos de adiposidad. Una disminución del IMC-SDS > 0,5 se asoció con una mejora significativa de la resistencia a la insulina y una disminución del BMI-SDS > 1,0 se asoció con una disminución significativa del porcentaje de pacientes que mostraban valores altos de presión arterial sistólica, HOMA-IR y perfil lipídico Conclusiones: con una reducción del IMC-SDS ≥ 0,5 se observa una mejoría tanto en la composición corporal como en los factores de riesgo cardiovascular en los adolescentes obesos; no obstante, estos beneficios son mayores si la reducción del IMC-SDS es superior a 1.0.

Clinical data and basal gonadotropins in the diagnosis of central precocious puberty in girls.

OBJECTIVE: The objective of this study was to analyze whether some auxological characteristics or a single basal gonadotropin measurement will be sufficient to distinguish the prepubertal from pubertal status. METHODS: Auxologycal characteristics were recorded and serum LH and FSH were measured by immunochemiluminescence assays before and after GnRH stimulation test in a sample of 241 Caucasian girls with breast budding between 6- and 8-years old. Peak LH levels higher than 5 IU/L were considered a pubertal response. Area under the curve, cut-off points, sensitivity, and specificity for auxologycal variables and basal gonadotropins levels were determined by receiver operating curves. RESULTS: There were no significant differences in age at onset, weight, height, BMI and height velocity between both groups. Bone age was significantly higher in pubertal girls (P < 0.05), although with limited discriminatory capacity. The sensitivity and specificity for the basal LH levels were 89 and 82%, respectively, for a cut off point of 0.1 IU/L. All girls in the pubertal group had a basal LH higher than 1.0 IU/L (positive predictive value of 100%). There was a wide overlap of basal FSH and LH/FSH ratio between prepubertal and pubertal girls. CONCLUSIONS: Auxologycal characteristics should not be used only in the differential diagnosis between prepubertal from pubertal status in 6- to 8-year-old girls. We found a high specificity of a single basal LH sample and it would be useful for establishing the diagnosis of puberty in this age group, reducing the need for GnRH stimulation testing.

Are there any seasonal variations in 25-hydroxyvitamin D and parathyroid hormone serum levels in children and adolescents with severe obesity?

The objective of this study was to analyze the prevalence of hypovitaminosis D in children with severe obesity. We hypothesized that severe obesity could modify the seasonal variations in 25(OH)D and PTH serum levels throughout the year. A cross-sectional clinical and blood testing (calcium, phosphorus, 25(OH)D, and PTH) was carried out in 282 patients with severe obesity, aged 7.2-15.2 years. A control group was recruited (348 healthy children, aged 7.1-14.9 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. Vitamin D deficiency and hyperparathyroidism were more frequent (p < 0.05) in the obesity group (44.5 vs. 11.5% and 22.4 vs. 3.9%, respectively). There were seasonal variations in 25(OH)D levels in the obesity group, but they were lower (p < 0.05) with respect to the control group. In contrast, PTH levels were higher (p < 0.05) in the obesity group with respect to the control group, but there were no significant seasonal variations in PTH levels.Conclusion: Suboptimal vitamin D status and high levels of PTH are a common feature in pediatric population with severe obesity. In these patients, the seasonal variations in 25(OH)D were not modified, and PTH levels remained increased throughout the year, but without any seasonal variations. What is Known: • Obesity has been associated with lower 25(OH)D and higher PTH levels. • Relation among vitamin D and PTH through a natural year in children with obesity is partially known. What is New: • Seasonal variations in 25(OH)D are maintained in children with severe obesity, but PTH levels remained increased throughout the year, without seasonal variations. • -PTH levels in obesity are independent of vitamin D status and do not appear to represent secondary hyperparathyroidism.

Crecimiento recuperador y factores asociados en niños de muy bajo peso al nacer / Catch-up growth and associated factors in very low birth weight infants

INTRODUCCIÓN: Las características del crecimiento recuperador en niños con muy bajo peso (MBP) al nacer no se han establecido con claridad. El objetivo del estudio fue analizar el crecimiento recuperador de talla y factores asociados en una cohorte de niños con MBP al nacer (< 1.500 g) desde el nacimiento hasta los 14 años de edad. MÉTODOS: Se recogieron datos retrospectivos de peso y talla a uno, 2, 3, 4, 6, 8, 10, 12 y 14 años de edad en una cohorte de 170 recién nacidos con MBP. Se compararon estos datos antropométricos con los registrados en un grupo de control. RESULTADOS: Treinta y siete niños (21,8%) nacieron con extremado bajo peso y 32 (18,8%) fueron pretérmino extremo. A los 10 años de edad, el 7% de los niños con MBP (1.000-1.500 g) y el 35% de los niños con extremado bajo peso (< 1.500 g) tenían talla baja (p = 0,001). Casi todos los niños con MBP que tenían una talla normal a los 2, 4 y 10 años de edad habían alcanzado un peso adecuado en evaluaciones previas. El extremado bajo peso al nacer y el nacimiento pretérmino extremo resultaron ser predictores independientes de un crecimiento recuperador de talla inadecuado. CONCLUSIÓN: El patrón de crecimiento de niños con MBP al nacer tiene unas características específicas. El crecimiento recuperador de peso parece ser un factor importante para el crecimiento recuperador de talla, por lo que se recomienda un seguimiento nutricional cuidadoso en estos niños

INTRODUCTION: The characteristics of catch-up growth in very low birth weight infants (VLBW) have not been clearly established. The aim of this study was to analyse the height catch-up and some associated factors in a cohort of VLBW (birth weight < 1,500 g) from birth to age 14 years. METHODS: We obtained retrospective data on weight and height at birth and ages one, 2, 3, 4, 6, 8, 10, 12 and 14 years in a cohort of 170 VLBW. We compared these anthropometric values with those documented in a control group. RESULTS: Thirty-seven children (21.8%) were born with an extremely low birth weight and 32 (18.8%) extremely preterm. At 10 years of age, 7% of VLBW (1,000-1,500 g) and 35% of extremely low birth weight (< 1,500 g) children had short stature (P = .001). Almost all VLBW children who had a normal height at ages 2, 4 and 10 years had exhibited adequate weight catch-up in previous evaluations. We found that extremely low birth weight and extremely preterm were independent predictors for inadequate height catch-up. CONCLUSION: The growth pattern of VLBW children has specific characteristics. The catch-up in weight seems to be an important factor for catch-up in height, and therefore a thorough nutritional follow-up is recommended in these children

Reference values of fat mass index and fat-free mass index in healthy Spanish adolescents / Valores de referencia del índice de masa grasa y el índice de masa libre de grasa en adolescentes españoles sanos

INTRODUCTION: body mass index (BMI) does not allow to discriminate the composition of the different body compartments. The aim of this study was to develop reference values for the fat mass index (FMI) and fat-free mass index (FFMI) in healthy adolescents using anthropometric techniques in order to provide reference standards for daily clinical practice. METHODS: a cross-sectional study in 1,040 healthy Caucasian adolescents (470 boys and 570 girls) aged 10.1 to 14.9 years. Weight, height, and skinfold thickness were recorded, and BMI, percentage of total body fat, FMI and FFMI, and FMI and FFMI percentiles were calculated. RESULTS: FFMI and FMI percentiles for healthy adolescents (both sexes) categorized by age are displayed. In boys a significant increase in FFMI is observed, and both the percentage of total body fat and FMI significantly decreased. In contrast, in girls the percentage of body fat mass, FMI, and FFMI significantly increased. Except at 10 years of age, FMI was higher (p < 0.05) in girls at all ages. FFMI was higher (p < 0.05) in boys at all ages. CONCLUSIONS: reference values of FMI and FFMI would be a very useful instrument in clinical practice for the diagnosis and, especially, the analysis of body composition changes during the treatment of childhood obesity

INTRODUCCIÓN: el índice de masa corporal (IMC) no permite discriminar la composición proporcional de los distintos compartimentos corporales. El objetivo de este estudio fue elaborar tablas del índice de masa grasa (IMG) y de masa libre de grasa (IMLG) a partir de la medida de los pliegues cutáneos, para que sirvan como patrones de referencia de los adolescentes sanos de ambos sexos. MATERIAL Y MÉTODOS: estudio transversal de 1040 adolescentes caucásicos sanos (470 varones y 570 mujeres) de entre 10,1 y 14,9 años de edad. Se registraron el peso, la talla y el grosor del pliegue cutáneo, y se calcularon el IMC, el porcentaje de grasa total, el IMG, el IMLG y los percentiles del IMG e IMLG. RESULTADOS: se exponen los valores medios del IMG y el IMLG con su distribución percentilada en ambos sexos. En los varones aparece un incremento (p < 0,05) del IMLG con la edad, mientras que el porcentaje de grasa total y el IMG desminuyen (p < 0,05). En cambio, en las mujeres, el porcentaje de grasa total, el IMG y el IMLG se incrementan (p < 0,05) con la edad. Salvo a la edad de 10 años, el IMG fue superior (p < 0,05) en las mujeres de todas las edades, mientras que el IMLG fue superior (p < 0,05) en los varones de todas las edades. CONCLUSIÓN: los valores de referencia del IMG y el IMLG podrían ser un instrumento útil en la práctica clínica para el diagnóstico y, especialmente, el análisis de los cambios de la composición corporal durante el tratamiento de la obesidad infantil

Reference values of fat mass index and fat-free mass index in healthy Spanish adolescents.

INTRODUCTION: Introduction: body mass index (BMI) does not allow to discriminate the composition of the different body compartments. The aim of this study was to develop reference values for the fat mass index (FMI) and fat-free mass index (FFMI) in healthy adolescents using anthropometric techniques in order to provide reference standards for daily clinical practice. Methods: a cross-sectional study in 1,040 healthy Caucasian adolescents (470 boys and 570 girls) aged 10.1 to 14.9 years. Weight, height, and skinfold thickness were recorded, and BMI, percentage of total body fat, FMI and FFMI, and FMI and FFMI percentiles were calculated. Results: FFMI and FMI percentiles for healthy adolescents (both sexes) categorized by age are displayed. In boys a significant increase in FFMI is observed, and both the percentage of total body fat and FMI significantly decreased. In contrast, in girls the percentage of body fat mass, FMI, and FFMI significantly increased. Except at 10 years of age, FMI was higher (p < 0.05) in girls at all ages. FFMI was higher (p < 0.05) in boys at all ages. Conclusions: reference values of FMI and FFMI would be a very useful instrument in clinical practice for the diagnosis and, especially, the analysis of body composition changes during the treatment of childhood obesity.

INTRODUCCIÓN: Introducción: el índice de masa corporal (IMC) no permite discriminar la composición proporcional de los distintos compartimentos corporales. El objetivo de este estudio fue elaborar tablas del índice de masa grasa (IMG) y de masa libre de grasa (IMLG) a partir de la medida de los pliegues cutáneos, para que sirvan como patrones de referencia de los adolescentes sanos de ambos sexos. Material y métodos: estudio transversal de 1040 adolescentes caucásicos sanos (470 varones y 570 mujeres) de entre 10,1 y 14,9 años de edad. Se registraron el peso, la talla y el grosor del pliegue cutáneo, y se calcularon el IMC, el porcentaje de grasa total, el IMG, el IMLG y los percentiles del IMG e IMLG. Resultados: se exponen los valores medios del IMG y el IMLG con su distribución percentilada en ambos sexos. En los varones aparece un incremento (p < 0,05) del IMLG con la edad, mientras que el porcentaje de grasa total y el IMG desminuyen (p < 0,05). En cambio, en las mujeres, el porcentaje de grasa total, el IMG y el IMLG se incrementan (p < 0,05) con la edad. Salvo a la edad de 10 años, el IMG fue superior (p < 0,05) en las mujeres de todas las edades, mientras que el IMLG fue superior (p < 0,05) en los varones de todas las edades. Conclusión: los valores de referencia del IMG y el IMLG podrían ser un instrumento útil en la práctica clínica para el diagnóstico y, especialmente, el análisis de los cambios de la composición corporal durante el tratamiento de la obesidad infantil.

Effects of the application of a prolonged combined intervention on body composition in adolescents with obesity.

BACKGROUND: The aim of this study is to describe the effects of a prolonged dietary-behavioral-physical activity intervention (24 months) on body composition in a group of adolescents with obesity. METHODS: Longitudinal study in 196 individuals with obesity (86 boys and 110 girls) aged 10.1-14.9 years that completed a prolonged combined intervention (24 months). Values for weight, height, skinfold thickness, waist circumference, BMI, body fat, fat mass index (FMI) and fat-free mass index (FFMI) were registered or calculated. A good response to treatment was reported when a BMI z-score reduction of greater than or equal to 0.5 units of the initial value occurred after 24 month of follow up. RESULTS: A good response after 24 months of follow-up reached 58.2% (n = 114). In boys with obesity and BMI status improvement, weight z-score, BMI z-score, body fat, and FMI significantly decreased (p < 0.05). In girls with obesity and BMI status improvement, weight z-score, BMI z-score, waist circumference, waist z-score, body fat and FMI significantly decreased (p < 0.05). In both sexes the height and FFMI increased significantly (p < 0.05). The multiple logistic regression analysis showed that girls and younger age were associated with BMI status improvement; concurrently, the place of residence (urban or rural) and degree of obesity were not associated with BMI status improvement. CONCLUSION: The application of long-term combined strategies in the treatment of childhood obesity seems to be effective. As BMI decreases, a reduction in fat mass is also detected, with evident sexual dimorphism, in the absence of changes in fat-free mass and, consequently, in longitudinal growing.

Hypovitaminosis D and Cardiometabolic Risk Factors in Adolescents with Severe Obesity.

BACKGROUND/OBJECTIVES: Obesity is associated with cardiometabolic risk factors and with Vitamin D deficiency. The aim of this study was to examine the relationship between 25(OH)D concentrations and cardiometabolic risk factors in adolescents with severe obesity. SUBJECTS/METHODS: A cross-sectional clinical assessment (body mass index, fat mass index, fat-free mass index, waist-to-height ratio, and blood pressure) and metabolic study (triglycerides, total cholesterol, HDL-C, LDL-C, glucose, insulin, HOMA-IR, leptin, calcium, phosphorous, calcidiol, and PTH) were carried out in 236 adolescents diagnosed with severe obesity (BMI z-score > 3.0, 99th percentile), aged 10.2-15.8 years. The criteria of the US Endocrine Society were used for the definition of Vitamin D status. RESULTS: Subjects with Vitamin D deficiency had significantly elevated values (p < 0.05) for BMI z-score, waist circumference, waist z-score, body fat percentage, fat mass index, systolic and diastolic blood pressure, total cholesterol, triglycerides, LDL-C, insulin, HOMA-IR, leptin, and PTH than subjects with normal Vitamin D status. There was a significant negative correlation (p < 0.05) of serum 25(OH)D levels with body fat percentage, FMI, systolic BP, total cholesterol, triglyceride, LDL-C, glucose, insulin, HOMA-IR, leptin, and PTH. CONCLUSIONS: Low Vitamin D levels in adolescents with severe obesity were significantly associated with some cardiometabolic risk factors, including body mass index, waist circumference, fat mass index, high blood pressure, impaired lipid profile, and insulin resistance.

[Catch-up growth and associated factors in very low birth weight infants]. / Crecimiento recuperador y factores asociados en niños de muy bajo peso al nacer.

INTRODUCTION: The characteristics of catch-up growth in very low birth weight infants (VLBW) have not been clearly established. The aim of this study was to analyse the height catch-up and some associated factors in a cohort of VLBW (birth weight<1,500g) from birth to age 14 years. METHODS: We obtained retrospective data on weight and height at birth and ages one, 2, 3, 4, 6, 8, 10, 12 and 14 years in a cohort of 170 VLBW. We compared these anthropometric values with those documented in a control group. RESULTS: Thirty-seven children (21.8%) were born with an extremely low birth weight and 32 (18.8%) extremely preterm. At 10 years of age, 7% of VLBW (1,000-1,500g) and 35% of extremely low birth weight (<1,500g) children had short stature (P=.001). Almost all VLBW children who had a normal height at ages 2, 4 and 10 years had exhibited adequate weight catch-up in previous evaluations. We found that extremely low birth weight and extremely preterm were independent predictors for inadequate height catch-up. CONCLUSION: The growth pattern of VLBW children has specific characteristics. The catch-up in weight seems to be an important factor for catch-up in height, and therefore a thorough nutritional follow-up is recommended in these children.

Assessment of vitamin D status and parathyroid hormone during a combined intervention for the treatment of childhood obesity.

BACKGROUND: Obesity is associated with vitamin D deficiency. The aim of this work is to analyze the changes in vitamin D status and PTH levels in a group of children with obesity receiving combined intervention program in order to get BMI status reduction. METHODS: Longitudinal study in 119 children with obesity, aged 9.1-13.9 years, included in a 1-year combined dietary-behavioral-physical activity intervention. Anthropometric measurements (weight, height, BMI and fat mass index) were registered every 3 months and blood testing (calcium, phosphorous, 25(OH)D and PTH) were collected at the beginning and after 12 months of follow-up. A control group was recruited (300 healthy children, aged 8.1-13.9 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. RESULTS: Vitamin D deficiency was significantly higher in obesity group (31.1 vs. 14%). There was negative correlation between 25(OH)D and fat mass index (r = -0.361, p = 0.001). Patients with BMI reduction throughout combined intervention were 52 (43.7%). There was a significant increase in the prevalence of hypovitaminosis D in patients without BMI reduction at the end of follow-up, but in those patients with BMI reduction there was no changes of vitamin D status. CONCLUSIONS: Obesity increases the prevalence of suboptimal vitamin D status, and a BMI status reduction in children with obesity may be required to at least stabilize vitamin D status.

¿Es válido el aforismo: "El niño adelgaza manteniendo el peso porque está creciendo"? / No disponible

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Assessment of body composition changes during a combined intervention for the treatment of childhood obesity.

OBJECTIVE: One of the main objectives in the treatment of childhood obesity is to reduce the percentage of body fat mass without negatively affecting fat-free mass (FFM) and, consequently, longitudinal growth. The aim of this study was to analyze the changes that take place in body compartments in a group of patients with obesity under combined treatment. METHODS: This was a longitudinal study with 109 children with obesity 9.1 to 13.9 y of age included in a combined dietary-behavioral-physical activity intervention. Weight, height, skinfold thickness, and waist circumference were registered, and body mass index (BMI), fat mass index (FMI), FFM and waist-to-height ratio (WHR) were calculated over a period of 12 mo. The BMI z-score allowed us to establish two groups: obesity (n = 50) and severe obesity (n = 59). A nutritional improvement was considered when a decrease of BMI z-score of the initial value occurred after 12 mo of follow-up. RESULTS: The improvement in nutritional status reached 61.5% (n = 67). In the obesity group with nutritional improvement (n = 32), FMI significantly decreased (P < 0.005) and there were no significant differences in weight, height z-score, FFM, and WHR throughout the combined intervention. In the severe obesity group with nutritional improvement (n = 35), there were no significant differences in weight, height z-score, FMI, FFM, and WHR throughout combined intervention. CONCLUSIONS: Maintaining a constant weight in the mid- to long term to improve nutritional status would be adequate in children with infantile-juvenile obesity. However, maintaining a steady weight would not be sufficient for those patients diagnosed with severe obesity.

Prevalencia de hipovitaminosis D y factores asociados en la edad infantojuvenil / Prevalence of hypovitaminosis D and associated factors in Spanish population of school children and adolescents

OBJETIVO: Analizar la prevalencia de hipovitaminosis D y factores asociados en escolares y adolescentes residentes en una región del norte peninsular. DISEÑO: Estudio descriptivo transversal (muestreo de conveniencia). Emplazamiento: Atención primaria. PARTICIPANTES: Fueron incluidos 602 sujetos sanos de raza caucásica con edades comprendidas entre 3,1 y 15,4 años. Mediciones principales: Se ha calculado la prevalencia de hipovitaminosis D (variable dependiente) según los criterios de la US Endocrine Society: deficiencia (calcidiol < 20 ng/ml), insuficiencia (calcidiol: 20-29 ng/ml) y suficiencia (calcidiol ≥ 30 ng/ml). Se han registrado como variables independientes: sexo, edad, índice de masa corporal, lugar de residencia y estación del año, analizándose su asociación con la hipovitaminosis D mediante regresión logística múltiple. RESULTADOS: La prevalencia de hipovitaminosis D era del 60,4% (insuficiencia: 44,6%; deficiencia: 15,8%). Las variables asociadas con la hipovitaminosis D eran el sexo femenino (OR: 1,6; IC 95%: 1,1-2,3), la edad puberal (OR: 1,8; IC 95%: 1,2-2,6), las estaciones de otoño (OR: 9,5; IC 95%: 4,8-18,7), invierno (OR: 8,8; IC 95%: 4,5-17,5) y primavera (OR: 13,2; IC 95%: 6,4-27,5), el entorno urbano (OR:1,6; IC 95%: 1,1-2,2) y la obesidad severa (OR: 4,4; IC 95%: 1,9-10,3). CONCLUSIONES: En la población infantojuvenil existe una alta prevalencia de hipovitaminosis D, y los factores asociados son el sexo femenino, la edad puberal, el otoño, el invierno y la primavera, la obesidad severa y el entorno urbano. Habría que considerar la necesidad de administrar suplementos vitamínicos o ingerir mayores cantidades de sus fuentes dietéticas naturales y/o alimentos enriquecidos durante los meses de otoño, invierno y primavera

OBJECTIVE: To analyse the prevalence of hypovitaminosisD and associated factors in school children and adolescents living in a region of northern Spain. DESIGN: Cross-sectional study (convenience sampling). SETTING: Primary Health Care. PARTICIPANTS: A total of 602 Caucasian individuals (aged 3.1 to 15.4 years) were included in the study. MAIN MEASUREMENTS: Prevalence of hypovitaminosisD were calculated (dependent variable). HypovitaminosisD is defined according to the US Endocrine Society criteria: deficiency (calcidiol < 20 ng/mL), insufficiency (calcidiol: 20-29 ng/mL), and sufficiency (calcidiol ≥ 30 ng/mL). Gender, age, body mass index, residence, and season of the year were recorded (independent variables), and their association with hypovitaminosis D was analysed by multiple regression. RESULTS: The prevalence of hypovitaminosis D was 60.4% (insufficiency: 44.6%; deficiency: 15.8%). Multivariate analysis showed that factors associated to hypovitaminosis D were being female (OR: 1.6; 95% CI: 1.1-2.3), pubertal age (OR: 1.8; 95% CI: 1.2-2.6), autumn (OR: 9.5; 95% CI: 4.8-18.7), winter (OR: 8.8; 95% CI: 4.5-17.5) and spring time (OR: 13.2; 95% CI: 6.4-27.5), living in urban areas (OR:1.6; CI 95%: 1.1-2.2), and severe obesity (OR: 4.4; 95% CI: 1.9-10.3). CONCLUSIONS: There is a high prevalence of hypovitaminosisD in juvenile populations. being female, pubertal age, autumn, winter and spring seasons, severe obesity, and living in urban areas are factors associated to hypovitaminosisD. Consideration should be given to the administration of vitamin supplements and/or the increase in the ingestion of natural vitamin D dietary sources