Factores promotores de lactancia materna. Estudio LATMAGAL / Breastfeeding promoting factors: LATMAGAL study

Introducción: la Organización Mundial de la Salud (OMS) recomienda la lactancia materna exclusiva hasta los 6 meses (LME6) de vida por sus beneficios. Las últimas publicaciones evidencian que no se está alcanzando este objetivo. El fin principal del estudio ha sido determinar la prevalencia de lactancia materna (LM) en la población gallega y los factores favorecedores y limitantes de la misma. Material y métodos: estudio descriptivo observacional y transversal a través de encuestas anónimas a madres de bebés de 12 a 18 meses (n = 280) en las consultas de Pediatría de Atención Primaria. Resultados: la prevalencia de inicio de LM es de 85,3%, LME6 de 47,2% y solamente 38,9% hasta el año de vida. Destaca un índice superior de inicio de LM en el ámbito rural (87,1% vs. 83,5%), aunque su duración es mayor en el ámbito urbano (LME6 53,1% vs. 35,5%). Se estableció como principal factor favorecedor de LM la recomendación por profesionales sanitarios de iniciarla en el puerperio y los consejos previos al alta hospitalaria (p <0,01). La supervisión de las primeras tomas aumenta hasta 3 veces más la probabilidad de inicio de LM. Como factores limitantes destacan la producción insuficiente de leche (p = 0,01), problemas de salud maternos (p = 0,01) y el fin de la baja maternal (p = 0,04). Conclusión: nuestros datos de prevalencia de inicio y de LME6 son superiores a los aportados en otros estudios españoles. Intensificar la promoción de la LM tanto a nivel hospitalario como de Atención Primaria y la supervisión de las primeras tomas son estrategias importantes para alcanzar cifras similares a recomendaciones internacionales (AU)

Introduction: the WHO recommends exclusive breastfeeding (EBF) up to 6 months of life due to its proven benefits. The latest published studies show that this objective is currently not being accomplished. The aim of this study was to determine the prevalence of breastfeeding (BF) in a Galician population, and the factors that promoted and limited breastfeeding.Methods: observational and cross-sectional descriptive study through anonymous surveys of mothers of babies aged from 12 to 18 months (n = 280) in primary care paediatrics clinics.Results: we found a prevalence of 85.3% for BF initiation, of 47.2% for EBF at 6 months and of only 38.9% for BF maintenance at 1 year. We found a higher frequency of BF initiation in rural settings (87.1% vs. 83.5%), although BF duration was greater in urban settings (EBF6 53.1% vs. 35.5%). We identified the recommendation by professionals to start BF during the puerperium and BF guidance before discharge from hospital as the main factors that promoted BF (p <0.01). Supervision of the first feedings increased the probability of initiation of BF by up to 3 times. The main BF limiting factors were insufficient milk production (p = 0.01), maternal health problems (p = 0.01) and the end of maternal leave (p = 0.04).Conclusion: we found a higher prevalence of BF initiation and EBF at 6 months compared to other Spanish studies. Increasing promotion of BF in both the hospital and primary care setting and supervision of the first feedings are important strategies to achieve figures that approximate the targets set in international breastfeeding recommendations. (AU)

Spanish National Registry of Paediatric Coeliac Disease: Changes in the Clinical Presentation in the 21st Century.

OBJECTIVES: Over the last several decades, there has been a tendency towards a predominance of less symptomatic forms of coeliac disease (CD) and an increase in the patient age at diagnosis. This study aimed to assess the clinical presentation and diagnostic process of paediatric CD in Spain. METHODS: A nationwide prospective, observational, multicentre registry of new paediatric CD cases was conducted from January 2011 to June 2017. The data regarding demographic variables, type of birth, breast-feeding history, family history of CD, symptoms, height and weight, associated conditions, serological markers, human leukocyte antigen (HLA) phenotype, and histopathological findings were collected. RESULTS: In total, 4838 cases (61% girls) from 73 centres were registered. The median age at diagnosis was 4 years. Gastrointestinal symptoms were detected in 71.4% of the patients, and diarrhoea was the most frequent symptom (45.9%). The most common clinical presentation was the classical form (65.1%) whereas 9.8% ofthe patients were asymptomatic. There was a trend towards an increase in the age at diagnosis, proportion of asymptomatic CD cases, and usage of anti-deamidated gliadin peptide antibodies and HLA typing for CD diagnosis. There was, however, a decreasing trend in the proportion of patients undergoing biopsies. Some of these significant trend changes may reflect the effects of the 2012 ESPGHAN diagnosis guidelines. CONCLUSIONS: Paediatric CD in Spain is evolving in the same direction as in the rest of Europe, although classical CD remains the most common presentation form, and the age at diagnosis remains relatively low.

[Nutritional Study in Spanish Pediatric Population (EsNuPI)]. / Estudio Nutricional en Población Infantil de España (EsNuPI).

INTRODUCTION: Introduction: promoting healthy lifestyles already from the pediatric age for prevention of diseases at a short, mid and long-term is compulsory worldwide. Objectives: to know eating patterns and dietary habits, physical activity and sedentary behaviours in urban Spanish children aged one to nine years old, no vegan, by evaluating the differences between standard milk consumers (RS) and milk formula (AMS). Methods: prospective, observational, cross-sectional study with 1,514 children. A food frequency questionnaire, a physical activity and sedentary behaviour questionnaire, and two 24-hour dietary recalls (one face-to-face and one by phone) were used. Results: the daily energy intake was significantly higher in the RS group (1,503 Kcal vs 1,404 Kcal). The contribution of protein and fat to the total caloric value of the diet is high, being for the first one significantly higher in RS (16.5 % vs 15.6 %). However, for carbohydrate is low and significantly higher in AMS (46.7 % vs 45.5 %). The contribution of the food groups to the energy intake present significant differences between the groups. Conclusions: Spanish children between 1-9 years old have an adequate, but slightly elevated energy intake than the recommendations. There is a high contribution of protein and fat, and low of carbohydrate to the total caloric value. AMS children have a higher adherence to dietary guidelines and nutritional recommendations and, therefore, a suggested higher diet quality.

INTRODUCCIÓN: Introducción: es necesaria la promoción de estilos de vida saludables desde la edad pediátrica para la prevención de enfermedades a corto, medio y largo plazo. Objetivos: conocer los patrones de alimentación y hábitos dietéticos, actividad física e inactividad en niños de uno a nueve años españoles urbanos, no veganos, así como sus diferencias entre los consumidores de leche estándar (RS) y de fórmulas adaptadas, enriquecidas o suplementadas (AMS). Métodos: estudio prospectivo, observacional, transversal en 1.514 niños. Se analizan mediante cuestionario la frecuencia de consumo de alimentos, la actividad física, la inactividad y la ingesta dietética mediante dos registros de 24 horas, el primero presencial y el segundo telefónico. Resultados: entre los resultados ya obtenidos, la ingesta energética diaria fue significativamente superior en el grupo RS (1.503 Kcal vs. 1.404 Kcal). El aporte de proteínas y grasas en relación al valor calórico total de la dieta es elevado, siendo en el caso de las primeras significativamente mayor en RS (16,5 % vs. 15,6 %). Sin embargo, el de hidratos de carbono es bajo y significativamente mayor en AMS (46,7 % vs. 45,5 %). La contribución de los grupos de alimentos al aporte energético presenta diferencias significativas entre los grupos. Conclusiones: los niños españoles de uno a nueve años tienen una ingesta energética adecuada, aunque ligeramente superior a las recomendaciones. Hay una alta contribución de las proteínas y las grasas y una baja contribución de los hidratos de carbono al valor calórico total. Los niños AMS tienen una mayor adherencia a las guías alimentarias y recomendaciones nutricionales y, por tanto, potencialmente una mejor calidad de la dieta.

Ejercicio físico como «medicina» en enfermedades crónicas durante la infancia y la adolescencia / Exercise as medicine in chronic diseases during childhood and adolescence

La actividad física (AF) y el ejercicio físico (EF) mejoran la calidad de vida global, previenen la aparición de enfermedades en niños y adolescentes sanos, y sirve para el tratamiento de enfermedades crónicas prevalentes en la infancia. Si la AF y el EF son medicina, el sedentarismo y la inactividad provocan enfermedad. Se revisa en este artículo la evidencia científica existente al respecto y se ponen al día las recomendaciones para los profesionales involucrados en la salud del niño, ya que es necesario un buen conocimiento de cómo prescribir EF y AF en pediatría en diferentes enfermedades. Las intervenciones para evitar la inactividad del niño y del adolescente deben estar sustentadas en el apropiado aumento del nivel de AF, mediante programas de integración y capacitación, que consigan una mejora conjunta de la condición física neuromuscular y del rendimiento físico, cognitivo y psicosocial. La Asociación Española de Pediatría, a través del Comité de Promoción de la Salud, propone estrategias que faciliten este objetivo para mejorar la salud de nuestros pacientes a través de la práctica de EF y el aumento de la AF

Physical activity (PA) and exercise improve the overall quality of life, as well as prevent the onset of diseases in healthy children and adolescents, and as an aid to treat prevalent chronic diseases in childhood. PA and exercise are like medicine, but sedentary lifestyle and inactivity cause disease. In this article, the existing scientific evidence in this field is reviewed and recommendations for professionals involved in child health are updated. A good knowledge of how to prescribe exercise and PA in paediatrics in different diseases is necessary. Interventions to avoid inactivity of children and adolescents must be supported by the appropriate increase in the level of PA, through integration and training programs, which achieve both an overall improvement of the neuromuscular physical condition and also physical, cognitive, and psychosocial performance. The Health Promotion Committee of Spanish Paediatric Association proposes strategies that help to obtain this objective, aiming to improve the health of our patients through the practice of exercise and the increase in PA

[Exercise as medicine in chronic diseases during childhood and adolescence]. / Ejercicio físico como «medicina¼ en enfermedades crónicas durante la infancia y la adolescencia.

Physical activity (PA) and exercise improve the overall quality of life, as well as prevent the onset of diseases in healthy children and adolescents, and as an aid to treat prevalent chronic diseases in childhood. PA and exercise are like medicine, but sedentary lifestyle and inactivity cause disease. In this article, the existing scientific evidence in this field is reviewed and recommendations for professionals involved in child health are updated. A good knowledge of how to prescribe exercise and PA in paediatrics in different diseases is necessary. Interventions to avoid inactivity of children and adolescents must be supported by the appropriate increase in the level of PA, through integration and training programs, which achieve both an overall improvement of the neuromuscular physical condition and also physical, cognitive, and psychosocial performance. The Health Promotion Committee of Spanish Paediatric Association proposes strategies that help to obtain this objective, aiming to improve the health of our patients through the practice of exercise and the increase in PA.

[Evaluation of food habits and physical activity in Galician students]. / Evaluación de los hábitos de alimentación y actividad física en escolares gallegos.

INTRODUCTION: Introduction: obesity causes millions of deaths each year. Its high prevalence in children and adolescents from southern European countries, including Spain, is associated with the new food preferences and decreased physical activity. Objective: to evaluate diet quality and physical activity in Galician schoolchildren in order to assess if modifying the current intervention strategies in lifestyles is required. Methods: in the present study, 662 students from the south of Galicia were studied (9-17 years). Body mass index (BMI) was calculated as adiposity indicator. The dietary pattern was evaluated through the Kidmed test and physical activity with PAQ-C. The sample was stratified by BMI according to Cole international standards. Data were analysed with the SPPS software. Results: fifty-six per cent of children are at high risk of overnutrition or need to improve their nutrition. The average adherence to the Mediterranean diet was low (7.64 ± 2.28), worsening with age and adiposity significantly. The average level of physical activity was moderate (3.02 ± 0.74) and it was lower in girls and adolescents; 58% showed a low-moderate level of physical activity. Quality diet was positively correlated with physical activity and negatively with BMI. Conclusions: Galician students showed a diet and physical activity risky pattern according to international/national recommendations. After several years of awareness campaigns and lifestyle interventions, improving their diet and increasing physical activity is still necessary.

INTRODUCCIÓN: Introducción: la obesidad causa millones de muertes anuales. Su elevada prevalencia en niños y adolescentes de países del sur de Europa, entre ellos España, se asocia con las nuevas preferencias alimentarias y la disminución de actividad física. Objetivos: evaluar la calidad de la dieta y la práctica de actividad física en escolares gallegos para valorar la necesidad de modificar las estrategias actuales de intervención en estilos de vida. Métodos: se estudiaron 662 niños de Galicia (9-17 años). Se calculó su índice de masa corporal (IMC) como indicador de adiposidad. El patrón alimentario se evaluó con el cuestionario Kidmed y la actividad física con el PAQ-C. Se estratificó la muestra en función del IMC de acuerdo con los estándares internacionales de Cole. Los datos se analizan con el paquete SPSS. Resultados: el 56% de los escolares están en riesgo elevado de malnutrición por exceso o necesitan mejorar su alimentación. La adherencia media al patrón alimentario mediterráneo fue baja (7,64 ± 2,28), empeorando significativamente con la edad y la adiposidad. El nivel de actividad física medio fue moderado (3,02 ± 0,74), significativamente menor en niñas y adolescentes. El 58% mostraron un nivel bajo-moderado de actividad física. La calidad de la dieta se correlacionó positivamente con la actividad física y negativamente con el IMC. Conclusiones: los escolares gallegos presentaron un patrón alimentario y de actividad física de riesgo en relación con las recomendaciones nacionales/internacionales. Tras varios años de campañas de concienciación e intervenciones sobre estilos de vida, continúa siendo necesario mejorar la dieta y aumentar la práctica física-deportiva.

Fructose malabsorption in asymptomatic children and in patients with functional chronic abdominal pain: a prospective comparative study.

The objective of this prospective cohort study was to compare fructose malabsorption in patients with functional chronic abdominal pain and in healthy children. The sample was divided into two groups: asymptomatic children and pain-predominant functional gastrointestinal disorders according to the Rome IV criteria. All children were tested for fructose malabsorption by a standardized breath hydrogen test. Hydrogen and methane were measured and the test was presumed positive when it exceeded 20 ppm above baseline. If positive, patients were given a low-fructose diet and the response was evaluated. One hundred five children were included (34 healthy children, 71 with functional chronic abdominal pain), with similar demographic characteristics in both groups (35.2% male, age 9.5 ± 2.8 years). Hydrogen levels in breath were tested through a hydrogen test for fructose demonstrating malabsorption in 58.8% of healthy children (95%CI 40.8%-76.8%) and in 40.8% of children with chronic abdominal pain (95%CI 28.7%-53.0%), removing those who had bacterial overgrowth. Twenty-one of 31 patients with symptoms and a positive test (72.4%) reported an improvement on a low-fructose diet.Conclusion: Fructose malabsorption is more common in asymptomatic children than in patients with chronic abdominal pain. Better standardized test conditions are necessary to improve accuracy of diagnosis before using this test in clinical practice. What is Known: • Although fructose malabsorption is believed to be related with chronic abdominal pain, high-quality evidence is lacking. • Concerns have raised regarding the use of breath hydrogen test for fructose malabsorption in children with chronic abdominal pain. What is New: • Fructose malabsorption is not more common in children with pain-predominant functional gastrointestinal disorders than in asymptomatic children. • Improvement in symptoms with low-fructose diet may indicate that, although patients with pain-predominant functional gastrointestinal disorders did not have a higher percentage of malabsorption, they had greater fructose intolerance.

[Atlantic diet. Nutrition and gastronomy in Galicia]. / Dieta atlántica. Nutrición y gastronomía en Galicia.

INTRODUCTION: The diet of Galicia is the result of a perfect combination between the quality and diversity of the products of their lands and seas and a simple and healthy elaboration. To the benefits of the Galician products already known by the Celts, the Romans or the Early Medieval pilgrims have been added the inheritances received from the American shore of this ocean that we share, constituting the bases of the Atlantic diet. Galician food is characterized by an abundance of seasonal foods from plants (fruits, vegetables, potatoes, bread and cereals, nuts, chestnuts, honey and legumes), high consumption of fish and shellfish, moderate milk, veal meat fed exclusively with breast milk and pastures, olive oil, use of sauces with low energy load and high-quality fat and homemade desserts composed mainly of flour, eggs and nuts. The Galician Atlantic diet is healthy, functional and bioactive, and without doubt along with a favorable genetic profile, and adequate lifestyles, physical activity and inactivity, favored by our urbanism, with a distribution of the population in small rural areas, has collaborated so that we have one of the longest living populations with a high quality of life. Currently, the data reflect alarming figures of overweight and obesity, especially in the infant-juvenile age, most likely in relation to, among others, the loss of adherence to our traditional diet. To continue as before, Galician children and adolescents could live less than their grandparents, but also with more associated comorbidities. It is necessary to establish strategies to promote recovery and adherence of our Atlantic diet in north-western Spain.

INTRODUCCIÓN: La dieta de Galicia es el resultado de una conjunción perfecta entre la calidad y la diversidad de los productos de sus tierras y mares y una elaboración sencilla y saludable. A las bondades de los productos gallegos, ya conocidas por los celtas, los romanos o los peregrinos altomedievales, se han sumado las herencias recibidas desde la orilla americana de este océano que compartimos hasta constituir las bases de la llamada dieta atlántica. La alimentación gallega se caracteriza por la abundancia de alimentos de temporada (plantas, frutas, vegetales, patatas, pan y cereales, nueces, castañas, miel y leguminosas), por el elevado consumo de pescados y mariscos y por el moderado consumo de lácteos; por la carne de terneras alimentadas exclusivamente con leche materna y pastos; por el aceite de oliva, por el uso de salsas con baja carga energética y de alta calidad de la grasa y por los postres caseros compuestos principalmente por harina, huevos y frutos secos. La dieta atlántica gallega es saludable, funcional y bioactiva, y, sin duda, junto a un perfil genético beneficioso y unos estilos de vida, una actividad física e inactividad adecuados, favorecidos por nuestro urbanismo ­con una población distribuida en pequeños núcleos rurales­, ha contribuido a que tengamos una de las poblaciones más longevas y con una alta calidad de vida. Actualmente, los datos reflejan cifras alarmantes de sobrepeso y obesidad, especialmente en la etapa infantil-juvenil, relacionadas, muy probablemente, entre otros aspectos, con la pérdida de adherencia a nuestra dieta tradicional. De seguir como hasta ahora, los niños y adolescentes gallegos podrían vivir menos que sus abuelos y, además, con más comorbilidades asociadas. Se hace necesario establecer estrategias de promoción para la recuperación y fidelización de nuestra dieta atlántica del noroeste de España.

Dieta atlántica. Nutrición y gastronomía en Galicia / Atlantic diet. Nutrition and gastronomy in Galicia

La dieta de Galicia es el resultado de una conjunción perfecta entre la calidad y la diversidad de los productos de sus tierras y mares y una elaboración sencilla y saludable. A las bondades de los productos gallegos, ya conocidas por los celtas, los romanos o los peregrinos altomedievales, se han sumado las herencias recibidas desde la orilla americana de este océano que compartimos hasta constituir las bases de la llamada dieta atlántica. La alimentación gallega se caracteriza por la abundancia de alimentos de temporada (plantas, frutas, vegetales, patatas, pan y cereales, nueces, castañas, miel y leguminosas), por el elevado consumo de pescados y mariscos y por el moderado consumo de lácteos; por la carne de terneras alimentadas exclusivamente con leche materna y pastos; por el aceite de oliva, por el uso de salsas con baja carga energética y de alta calidad de la grasa y por los postres caseros compuestos principalmente por harina, huevos y frutos secos. La dieta atlántica gallega es saludable, funcional y bioactiva, y, sin duda, junto a un perfil genético beneficioso y unos estilos de vida, una actividad física e inactividad adecuados, favorecidos por nuestro urbanismo -con una población distribuida en pequeños núcleos rurales-, ha contribuido a que tengamos una de las poblaciones más longevas y con una alta calidad de vida. Actualmente, los datos reflejan cifras alarmantes de sobrepeso y obesidad, especialmente en la etapa infantil-juvenil, relacionadas, muy probablemente, entre otros aspectos, con la pérdida de adherencia a nuestra dieta tradicional. De seguir como hasta ahora, los niños y adolescentes gallegos podrían vivir menos que sus abuelos y, además, con más comorbilidades asociadas. Se hace necesario establecer estrategias de promoción para la recuperación y fidelización de nuestra dieta atlántica del noroeste de España

The diet of Galicia is the result of a perfect combination between the quality and diversity of the products of their lands and seas and a simple and healthy elaboration. To the benefits of the Galician products already known by the Celts, the Romans or the Early Medieval pilgrims have been added the inheritances received from the American shore of this ocean that we share, constituting the bases of the Atlantic diet. Galician food is characterized by an abundance of seasonal foods from plants (fruits, vegetables, potatoes, bread and cereals, nuts, chestnuts, honey and legumes), high consumption of fish and shellfish, moderate milk, veal meat fed exclusively with breast milk and pastures, olive oil, use of sauces with low energy load and high-quality fat and homemade desserts composed mainly of flour, eggs and nuts. The Galician Atlantic diet is healthy, functional and bioactive, and without doubt along with a favorable genetic profile, and adequate lifestyles, physical activity and inactivity, favored by our urbanism, with a distribution of the population in small rural areas, has collaborated so that we have one of the longest living populations with a high quality of life. Currently, the data reflect alarming figures of overweight and obesity, especially in the infant-juvenile age, most likely in relation to, among others, the loss of adherence to our traditional diet. To continue as before, Galician children and adolescents could live less than their grandparents, but also with more associated comorbidities. It is necessary to establish strategies to promote recovery and adherence of our Atlantic diet in north-western Spain

[The first 1000 days: an opportunity to reduce the burden of noncommunicable diseases]. / Los primeros 1000 días: una oportunidad para reducir la carga de las enfermedades no transmisibles.

INTRODUCTION: Growth and development are determined by genetic and environmental factors since the very early embryonic life. Long-term health risks, as obesity and other non-communicable diseases (NCD), could be programmed since these early stages. Early life, characterized by plasticity, is the ideal time to intervene and to prevent the risk of suffering a NCD (window of opportunity). Optimal nutrition during the first 1,000 days, since conception to the end of the second year of life, has a determinant role for long-term health. Pregnancy, infancy and toddler periods have specific nutritional requirements. Intestinal microbiota enhances maturation and functioning of the immune system. The interactions between host and intestinal microbiota are potential factors influencing early programming of the intestinal function. Alterations in intestinal colonization are associated to a higher risk of allergic diseases in childhood. Scientific evidence supports the fact that the first 1,000 days are crucial to achieve a better long-term health and represents a strategic period to intervene under the perspective of prevention and public health.

INTRODUCCIÓN: El crecimiento y desarrollo de un individuo está determinado desde la etapa embrionaria por su genética y los factores ambientales con los que interactúa. Los riesgos para la salud infantil y adulta pueden programarse durante las etapas fetal-neonatal y esta programación metabólica precoz puede afectar al desarrollo posterior de enfermedades como la obesidad y otras enfermedades no transmisibles (ENT) asociadas. La vida temprana, por la gran plasticidad que la caracteriza, constituye el momento ideal para intervenir y prevenir el riesgo de ENT (ventana de oportunidad). Una nutrición óptima durante los primeros 1000 días, que comprende desde la concepción hasta los dos años, es clave para la salud a lo largo de la vida. El rápido crecimiento y desarrollo del organismo y sus funciones durante el embarazo, la lactancia y el niño de corta edad conlleva requisitos nutricionales específicos en cada una de estas etapas. La microbiota del tracto gastrointestinal desempeña una labor fundamental en la función y el desarrollo del sistema inmune. Las interacciones entre el hospedador y su microbiota intestinal se consideran factores potenciales en la programación temprana de las funciones intestinales, con una evidencia creciente de que las alteraciones de la colonización bacteriana en el neonato se asocian con un mayor riesgo de enfermedad, incluidas las enfermedades alérgicas. La evidencia científica acumulada muestra que los primeros 1000 días son cruciales para alcanzar el mejor desarrollo y salud a largo plazo, y constituyen un periodo estratégico en términos de prevención y salud pública.

Study on the nutritional status and feeding habits in school-children in Madrid City (Spain) during the economic crisis.

INTRODUCTION: the recent economic and financial crisis has affected most Western countries, especially families of low socioeconomic classes. We speculate that worsening of socioeconomic condition associated with the crisis would increase obesity, mainly in disadvantaged families. MATERIAL AND METHODS: cross-sectional study of the 290,111 children aged three to 12 years old attending public school during the term 2014-2015 in Madrid City, by means of a stratified weighted sample randomly chosen, taking into account age (grade), city district and schools. The questionnaire included weight and height (auto-reported), dietary report (weekly frequency of intake), as well as socioeconomic variables. RESULTS: 1,208 questionnaires were evaluated from 64 classes. Half of participants were boys; 42% were younger than five years old, 35% werebetween six and eight years old, and 23% older than eight. Undernutrition was present in 5.0%, and excess of weight (overweight + obesity) in 36.7%. Undernutrition was higher in children under the age of six (9.1%). No relationship was found between undernutrition and the characteristics of the families but was slightly higher in families where both parents were unemployed. Excess of weight was higher in children of non-Spaniard parents (44% vs 32%, p < 0.0001), as well as in those families with economic problems (41% vs 31%, p = 0.0005). Only for meat, grains and dairy, the weekly intake was close to the recommendations. CONCLUSIONS: children from lower income households were at a higher risk of being overweight compared with their peers. Participation in a school-based food aid program may reduce food insecurity for children and their families.

Study on the nutritional status and feeding habits in school-children in madrid city (Spain) during the economic crisis / Impacto de la crisis económica en el estado nutricional y en los hábitos alimentarios de escolares de Madrid (España)

Introduction: the recent economic and financial crisis has affected most Western countries, especially families of low socioeconomic classes. We speculate that worsening of socioeconomic condition associated with the crisis would increase obesity, mainly in disadvantaged families. Material and methods: cross-sectional study of the 290,111 children aged three to 12 years old attending public school during the term 2014-2015 in Madrid City, by means of a stratified weighted sample randomly chosen, taking into account age (grade), city district and schools. The questionnaire included weight and height (auto-reported), dietary report (weekly frequency of intake), as well as socioeconomic variables. Results: 1,208 questionnaires were evaluated from 64 classes. Half of participants were boys; 42% were younger than five years old, 35% were between six and eight years old, and 23% older than eight. Undernutrition was present in 5.0%, and excess of weight (overweight + obesity) in 36.7%. Undernutrition was higher in children under the age of six (9.1%). No relationship was found between undernutrition and the characteristics of the families but was slightly higher in families where both parents were unemployed. Excess of weight was higher in children of non-Spaniard parents (44% vs 32%, p < 0.0001), as well as in those families with economic problems (41% vs 31%, p = 0.0005). Only for meat, grains and dairy, the weekly intake was close to the recommendations. Conclusions: children from lower income households were at a higher risk of being overweight compared with their peers. Participation in a school-based food aid program may reduce food insecurity for children and their families

Introducción: la reciente crisis económica y financiera que ha afectado a los países occidentales ha sido especialmente más intensa en las familias con menos recursos económicos. Nos preguntamos si el empeoramiento de la situación económica se ha asociado a un aumento en la tasa de obesidad infantil. Material y métodos: estudio transversal de una muestra ponderada que representase a los 290.111 niños de tres a 12 años matriculados en las escuelas públicas de Madrid en el curso 2014-2015. Se utilizó un cuestionario que incluía peso y talla (autorreportados), ingesta dietética (frecuencia semanal de consumo) y variables socioeconómicas. Resultados: se evaluaron 1.208 cuestionarios de 64 clases, repartidos por igual entre niños y niñas. El 42% eran menores de cinco años, el 35% tenía entre seis y ocho años, y el 23% eran mayores de ocho años. Se presentó desnutrición en el 5,0% de la muestra, mientras que se halló exceso de peso (sobrepeso + obesidad) en el 36,7%. El bajo peso fue mayor en los niños < 6 años (9,1%), sin diferencias entre sexos. No se pudo encontrar ninguna correlación entre la desnutrición y las características de las familias, aunque fue ligeramente superior cuando ambos padres estaban en el paro. El exceso de peso fue mayor en hijos de padres no españoles (42% vs. 32%, p < 0,0001), así como en las familias con dificultades económicas (41% vs. 31%, p = 0,0005). La ingesta media semanal correcta solo se encontró en carne, cereales y lácteos. Conclusiones: los niños de familias con un nivel socioeconómico bajo tienen mayor riesgo de padecer un exceso de peso. La participación en comedores escolares podría disminuir la inseguridad alimentaria, especialmente en tiempos de dificultades económicas

Estudio colaborativo español: descripción de la práctica clínica habitual en obesidad infantil / Spanish collaborative study: Description of usual clinical practice in infant obesity

Introducción: La obesidad infantil es un problema de salud de alta prevalencia. Aunque existen guías clínicas para su manejo, la variabilidad en su abordaje clínico es un hecho. El objetivo de este estudio es describir la práctica clínica habitual en unidades de Endocrinología Pediátrica y evaluar su adecuación a la guía recomendada. Material y métodos: Se realizó un estudio observacional, transversal y descriptivo mediante encuesta a endocrinólogos infantiles de la Sociedad Española de Endocrinología Pediátrica. Las preguntas fueron formuladas en base a las recomendaciones de la «Guía de Práctica Clínica sobre la Prevención y el Tratamiento de la Obesidad Infantojuvenil» del Ministerio de Sanidad español. Resultados: Se obtuvieron 125 encuestas de todas la Comunidades Autónomas. Se observó variabilidad en el número de pacientes atendidos al mes y en la frecuencia de las visitas. El 70% de los encuestados no dispone de un nutricionista ni de psicólogo o psiquiatra al que derivar a los pacientes. En el tratamiento, las medidas dietéticas son las más empleadas; un 69% nunca ha prescrito fármacos para perder peso. De los que prescriben, el 52,6% no utilizan el consentimiento informado como paso previo a su empleo. Conclusiones: Pocos centros cumplen las recomendaciones de la Guía de Práctica Clínica sobre la Prevención y el Tratamiento de la Obesidad Infantil en un plan de calidad establecido. La práctica clínica difiere mucho entre los endocrinólogos pediátricos encuestados, sin existir protocolos unificados de actuación, y con escasa disponibilidad de recursos para el tratamiento integral que precisa esta enfermedad

Introduction: Childhood obesity is a high prevalence health problem. Although there are clinical guidelines for its management, there is variability in its clinical approach. The aim of this study is to describe the usual clinical practice in Paediatric Endocrinology Units in Spain and to evaluate if it resembles the recommended guidelines. Material and methods: An observational, cross-sectional and descriptive study was carried out by means of a questionnaire sent to paediatric endocrinologists of the Spanish Society of Paediatric Endocrinology. The questions were formulated based on the recommendations of "Clinical Practice Guidelines on the Prevention and Treatment of Childhood Obesity" issued by the Spanish Ministry of Health. Results: A total of 125 completed questionnaires were obtained from all Autonomous Communities. Variability was observed both in the number of patients attended and in the frequency of the visits. The majority (70%) of the paediatricians who responded did not have a dietitian, psychologist or psychiatrist, in their centre to share the treatment for obese children. As regards treatment, dietary advice is the most used, and 69% have never prescribed weight-loss drugs. Of those who have prescribed them, 52.6% did not use informed consent as a prior step to them being used. Conclusions: There are few centres that comply with the recommendations of the clinical practice guidelines on prevention and treatment of childhood obesity as an established quality plan. Clinical practice differs widely among the paediatric endocrinologists surveyed. There are no uniform protocols of action, and in general there is limited availability of resources for the multidisciplinary treatment required by this condition

[Spanish collaborative study: Description of usual clinical practice in infant obesity]. / Estudio colaborativo español: descripción de la práctica clínica habitual en obesidad infantil.

INTRODUCTION: Childhood obesity is a high prevalence health problem. Although there are clinical guidelines for its management, there is variability in its clinical approach. The aim of this study is to describe the usual clinical practice in Paediatric Endocrinology Units in Spain and to evaluate if it resembles the recommended guidelines. MATERIAL AND METHODS: An observational, cross-sectional and descriptive study was carried out by means of a questionnaire sent to paediatric endocrinologists of the Spanish Society of Paediatric Endocrinology. The questions were formulated based on the recommendations of "Clinical Practice Guidelines on the Prevention and Treatment of Childhood Obesity" issued by the Spanish Ministry of Health. RESULTS: A total of 125 completed questionnaires were obtained from all Autonomous Communities. Variability was observed both in the number of patients attended and in the frequency of the visits. The majority (70%) of the paediatricians who responded did not have a dietitian, psychologist or psychiatrist, in their centre to share the treatment for obese children. As regards treatment, dietary advice is the most used, and 69% have never prescribed weight-loss drugs. Of those who have prescribed them, 52.6% did not use informed consent as a prior step to them being used. CONCLUSIONS: There are few centres that comply with the recommendations of the clinical practice guidelines on prevention and treatment of childhood obesity as an established quality plan. Clinical practice differs widely among the paediatric endocrinologists surveyed. There are no uniform protocols of action, and in general there is limited availability of resources for the multidisciplinary treatment required by this condition.

[Excess weight in patients with cystic fibrosis: is it always beneficial?]

INTRODUCTION: The primary objective of this study was to find out the prevalence of overweight and obese status, as well as their association to pulmonary function, total cholesterol and vitamin D in patients with cystic fibrosis (CF). MATERIALS AND METHODS: This is a multicenter descriptive and cross-sectional study. Twelve Spanish hospitals participated. 451 patients with CF were included. Adults were classified according to body mass index (BMI) and children were classified according to BMI percentiles (WHO tables). Pearson's correlation, Anova, Student's t-test and multiple linear regression were conducted. RESULTS: Mean age was 12.3 (range 4-57) years old, 51% were male and 18% had pancreatic sufficiency. Participants were classified in five nutritional status categories: 12% were malnourished; 57%, at nutritional risk; 24%, normally nourished; 6%, overweight; and 1%, obese. Pulmonary function in overweight or obese patients (91 ± 19%) was better than in malnourished patients (77 ± 24%) (p = 0.017). However, no difference was observed between those at nutritional risk (86 ± 19%) or normally nourished (90 ± 22%) groups. Overweight and obese patients had higher levels of total cholesterol (p = 0.0049), a greater proportion of hypercholesterolemia (p = 0.001), as well as lower levels of 25 OH vitamin D (p = 0.058). CONCLUSIONS: Prevalence of overweight and obese was 6 and 1%. Excess weight status does not offer any benefit in pulmonary function in comparison to normally nourished patients.

Excess weight in patients with cystic fibrosis: is it always beneficial? / Incremento de peso en pacientes con fibrosisquística: ¿es siempre beneficioso?

Introduction: The primary objective of this study was to find out the prevalence of overweight and obese status, as well as their association to pulmonary function, total cholesterol and vitamin D in patients with cystic fibrosis (CF). Materials and methods: This is a multicenter descriptive and cross-sectional study. Twelve Spanish hospitals participated. 451 patients with CF were included. Adults were classified according to body mass index (BMI) and children were classified according to BMI percentiles (WHO tables). Pearson’s correlation, Anova, Student’s t-test and multiple linear regression were conducted. Results: Mean age was 12.3 (range 4-57) years old, 51% were male and 18% had pancreatic sufficiency. Participants were classified in five nutritional status categories: 12% were malnourished; 57%, at nutritional risk; 24%, normally nourished; 6%, overweight; and 1%, obese. Pulmonary function in overweight or obese patients (91 ± 19%) was better than in malnourished patients (77 ± 24%) (p = 0.017). However, no difference was observed between those at nutritional risk (86 ± 19%) or normally nourished (90 ± 22%) groups. Overweight and obese patients had higher levels of total cholesterol (p = 0.0049), a greater proportion of hypercholesterolemia (p = 0.001), as well as lower levels of 25 OH vitamin D (p = 0.058). Conclusions: Prevalence of overweight and obese was 6 and 1%. Excess weight status does not offer any benefit in pulmonary function in comparison to normally nourished patients (AU)

Introducción y objetivos: conocer la prevalencia de sobrepeso y obesidad, así como su asociación con la función pulmonar, el colesterol total y la vitamina D en pacientes con fibrosis quística (FQ). Material y métodos: estudio multicéntrico descriptivo y transversal. Participaron 12 hospitales españoles. Fueron incluidos 451 pacientes con FQ, clasificados según el índice de masa corporal (IMC) en adultos y el IMC percentilado (tablas OMS) en niños. Análisis estadístico: C.Pearson, Anova, t de Student y regresión lineal múltiple. Resultados: la mediana de edad fue 12,3 (rango 4-57) años. Un 51% eran varones y el 18%, suficientes pancreáticos (SP). El 12% estaba desnutrido; el 57%, en riesgo nutricional; el 24%, normonutrido; el 6% presentaba sobrepeso; y un 1%, obesidad. La función pulmonar en los pacientes con sobrepeso (91 ± 19%) era mejor que en los desnutridos (77 ± 24%) (p = 0,017), sin embargo, no se observaron diferencias con respecto a los que estaban en riesgo nutricional (86 ± 19%) o normonutridos (90 ± 22%). Los pacientes con sobrepeso tenían más elevado el colesterol total (p = 0,0049), mayor proporción de hipercolesterolemia (p = 0,001), así como niveles más bajos de 25 OH vitamina D (p = 0,058). Conclusiones: la prevalencia de sobrepeso y obesidad fue del 6 y el 1%. El sobrepeso y la obesidad no ofrecen beneficio sobre la función pulmonar en comparación con los normonutridos (AU)

[VITAMIN D AND CHRONIC LUNG COLONIZATION IN PEDIATRIC AND YOUNG ADULTS CYSTIC FIBROSIS PATIENTS]. / VITAMINA D Y COLONIZACIONES PULMONARES CRÓNICAS EN PACIENTES PEDIÁTRICOS Y ADULTOS JÓVENES CON FIBROSIS QUÍSTICA.

INTRODUCTION AND OBJECTIVES: evaluate vitamin D status and its association with chronic lung colonisation in Cystic Fibrosis patients. MATERIAL AND METHODS: descriptive cross-sectional multicenter study. From November 2012 to April 2014, at 12 national hospitals, 377 patients with Cystic Fibrosis were included. Vitamin D levels < 30 ng/ml were classified as insufficient. Chronic colonisation was considered if they had at least two positive cultures in the past year. RESULTS: the median age was 8.9 years (2 months to 20 years). 65% had insufficient levels of vitamin D. There was an inverse correlation between age and vitamin D levels (r = -0.20 p < 0.001). Those diagnosed by screening, were younger and had higher levels of vitamin D. There was an inverse correlation between the number of colonisations and vitamin D levels (r = -0.16 p = 0.0015). Adjusting for age, pancreatic status and diagnosis by screening, colonization by S. aureus in 6 years, increased the risk of insufficient levels of vitamin D: OR 3.17 (95% CI 1.32 to 7.61) (p = 0.010) and OR 3.77 (95% CI 1.37 to 10 , 37) (p = 0.010), respectively. CONCLUSIONS: despite adequate supplementation, more than half of our patients did not achieve optimal levels of vitamin D. Regardless of age, diagnosis by screening or pancreatic status, chronic colonization by Pseudomonas sp. in children and adolescents and S. Aureus in infants and preschoolars increases the risk of developing vitamin D deficiency in these patients.

Introducción y objetivos: conocer la situación en la que se encuentran los pacientes con fibrosis quística en relación con sus niveles de vitamina D y su asociación con las colonizaciones pulmonares crónicas. Material y métodos: estudio multicéntrico transversal. Participaron 12 hospitales nacionales. De noviembre a abril del 2012 al 2014 se incluyeron 377 pacientes con fibrosis quística. Se consideraron insuficientes niveles de vitamina D < 30 ng/ml. Presentar al menos dos cultivos positivos en el último año fue considerado un criterio de colonización crónica. Resultados: los pacientes tenían una mediana de edad de 8,9 años (2 meses­20 años). Un 65% presentaban niveles insuficientes de vitamina D. Se observó una correlación inversa entre edad y niveles de vitamina D (r = -0,20 p < 0,001). Los diagnosticados por cribado eran más jóvenes y tenían niveles de vitamina D más altos. Los niveles de vitamina D presentaron una correlación inversa con el número de colonizaciones pulmonares (r = -0,16 p = 0,0015). Ajustando por edad, función pancreática y diagnóstico mediante cribado, la colonización por S. Aureus en menores de seis años y por Pseudomonas sp. en los mayores de esa edad, incrementaban el riesgo de presentar niveles insuficientes de vitamina D: OR 3,17 (IC95% 1,32-7,61) (p=0,010) y OR 3,77 (IC95% 1,37- 10,37)(p = 0,010), respectivamente. Conclusiones: a pesar de una suplementación adecuada, más de la mitad de nuestros pacientes no alcanzan niveles óptimos de vitamina D. La colonización crónica por Pseudomonas sp. en escolares y adolescentes y por S. Aureus en lactantes y preescolares se asocia de forma independiente con la deficiencia de vitamina D.

Vitamina D y colonizaciones pulmonares crónicas en pacientes pediátricos y adultos jóvenes con fibrosis quística / Vitamin D and chronic lung colonization in pediatric and young adults cystic fibrosis patients

Introducción y objetivos: conocer la situación en la que se encuentran los pacientes con fibrosis quística en relación con sus niveles de vitamina D y su asociación con las colonizaciones pulmonares crónicas. Material y métodos: estudio multicéntrico transversal. Participaron 12 hospitales nacionales. De noviembre a abril del 2012 al 2014 se incluyeron 377 pacientes con fibrosis quística. Se consideraron insuficientes niveles de vitamina D < 30 ng/ml. Presentar al menos dos cultivos positivos en el último año fue considerado un criterio de colonización crónica. Resultados: los pacientes tenían una mediana de edad de 8,9 años (2 meses-20 años). Un 65% presentaban niveles insuficientes de vitamina D. Se observó una correlación inversa entre edad y niveles de vitamina D (r = -0,20 p < 0,001). Los diagnosticados por cribado eran más jóvenes y tenían niveles de vitamina D más altos. Los niveles de vitamina D presentaron una correlación inversa con el número de colonizaciones pulmonares (r = -0,16 p = 0,0015). Ajustando por edad, función pancreática y diagnóstico mediante cribado, la colonización por S. Aureus en menores de seis años y por Pseudomonas sp. en los mayores de esa edad, incrementaban el riesgo de presentar niveles insuficientes de vitamina D: OR 3,17 (IC95% 1,32-7,61) (p=0,010) y OR 3,77 (IC95% 1,37- 10,37)(p = 0,010), respectivamente. Conclusiones: a pesar de una suplementación adecuada, más de la mitad de nuestros pacientes no alcanzan niveles óptimos de vitamina D. La colonización crónica por Pseudomonas sp. en escolares y adolescentes y por S. Aureus en lactantes y preescolares se asocia de forma independiente con la deficiencia de vitamina D (AU)

Introduction and objectives: evaluate vitamin D status and its association with chronic lung colonisation in Cystic Fibrosis patients. Material and methods: descriptive cross-sectional multicenter study. From November 2012 to April 2014, at 12 national hospitals, 377 patients with Cystic Fibrosis were included. Vitamin D levels < 30 ng/ml were classified as insufficient. Chronic colonisation was considered if they had at least two positive cultures in the past year. Results: the median age was 8.9 years (2 months to 20 years). 65% had insufficient levels of vitamin D. There was an inverse correlation between age and vitamin D levels (r = -0.20 p < 0.001). Those diagnosed by screening, were younger and had higher levels of vitamin D. There was an inverse correlation between the number of colonisations and vitamin D levels (r = -0.16 p = 0.0015). Adjusting for age, pancreatic status and diagnosis by screening, colonization by S. aureus in <6 years and Pseudomonas sp. in > 6 years, increased the risk of insufficient levels of vitamin D: OR 3.17 (95% CI 1.32 to 7.61) (p = 0.010) and OR 3.77 (95% CI 1.37 to 10,37) (p = 0.010), respectively. Conclusions: despite adequate supplementation, more than half of our patients did not achieve optimal levels of vitamin D. Regardless of age, diagnosis by screening or pancreatic status, chronic colonization by Pseudomonas sp. in children and adolescents and S. Aureus in infants and preschoolars increases the risk of developing vitamin D deficiency in these patients (AU)

Hipertransaminasemia secundaria a macroaspartato aminotransferasa / Secondary hypertransaminasemia to macro-aspartate aminotransferase

No disponible