BODY COMPOSITION CHANGES DURING A MULTIDISCIPLINARY TREATMENT PROGRAMME IN OVERWEIGHT ADOLESCENTS: EVASYON STUDY.

INTRODUCTION: the main objectives of weight-loss interventions are to decrease fat mass while maintaining fatfree mass. OBJECTIVE: our aim was to address effectiveness body composition changes in overweight adolescents assessed by different body composition methods following an obesity intervention programme. MATERIAL AND METHODS: the life-style intervention was multi-disciplinary, with 13 months follow-up. Participants were 13-to-16 year-old overweight, or obese, Spanish adolescents. The adolescents (n = 156; 54.8% females) had body composition measured with anthropometry, dual-energy X-ray absorptiometry and air-displacement plethysmography. All measurements were made at baseline, and after 2- and 13-months. Repeated measures analysis of covariance to compare mean anthropometric changes over time and the Bonferroni correction were applied. Imputation of anthropometric measures was performed. RESULTS: a high significant decrease in fat mass index was achieved in males after 2-and 13-months of intervention as measured by anthropometry (1.16 and 1.56 kg / m2, respectively), X-ray absorptiometry (1.51 and 1.91 kg / m2) and plethysmography (2.13 and 2.44 kg/m2). Moreover, a short and long-term maintenance of fat-and fat-free mass index was observed by X-ray absorptiometry in females (0.94 and 0.68 kg/m2). CONCLUSION: our multidisciplinary approach to lifestyle intervention has a favourable impact on body fat mass and fat-free mass index as well as waist-to-height ratio, over 13 months intervention in overweight and obese adolescents.

Introducción: el principal objetivo de las intervenciones de pérdida de peso es disminuir la masa grasa manteniendo la masa libre de grasa. Objetivo: evaluar la efectividad de una intervención multidisciplinar en la composición corporal de adolescentes con sobrepeso, evaluados mediante diferentes métodos de composición corporal. Material y métodos: la intervención fue multidisciplinar sobre el estilo de vida, aplicada durante 13 meses. Los participantes eran adolescentes entre 13 y 16 años con sobrepeso y obesidad. Los adolescentes (n = 156; 54,8% mujeres) fueron evaluados mediante antropometría, absorciometría dual de rayos X y pletismografía por desplazamiento de aire. Todas las mediciones se realizaron al inicio, a los 2 y a los 13 meses. Se aplicaron análisis de la covarianza de medidas repetidas y la corrección de Bonferroni. Se realizó la imputación de las medidas antropométricas. Resultados: se logró una alta disminución significativa en el índice de masa grasa en los hombres después de 2 y 13 meses de intervención, según antropometría (1,16 y 1,56 kg/m2, respectivamente), absorciometría de rayos X (1,51 y 1,91 kg/m2) y pletismografía (2,13 y 2,44 kg/m2). Por otra parte, el mantenimiento a corto y largo plazo de la grasa y libre de grasa en el índice de masa fue observado por absorciometría de rayos X en las mujeres (0,94 y 0,68 kg/m2). Conclusión: la intervención multidisciplinar sobre estilo de vida tiene un impacto favorable en la masa grasa corporal y el índice de masa libre de grasa, así como en la relación cintura-altura, durante 13 meses de intervención en adolescentes con sobrepeso y obesidad.

Body composition changes during a multidisciplinary treatment programme in overweight adolescents: EVASYON Study / Cambios de composición corporal durante el tratamiento multidisciplinar en adolescentes obesos: estudio EVASYON

Introduction: the main objectives of weight-loss interventions are to decrease fat mass while maintaining fatfree mass. Objective: our aim was to address effectiveness body composition changes in overweight adolescents assessed by different body composition methods following an obesity intervention programme. Material and methods: the life-style intervention was multi-disciplinary, with 13 months follow-up. Participants were 13-to-16 year-old overweight, or obese, Spanish adolescents. The adolescents (n=156; 54.8% females) had body composition measured with anthropometry, dual-energy X-ray absorptiometry and air-displacement plethysmography. All measurements were made at baseline, and after 2- and 13-months. Repeated measures analysis of covariance to compare mean anthropometric changes over time and the Bonferroni correction were applied. Imputation of anthropometric measures was performed. Results: a high significant decrease in fat mass index was achieved in males after 2-and 13-months of intervention as measured by anthropometry (1.16 and 1.56 kg/m2, respectively), X-ray absorptiometry (1.51 and 1.91 kg/m2) and plethysmography (2.13 and 2.44 kg/m2). Moreover, a short and long-term maintenance of fat-and fat-free mass index was observed by X-ray absorptiometry in females (0.94 and 0.68 kg/m2). Conclusion: our multidisciplinary approach to lifestyle intervention has a favourable impact on body fat mass and fat-free mass index as well as waist-to-height ratio, over 13 months intervention in overweight and obese adolescents (AU)

Introducción: el principal objetivo de las intervenciones de pérdida de peso es disminuir la masa grasa manteniendo la masa libre de grasa. Objetivo: evaluar la efectividad de una intervención multidisciplinar en la composición corporal de adolescentes con sobrepeso, evaluados mediante diferentes métodos de composición corporal. Material y métodos: la intervención fue multidisciplinar sobre el estilo de vida, aplicada durante 13 meses. Los participantes eran adolescentes entre 13 y 16 años con sobrepeso y obesidad. Los adolescentes (n=156; 54,8% mujeres) fueron evaluados mediante antropometría, absorciometría dual de rayos X y pletismografía por desplazamiento de aire. Todas las mediciones se realizaron al inicio, a los 2 y a los 13 meses. Se aplicaron análisis de la covarianza de medidas repetidas y la corrección de Bonferroni. Se realizó la imputación de las medidas antropométricas. Resultados: se logró una alta disminución significativa en el índice de masa grasa en los hombres después de 2 y 13 meses de intervención, según antropometría (1,16 y 1,56 kg/m2, respectivamente), absorciometría de rayos X (1,51 y 1,91 kg/m2) y pletismografía (2,13 y 2,44 kg/m2). Por otra parte, el mantenimiento a corto y largo plazo de la grasa y libre de grasa en el índice de masa fue observado por absorciometría de rayos X en las mujeres (0,94 y 0,68 kg/m2). Conclusión: la intervención multidisciplinar sobre estilo de vida tiene un impacto favorable en la masa grasa corporal y el índice de masa libre de grasa, así como en la relación cintura-altura, durante 13 meses de intervención en adolescentes con sobrepeso y obesidad (AU)

Anthropometric indices to assess body-fat changes during a multidisciplinary obesity treatment in adolescents: EVASYON Study.

BACKGROUND & AIMS: The main objectives of weight loss interventions in children and adolescents are to decrease fat mass while maintaining fat-free mass. Several methods are available to assess childhood and adolescence obesity, such as weight and height, bioelectrical impedance, skin-fold thickness measurements and other laboratory methods. The aim was to assess simple anthropometric indices as predictors of body-fat changes, using dual-energy X-ray absorptiometry measurements as reference method. METHODS: Multi-intervention approach (diet, physical activity and psychological support in a family-group-based treatment) was implemented with a one-year follow-up in 13-to-16-year-old overweight or obese Spanish adolescents. A total of 83 adolescents were recruited from Granada and Zaragoza, males (n = 43) (31.6 kg/m(2)) and females (n = 40) (32.0 kg/m(2)). We measured body composition with anthropometry and dual-energy X-ray absorptiometry. All measurements were made at baseline, and after 2 and 13 months. Random coefficient regression model was used to calculate the proportion of body composition changes during follow-up that would be explained by simple body composition indices based on anthropometric measures. RESULTS: After controlling for age and Tanner stage, body mass index explained 76.5% of body composition changes in males and 90.1% in females, while fat mass index (assessed by skin-folds) explained 78.9% of body composition changes in males and 84.0% of body composition changes in females. CONCLUSIONS: In conclusion, we found that BMI was a good indicator of body fat composition changes in children and adolescents, although FMI assessed by anthropometry was also a good indicator.

Common variants in genes related to lipid and energy metabolism are associated with weight loss after an intervention in overweight/obese adolescents.

BACKGROUND: Some SNPs related to lipid and energy metabolism may be implicated not only in the development of obesity and associated comorbidities, but also in the weight loss response after a nutritional intervention. OBJECTIVE: In this context, the present study analyzed four SNPs located within four genes known to be associated with obesity and other obesity-related complications, and their putative role in a weight-loss intervention in overweight/obese adolescents. METHODS: The study population consisted of 199 overweight/obese adolescents (13-16 yr old) undergoing 10 weeks of a weight loss multidisciplinary intervention: the EVASYON programme (www.estudioevasyon.org). Adolescents were genotyped for 4 SNPs, and anthropometric measurements and biochemical markers were analyzed at the beginning and after the intervention. RESULTS: Interestingly, APOA5(rs662799) was associated with the baseline anthropometric and biochemical outcomes, whereas FTO (rs9939609) seemed to be related with the change of these values after the 10-week intervention. The other two SNPs, located in the CETP (rs1800777) and the APOA1 (rs670) genes, showed important relationships with adiposity markers. Specifically, a combined model including both SNPs turned up to explain up to 24% of BMI-SDS change after 10 weeks of the multidisciplinary intervention, which may contribute to under - stand the weight loss response. CONCLUSION: Common variants in genes related to lipid and energy metabolism may influence not only biochemical outcomes but also weight loss response after a multidisciplinary intervention carried out in obese/overweight adolescents..

ANTECEDENTES: Algunas variantes genéticas relacionadas con el metabolismo lipídico y energético pueden estar implicadas en la respuesta a una intervención nutricional además de estar asociadas con el desarrollo de obesidad y comorbilidades asociadas. OBJETIVO: En este sentido, este artículo analiza cuatro polimorfismos situados en cuatro genes que han sido previamente asociados con la obesidad u otras complicaciones asociadas a la misma, así como su posible papel en la respuesta a una intervención para la pérdida de peso en adolescentes con sobrepeso u obesidad. MÉTODOS: La población en estudio está formada por 199 adolescentes con sobrepeso u obesidad (13-16 años) llevando a cabo una intervención multidisciplinar de 10 semanas para la pérdida de peso: programa EVASYON (www.estudioevasyon.org). Los adolescentes fueron genotipados para los 4 SNPs y tanto al comienzo como al final de la intervención se analizaron marcadores bioquímicos y se tomaron medidas antropométricas. RESULTADOS: Rs662799 del gen APOA5 se asoció al inicio con parámetros antropométricos y bioquímicos, mientras que el rs9939609 del gen FTO parecía estar asociado con el cambio de estas variables tras 10 semanas de intervención. Las variantes rs1800777 del gen CETP y rs670 del gen APOA1 mostraron una importante asociación con marcadores de adiposidad. Concretamente, un modelo combinado incluyendo los dos polimorfismos logró explicar hasta un 24% del cambio en el IMC-SDS tras 10 semanas de intervención. CONCLUSIÓN: Variantes genéticas previamente relacionadas con el metabolismo lipídico y energético, pueden repercutir no solamente en valores bioquímicos sino también en la respuesta a una intervención multidisciplinar para la pérdida de peso en adolescentes con sobrepeso u obesidad.

Common variants in genes related to lipid and energy metabolism are associated with weight loss after an intervention in overweight/obese adolescents / Asociación entre variantes genéticas relacionadas con el metabolismo lipídico y energético y la pérdida de peso tras una intervención en adolescentes con sobrepeso u obesidad

Background: Some SNPs related to lipid and energy metabolism may be implicated not only in the development of obesity and associated comorbidities, but also in the weight loss response after a nutritional intervention. Objective: In this context, the present study analyzed four SNPs located within four genes known to be associated with obesity and other obesity-related complications, and their putative role in a weight-loss intervention in overweight/obese adolescents. Methods: The study population consisted of 199 overweight/obese adolescents (13-16 yr old) undergoing 10 weeks of a weight loss multidisciplinary intervention: the EVASYON programme (www.estudioevasyon.org). Adolescents were genotyped for 4 SNPs, and anthropometric measurements and biochemical markers were analyzed at the beginning and after the intervention. Results: Interestingly, APOA5(rs662799) was associated with the baseline anthropometric and biochemical outcomes, whereas FTO (rs9939609) seemed to be related with the change of these values after the 10-week intervention. The other two SNPs, located in the CETP (rs1800777) and the APOA1 (rs670) genes, showed important relationships with adiposity markers. Specifically, a combined model including both SNPs turned up to explain up to 24% of BMI-SDS change after 10 weeks of the multidisciplinary intervention, which may contribute to under - stand the weight loss response. Conclusion: Common variants in genes related to lipid and energy metabolism may influence not only biochemical outcomes but also weight loss response after a multidisciplinary intervention carried out in obese/overweight adolescents (AU)

Antecedentes: Algunas variantes genéticas relacionadas con el metabolismo lipídico y energético pueden estar implicadas en la respuesta a una intervención nutricional además de estar asociadas con el desarrollo de obesidad y comorbilidades asociadas. Objetivo: En este sentido, este artículo analiza cuatro polimorfismos situados en cuatro genes que han sido previamente asociados con la obesidad u otras complicaciones asociadas a la misma, así como su posible papel en la respuesta a una intervención para la pérdida de peso en adolescentes con sobrepeso u obesidad. Métodos: La población en estudio está formada por 199 adolescentes con sobrepeso u obesidad (13-16 años) llevando a cabo una intervención multidisciplinar de 10 semanas para la pérdida de peso: programa EVASYON (www.estudioevasyon.org). Los adolescentes fueron genotipados para los 4 SNPs y tanto al comienzo como al final de la intervención se analizaron marcadores bioquímicos y se tomaron medidas antropométricas. Resultados: Rs662799 del gen APOA5 se asoció al inicio con parámetros antropométricos y bioquímicos, mientras que el rs9939609 del gen FTO parecía estar asociado con el cambio de estas variables tras 10 semanas de intervención. Las variantes rs1800777 del gen CETP y rs670 del gen APOA1 mostraron una importante asociación con marcadores de adiposidad. Concretamente, un modelo combinado incluyendo los dos polimorfismos logró explicar hasta un 24% del cambio en el IMC-SDS tras 10 semanas de intervención. Conclusión: Variantes genéticas previamente relacionadas con el metabolismo lipídico y energético, pueden repercutir no solamente en valores bioquímicos sino también en la respuesta a una intervención multidisciplinar para la pérdida de peso en adolescentes con sobrepeso u obesidad (AU)

Interventions for treating obesity in children.

Childhood obesity remains an important public health concern and prevention programmes should be the priority in order to decrease the prevalence of obesity. The aim of this review is to summarize the most effective types of intervention for treating obesity in children and adolescents. A number of identified strategies used to treat childhood obesity range from lifestyle approaches, pharmacotherapy to surgical intervention. Dietary treatment of obese children and adolescents should aim to ensure adequate growth and development by reducing excessive fat mass accumulation, avoiding loss of lean body mass, improving well-being and self-esteem, and preventing cyclical weight regain. Management protocols involve behaviour modifications, family support, and lifestyle changes which are difficult to put into practice and may require multidisciplinary professional teams. The cornerstone of weight loss programmes is to achieve a negative energy balance. There is evidence that dietary interventions are more effective in achieving weight loss when combined with other strategies, such as increasing physical activity levels and/or psychological interventions to promote behavioural changes. Psychological interventions have been employed in an effort to achieve long-term maintenance of behavioural change. Childhood obesity treatments should involve a combination of lifestyle changes including strategies to reduce energy intake, increase physical activity, reduce sedentary activities, facilitate family involvement and change behaviours associated with eating and physical activity. However, drug therapy in obese children must not be used as isolated treatment but as complementary to the traditional treatments of diet, physical activity and lifestyle changes. Besides, surgical procedures have been used to treat severe morbid obesity in children and adolescents when more conservative treatments have proven to be inadequate.

Body composition changes during interventions to treat overweight and obesity in children and adolescents; a descriptive review.

Nutrition, physical activity and behavior-modifying techniques are widely applied components of interventions treating obesity. Our aim was to review available information on the short and long term effects of intervention treatment on body fat composition of overweight and obese children and adolescents and, to obtain a further understanding on how different body composition techniques detect longitudinal changes. In total, thirteen papers were included; seven included a multidisciplinary intervention component, five applied a combined dietary and physical activity intervention and one a physical activity intervention. Body composition techniques used included anthropometric indices, bioelectrical impedance analysis, and dual energy X-ray absorptiometry. Percentage of fat mass change was calculated in when possible. Findings suggested, no changes were observed in fat free mass after 16 weeks of nutritional intervention and the lowest decrease on fat mass percentage was obtained. However, the highest fat mass percentage with parallel increase in fat free mass, both assess by DXA was observed in a multi-component intervention applied for 20 weeks. In conclusion, more studies are needed to determine the best field body composition method to monitor changes during overweight treatment in children and adolescents.

Nutrición, actividad física y la modificación del comportamiento alimentarios son técnicas muy empleadas en el tratamiento de la obesidad. El objetivo de este trabajo es revisar la información disponible de los efectos a corto y largo plazo del tratamiento del sobrepeso y obesidad en niños y adolescentes en la grasa corporal, y obtener una mejor comprensión de las técnicas empleadas para detectar los cambios longitudinales. Se incluyeron un total de 13 estudios, siete incluyen un tratamiento multidisciplinar, cinco aplicaron un tratamiento combinado de nutrición y actividad física y sólo uno realizaba un tratamiento de actividad física. Las técnicas de composición corporal empleadas incluyeron índices antropométricos, impedancia eléctrica y absorciometría dual de rayos X. El cambio de porcentaje de grasa se calculó cuando fue posible. Los resultados sugieren el mayor cambio en porcentaje de grasa con un aumento paralelo de la masa libre de grasa, ambos determinados con absorciometría dual de rayos X en la intervención multidisciplinar durante 20 semanas. En conclusión, se necesitan más estudios que determinen el mejor método de composición corporal para controlar los cambios durante el tratamiento de del sobrepeso en niños y adolescentes.

Differential DNA methylation patterns between high and low responders to a weight loss intervention in overweight or obese adolescents: the EVASYON study.

In recent years, epigenetic markers emerged as a new tool to understand the influence of lifestyle factors on obesity phenotypes. Adolescence is considered an important epigenetic window over a human's lifetime. The objective of this work was to explore baseline changes in DNA methylation that could be associated with a better weight loss response after a multidisciplinary intervention program in Spanish obese or overweight adolescents. Overweight or obese adolescents (n=107) undergoing 10 wk of a multidisciplinary intervention for weight loss were assigned as high or low responders to the treatment. A methylation microarray was performed to search for baseline epigenetic differences between the 2 groups (12 subjects/group), and MALDI-TOF mass spectrometry was used to validate (n=107) relevant CpG sites and surrounding regions. After validation, 5 regions located in or near AQP9, DUSP22, HIPK3, TNNT1, and TNNI3 genes showed differential methylation levels between high and low responders to the multidisciplinary weight loss intervention. Moreover, a calculated methylation score was significantly associated with changes in weight, BMI-SDS, and body fat mass loss after the treatment. In summary, we have identified 5 DNA regions that are differentially methylated depending on weight loss response. These methylation changes may help to better understand the weight loss response in obese adolescents.

Body composition changes during interventions to treat overweight and obesity in children and adolescents: a descriptive review / Cambios en la composición corporal durante el tratamiento de la obesidad y sobrepeso en niños y adolescentes; revisión descriptiva

Nutrition, physical activity and behavior-modifying techniques are widely applied components of interventions treating obesity. Our aim was to review available information on the short and long term effects of intervention treatment on body fat composition of overweight and obese children and adolescents and, to obtain a further understanding on how different body composition techniques detect longitudinal changes. In total, thirteen papers were included; seven included a multidisciplinary intervention component, five applied a combined dietary and physical activity intervention and one a physical activity intervention. Body composition techniques used included anthropometric indices, bioelectrical impedance analysis, and dual energy X-ray absorptiometry. Percentage of fat mass change was calculated in when possible. Findings suggested, no changes were observed in fat free mass after 16 weeks of nutritional intervention and the lowest decrease on fat mass percentage was obtained. However, the highest fat mass percentage with parallel increase in fat free mass, both assess by DXA was observed in a multicomponent intervention applied for 20 weeks. In conclusion, more studies are needed to determine the best field body composition method to monitor changes during overweight treatment in children and adolescents (AU)

Nutrición, actividad física y la modificación del comportamiento alimentarios son técnicas muy empleadas en el tratamiento de la obesidad. El objetivo de este trabajo es revisar la información disponible de los efectos a corto y largo plazo del tratamiento del sobrepeso y obesidad en niños y adolescentes en la grasa corporal, y obtener una mejor comprensión de las técnicas empleadas para detectar los cambios longitudinales. Se incluyeron un total de 13 estudios, siete incluyen un tratamiento multidisciplinar, cinco aplicaron un tratamiento combinado de nutrición y actividad física y sólo uno realizaba un tratamiento de actividad física. Las técnicas de composición corporal empleadas incluyeron índices antropométricos, impedancia eléctrica y absorciometría dual de rayos X. El cambio de porcentaje de grasa se calculó cuando fue posible. Los resultados sugieren el mayor cambio en porcentaje de grasa con un aumento paralelo de la masa libre de grasa, ambos determinados con absorciometría dual de rayos X en la intervención multidisciplinar durante 20 semanas. En conclusión, se necesitan más estudios que determinen el mejor método de composición corporal para controlar los cambios durante el tratamiento de del sobrepeso en niños y adolescentes (AU)

Obesity susceptibility loci on body mass index and weight loss in Spanish adolescents after a lifestyle intervention.

OBJECTIVE: To estimate the contribution of 9 obesity-related polymorphisms and a genetic predisposition score (GPS) on anthropometric and biochemical variables before and after a weight loss intervention program in overweight/obese Spanish adolescents. STUDY DESIGN: Overweight/obese adolescents (n = 168; 12-16 years) participating in the EVASYON program were genotyped for 9 obesity-related single nucleotide polymorphisms in the FTO, MC4R, TMEM18, IL6, PPARG, and ADIPQ genes. RESULTS: At baseline, the GPS showed a significant association with body mass index-standard deviation score (BMI-SDS) and fat mass. After 3 months of intervention, this GPS also showed a relationship with the variation of both anthropometric measurements. After adjusting for baseline BMI-SDS, subjects with a lower GPS had a greater improvement on metabolic profile, as well as a better response to physical activity, compared with those subjects with a higher GPS. CONCLUSIONS: The GPS seems to have an important relationship with BMI-SDS and fat mass both at baseline and after a 3-month weight loss lifestyle intervention. Obese and overweight adolescents with a lower GPS have a greater benefit of weight loss after 3 months of a multidisciplinary lifestyle intervention.

Changes in cardiometabolic risk factors, appetite-controlling hormones and cytokines after a treatment program in overweight adolescents: preliminary findings from the EVASYON study.

OBJECTIVE: We investigated the effects of the EVASYON program on body fatness, cardiometabolic risk factors, gut appetite-controlling hormones and serum levels of cytokines in adolescents with overweight or obesity (OW/OB). METHODS: This study comprised 13 boys (10 obese) and 12 girls (8 obese), aged 13-16 years, from a Madrid Hospital. The EVASYON program was based on a calorie-restricted diet (10-40%), increased physical activity (at least 60 min/day 5 days a week), psychological therapy and nutritional education for 13 months. Anthropometric and blood pressure measurements were measured before and after intervention. Serum glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, leptin, total peptide YY and insulin levels were determined before and after intervention. Serum levels of cytokines IL-1ß, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, and TNF-α were also assessed before and after intervention. RESULTS: A decrease in body mass index (BMI), BMI z-score, skinfolds (triceps, biceps, subscapular, thigh, and calf), sum of six skinfolds and body circumferences (arm relaxed and flexed, waist, hip, and proximal thigh) values were observed after the intervention program (all p < 0.05). In addition, diastolic blood pressure also decreased (p < 0.05). A decrease in serum leptin levels (-48.4%, p < 0.001) was observed after intervention without changes in total peptide YY and insulin levels. Levels of IL-8, IL-10, and TNF-α also decreased (all p < 0.05) after the intervention program. CONCLUSIONS: These preliminary results evidence that the EVASYON program may improve body fat, leptin, and some pro-inflammatory cytokines in adolescents with OW/OB.

Subcutaneous fat distribution in small for gestational age newborns.

We assessed the anthropometric characteristics of symmetric (SGA-S) and asymmetric (SGA-A) term newborns and describe their subcutaneous fat differences. We assessed perinatal data, maternal characteristics and anthropometric variables (including skinfold thicknesses) in 139 small for gestational age (SGA) term infants, classified as symmetric and asymmetric according to their ponderal index (using the 10(th) percentile as the cut-off criterion). Despite an overall small body size and lower amounts of subcutaneous fat than the reference population, SGA-S term newborns showed a proportionate body fat distribution and SGA-A were thinner and had a lower percentage of central subcutaneous fat than SGA-S. These findings, resulting from intrauterine growth restriction, could be associated with different early and later postnatal outcomes among SGA groups.

Design and evaluation of a treatment programme for Spanish adolescents with overweight and obesity. The EVASYON Study.

BACKGROUND: The prevalence of overweight and obesity (OW/OB) among adolescents worldwide has increased since the 60 s. Spain has reached one of the highest OW/OB prevalence rates among adolescents from European countries. The aim of this methodological paper is to describe the design and evaluation in the EVASYON study (Development, implementation and evaluation of the efficacy of a therapeutic programme for adolescents with OW/OB: integral education on nutrition and physical activity). METHODS/DESIGN: The EVASYON was planned by a multidisciplinary team to treat OW/OB in Spanish adolescents. The EVASYON is a multi-centre study conducted in 5 hospitals in 5 Spanish cities (Granada, Madrid, Pamplona, Santander and Zaragoza) and two hundred and four OW/OB Spanish adolescents were recruited for this intervention. The treatment was implemented for approximately one-year follow-up. The adolescents were treated in groups of a maximum of 10 subjects; each group had 20 visits during the treatment period in two phases: intensive during the first 2 months (1st to 9th visits), and extensive during the last 11 months (10th to 20th visits). In order to assess the efficacy of the treatment, 8 dimensions were measured: diet; physical activity and fitness; eating behaviour; body composition; haematological profile; metabolic profile; minerals and vitamins; immuno-inflammatory markers. Moreover, genetic polymorphisms were also determined. DISCUSSION: The treatment programme developed in the EVASYON study was designed as a national pilot study to be implemented as an effective treatment for adolescents with OW/OB into the Spanish Health Care Service.

Interplay between weight loss and gut microbiota composition in overweight adolescents.

The aim of this study was to determine the influence of an obesity treatment program on the gut microbiota and body weight of overweight adolescents. Thirty-six adolescents (13-15 years), classified as overweight according to the International Obesity Task Force BMI criteria, were submitted to a calorie-restricted diet (10-40%) and increased physical activity (15-23 kcal/kg body weight/week) program over 10 weeks. Gut bacterial groups were analyzed by quantitative real-time PCR before and after the intervention. A group of subjects (n=23) experienced >4.0 kg weight loss and showed significant BMI (P=0.030) and BMI z-score (P=0.035) reductions after the intervention, while the other group (n=13) showed <2.0 kg weight loss. No significant differences in dietary intake were found between both groups. In the whole adolescent population, the intervention led to increased Bacteroides fragilis group (P=0.001) and Lactobacillus group (P=0.030) counts, and to decreased Clostridium coccoides group (P=0.028), Bifidobacterium longum (P=0.031), and Bifidobacterium adolescentis (P=0.044) counts. In the high weight-loss group, B. fragilis group and Lactobacillus group counts also increased (P=0.001 and P=0.007, respectively), whereas C. coccoides group and B. longum counts decreased (P=0.001 and P=0.044, respectively) after the intervention. Total bacteria, B. fragilis group and Clostridium leptum group, and Bifidobacterium catenulatum group counts were significantly higher (P<0.001-0.036) while levels of C. coccoides group, Lactobacillus group, Bifidobacterium, Bifidobacterium breve, and Bifidobacterium bifidum were significantly lower (P<0.001-0.008) in the high weight-loss group than in the low weight-loss group before and after the intervention. These findings indicate that calorie restriction and physical activity have an impact on gut microbiota composition related to body weight loss, which also seem to be influenced by the individual's microbiota.

Reference levels for 17-hydroxyprogesterone, 11-desoxycortisol, cortisol, testosterone, dehydroepiandrosterone sulfate and androstenedione in infants from birth to six months of age.

Reference plasma adrenal steroid levels during early infancy are frequently used to verify hormone measurements when any adrenal abnormality is suspected. We aim to obtain longitudinal reference plasma levels for 17-hydroxyprogesterone (17OHP), 11-desoxycortisol (11DOC), cortisol, dehydroepiandrosterone sulfate (DHEAS), testosterone, and androstenedione in healthy infants from birth to 6 months of age. In 138 term infants, 80 males and 58 females, plasma steroid levels were measured using specific RIA procedures at birth and on the 3rd, 15th, 30th, 60th, 90th, 120th, 150th, and 180th days of life. Smoothed percentiles for each variable were calculated according to the LMS method (LMS program version 1.16, Institute of Child Health, London). Except for cortisol, plasma levels of adrenal steroids decreased progressively from birth to 6 months of age. Plasma concentrations of 17OHP, 11DOC, and cortisol did not show gender differences, but testosterone and androstenedione were significantly higher in boys, and DHEAS levels were higher in girls. Longitudinal reference plasma levels for 17OHP, 11DOC, cortisol, DHEAS, testosterone, and androstenedione have been described in an adequate sample of healthy infants from birth to 6 months of age. These standards, displayed as smoothed percentiles, may be used as reference values in the management of congenital endocrine (adrenal or gonadal) abnormalities that appear in the first weeks of life.

Epidemiology and genetic risk of type 1 diabetes among children in Aragon community, Spain.

The incidence of type 1 diabetes in children from Aragon (a population of the North of Spain) is reported determining the relations between the onset of type 1 diabetes and gender, age at diagnosis, genetic risk (HLA class II genes) or climatology factors. The population at risk was all 0-14 year-old inhabitants. Patients were identified from five sources: hospitals, primary assistance, endocrinologists, diabetic associations and diabetes camps. The degree of ascertainment was 98.93%. HLA genetic study was performed. Annual incidence was 16.4 per 100,000 per year (95% CI: 14.7-18.2). This incidence was significantly higher in males than in females, 18.7 versus 14.2 (p<0.02), and increased with age. The haplotypes (DR3)-DQB1*0201/(DR4)-DQB1*0302 and (DR3)-DQB1*0201/(DR7)-DQB1*0202 conferred the highest risk of type 1 diabetes. A relative high incidence of type 1 diabetes mellitus has been demonstrated in the Northeast of Spain, and it does not support south-to-north incidence gradient in Europe. Haplotypes that conferred a higher risk of disease agree with those founded in other Caucasic populations.

Effect of the Ala12 allele in the PPARgamma-2 gene on the relationship between birth weight and body composition in adolescents: the AVENA study.

The intent of this study was to assess whether the effect of birth weight on later body composition is modified by Pro12Pro, Pro12Ala, and Ala12Ala genotypes of the peroxisome proliferator-activated receptor gamma-2 (PPARgamma-2) gene. The PPARgamma-2 gene polymorphism was genotyped in 273 adolescents aged 13-18.5 y, born at term and whose birth weight was known. They were selected from a cross-sectional multicenter study conducted in five Spanish cities in 2000-2002. Body mass index (BMI) was calculated from weight and height measurements, and body composition and fat distribution were estimated from skinfold thickness. A total of 229 subjects (111 males and 118 females) carried the Pro12Pro genotype and 44 (22 males and 22 females) the Pro12Ala and Ala12Ala PPARgamma-2 genotypes. In the Pro12Pro group, birth weight Z score was positively associated with both fat-free mass (FFM) (p < 0.05) and fat mass (FM) (p < 0.05), but these relationships disappeared after controlling for age, gestational age, socioeconomic status (SES), physical activity, Tanner stage, sex, and BMI. In the Ala12 group, birth weight Z score was positively associated with FFM (p < 0.01), and this relationship remained significant after controlling for confounding variables (p < 0.05). Small body weight at birth may program lower FFM in adolescents carrying the Ala12 allele in the PPARgamma-2 gene.