Ideal cardiovascular health and inflammation in European adolescents: The HELENA study.

BACKGROUND AND AIMS: Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents. METHODS AND RESULTS: As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several individual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls. CONCLUSION: Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention.

[Immigration and factors associated with breastfeeding. CALINA study]. / Inmigración y factores asociados con la lactancia materna. Estudio CALINA.

OBJECTIVE: To identify socio-cultural, obstetric and perinatal characteristics associated with complete breastfeeding (CBF) during the first 4 months of age, depending on maternal origin. MATERIAL AND METHODS: Socio-cultural, obstetric and perinatal aspects associated with breastfeeding depending on maternal origin were evaluated in a longitudinal study in a representative infant population from Aragon (n = 1452). RESULTS: The prevalence of CBF was higher in immigrant mothers than in those from Spain. CBF was maintained in 37.2% of mothers from Spain at 4 months, compared with 43% of immigrants (P=.039) (RR Spanish/immigrants=0.76; 95% CI: 0.58-0.99); at 6 months this occurred in 13.9% vs. 23.8%, respectively (P<.001) (RR Spanish/immigrants=0.52; 95% CI: 0.37-0.72). The factors associated with CBF at 4 months are different between both groups. Mothers born in Spain are older (P=.002), have higher academic level (P=.001), greater parity (P=.003), and a higher probability of vaginal delivery (P=.005); and their children have the highest anthropometric values at birth. However, in immigrant mothers, the maintenance of CBF was associated with a higher maternal body mass index and with working at home. In both groups, CBF remains more frequently in those mothers who do not smoke (P=.001). CONCLUSIONS: The prevalence of CBF during the first months of life is higher in immigrant mothers than in those from Spain, and socio-cultural, obstetric and perinatal factors are different, depending on maternal origin.

[Perinatal aspects, growth and feeding of infants born small for gestational age]. / Aspectos perinatales, crecimiento y tipo de lactancia de los nacidos pequeños para su edad gestacional.

INTRODUCTION: Being born small for gestational age (SGA) has short and long term risks. The aim of this study was to describe perinatal and socio-cultural characteristics, and the pattern of growth and diet of SGA infants during their first 6 months of life. MATERIALS AND METHODS: Anthropometry and diet were evaluated during six months in a representative sample of 1596 newborns the population of Aragon (Spain). RESULTS: Mothers of SGA (N=94) infants gained less weight during pregnancy (10.5±5.8 vs 12.0±5.07 kg, P=.012), gestational age at birth was lower (37.84±1.7 vs 39.06±1.6 weeks, P<.001), and the probability of cesarean delivery was higher (37.2% vs 20.5%, P=.001). The height of the mother was lower in the SGA group (1.61±0.58 vs 1.63±0.06 metres, P=.004), but their body mass index was similar. No differences were found between groups in social or cultural aspects. Mothers of SGA infants smoked more during pregnancy (32.3% vs 18.5%, P=.003) (RR = 1.92; 95% CI; 1.31 to 3.02). Infants born SGA remained smaller during the first 6 months of life, and the monthly weight gain was similar to the rest. In the SGA group, the prevalence of breastfeeding was lower at 4 months of age (54.9% vs 68.2%, RR = 0.58, 95% CI; 0.38 to 0.89). CONCLUSIONS: Infants born SGA are more likely to converge a number of characteristics that must be considered together because they may lead to health risks. SGA do not show a rapid recovery pattern of postnatal growth, and their smaller size persists at six months.

[Socio-cultural, obstetric and anthropometric characteristics of newborn children of mothers who smoke in Spain]. / Características socioculturales, obstétricas y antropométricas de los recién nacidos hijos de madre fumadora.

INTRODUCTION: One in every four women smoke at the beginning of the pregnancy in Spain; of these, 25-50% give up smoking during gestation and most of them smoke again after childbirth. Maternal smoking has harmful effects on babies, such as low birth-weight with its resulting morbidity. The objective of this study is to compare the anthropometric and socio-cultural characteristics between newborns from smoking mothers and those from non- smoking ones. MATERIALS AND METHODS: Smoking habits and the socio-cultural characteristics were assessed from a sample of 1499 pregnant women, as well as their newborn anthropometric variables of their newborn babies during 2009 in the Aragon region of Spain. RESULTS: In the sample of 1499 pregnant women the prevalence of smoking during pregnancy was 19.6%; among the Spanish women, 23% of them smoked during the gestation compared with only 11% in women from other countries. The smoker mothers were younger and they had a lower educational level than the non smoker ones; however, there were no statistical differences between their anthropometric characteristics. Newborns from smoker women in Aragon had a lower weigh at delivery (3155 vs. 3295 grams: p<.001) and a relative risk of low weight at birth for their gestational age of 2.1 (95% CI: 1.35 - 2.97). The length and the rest of newborn anthropometric variables were also affected. CONCLUSION: The prevalence of smoking during gestation is high in Aragon. The mothers who smoke are younger and have different socio-cultural characteristics compared with non-smoker mothers. Maternal smoking habits have a harmful effect on newborn nutritional status, representing an avoidable risk of low weight at birth.

[Nutritional characteristics of newborns of overweight and obese mothers]. / Características nutricionales de los recién nacidos de madres con sobrepeso y obesidad.

INTRODUCTION: Maternal nutritional status is an important factor of adequate intrauterine growth and neonatal weight. The aim of this study is to evaluate the relationship between pre-gestational BMI (Body Mass Index) and breastfeeding duration, as well as infant anthropometric measurements during their first six months of life. MATERIALS AND METHODS: Anthropometric measurements and the type of feeding were evaluated in a representative sample of 1,547 newborns from our population during 2009, according to their maternal BMI, and also in a sub-cohort of 759 infants followed up to 6 months of life. RESULTS: A total of 72.9% of women had a normal weight, 18.7% were overweight and 8.4% obese. Women with a BMI ≥ 25 kg/m(2) had lower weight gain during pregnancy (P < .001), lower socioeconomic and cultural level (P < .001), and their infants had higher weight at delivery (P=.003) and at 6 months of life, with no differences in body length. Newborn weight increased in relation to maternal BMI, but over 35 kg/m(2) it decreased progressively (P < .001). Breastfeeding prevalence in obese women was 58.5% at hospital postpartum discharge, and 8.6% at six months of life; as opposed to 70.8% and 13.9%, respectively in women with normal BMI. CONCLUSIONS: In our sample, maternal obesity is associated with a low socioeconomic and cultural level, higher infant weight at delivery and at 6 months of life, and less prevalence of exclusive breastfeeding; all of them nutritional risk factors in the short and long term.

El índice de masa corporal, ¿predice adecuadamente el nivel de adiposidad y el riesgo cardiovascular en niños y adolescentes? / Is the body mass index a good predictor of excess body fat and cardiovascular risk in children and adolescents?

El índice de masa corporal (IMC) varía considerablemente durante la infancia y la adolescencia según la edad y el sexo. El IMC es el parámetro que más frecuentemente se utiliza para predecir el exceso de grasa corporal porque se determina fácilmente y se correlaciona bien con la adiposidad. Recientemente, se han propuesto los puntos de corte internacionaleds e IMC(International Obesity Task Force) para la definición de sobrepeso y obesidad en niños y adolescentes, para cada edad y sexo. Además de con el exceso de grasa corporal, el IMC se correlaciona con varios componentes del síndrome metabólico: dislipemia, hipertensión, resistencia a la insulina/hiperinsulinismoe intolerancia a los carbohidratos/diabetes mellitus tipo 2. El IMC no es capaz de predecir con fiabilidad el porcentaje de masa grasa específicamente en un individuo, pero es un buen indicador indirecto de adiposidad. Por otro lado, pese a su aceptable sensibilidad y especificidad, puede clasificar como obesos o con sobrepeso a los individuos que no tengan realmente exceso de grasa corporal

Body mass index (BMI) values vary during childhood and adolescence depending on age and gender. The BMI is the parameter most frequently used for the screening of excess body fat because it is easy to determine and it tends to correlate well with body fat. International Obesity Task Force(IOTF) BMI cut off points for the definition of excess weight and obesity have recently been proposed for each age and sex, corresponding to adult BMI values of 25 and 30 at the age of 18 years. In addition to excess body fat, the BMI has been correlated with various components of metabolic syndrome: dyslipidemia, hypertension, insulin resistance/hyperinsulinemai and impaired glucosetolerance/type 2 diabetes. The BMI is not a reliable predictor of the percent fat mass at the individual level, but is a good index of adiposity. Nevertheless, despite its acceptable sensitivity and specificity, the BMI may classify as obese or overweight individuals who do not really have excess adiposity

Detección de factores de riesgo cardiovascular en niñoscon obesidad nutricional / Detection of cardiovascular risk factor in children with nutritional obesity

La obesidad infantil representa en la actualidad un importante problema para la Salud Pública en los países desarrollados, como es el caso de España. En la práctica diaria, será importante la detección de aquellos niños que presenten riesgo de tener complicaciones cardiovasculares en la edad adulta, por esta razón se deben intentar identificar los factores de riesgo cardiovascular en dicha población. A pesar de que el uso del índice de masa corporal (IMC) estaría indicado únicamente para el screening de la obesidad, en la actualidad se acepta su uso para el diagnóstico clínico, en función de los valores de IMC referidos a cada edad y sexo. Parece importante utilizar los estándares internacionales publicados recientemente, que fijan unos valores equiparables a los 25 y 30 kg/m2 utilizados en adultos. Para valorar el riesgo de complicaciones se podría utilizar el perímetro de la cintura. Aquellos niños que presenten obesidad, según el IMC, y una medida del perímetro de la cintura superior al percentil 75, deberían beneficiarse de una exploración completa del riesgo cardiovascular que incluiría la medida de la tensión arterial y determinación de glucosa, insulina y perfil lipídico completo (AU)

[Dependence and necessities of non-covered services for the elderly in a health sector of Zaragoza]. / Dependencia y necesidades de cuidados no cubiertas de las personas mayores de una zona de Salud de Zaragoza.

BACKGROUND: Dependency to carry out the activities of daily living (ADL) and home care needs of older adults depend upon factors which are not well understood. Caregiving is mainly provided by the family. The aim of this study is to estimate the prevalence of ADL dependence and associated factors among older adults and to identify associated factors with unmet home care needs in people over age 75 in Zaragoza (Spain). METHOD: A cross-sectional study was conducted on a representative sample of the community dwelling population over age, 75 in one Health Care District in Saragossa in 1998 (n = 351). Data were collected during a personal interview. ADL dependency was assessed by the Katz index. Home care needs were assessed using prevalent norms for desired frequency of care. Sources of informal care, socio-demographic characteristics, self-rated health and depression (Yesavage Geriatric Depression Scale) were considered independent variables. Logistic regression was used to identify factors associated with both ADL dependency and unmet home care needs. RESULTS: Prevalence of ADL dependence is 37.3%. The variables predicting ADL dependence are the perception of poor health, depression, being a female and being over 85 years of age. The prevalence of unmet care needs among ADL dependent individuals is 22.1%. Sources of help are limited to the families. Being a woman and living alone are the stronger risk factors for unmet needs. CONCLUSIONS: A high percentage of older adults are dependent. Informal support is insufficient and confined to the family. The social and health care system in Spain should provide to the family, emotional, financial and social support and special care for disabled people living alone and with limited material resources.

Dependencia y necesidades de cuidados no cubiertas de las personas mayores de una zona de salud de Zaragoza / Dependency and Unmet Need of Care in Older People in a Health Area of Saragossa, Spain

Fundamento: El nivel de autonomía para las actividades del cuidado personal en personas mayores y la necesidad de apoyo no cubiertas dependen de diferentes factores poco conocidos en nuestro medio. Los cuidados en la dependencia se facilitan principalmente por el sistema informal de cuidados. El propósito del estudio es estimar la prevalencia de dependencia para las actividades del cuidado personal y los factores asociados, e identificar los factores asociados con las necesidades de cuidados no cubiertas en personas dependientes, en población mayor de 75 años de Zaragoza. Método: Se realizó un estudio transversal en una muestra representativa de la población no institucionalizada mayor de 75 años, en una Zona de Salud de Zaragoza, en el año 1998 (n=351). Los datos se cumplimentaron a través de una entrevista directa. Se utilizó el índice de Katz para valorar la capacidad funcional para las actividades del cuidado personal y un cuestionario ad hoc para el apoyo informal y el resto de variables. El apoyo informal, las características sociodemográficas, autopercepción de salud y depresión (Escala de Depresión de Yesavage) se consideraron como variables independientes. Se aplicó la regresión logística para identificar los factores asociados a la dependencia y necesidades de cuidados no cubiertas. Resultados: La prevalencia de dependencia para las actividades del cuidado personal es de un 37,3 per cent. Las variables que predicen la dependencia para las actividades del cuidado personal son una mala percepción de salud, depresión establecida, ser mujer y ser mayor de 85 años. La prevalencia de necesidades de apoyo no cubiertas en personas dependientes para las actividades del cuidado personal es de 22,1 per cent. El apoyo informal lo presta la familia. Ser mujer y vivir sola se presenta como un factor de riesgo para no tener las necesidades cubiertas, así como también no estar deprimido. Conclusiones: El porcentaje de personas mayores con dependencia es elevado. El apoyo informal es insuficiente y limitado a la familia. El modelo de atención a las personas mayores en España debería desarrollar servicios de apoyo emocional, económicos y sociales a la familia y establecer una especial atención sobre las personas con dependencia que viven solas y con escasos recursos materiales (AU)

Interés de la cuantificación del gasto energético en pediatría. Métodos de laboratorio y de campo / Utility of the quantification of energy expenditure in pediatrics: laboratory and field methods

El gasto y la ingestión energéticos son los dos actores modificables que intervienen en el balance energético de un individuo. Los métodos que se utilizan actualmente para la cuantificación de los componentes del gasto energético (calorimetría directa e indirecta, monitorización del ritmo cardiaco minuto a minuto, agua doblemente marcada, acelerometría y cuestionarios de actividad física), permiten la evaluación de las necesidades calóricas existentes en cualquier alteración nutricional caracterizada por balances energéticos positivos (obesidad) o negativos (sida, fibrosis quística, etc.). Además de su utilidad en la práctica clínica diaria, algunos de estos métodos son empleados en grupos de niños y adolescentes, en condiciones libres, para el estudio de los hábitos de actividad física y de la energía gastada en su realización (AU)

Nuevos métodos para la evaluación del estado nutricional del niño y adolescente / New methods for the assessment of nutritional status

Actualmente existen numerosos métodos para la evaluación del estado nutricional y la composición corporal del niño y del adolescente. Se pueden clasificar en métodos `de referencia' y métodos `de campo'. Los primeros suelen ser precisos y exactos, aunque también caros y difíciles de adaptar a la práctica clínica. Los segundos son fáciles de realizar, portátiles y cómodos para utilizar en la cabecera de la cama del enfermo, pero no consiguen la exactitud de los anteriores. La aparición de ciertos métodos como la pletismografía por desplazamiento de aire, la absorciometría dual por rayos-X, la espectroscopía de infrarrojos o las nuevas técnicas de Impedanca bioeléctrica han permitido, mediante estudios piloto, explorar las posibilidades de ciertos métodos de referencia utilizándolos como métodos de campo, obteniendo datos más precisos en muestras numerosas de individuos (AU)

[Effect of apolipoprotein E phenotypes on the response to dietary treatment of children with hypercholesterolemia]. / Efecto de los fenotipos de la apolipoproteína E en la respuesta al tratamiento dietético en niños con hipercolesterolemia.

OBJECTIVE: Our objective was to determine if apo E phenotypes have any effect on the serum lipoprotein response to dietary intervention in children with hypercholesterolemia. PATIENTS AND METHODS: We have selected 76 children with total serum cholesterol levels higher than 200 mg/dL. At diagnosis, each patient met with a member of our clinic that established dietary recommendations (total and saturated fat intake: 30 and 10%, respectively, of total energy intake). At diagnosis and after 6 months of therapy we determined a lipoprotein profile. RESULTS: After 6 months of therapy, there was only a significant change in children with phenotype E3/E4, with significant decreases in serum total cholesterol (from 247 +/- 43 to 231 +/- 47 mg/dL, p = 0.002), LDL-cholesterol (from 164 +/- 47 to 149 +/- 48 mg/dL, p = 0.002) and triglycerides (from 81 +/- 36 to 71 +/- 31 mg/dL, p = 0.028) concentrations. Absolute and % delta differences in serum lipoprotein concentrations before and after dietary treatment do not show significant differences between apo E phenotype groups. CONCLUSIONS: In the group studied, apo E phenotypes do not determine the response to a low-fat, low-cholesterol diet in children with hypercholesterolemia. To know the factors that determine the variability in the response to dietary intervention in children with hypercholesterolemia it would be interesting to study other familial and genetic factors.

[Body fat mass in boys and male adolescents]. / Masa grasa corporal en niños y adolescentes de sexo masculino.

OBJECTIVE: To describe the proportion of body fat mass, quantified from the measurement of 4 skinfold thickness, in a sample of male children of Zaragoza. METHODS: In 1995, we have studied 701 males aged 6.0 to 14.9 years, from 6 schools of the province of Zaragoza. We have measured: weight, height, and biceps, triceps, subscapular and suprailiac skinfold thicknesses. Body density has been calculated from the 4 skinfold measurements, with the formulas of Sarría et al. Fat mass (%), was calculated with the Weststrate and Deurenberg's formulas. In each age group, we present mean, standard deviation and 5, 25, 50, 75 and 95th percentiles. RESULTS: We present mean, standard deviation and 5, 25, 50, 75 and 95th percentiles of body fat mass (%), in each age group. Body fat mass (%) progressively increased until 10.5 years and, after, progressively decrease at least until 14.5 years. CONCLUSIONS: We present data of body fat mass (%), calculated from the measurement of 4 skinfold thicknesses, obtained from a reference population in the province of Zaragoza. These data are useful as more rationale criteria in the diagnosis of obesity in children and adolescents.

[Fat distribution in children and adolescents of both sexes]. / Distribución de la grasa en niños y adolescentes de ambos sexos.

OBJECTIVE: The aim of this study was to describe anthropometric indexes of fat distribution in 6.0 to 14.9 year old children and to estimate the timing of differentiation of fat patterning in male and female children and adolescents. PATIENTS AND METHODS: We have studied a sample of 1,360 children (701 boys and 659 girls) from Zaragoza, Spain. We have measured triceps and subscapular skinfold thicknessess and waist and hip circumferences. With these measurements, we have calculated the indexes of fat distribution including waist-to-hip circumference ratio and triceps-to-subscapular skinfold thickness ratio. We present the percentiles of these indexes. RESULTS: All percentiles of the waist-to-hip ratio were higher in males than in females. Percentiles 5, 50 and 95 of the triceps-to-subscapular skinfold thickness ratio showed similar values in males and females, except that percentile 95 was higher in males than in females after 10.5 years. CONCLUSIONS: The waist-to-hip ratio seems to define earlier the pattern of fat distribution in children than does the triceps-to-subscapular skinfold thickness ratio. If we take into account the waist-to-hip ratio, the pattern of fat distribution is already present in school age children.

[Assessment of the submandibular adipose skinfold for the determination of a nutritional status in children and adolescents]. / Valoración del pliegue adiposo submandibular para la determinación del estado nutricional en la infancia y adolescencia.

OBJECTIVE: The aim of this study was to show the validity of a new skinfold thickness for measuring nutritional status in children. We also compare submandibular skinfold thickness with other anthropometric measures and indices. PATIENTS AND METHODS: We have studied 899 boys and 837 girls between 3.0 and 15.1 years of age. All of them were healthy and from different socioeconomic statuses. We measured weight, height, obesity indices, circumferences, indices of body fat distribution and indices of body fat. Data were divided according to age and sex. We calculated the percentiles of submandibular skinfold thickness and correlations between this parameter and all other measurements were performed. The mean values of the two sexes were compared by using Student's t-test. RESULTS: Submandibular skinfold is an easy and fast skinfold to measure. Its value is maximum at 10 and 11 years in girls and boys, respectively. This measurement is higher in girls than in boys at 5, 7, 10, 13 and 14 years of age (p < 0.05). There was a high correlation between this skinfold value and almost all of the measurements and indices studied, especially with the body mass index (r = 0.589), the sum of the four conventional skinfolds (r = 0.844), arm circumference (r = 0.513), arm fat area (r = 0.776) and percentage body fat (r = 0.830). CONCLUSIONS: Submandibular skinfold thickness in children and adolescents shows a high correlation with body fat indices. It is for this reason that it could be used as a new measurement to assess nutritional status and obesity in children.

[Lipoprotein profile determinants in children and adolescents from a lipid consultation clinic. The impact of diet, body composition and physical activity]. / Determinantes del perfil lipídico en niños y adolescentes asistidos en una consulta de lípidos. Importancia de la dieta, composición corporal y actividad física.

OBJECTIVE: Diet, physical activity, physical fitness and body composition are factors that contribute to lipid disorders; however, we do not know whether they are relevant in children of the general population and in children with dyslipoproteinemias. PATIENTS AND METHODS: We have studied all of these factors in 89 children, aged 4.0 to 20.0 years. Children were divided into two groups: 1) Normocholesterolemics (total cholesterol < 225 mg/dL) and 2) Hypercholesterolemics (total cholesterol > or = 225 mg/dL). RESULTS: In normocholesterolemic children, the main determinants of total and low-density lipoprotein cholesterol were height and cholesterol intake, which explained both 50 and 32% of its variability, respectively. The main determinants of high density lipoprotein cholesterol were blood pressure after submaximal loading and fat mass, which explained 50% of the variability. In hypercholesterolemic children, fat and carbohydrate intake and physical activity explained more than 90% of the variability of total and low density lipoprotein cholesterol. Resting energy expenditure explained 40% of the variability of high density lipoprotein cholesterol. CONCLUSIONS: In the treatment of children and adolescents with dyslipoproteinemias, we must emphasize not only dietary intake, but also physical activity. To increase high density lipoprotein cholesterol we must also improve physical fitness and decrease the amount of body fat mass.