XVIII Congreso SEINAP. Los azúcares en la dieta de niños y adolescentes (posicionamiento de la ESPGHAN) / XVIII Congress of SEINAP. Sugar in the diet of children and adolescents (position of the ESPGHAN)

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Association of telomere length with IL-6 levels during an obesity treatment in adolescents: interaction with the-174G/C polymorphism in the IL-6gene.

BACKGROUND: Shorter telomeres have been associated with elevated risk for age-related diseases. However, little is known about the biomarker role of telomere length (TL) for predicting inflammation and glucose alterations. OBJECTIVE: The objective of this research is to evaluate the association between TL, inflammatory markers and glucose levels after a 2-month weight-loss programme in obese adolescents. METHODS: Telomere length was measured using a quantitative polymerase chain reaction in 66 obese adolescents aged 12-17 years (51% men) from the EVASYON programme. The adolescents were genotyped for the polymorphism -174G/C (rs1800795) in the IL-6gene, and anthropometric and biochemical markers as well as inflammatory cytokines were analysed. RESULTS: Multiple-adjusted models showed that longer telomeres at baseline were associated with a higher reduction in glucose (B = -4.08, 95% confidence interval: -6.66 to -1.50) and IL-6 (B = -1.03, 95% confidence interval: -2.01 to -0.05) serum levels after 2 months of the weight-loss treatment. The -174G/C polymorphism modulated the association between basal TL and changes in IL-6 (P interaction = 0.029). Thus, subjects with the GG + GC genotype and with longer telomeres showed a higher decrease in IL-6 levels than CC homozygotes. CONCLUSION: Longer telomeres are associated with an improvement in glucose tolerance and inflammation after a weight-loss programme in obese adolescents. Moreover, the -174G/C polymorphism may influence the relationship between TL and IL-6 changes.

Behavioral predictors of attrition in adolescents participating in a multidisciplinary obesity treatment program: EVASYON study.

The aims of this study were to identify the cognitive and behavioral predictors of dropping out and to estimate the attrition rate during different phases of an intervention program to treat overweight and obesity in adolescents. Overweight/obese adolescents (n=156, aged: 13-16 years; 71 male and 85 female subjects) were included in a multicomponent (diet, physical activity and psychological support) family-based group treatment program. At baseline and after 2 months (intensive phase) and 13 months (extensive phase) of follow-up, we measured adolescents' cognitive and behavioral dimensions, together with the parents' perception of their child's behavior. Of the 156 adolescents selected, 112 completed the full program (drop-out rate of 28.2%). The risk of dropping out during the extensive phase increased by 20% for each unit increase in the adolescent's social insecurity score (odds ratio=1.20, 95% confidence interval=1.07-1.34, P=0.002). The adolescents who had a high interoceptive awareness showed a significant decrease of 13.0% in the probability of dropping out (odds ratio=0.87, 95% confidence interval=0.77-0.99, P=0.040). Adolescents' social insecurity was the main predictor of drop-out in a multicomponent family-group-based obesity treatment program. To reduce attrition rates in these programs, the individual's social insecurity level needs to be reduced, whereas the family's awareness of eating-related behavior needs adjustment.

Maternal Body Weight and Gestational Diabetes Differentially Influence Placental and Pregnancy Outcomes.

CONTEXT: Maternal obesity and gestational diabetes mellitus (GDM) can both contribute to adverse neonatal outcomes. The extent to which this may be mediated by differences in placental metabolism and nutrient transport remains to be determined. OBJECTIVE: Our objective was to examine whether raised maternal body mass index (BMI) and/or GDM contributed to a resetting of the expression of genes within the placenta that are involved in energy sensing, oxidative stress, inflammation, and metabolic pathways. METHODS: Pregnant women from Spain were recruited as part of the "Study of Maternal Nutrition and Genetics on the Foetal Adiposity Programming" survey at the first antenatal visit (12-20 weeks of gestation) and stratified according to prepregnancy BMI and the incidence of GDM. At delivery, placenta and cord blood were sampled and newborn anthropometry measured. RESULTS: Obese women with GDM had higher estimated fetal weight at 34 gestational weeks and a greater risk of preterm deliveries and cesarean section. Birth weight was unaffected by BMI or GDM; however, women who were obese with normal glucose tolerance had increased placental weight and higher plasma glucose and leptin at term. Gene expression for markers of placental energy sensing and oxidative stress, were primarily affected by maternal obesity as mTOR was reduced, whereas SIRT-1 and UCP2 were both upregulated. In placenta from obese women with GDM, gene expression for AMPK was also reduced, whereas the downstream regulator of mTOR, p70S6KB1 was raised. CONCLUSIONS: Placental gene expression is sensitive to both maternal obesity and GDM which both impact on energy sensing and could modulate the effect of either raised maternal BMI or GDM on birth weight.

The impact of maternal obesity on iron status, placental transferrin receptor expression and hepcidin expression in human pregnancy.

BACKGROUND: Obesity is associated with decreased iron status, possibly due to a rise in hepcidin, an inflammatory protein known to reduce iron absorption. In animals, we have shown that maternal iron deficiency is minimised in the foetus by increased expression of placental transferrin receptor (pTFR1), resulting in increased iron transfer at the expense of maternal iron stores. OBJECTIVE: This study examines the effect of obesity during pregnancy on maternal and neonatal iron status in human cohorts and whether the placenta can compensate for decreased maternal iron stores by increasing pTFR1 expression. SUBJECTS/METHODS: A total of 240 women were included in this study. One hundred and fifty-eight placentas (Normal: 90; Overweight: 37; Obese: 31) were collected at delivery. Maternal iron status was measured by determining serum transferrin receptor (sTFR) and ferritin levels at 24 and 34 weeks and at delivery. Hepcidin in maternal and cord blood was measured by ELISA and pTFR1 in placentas by western blotting and real-time RT-PCR. RESULTS: Low iron stores were more common in obese women. Hepcidin levels (ng ml(-1)) at the end of the pregnancy were higher in obese than normal women (26.03±12.95 vs 18.00±10.77, P<0.05). Maternal hepcidin levels were correlated with maternal iron status (sTFR r=0.2 P=0.025), but not with neonatal values. mRNA and protein levels of pTFR1 were both inversely related to maternal iron status. For mRNA and all women, sTFR r=0.2 P=0.044. Ferritin mRNA levels correlated only in overweight women r=-0.5 P=0.039 with hepcidin (r=0.1 P=0.349), irrespective of maternal body mass index (BMI). CONCLUSIONS: The data support the hypothesis that obese pregnant women have a greater risk of iron deficiency and that hepcidin may be a regulatory factor. Further, we show that the placenta responds to decreased maternal iron status by increasing pTFR1 expression.

Comparison of childhood size and dietary differences at age 4 years between three European countries.

BACKGROUND/OBJECTIVES: Obesity in childhood is very common in Europe. It may be linked to diet, and intakes of protein and polyunsaturated fatty acids (PUFA) have been investigated. The study aims to investigate child size and dietary differences at the age of 4 years between three European countries and to assess dietary adequacy. SUBJECTS/METHODS: A total of 161 4-year-old children from Spain, Germany and Hungary, whose mothers participated in a pregnancy micronutrient supplementation trial, were included in this analysis. Child size was assessed by standardised anthropometry and diet calculated from parent-completed food frequency questionnaires. Adequacy of the diet was evaluated using US guidelines. RESULTS: The Spanish children had a higher mean body mass index (BMI) (16.4±1.5) compared with German (15.7±1.0) and Hungarian children (14.9±1.4, P<0.01). In Spanish children, dietary intakes were higher in animal protein density, particularly from dairy foods, were little different in total protein density and slightly lower in n-6 PUFA density compared with the intakes in the other groups. Dietary intakes of most children (% contribution to energy) were higher than those recommended for protein, saturated fat and added sugar. CONCLUSIONS: Spanish children had a higher mean BMI compared with German and Hungarian children. Diets taken by Spanish children may be more obesogenic than those taken by German or Hungarian children. In the present study, many children in all three countries were consuming diets that were high in protein, saturated fat and sugar.

Views of parents in four European countries about the effect of food on the mental performance of primary school children.

BACKGROUND/OBJECTIVES: Several factors affect the mental performance of children. The importance that parents attribute to food-related determinants, compared with genetic, socio-economic and school environment, was investigated. SUBJECTS/METHODS: Parents of school children (aged 4-11) were recruited through state primary schools in four European countries. Interviews were conducted in which participants were asked to sort 18 cards representing possible determinants of four elements of mental performance (attention, learning, mood and behaviour) according to perceived strength of effect. Determinants were identified from the literature and grouped in six categories: food-related, school environment, physical, social, psychological and biological. Effects were scored: 0=none; 1=moderate; and 2=strong. Views were compared between and within countries. RESULTS: Two hundred parents took part (England: 53; Germany: 45; Hungary: 52; Spain: 50). Differences existed between countries in the proportions reporting university education and being in employment. Taking all countries together, parents consider the food category (mean 1.33) to have a lower impact on a child's mental performance than physical (activity and sleep, 1.77), psychological (mood and behaviour, 1.69) and school environment (1.57). Social (1.12) and biological (0.91) determinants were ranked lower than food. Of determinants in the food category, parents thought regularity of meals had more influence on mental performance (1.58) than what a child eats now (1.36), food at school (1.35), nutrition as a baby/infant (1.02). CONCLUSION: Scope exists to improve parental awareness of the repercussions of their dietary choices for the mental performance of their children.

Influences on infant feeding decisions of first-time mothers in five European countries.

BACKGROUND/OBJECTIVES: Infant feeding decisions made by new parents have significant health implications. The study aimed to investigate: influences on infant feeding decisions; characteristics of mothers reporting reliance on alternative information sources; associations between reliance on different sources and intentions to exclusively breastfeed and introduce complementary foods later; and subsequent breastfeeding and weaning behaviours. SUBJECTS/METHODS: First-time mothers in five European countries (England, Finland, Germany, Hungary, Spain) completed questionnaires about the importance of 17 influences on infant feeding choices at birth and 8 months later, during 2007-2008. Use of individual sources and reliance on four categories (family and friends, health professionals, written materials, audio-visual media) were compared between countries. Associations between information sources used and mother characteristics, feeding intentions and behaviours were investigated using appropriate statistical tests. RESULTS: In all, 2071 first-time mothers provided baseline data; 78% at 8 months. Variation exists between countries in the influence of different sources on feeding decisions of first-time mothers. Across all countries, the most important influences at both time points were books, partner and antenatal midwife. Mothers in higher income quintiles and remaining at school beyond age 16 years reported greater reliance on written sources (P<0.0005). Mothers relying most on written sources reported longer exclusive breastfeeding (P=0.002), and a tendency to introduce foods other than milk later (P=0.079) than mothers relying most on personal or professional contacts. CONCLUSION: Further research is required about which dissemination strategies are most effective at improving infant feeding behaviours in varied cultural settings, and for different socio-economic groups.

Design of the nutritional therapy for overweight and obese Spanish adolescents conducted by registered dieticians: the EVASYON study.

BACKGROUND: Dietary treatment for obese 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. The aim of this article is to describe the dietary intervention design and the methods used to evaluate nutritional knowledge and behavior in the EVASYON study (Development, implementation and evaluation of the efficacy of a therapeutic programme for overweight/obese adolescents). METHODS/DESIGN: EVASYON is a multi-centre study conducted in 5 Spanish hospital settings (Granada, Madrid, Pamplona, Santander and Zaragoza), where 204 overweight/obese Spanish adolescents were treated in groups of 9 to 11 subjects over 20 visits. The study was implemented in two stages: an intensive, calorie-restricted period for the first 9 weeks, and an extensive body-weight follow-up period for the last 11 months. A moderate energy intake restriction was applied in the intensive period according to the degree of obesity, on the basis of a balanced diet supplying 50-55% of daily energy as carbohydrates; 30-35% as fats and 10-15% as proteins. In the intensive period, adolescents were prescribed both a fixed full-day meal plan for the first three weeks and a full day meal plan with different food-choices for 6 weeks. Later, adolescents received a flexible meal plan based on food exchanges for the follow-up period until the end of the trial. Data on food intake, dietary and meal-related habits and behavior were collected by means of dietary questionnaires. To analyse nutritional knowledge, adolescents were examined regarding nutrient concepts and food adoitems for a healthy diet with the appropriate tools. Participants were given nutritional information with complementary teaching material, which was available on the EVASYON website (www.estudioevasyon.com). DISCUSSION: The dietary intervention of the EVASYON programme with a moderate calorie restriction for a limited period of time could be a good strategy in treating overweight and obese adolescents and that will be tested further. Moreover, combining fixed plan with free-choice menus may help adolescents and their families to make right decisions for every day meals.

Design of the nutritional therapy for overweight and obese Spanish adolescents conducted by registered dieticians; the EVASYON study / Diseño de terapia nutricional para adolescentes españoles con sobrepeso y obesidad realizado por dietistas titulados; el estudio EVASYON

Background: Dietary treatment for obese 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. The aim of this article is to describe the dietary intervention design and the methods used to evaluate nutritional knowledge and behavior in the EVASYON study (Development, implementation and evaluation of the efficacy of a therapeutic programme for overweight/obese adolescents). Methods/design: EVASYON is a multi-centre study conducted in 5 Spanish hospital settings (Granada, Madrid, Pamplona, Santander and Zaragoza), where 204 overweight/obese Spanish adolescents were treated in groups of 9 to 11 subjects over 20 visits. The study was implemented in two stages: an intensive, calorie-restricted period for the first 9 weeks, and an extensive body-weight follow-up period for the last 11 months. A moderate energy intake restriction was applied in the intensive period according to the degree of obesity, on the basis of a balanced diet supplying 50-55% of daily energy as carbohydrates; 30-35% as fats and 10-15% as proteins. In the intensive period, adolescents were prescribed both a fixed full-day meal plan for the first three weeks and a full day meal plan with different food-choices for 6 weeks. Later, adolescents received a flexible meal plan based on food exchanges for the follow-up period until the end of the trial. Data on food intake, dietary and meal-related habits and behavior were collected by means of dietary questionnaires. To analyse nutritional knowledge, adolescents were examined regarding nutrient concepts and food adoitems for a healthy diet with the appropriate tools. Participants were given nutritional information with complementary teaching material, which was available on the EVASYON website (www.estudioevasyon.com). Discussion: The dietary intervention of the EVASYON programme with a moderate calorie restriction for a limited period of time could be a good strategy in treating overweight and obese adolescents and that will be tested further. Moreover, combining fixed plan with free-choice menus may help adolescents and their families to make right decisions for every day meals (AU)

Antecedentes: El tratamiento dietético para los adolescentes obesos debería asegurar el crecimiento y desarrollo adecuados al reducir la acumulación excesiva de masa grasa, evitar la pérdida de masa magra corporal, mejorar el bienestar y la autoestima y prevenir la ganancia cíclica de peso. El objetivo de este artículo es el de describir el diseño de la intervención dietética y los métodos empleados para evaluar el conocimiento y la conducta nutricionales del estudio EVASYON (Desarrollo, implantación y evaluación de la eficacia de un programa terapéutico para adolescentes con sobrepeso/obesidad). Métodos/diseño: EVASYON es un estudio multicéntrico realizado en 5 hospitales españoles (Granada, Madrid, Pamplona, Santander y Zaragoza), en el que se trató a 204 adolescentes españoles con sobrepeso/obesidad en grupos de 9 a 11 individuos a lo largo de 20 visitas. El estudio se implantó en dos etapas: un período intensivo de restricción calórica durante las 9 primeras visitas y un período extensivo de seguimiento del peso corporal durante los últimos 11 meses. Se aplicó una restricción moderada de consumo de energía durante el período intensivo en función del grado de obesidad, sobre la base de una dieta equilibrada que aporta el 50-55% de la energía diaria en forma de carbohidratos; 30-35% como grasas y 10-15% como proteínas. En el período intensivo, se prescribió a los adolescentes un régimen de comidas fijo para todo el día durante las 3 primeras semanas y un plan de comidas para todo el día con diferentes opciones durante 6 semanas. Posteriormente, los adolescentes recibieron un régimen de comidas flexible sobre la base de los intercambios de alimentos durante el período de seguimiento hasta el final del ensayo. Se recogieron los datos de consumo de alimentos, dietéticos y hábitos relacionados con las comidas mediante cuestionarios de dieta. Para analizar el conocimiento nutricional, se examinó a los adolescentes con respecto a conceptos de nutrición y alimentos concretos para una dieta sana con las herramientas adecuadas. Se proporcionó a los participantes información nutricional con material educativo complementario que estaba disponible en la página web del estudio (www.estudioevasyon.com). 
Discusión: La intervención dietética del programa EVASYON con una restricción calórica moderada durante un período de tiempo limitado podría ser una buena estrategia para el tratamiento de los adolescentes con sobrepeso y obesidad y se probará más adelante. Además, el combinar el plan fijo con menús de elección libre podría ayudar a los adolescentes y sus familias a tomar las decisiones correctas para las comidas de todos los días (AU)

Inverse association between trans isomeric and long-chain polyunsaturated fatty acids in pregnant women and their newborns: data from three European countries.

BACKGROUND: trans unsaturated fatty acids are thought to interfere with essential fatty acid metabolism. To extend our knowledge of this phenomenon, we investigated the relationship between trans isomeric and long-chain polyunsaturated fatty acids (LCPUFA) in mothers during pregnancy and in their infants at birth. METHODS: Fatty acid composition of erythrocyte phosphatidylcholine (PC) and phosphatidylethanolamine (PE) was determined in Spanish (n = 120), German (n = 78) and Hungarian (n = 43) women at the 20th and 30th week of gestation, at delivery and in their newborns. RESULTS: At the 20th week of gestation, the sum of trans fatty acids in PE was significantly (p < 0.01) lower in Hungarian [0.73 (0.51), % wt/wt, median (IQR)] than in Spanish [1.42 (1.36)] and German [1.30 (1.21)] women. Docosahexaenoic acid (DHA) values in PE were significantly (p < 0.01) higher in Hungarian [5.65 (2.09)] than in Spanish [4.37 (2.60)] or German [4.39 (3.3.2)] women. The sum of trans fatty acids significantly inversely correlated to DHA in PCs in Spanish (r = -0.37, p < 0.001), German (n = -0.77, p < 0.001) and Hungarian (r = -0.35, p < 0.05) women, and in PEs in Spanish (r = -0.67, p < 0.001) and German (r = -0.71, p < 0.001), but not in Hungarian (r = -0.02) women. Significant inverse correlations were seen between trans fatty acids and DHA in PEs at the 30th week of gestation (n = 241, r = -0.52, p < 0.001), at delivery (n = 241, r = -0.40, p < 0.001) and in cord lipids (n = 218, r = -0.28, p < 0.001). CONCLUSION: Because humans cannot synthesize trans isomeric fatty acids, the data obtained in the present study support the concept that high maternal trans isomeric fatty acid intake may interfere with the availability of LCPUFA both for the mother and the fetus.

Nutritional profiles in a public health perspective: a critical review.

Nutritional profiling is defined as 'the science of categorizing foods according to their nutritional composition' and it is useful for food labelling and regulation of health claims. The evidence for the link between nutrients and health outcomes was reviewed. A reduced salt intake reduces blood pressure, but only a few randomized controlled trials have verified the effect of salt on overall and cardiovascular mortality. Evidence linking a reduced fat intake with cardiovascular mortality and obesity is generally non-significant. Studies that have examined the relationship between obesity and diet have produced contrasting results. A simulation exercise that demonstrated that the impact of a reduced salt and fat intake on overall mortality would be negligible in the European population was carried out. Consideration of the literature and the results of this simulation exercise suggest that the introduction of nutritional profiles in Europe would be expected to have a very limited impact on health outcomes.

Gut microbiota composition is associated with body weight, weight gain and biochemical parameters in pregnant women.

Obesity is associated with complications during pregnancy and increased health risks in the newborn. The objective of the present study was to establish possible relationships between gut microbiota, body weight, weight gain and biochemical parameters in pregnant women. Fifty pregnant women were classified according to their BMI in normal-weight (n 34) and overweight (n 16) groups. Gut microbiota composition was analysed by quantitative real-time PCR in faeces and biochemical parameters in plasma at 24 weeks of pregnancy. Reduced numbers of Bifidobacterium and Bacteroides and increased numbers of Staphylococcus, Enterobacteriaceae and Escherichia coli were detected in overweight compared with normal-weight pregnant women. E. coli numbers were higher in women with excessive weight gain than in women with normal weight gain during pregnancy, while Bifidobacterium and Akkermansia muciniphila showed an opposite trend. In the whole population, increased total bacteria and Staphylococcus numbers were related to increased plasma cholesterol levels. Increased Bacteroides numbers were related to increased HDL-cholesterol and folic acid levels, and reduced TAG levels. Increased Bifidobacterium numbers were related to increased folic acid levels. Increased Enterobacteriaceae and E. coli numbers were related to increased ferritin and reduced transferrin, while Bifidobacterium levels showed the opposite trend. Therefore, gut microbiota composition is related to body weight, weight gain and metabolic biomarkers during pregnancy, which might be of relevance to the management of the health of women and infants.

Shifts in clostridia, bacteroides and immunoglobulin-coating fecal bacteria associated with weight loss in obese adolescents.

OBJECTIVE: To evaluate the effects of a multidisciplinary obesity treatment programme on fecal microbiota composition and immunoglobulin-coating bacteria in overweight and obese adolescents and their relationship to weight loss. DESIGN: Longitudinal intervention study based on both a calorie-restricted diet (calorie reduction=10-40%) and increased physical activity (calorie expenditure=15-23 kcal/kg body weight per week) for 10 weeks. PARTICIPANTS: Thirty-nine overweight and obese adolescents (BMI mean 33.1 range 23.7-50.4; age mean 14.8 range, 13.0-16.0). MEASUREMENTS: BMI, BMI z-scores and plasma biochemical parameters were measured before and after the intervention. Fecal microbiota was analyzed by fluorescent in situ hybridization. Immunoglobulin-coating bacteria were detected using fluorescent-labelled F(ab')2 antihuman IgA, IgG and IgM. RESULTS: Reductions in Clostridium histolyticum and E. rectale-C. coccoides proportions significantly correlated with weight and BMI z-score reductions in the whole adolescent population. Proportions of C. histolyticum, C. lituseburense and E. rectale-C. coccoides dropped significantly whereas those of the Bacteroides-Prevotella group increased after the intervention in those adolescents who lost more than 4 kg. Total fecal energy was almost significantly reduced in the same group of adolescents but not in the group that lost less than 2.5 kg. IgA-coating bacterial proportions also decreased significantly in participants who lost more than 6 kg after the intervention, paralleled to reductions in C. histolyticum and E. rectale-C. coccoides populations. E. rectale-C. coccoides proportions also correlated with weight loss and BMI z-score reduction in participants whose weight loss exceeded 4 kg. CONCLUSIONS: Specific gut bacteria and an associated IgA response were related to body weight changes in adolescents under lifestyle intervention. These results suggest interactions between diet, gut microbiota and host metabolism and immunity in obesity.

Estudio de la influencia de la nutrición y genética maternas sobre la programación del desarrollo del tejido adiposo fetal (Estudio PREOBE) / Study of maternal nutrition and genetic on the foetal adiposity programming (The PREOBE study)

Introducción: La genética y la alimentación de la madre antes y durante el embarazo, las distintas patologías metabólicas maternas, así como la ingesta de nutrientes en los primeros meses de vida del recién nacido parecen estar implicados en la etiología de la obesidad y sus consecuencias a largo plazo. La posible contribución de estos y otros factores, los mecanismos y sus efectos en el metabolismo y desarrollo de la enfermedad están aún en fase de investigación. Objetivo: Obtener un mayor conocimiento del desarrollo del tejido adiposo fetal y la influencia de factores genéticos, dietéticos y ambientales sobre el riesgo a largo plazo de padecer obesidad. Metodología: Se han establecido cuatro grupos de estudio de 30 madres gestantes cada uno: 1) grupo control; 2) madres con intolerancia a la glucosa/diabetes gestacional; 3) madres con escasa ganancia ponderal durante el embarazo, y 4) madres con sobrepeso/obesidad al inicio del embarazo. Se realizará un análisis de los siguientes parámetros: 1) ingesta dietética; 2) hábitos y estilo de vida; 3) actividad física; 4) antropometría y composición corporal; 5) estudio hematológico; 6) estudio bioquímico (biomarcadores lipídicos y metabólicos); 7) perfil inmunológico; 8) perfil psicológico; 9) marcadores genéticos, y 10) marcadores microbiológicos; todos ellos relacionados con la formación del tejido adiposo fetal en las primeras etapas de la vida y el riesgo de padecer obesidad en el futuro. Conclusión: En este proyecto, coordinado por el Departamento de Pediatría de la Facultad de Medicina de la Universidad de Granada y que cuenta con la participación de otros grupos de investigación de larga y acreditada experiencia, se pretende obtener un mayor conocimiento de los orígenes de la obesidad en la infancia y posterior desarrollo de esta enfermedad en etapas posteriores de la vida (AU)

Background: Maternal genetics and feeding before and during pregnancy, different maternal metabolic pathologies, as well as nutrient intakes of newborns in their first months of life may be involved in the obesity aetiology and its long-term consequences. The possible role of these and others factors, the mechanisms and the effects on the metabolism, and the development of this disease need further research. Objective: To acquire more knowledge about foetal adipose tissue development and the influence of genetic, dietetic and environmental factors on the risk to suffer from obesity. Methodology: Four study groups have been established with 30 pregnant women in each one: 1) control group; 2) mothers with glucose intolerance/gestational diabetes; 3) women with low weight gain during pregnancy, and 4) women with overweight/obesity at the beginning of the pregnancy. The magnitudes to be studied are: 1) dietary intake; 2) life-style habits; 3) physical activity; 4) anthropometry and body composition; 5) haematological study; 6) biochemical study (lipid and metabolic biomarkers); 7) immune function profile related to nutritional status; 8) psychological profile; 9) genetic biomarkers, and 10) microbiological markers; all of them in relation to the development of the foetal adipose tissue in the first stages of life and the risk of suffering from obesity in the future. Conclusion: This project, coordinated by the Department of Paediatrics of the School of Medicine in the University of Granada, and with the collaboration of well-known and expert research groups, tries to contribute to the knowledge about the obesity aetiology in infancy and its subsequent development in later periods of life (AU)

Dietary intake of natural sources of docosahexaenoic acid and folate in pregnant women of three European cohorts.

BACKGROUND: Folic acid plays a fundamental role in cell division and differentiation. Docosahexaenoic acid (DHA) has been associated with infantile neurological and cognitive development. Thus, optimal intrauterine development and growth requires adequate supply of these nutrients during pregnancy. METHODS: Healthy pregnant women, aged 18-41 years, were recruited in Granada (Spain; n = 62), Munich (Germany; n=97) and Pécs (Hungary; n=152). We estimated dietary DHA and folate intake in weeks 20 (w20) and 30 of gestation (w30) using a food frequency questionnaire with specific focus on the dietary sources of folate and DHA. RESULTS: Both w20 and w30 Spanish participants had significantly higher daily DHA intakes (155+/-13 and 161+/-9 mg/1,000 kcal) than the German (119+/-9 and 124 +/- 12 mg/1,000 kcal; p=0.002) and Hungarian participants (122+/-8 and 125 +/- 10 mg/1,000 kcal; p=0.005). Hungarian women had higher folate intakes in w20 and w30 (149+/-5 and 147+/-6 microg/1,000 kcal) than Spanish (112+/-2 and 110+/-2 microg/1,000 kcal; p<0.001) and German participants (126+/-4 and 120+/-6 microg/1,000 kcal; p<0.001), respectively. CONCLUSION: Dietary DHA and folate intake of pregnant women differs significantly across the three European cohorts. Only 7% of the participants reached the recommended folate intake during pregnancy, whereas nearly 90% reached the DHA recommended intake of 200 mg per day.

[Study of maternal nutrition and genetic on the foetal adiposity programming (The PREOBE study)]. / Estudio de la influencia de la nutrición y genética maternas sobre la programación del desarrollo del tejido adiposo fetal (Estudio PREOBE).

BACKGROUND: Maternal genetics and feeding before and during pregnancy, different maternal metabolic pathologies, as well as nutrient intakes of newborns in their first months of life may be involved in the obesity aetiology and its long-term consequences. The possible role of these and others factors, the mechanisms and the effects on the metabolism, and the development of this disease need further research. OBJECTIVE: To acquire more knowledge about foetal adipose tissue development and the influence of genetic, dietetic and environmental factors on the risk to suffer from obesity. METHODOLOGY: Four study groups have been established with 30 pregnant women in each one: 1) control group; 2) mothers with glucose intolerance/gestational diabetes; 3) women with low weight gain during pregnancy, and 4) women with overweight/obesity at the beginning of the pregnancy. The magnitudes to be studied are: 1) dietary intake; 2) life-style habits; 3) physical activity; 4) anthropometry and body composition; 5) haematological study; 6) biochemical study (lipid and metabolic biomarkers); 7) immune function profile related to nutritional status; 8) psychological profile; 9) genetic biomarkers, and 10) microbiological markers; all of them in relation to the development of the foetal adipose tissue in the first stages of life and the risk of suffering from obesity in the future. CONCLUSION: This project, coordinated by the Department of Paediatrics of the School of Medicine in the University of Granada, and with the collaboration of well-known and expert research groups, tries to contribute to the knowledge about the obesity aetiology in infancy and its subsequent development in later periods of life.

Influence of dietary source of docosahexaenoic and arachidonic acids on their incorporation into membrane phospholipids of red blood cells in term infants.

Here we studied whether the chemical structure of dietary arachidonic and docosahexaenoic acids in full-term infant diets affects their incorporation into erythrocyte membrane phospholipids. From birth to 3 months, infants were fed breast milk (n = 9) or formula milk containing arachidonic acid and docosahexaenoic acid provided by egg phospholipids (n = 10) or by low-eicosapentaenoic acid fish oil and fungal triglycerides (n = 10). We compared the fatty acid composition of erythrocyte phosphatidylethanolamine, phosphatidylcholine and sphingomyelin before and after administration of the experimental diet. At 3 months, infants on formula milk showed lower concentrations of docosahexaenoic acid (in phosphatidylcholine and in phosphatidylethanolamine) and arachidonic acid (in phosphatidylcholine) than those receiving breast milk. We conclude the incorporation of the two fatty acids into erythrocyte phospholipids depends mainly on the lipid composition of the diet received rather than the chemical form in which they are delivered.

Effects of metabolic control on vitamin E nutritional status in children with type 1 diabetes mellitus.

OBJECTIVE: To evaluate the effects of the metabolic control of the insulin-dependent diabetes mellitus (IDDM) on the nutritional status of vitamin E. METHODS: A total of 47 children with IDDM and a mean age of 11.91+/-1.60 (mean+/-SD) years were studied, matched for age and sex with 16 healthy children (11.75+/-1.83 years). Following the American and British Associations for IDDM, we used a classification of "good", "moderate" or "poor" control of the illness: (a) good control [glycosilated haemoglobin (HbAlc) < or =7%]; (b) moderate control (7%< HbAlc < or =8%); and (c) poor control (HbAlc>8%). Serum concentrations of total cholesterol (CHOL), triglycerides (TG), high-density lipoproteins-cholesterol (HDLc), very low- and low-density lipoproteins cholesterol (VLDLc and LDLc), plasma and erythrocyte vitamin E (Vit Ep and Vit Ee) and plasma vitamin A (Vit Ap) were measured in all children. RESULTS: The children with "poor" metabolic control of the illness presented significantly higher plasma concentrations of CHOL, LDLc, VLDLc, LDLc/HDLc, (VLDL+LDL)c/HDLc, TG and Vit Ep; higher indices Vit Ep/Vit Ee and Vit Ep/Vit Ap relative to those with a "good" control of the illness. Direct-linear correlations were found between Vit Ep and the percentage of HbAlc and with the markers of atherogenic risk in the IDDM children. CONCLUSION: There is a significant rise in Vit Ep concentrations as metabolic control of the illness worsens, whereas Vit Ee remained unchanged. These results suggest that vitamin E maintains its nutritional status despite a poor control of the IDDM during childhood.