Vitamin D status and parathyroid hormone assessment in girls with central precocious puberty.

PURPOSE: The objective of this study was to analyze vitamin D status and PTH concentrations in 6- to 8-year-old girls with central precocious puberty. METHODS: A cross-sectional clinical and blood testing study (calcium, phosphorus, 25(OH)D and PTH) was carried out in 78 girls with central precocious puberty (CPP group), aged 6.1-7.9 years. A control group was recruited (137 prepubertal girls, aged 6.1-8.2 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. RESULTS: There were no significant differences in vitamin D status between both groups. There were no significant differences in 25(OH)D concentrations between CPP (25.4 ± 8.6 ng/mL) and control groups (28.2 ± 7.4 ng/mL). In contrast, PHT concentrations in CPP group (44.8 ± 16.3 pg/mL) were higher (p < 0.05) with respect to control group (31.0 ± 11.9 ng/mL). In CPP group, there was a positive correlation (p < 0.05) between PTH concentrations and growth rate, bone age, and basal estradiol, basal FSH, basal LH and LH peak concentrations. CONCLUSION: Vitamin D status in 6- to 8-year-old girls with CPP is similar to that in prepubertal girls. PTH concentrations were significantly higher in girls with CPP, and this could be considered as a physiological characteristic of puberty and, in this case, of pubertal precocity.

Hyper-androgenemia and obesity in early-pubertal girls.

PURPOSE: The aim of this study was to examine the hormonal profile in early-pubertal girls with obesity. We hypothesized that these patients might already present hormonal alterations with POCS-like features. METHODS: Cross-sectional study in a sample of 283 peri-pubertal girls (prepubertal and early-puberty subgroups), aged 6.1-12.0 years, diagnosed with obesity (BMI-SDS > 2.0, 97th percentile), so-called obesity group. They all underwent clinical examination and blood testing for hormonal measurements (leptin, TSH, FT4, IGF-1, IGFBP3, prolactin, insulin, FSH, LH, estradiol, ACTH, cortisol, 17-OH-P, DHE-S, androstenedione, testosterone and free testosterone). A control group was recruited: 243 healthy girls, aged 6.3-12.1 years, with normal BMI status. RESULTS: Prepubertal girls with obesity had significantly higher values (p < 0.05) for BMI-SDS, leptin, insulin and HOMA-IR levels than control group. Early-pubertal girls with obesity also had significantly higher values (p < 0.05) for BMI-SDS, leptin, IGF-1, IGFBP3, insulin and HOMA-IR, LH, ratio LH/FSH, ACTH, DHE-S, androstenedione, testosterone and free testosterone levels than control group. In early-pubertal girls with obesity (not prepubertal girls), there was a positive correlation (p < 0.01) between leptin levels with LH, androstenedione and testosterone, and HOMA-IR with LH and testosterone levels. There was also a positive correlation (p < 0.01) between IGF-1 levels with LH, androstenedione, DHE-S and testosterone; and LH levels with testosterone. CONCLUSION: The results obtained support our hypothesis that an abnormal hormonal profile with POCS-like features can already be detected (insulin resistance and hyperinsulinemia, increased secretion of LH and ACTH, and overproduction of ovarian and adrenal androgens) in early-pubertal girls with obesity.

Changes in body composition and cardiometabolic risk factors in relation to the reduction in body mass index in adolescents with obesity / Cambios en la composición corporal y factores de riesgo cardiometabólico en relación con la reducción del índice de masa corporal en adolescentes con obesidad

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

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

Vitamin D status and response to growth hormone treatment in prepubertal children with growth hormone deficiency.

PURPOSE: To analyze whether vitamin D deficiency could condition the growth response to GH therapy, as well as to analyze if GH treatment modifies both seasonal variations and vitamin D levels in these patients. METHODS: Retrospective study in 98 prepubertal children with GH deficiency (GHD), aged 4.1-8.9 years treated with GH. Growth rate and blood testing (calcium, phosphorus, IGF-I, 25(0H)D and PTH) were monitored at diagnostic and every six months until 24 months of treatment. A control group was recruited (247 healthy children, aged 3.8-9.7 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. RESULTS: There were no significant differences in vitamin D deficiency among control (12.5%) and GHD groups (15.3%) before starting treatment. Growth rate and IGF-1 and PTH increased (p < 0.05) during GH treatment, but there were no significant differences in calcium, phosphorus and 25(OH)D. There were no significant differences in growth rate and IGF-1, calcium and phosphorus levels in relation to the seasons along GH treatment. There was no correlation between 25(OH)D and IGF-1 during GH therapy. In every programmed control, patients with vitamin D deficiency showed lower growth rate (p < 0.05) compared to patients with vitamin D insufficiency or sufficiency. CONCLUSION: GH treatment, at least during the first two years, does not modify the vitamin D levels. Vitamin D deficiency could condition the response to GH therapy so vitamin D monitoring should be considered as part of the routine evaluation of children with GH treatment.

Prevalence of hypovitaminosis D and associated factors in obese Spanish children.

BACKGROUND/OBJECTIVES: Vitamin D deficiency may contribute to endocrine health and disease (diabetes, autoimmune thyroid diseases, polycystic ovarian syndrome, etc.). The aim of this study was to determine the prevalence and specific factors for hypovitaminosis D among children stratified by body mass index (BMI) in Northern Spain. SUBJECTS/METHODS: A cross-sectional clinical (sex, age, season of study visit, place of residence and BMI) and blood testing (calcium, phosphorous, calcidiol and parathyroid hormone (PTH)) were accomplished in 546 Caucasian individuals (aged 3.2-15.8 years). The BMI (Z-score) allowed establishing four groups: normal, overweight, obesity and severe obesity. The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. RESULTS: Calcidiol levels were significantly higher in normal and overweight groups (P=0.001), whereas PTH levels were significantly higher in obesity and severe obesity groups (P=0.001). Hypovitaminosis D prevalence was significantly higher in severe obesity (81.1%) and obesity (68.2%) groups, whereas was lowest in overweight (55%) and normal (58.1%) groups (P=0.001). There was a negative correlation between calcidiol and PTH levels (P<0.01). Female (90.9%), adolescent group (88,2%), winter (100%) and autumn (82.4%) time and urban residence (94.1%) imply a higher prevalence of hypovitaminosis D in subjects with severe obesity (P<0.001). Female, puberal age, autumn, winter and spring time, urban residence and severe obesity were found to be independent predictors for hypovitaminosis D. CONCLUSIONS: Severe obesity could be considered as an associated factor for vitamin D deficiency, and, owing to its high prevalence, the implementation of systematic screening and hypovitaminosis treatment programs would be particularly useful.

Plexopatía braquial unilateral en un lactante como manifestación precoz de una neuropatía hereditaria con parálisis sensible a la presión / Brachial plexopathy as early manifestation of hereditary neuropathy with liability to pressure palsy in infancy

La neuropatía hereditaria con parálisis sensible a la presión (NHPP) suele manifestarse en la adolescencia y/o edad adulta, y es relativamente excepcional en edades más tempranas. Se presenta un caso de plexopatía braquial unilateral en un lactante de 4 meses de edad como manifestación precoz de NHPP, y se destaca la importancia de los datos anamnésicos familiares junto con el estudio neurofisiológico y molecular en la sospecha diagnóstica precoz (AU)

Hereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant disorder characterized by recurrent mono-neuropathies related to minimal trauma o compression. HNPP usually manifests in adolescence or adulthood, being relatively exceptional at an earlier age. A 4-month-old boy with brachial plexopathy as early manifestation of HNPP is presented. Familiar anamnesis, as well as neurophysiological and molecular studies, stands out in early diagnostic suspicion. In this case, the early manifestation and its semiological characteristics accentuate its peculiarity (AU)

Modelo dietético en pacientes con déficit de atención e hiperactividad / Dietary patterns in patients with attention deficit hyperactivity disorder

OBJETIVO: Estudiar los hábitos alimentarios en un grupo de pacientes con trastorno de déficit de atención e hiperactividad (TDAH) en tratamiento con metilfenidato de liberación prolongada (MTF-LP). MATERIAL Y MÉTODOS: Encuesta nutricional (consumo de alimentos de 3 días consecutivos) a 150 pacientes con TDAH (100 varones y 50 mujeres) en tratamiento con MTF-LP, y a 150 sujetos sanos de la misma edad (grupo control). Se han comparado la ingesta de alimentos y nutrientes y el estado nutricional entre ambos grupos. RESULTADOS: La dosis media de MTF-LP era de 1,02 mg/kg/día. En el grupo con TDAH el estado nutricional era significativamente inferior (p < 0,05). La ingesta de cereales, carnes, legumbres y frutas era significativamente inferior (p < 0,05) en el grupo con TDAH. El aporte calórico del almuerzo, comida del mediodía y merienda era significativamente superior (p < 0,05) en el grupo control; mientras que el aporte calórico de la cena era significativamente superior (p < 0,05) en el grupo con TDAH. En el grupo control el aporte calórico y de proteínas, hidratos de carbono, grasas y fibra, calcio, hierro, magnesio, cinc, selenio y fósforo, tiamina, niacina, vitamina B6 y folatos era significativamente superior (p < 0,05) respecto al grupo TDAH. CONCLUSIONES: El tratamiento con MTF-LP modifica sustancialmente la distribución porcentual del aporte calórico de las distintas ingestas diarias. El aporte calórico y de nutrientes en los pacientes en tratamiento con MTF-LP es, en general, inferior al de la población sana de la misma edad. Habría que considerar la necesidad de impartir, simultáneamente con el tratamiento multimodal, programas de educación nutricional a estos pacientes y/o sus familias

OBJECTIVE: To evaluate the dietary patterns in a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) and under treatment with extended-release methylphenidate (MPH-ER).MATERIAL AND METHODS: A nutrition survey (food intake recall for three consecutive days) was carried out on 100 patients diagnosed with ADHD and under treatment with MPH-ER, and in 150healthy children (control group). Calorie and nutrient intake, as well as nutrition status, were evaluated and compared in both groups. RESULTS: The mean MPH-ER dose was 1.02 mg/kg/day. Nutritional status in the ADHD group was significantly lower (P < .05) than in control group. The consumption of cereals, meat, pulses and fruits in the control group was significantly higher (P < 0.05) than in ADHD group. Calorie intake in the mid-morning snack, lunch and afternoon snack was significantly higher (P < 0.05) in the control group. Calorie intake at supper was significantly higher (P < 0.05) in the ADHD group. Total calorie intake, as well as protein, carbohydrates, fat, fibre, calcium, iron, magnesium, zinc, selenium and phosphorous, thiamine, niacin, vitamin B6 and folate intake in the control group was significantly higher than in ADHD group. CONCLUSIONS: Treatment with MPH-ER substantially modifies the percentage distribution of calorie intake of the different meals. The daily calorie and nutrients intake in patients under treatment with MPH-ER is, generally, lower than in the healthy population of a similar age. Nutrition education should be provided, along with multimodal treatment, to the patients and/or their families

[Dietary patterns in patients with attention deficit hyperactivity disorder]. / Modelo dietético en pacientes con déficit de atención e hiperactividad.

OBJECTIVE: To evaluate the dietary patterns in a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) and under treatment with extended-release methylphenidate (MPH-ER). MATERIAL AND METHODS: A nutrition survey (food intake recall for three consecutive days) was carried out on 100 patients diagnosed with ADHD and under treatment with MPH-ER, and in 150 healthy children (control group). Calorie and nutrient intake, as well as nutrition status, were evaluated and compared in both groups. RESULTS: The mean MPH-ER dose was 1.02 mg/kg/day. Nutritional status in the ADHD group was significantly lower (P < .05) than in control group. The consumption of cereals, meat, pulses and fruits in the control group was significantly higher (P < .05) than in ADHD group. Calorie intake in the mid-morning snack, lunch and afternoon snack was significantly higher (P < .05) in the control group. Calorie intake at supper was significantly higher (P < .05) in the ADHD group. Total calorie intake, as well as protein, carbohydrates, fat, fibre, calcium, iron, magnesium, zinc, selenium and phosphorous, thiamine, niacin, vitamin B6 and folate intake in the control group was significantly higher than in ADHD group. CONCLUSIONS: Treatment with MPH-ER substantially modifies the percentage distribution of calorie intake of the different meals. The daily calorie and nutrients intake in patients under treatment with MPH-ER is, generally, lower than in the healthy population of a similar age. Nutrition education should be provided, along with multimodal treatment, to the patients and/or their families.

Evolución natural del exceso de peso corporal (sobrepeso y obesidad) / Natural evolution of excess body weight (overweight and obesity) in children

Objetivo: Analizar la evolución cronológica del exceso de peso corporal (sobrepeso y obesidad) para sensibilizar a los diferentes ámbitos de intervención (familiar, escolar, empresarial y sanitario) a adoptar las medidas oportunas. Material y métodos: Se han registrado retrospectivamente pesos, tallas e índice de masa corporal (IMC) de 604 sujetos sanos (307 varones y 297 mujeres) al nacimiento y a las edades de 1, 2, 3, 4, 6, 8, 10, 12 y 14 años. Se ha calculado el exceso de peso corporal con las referencias nacionales de Ferrández et al. Resultados: La prevalencia del exceso de peso corporal a los 14 años de edad era significativamente superior (p < 0,05) en los varones (29%) respecto a las mujeres (12,8%). En ambos sexos, el IMC (kg/m2) era significativamente superior (p < 0,05) en cada una de las edades consideradas, salvo al nacimiento y al año de edad, en los pacientes con exceso de peso corporal a los 14 años de edad respecto al grupo normonutrido a la misma edad. En los grupos que a los 14 años tenían exceso de peso corporal, el IMC (Z-score) ya alcanzaba rango de sobrepeso u obesidad a los 4 años de edad, que se iría incrementando progresivamente. Conclusiones: El exceso de peso corporal comenzaría en edades tempranas de la vida, cuando la dieta del niño depende casi exclusivamente de los hábitos familiares, que luego se agravaría con la escolarización y, por último, en la adolescencia tendría lugar un desproporcionado incremento ponderal probablemente relacionado con unos hábitos alimentarios y estilos de vida adquiridos poco saludables (AU)

Objective: To analyze the chronological evolution of excess body weight (overweight and obesity)in order to raise public awareness within the different areas of intervention (family, school, business environment, health services) and to take effective actions. Material and methods: Weight, height and body mass index (BMI) of 604 healthy subjects (307males and 297 females) have been recorded at birth and at the age of 1, 2, 3, 4, 6, 8, 10, 12 and14 years. The excess body weight has been calculated according to national references from Ferrández et al. Results: Prevalence of excess body weight at age 14 years was significantly higher (P<.05) in males (29%) than in females (12.8%). BMI (kg/m2) was significantly higher (P<.05) for both sexes in every age period, except for birth and age 1 year, in those patients with excess body weight at age 14, with respect to patients with normal nutritional status of the same age. Those groups with excess body weight at age 14 showed a BMI (Z-score) reaching overweight or obesity levels at age 4, and progressively increasing. Conclusions: Excess body weight probably starts at early stages in life, when dietary habits of the child depends almost exclusively on family habits, and may be aggravated during school attendance. Finally, a disproportionate weight increase occurs in adolescence that is probably related to unhealthy dietary habits and way of life (AU)

Análisis nutricional del desayuno y almuerzo en una población universitaria / Nutritional analysis of breakfast on rising and mid-morning snack in a college population

Objetivo: Realizar un estudio descriptivo del modelo de desayuno de una población universitaria y analizar su aporte energético y de nutrientes en relación con los requerimientos nutricionales establecidos. Material y métodos: Registro de consumo de alimentos durante la mañana (desayuno/almuerzo) de un día lectivo a una muestra de 740 universitarios (286 varones y 454 mujeres) con edades comprendidas entre 18 y 25 años. De cada encuestado se registraba sexo, edad, peso, talla e índice de masa corporal y tipo de residencia. Se han calculado las ingestas porcentuales de nutrientes en relación con las ingestas recomendadas (%IR). Resultados: El 98,6% desayunaba y el 54,2% almorzaba diariamente, y el 53.5% realizaba ambas ingestas. Lácteos (92,6%), cereales (58,8%) y dulces (57,9%) en el desayuno, y cereales (46,6%), frutas (40,7%) y embutidos (34,9%) en el almuerzo eran los alimentos más habituales. El %IR de la ingesta calórica (desayuno/almuerzo) era del 24,4% en varones y del 24,6% en mujeres (NS). El %IR de la ingesta de colesterol (desayuno:/almuerzo) era de 38,2% en varones y del 23,9% en mujeres (p < 0,05). En el desayuno los %IR de minerales y vitaminas eran significativamente superiores (p < 0,05) respecto a los del almuerzo. Conclusiones: Este modelo de desayuno/almuerzo difería del prototipo dietético saludable con un consumo excesivo de dulces, bollería y repostería (desayuno) y carnes y derivados (almuerzo). La mitad de los encuestados no almorzaban y su ingesta calórica matutina estaba por debajo de lo recomendado. Tratándose de estudiantes universitarios inquieta el efecto potencialmente negativo que pudiera tener sobre el rendimiento académico (AU)

GOAL: To carry out a descriptive study on the breakfast model in a college population and to analyze the energy and nutrients provided, in connection with established nutritional requirements. MATERIAL AND METHODS: Registry of food intake for breakfast (on rising and mid-morning snack) of a school day in a sample of 740 collegestudents (286 men and 454 women) with ages ranging 19-24 years. Gender, age, weight, height, and body mass index, and type of residence were collected from each interviewee. Percentages intakes of nutrients have been calculated in proportion to established dietary recommendations (%IR).RESULTS:93.2% had breakfast on rising and 83.8% took a mid-morning snack daily, and 53.5% do both intakes. The most common foods were dairy products (92.6%), cereals (58.8%) and sweet food (57.9%) at breakfast, and cereals (46.6%), fruits (40.7%) and sausages (34.9%) at mid-morning. The %IR of the calorie intake was 24.4% in males and 24.6% in females (n.s.). The %IR of the cholesterol intake was 38.2% in males and 23.9% in females (p < 0.05). The %IR for minerals and vitamins were greater (p < 0.05) in early breakfast. CONCLUSIONS:This breakfast model differs from the prototype of a healthy diet through an excessive consumption of sweet foods (early breakfast) and meat and derivatives (snack). Half of interviewee did not a mid-morning snack and the morning caloric intake was below recommended. In the case of university students concerned about the potentially negative effect it may have on academic performance (AU)

[Nutritional analysis of breakfast on rising and mid-morning snack in a college population]. / Análisis nutricional del desayuno y almuerzo en una población universitaria.

GOAL: To carry out a descriptive study on the breakfast model in a college population and to analyze the energy and nutrients provided, in connection with established nutritional requirements. MATERIAL AND METHODS: Registry of food intake for breakfast (on rising and mid-morning snack) of a school day in a sample of 740 college students (286 men and 454 women) with ages ranging 19-24 years. Gender, age, weight, height, and body mass index, and type of residence were collected from each interviewee. Percentages intakes of nutrients have been calculated in proportion to established dietary recommendations (%IR). RESULTS: 93.2% had breakfast on rising and 83.8% took a mid-morning snack daily, and 53.5% do both intakes. The most common foods were dairy products (92.6%), cereals (58.8%) and sweet food (57.9%) at breakfast, and cereals (46.6%), fruits (40.7%) and sausages (34.9%) at mid-morning. The %IR of the calorie intake was 24.4% in males and 24.6% in females (n.s.). The %IR of the cholesterol intake was 38.2% in males and 23.9% in females (p < 0.05). The %IR for minerals and vitamins were greater (p < 0.05) in early breakfast. CONCLUSIONS: This breakfast model differs from the prototype of a healthy diet through an excessive consumption of sweet foods (early breakfast) and meat and derivatives (snack). Half of interviewee did not a mid-morning snack and the morning caloric intake was below recommended. In the case of university students concerned about the potentially negative effect it may have on academic performance.

Objetivo: Realizar un estudio descriptivo del modelo de desayuno de una población universitaria y analizar su aporte energético y de nutrientes en relación con los requerimientos nutricionales establecidos. Material y métodos: Registro de consumo de alimentos durante la mañana (desayuno/almuerzo) de un día lectivo a una muestra de 740 universitarios (286 varones y 454 mujeres) con edades comprendidas entre 18 y 25 años. De cada encuestado se registraba sexo, edad, peso, talla e índice de masa corporal y tipo de residencia. Se han calculado las ingestas porcentuales de nutrientes en relación con las ingestas recomendadas (%IR). Resultados: El 98,6% desayunaba y el 54,2% almorzaba diariamente, y el 53.5% realizaba ambas ingestas. Lácteos (92,6%), cereales (58,8%) y dulces (57,9%) en el desayuno, y cereales (46,6%), frutas (40,7%) y embutidos (34,9%) en el almuerzo eran los alimentos más habituales. El %IR de la ingesta calórica (desayuno/almuerzo) era del 24,4% en varones y del 24,6% en mujeres (NS). El %IR de la ingesta de colesterol (desayuno:/almuerzo) era de 38,2% en varones y del 23,9% en mujeres (p < 0,05). En el desayuno los %IR de minerales y vitaminas eran significativamente superiores (p < 0,05) respecto a los del almuerzo. Conclusiones: Este modelo de desayuno/almuerzo difería del prototipo dietético saludable con un consumo excesivo de dulces, bollería y repostería (desayuno) y carnes y derivados (almuerzo). La mitad de los encuestados no almorzaban y su ingesta calórica matutina estaba por debajo de lo recomendado. Tratándose de estudiantes universitarios inquieta el efecto potencialmente negativo que pudiera tener sobre el rendimiento académico.

[Natural evolution of excess body weight (overweight and obesity) in children]. / Evolución natural del exceso de peso corporal (sobrepeso y obesidad).

OBJECTIVE: To analyze the chronological evolution of excess body weight (overweight and obesity) in order to raise public awareness within the different areas of intervention (family, school, business environment, health services) and to take effective actions. MATERIAL AND METHODS: Weight, height and body mass index (BMI) of 604 healthy subjects (307 males and 297 females) have been recorded at birth and at the age of 1, 2, 3, 4, 6, 8, 10, 12 and 14 years. The excess body weight has been calculated according to national references from Ferrández et al. RESULTS: Prevalence of excess body weight at age 14 years was significantly higher (P<.05) in males (29%) than in females (12.8%). BMI (kg/m2) was significantly higher (P<.05) for both sexes in every age period, except for birth and age 1 year, in those patients with excess body weight at age 14, with respect to patients with normal nutritional status of the same age. Those groups with excess body weight at age 14 showed a BMI (Z-score) reaching overweight or obesity levels at age 4, and progressively increasing. CONCLUSIONS: Excess body weight probably starts at early stages in life, when dietary habits of the child depends almost exclusively on family habits, and may be aggravated during school attendance. Finally, a disproportionate weight increase occurs in adolescence that is probably related to unhealthy dietary habits and way of life.

[Are they valid Spanish growth reference charts?]. / ¿Son válidas las curvas y tablas de crecimiento españolas actuales?

OBJECTIVE: To modify the results of the longitudinal study on growth in Navarra (NA 09) by censoring the obesity cases from the population sample as well as to perform a comparative analysis with the most qualified Spanish and international growth curves. MATERIALS AND METHODS: all the cases with obesity according to Cole et al. standards have been censored out of the 930 participants in NA-09, the final sample being 782 participants (371 males and 411 females). The results obtained were compared with the Spanish studies by Serra-Majem et al. (enKid study), Carrascosa et al. (ESP 08), and NA 09, which do not censor the obesity cases, and with the Centers for Disease Control and Prevention (CDC, 2000) table, and the WHO tables (WHO, 2007) that apply depuration criteria of the poorly healthy anthropometric data (obesity and malnutrition). RESULTS: We present the mean values adjusted by height, weight, and BMI with their percentile distribution for both genders. When comparing with the Spanish studies, we observe that the evolutionary values of the 3d and 50th percentiles for height, weight, and BMI are virtually the same; however, the evolutionary values for the 97th percentile for weight and BMI tend to differ more and more. When comparing them to the international standards, the evolutionary values for the 3d, 50th, and 97th percentiles for BMI lay between both references. CONCLUSIONS: for the growth curves and tables to be useful as reference patterns, all obese people should be excluded from their elaboration; otherwise, they should be considered as only descriptive studies of a population with a recognized tendency to excessive body weight and thus their clinical applicability would be put in question.

¿Son válidas las curvas y tablas de crecimiento españolas actuales? / Are they valid Spanish growth reference charts?

Objetivo: Modificar los resultados del Estudio longitudinal del crecimiento en Navarra (NA 09) mediante la exclusión en la muestra poblacional de los casos de obesidad; así como realizar un análisis comparativo con las curvas de crecimiento españolas e internacionales más cualificadas. Material y métodos: De los 930 participantes del NA-09 se han excluido todos los casos de obesidad según los estándares de Cole et al., siendo la muestra definitiva de 782 participantes (371 varones y 411 mujeres). Los resultados obtenidos se comparan con los estudios españoles de Serra-Majem et al (estudio enKid), Carrascosa et al (ESP 08) y NA 09, que no excluyen los casos de obesidad; así como, con las tablas del Center for Disease Control and Prevention (CDC, 2000) y de la OMS (WHO, 2007) que aplican criterios de depuración de valores antropométricos poco saludables (obesidad y malnutrición). Resultados: Se exponen los valores medios modificados de la talla, peso e IMC con su distribución percentilada, en ambos sexos. Al compararlos con los estudios españoles se observa que los valores evolutivos de los percentiles 3 y 50 correspondientes a la talla, peso e IMC son prácticamente similares; sin embargo, los valores evolutivos del percentil 97 correspondientes al peso e IMC se van distanciando progresivamente. Al compararlos con los estándares internaciones los valores evolutivos de los percentiles 3, 50 y 97 correspondientes al IMC se intercalaban entre ambas referencias. Conclusiones: Para que las curvas y tablas de crecimiento puedan servir como patrones de referencia convendría también excluir en su elaboración a todos los pacientes con obesidad; ya que, de otra manera, podrían llegar a considerarse como estudios meramente descriptivos de una población con una reconocida tendencia al exceso de peso corporal y, por tanto, su aplicabilidad clínica quedaría en entredicho (AU)

Objective: To modify the results of the longitudinal study on growth in Navarra (NA 09) by censoring the obesity cases from the population sample as well as to perform a comparative analysis with the most qualified Spanish and international growth curves. Materials and methods: all the cases with obesity according to Cole et al. standards have been censored out of the 930 participants in NA-09, the final sample being 782 participants (371 males and 411 females). The results obtained were compared with the Spanish studies by Serra-Majem et al. (enKid study), Carrascosa et al. (ESP 08), and NA 09, which do not censor the obesity cases, and with the Centers for Disease Control and Prevention (CDC, 2000) table, and the WHO tables (WHO, 2007) that apply depuration criteria of the poorly healthy anthropometric data (obesity and malnutrition). Results: We present the mean values adjusted by height, weight, and BMI with their percentile distribution for both genders. When comparing with the Spanish studies, we observe that the evolutionary values of the 3d and 50th percentiles for height, weight, and BMI are virtually the same; however, the evolutionary values for the 97th percentile for weight and BMI tend to differ more and more. When comparing them to the international standards, the evolutionary values for the 3d, 50th, and 97th percentiles for BMI lay between both references. Conclusions: for the growth curves and tables to be useful as reference patterns, all obese people should be excluded from their elaboration; otherwise, they should be considered as only descriptive studies of a population with a recognized tendency to excessive body weight and thus their clinical applicability would be put in question (AU)

Magnetic resonance imaging abnormalities in children with epilepsy.

BACKGROUND AND PURPOSE: The aim of this study is to analyze the proportional distribution of epilepsy and epileptic syndromes in children and to describe the magnetic resonance imaging (MRI) abnormalities found in these patients. METHODS: Data from 457 children aged 1 month to 15 years at the time of diagnosis of epilepsy were recorded. A routine MRI has been requested in all patients with epilepsy at diagnosis according to a standardized pediatric seizure protocol. Abnormalities on MRI were classified as either significant or non-significant (standardized scoring system). International League Against Epilepsy criteria were used for diagnoses. RESULTS: The prevalence of significant MRI abnormalities was 21.9% (in infants 42.3%, in childhood 18.2%, and in adolescents 15.9%). The most common abnormalities included white-matter lesions (27.6%), volume loss (19.6%), gray-matter lesions (19.6%), and ventricular enlargement (12%). CONCLUSIONS: The use of MRI and a reliable standardized scoring system at diagnosis of epilepsy in children identified a high rate of significant abnormalities findings. This may have important implications for practice guidelines in this population.

[Adherence to a Mediterranean diet in a college population]. / Adherencia a la dieta Mediterránea en la población universitaria.

OBJECTIVE: To determine the adherence to the Mediterranean diet of a university population and to analyze several factors that may condition its nutritional quality. MATERIAL AND METHODS: Distribution of the Kidmed test to a random sample of 570 university students. The Kidmed index (0-12) indicated whether the adherence to the Mediterranean diet was low (0-3), intermediate (4-7) or high (8-12). The gender, age, weight, height, and body mass index were gathered from each participant, as well as the type of residence and the province of origin. RESULTS: The sample comprised 217 men and 353 women aged 18-25 years. 9.5% of the university students had a low Kidmed index, 62.1% intermediate, and 28.4% high. Those students living at their parental home had a high percentage of adherence (35.6%), significantly higher (p < 0.05) to that of those living at a student's residence (11.1%) or at a student's apartment (11.2%). Overweighed students had a low percentage of adherence (15.5%), significantly higher (p < 0.05) to those with a normal nutritional situation (8.5%). CONCLUSIONS: 71.6% of university students need to improve their dietary pattern (low to intermediate adherence to the Mediterranean diet), and we could observe a certain family factor of preservation of the traditional dietary habits. Those university students with low adherence had a higher risk for being overweighed. It would be convenient to develop nutritional education programs in the university curricula.

Nutrición y trastorno por déficit de atención/hiperactividad: seguimiento evolutivo de las variables antropométricas de un grupo de pacientes en tratamiento con metilfenidato de liberación osmótica / Nutrition and attention deficit hyperactivity disorder: developmental follow-up of the anthropometric variables of a group of patients receiving treatment with osmotic controlled-release methylphenidate

Objetivo. Realizar un análisis evolutivo de las variables antropométricas de un grupo de pacientes diagnosticados de trastorno por déficit de atención/hiperactividad (TDAH) para determinar la repercusión del tratamiento con metilfenidato de liberación osmótica (MTF-OROS). Pacientes y métodos. Se han revisado retrospectivamente las historias clínicas de 187 pacientes con TDAH en tratamiento con MTF-OROS durante 30 meses, registrándose los pesos y tallas e índice de masa corporal al diagnóstico (basal) y a los 6, 12, 18, 24 y 30 meses de seguimiento. Resultados. La edad media al diagnóstico era de 8,14 ± 1,6 años. La dosis de MTF-OROS fue incrementándose progresivamente hasta 36,9 ± 12,1 mg/día (1,05 mg/kg/día) a los 30 meses del seguimiento. Al diagnóstico, el 34,9% de los pacientes tenía una situación nutricional deficiente (subnutrición o malnutrición), que a los 30 meses de tratamiento afectaba al 50,3% de los pacientes. El valor basal del peso (Z-score) disminuía progresivamente durante el tratamiento, llegando a alcanzar unos valores significativamente inferiores (p < 0,05) respecto al valor basal a los 12 meses, y se mantenía significativamente inferior hasta los 30 meses. El valor basal de la talla (Z-score) también disminuía progresivamente durante el tratamiento, llegando a alcanzar unos valores significativamente inferiores (p < 0,05) respecto al valor basal a los 24 y 30 meses. Conclusiones. En el momento del diagnóstico de TDAH, uno de cada tres pacientes se hallaba en una situación nutricional deficiente (subnutrición o malnutrición). El tratamiento continuado con MTF-OROS durante 30 meses ejerce una influencia negativa sobre la talla, que posiblemente podría atenuarse mejorando la nutrición de los pacientes (AU)

Aim. To perform a developmental analysis of the anthropometric variables of a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) in order to determine the repercussions of treatment with osmotic controlled-release methylphenidate (MTF-OROS). Patients and methods. The medical records of 187 patients with ADHD under treatment with MTF-OROS over a period of 30 months were reviewed. Data collected included weight, height and body mass index at diagnosis (baseline) and at 6, 12, 18, 24 and 30 months’ follow-up. Results. The mean age at diagnosis was 8.14 ± 1.6 years. The dose of MTF-OROS was progressively increased until 36.9 ± 12.1 mg/day (1.05 mg/kg/day) at day 30 of the follow-up. At diagnosis, 34.9% of patients had a deficient nutritional situation (subnutrition or malnutrition), which affected 50.3% of the patients at 30 months. The baseline value for weight (Z-score) progressively decreased during treatment until values that were significantly lower than the baseline value at 12 months were reached (p < 0.05); these values remained significantly lower until 30 months. The baseline value for height (Z-score) also progressively decreased during treatment until values that were significantly lower than the baseline value at 24 and 30 months were reached (p < 0.05). Conclusions. At the time they were diagnosed with ADHD, one out of every three patients was in a deficient nutritional situation (subnutrition or malnutrition). Continued treatment with MTF-OROS for 30 months had a negative influence on height, which could perhaps be attenuated by improving the patients’ nutrition (AU)

[Nutrition and attention deficit hyperactivity disorder: developmental follow-up of the anthropometric variables of a group of patients receiving treatment with osmotic controlled-release methylphenidate]. / Nutricion y trastorno por deficit de atencion/hiperactividad: seguimiento evolutivo de las variables antropometricas de un grupo de pacientes en tratamiento con metilfenidato de liberacion osmotica.

AIM: To perform a developmental analysis of the anthropometric variables of a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) in order to determine the repercussions of treatment with osmotic controlled-release methylphenidate (MTF-OROS). PATIENTS AND METHODS: The medical records of 187 patients with ADHD under treatment with MTF-OROS over a period of 30 months were reviewed. Data collected included weight, height and body mass index at diagnosis (baseline) and at 6, 12, 18, 24 and 30 months' follow-up. RESULTS: The mean age at diagnosis was 8.14 ± 1.6 years. The dose of MTF-OROS was progressively increased until 36.9 ± 12.1 mg/day (1.05 mg/kg/day) at day 30 of the follow-up. At diagnosis, 34.9% of patients had a deficient nutritional situation (subnutrition or malnutrition), which affected 50.3% of the patients at 30 months. The baseline value for weight (Z-score) progressively decreased during treatment until values that were significantly lower than the baseline value at 12 months were reached (p < 0.05); these values remained significantly lower until 30 months. The baseline value for height (Z-score) also progressively decreased during treatment until values that were significantly lower than the baseline value at 24 and 30 months were reached (p < 0.05). CONCLUSIONS: At the time they were diagnosed with ADHD, one out of every three patients was in a deficient nutritional situation (subnutrition or malnutrition). Continued treatment with MTF-OROS for 30 months had a negative influence on height, which could perhaps be attenuated by improving the patients' nutrition.

Adherencia a la dieta mediterránea en la población universitaria / Adherence to a Mediterranean diet in a college population

Objetivo: Determinar la adherencia a la dieta mediterránea de una población universitaria y analizar diversos factores que pudieran condicionar su calidad nutricional. Material y métodos: Distribución del test kidmed a una muestra aleatoria de 570 universitarios. El índice kidmed (de 0 a 12) indicaba si la adherencia a la dieta mediterránea era baja (de 0 a 3), media (de 4 a 7) o alta (de 8 a 12).De cada encuestado se registraba sexo, edad, peso, talla e índice de masa corporal, tipo de residencia y provincia de procedencia. Resultados: La muestra era de 217 varones y 353 mujeres con edades entre 18 y 25 años. El 9,5% de los universitarios tenían un índice kidmed bajo, el 62,1% intermedio y el 28,4% alto. Aquellos universitarios que vivían en residencia familiar tenían un porcentaje de alta adherencia(35,6%) significativamente superior (p < 0,05) a los que vivían en colegio mayor (11,1%) o piso de estudiantes(11,2%). Los universitarios con sobrepeso tenían un porcentaje de baja adherencia (15,5%) significativamente superior (p < 0,05) a los que tenían una situación nutricional normal (8,5%). Conclusiones: El 71,6% de los universitarios necesitaban mejorar su patrón alimentario (adherencia media baja a la dieta mediterránea), apreciándose un cierto factor familiar conservador de las costumbres dietéticas tradicionales. Los universitarios con baja adherencia tenían mayor riesgo de sobrepeso. Seria conveniente desarrollar programas de educación nutricional en los curriculum universitarios (AU)

Objective: To determine the adherence to the Mediterranean diet of a university population and to analyze several factors that may condition its nutritional quality. Material and methods: Distribution of the Kidmed test to a random sample of 570 university students. The Kidmed index (0-12) indicated whether the adherence to the Mediterranean diet was low (0-3), intermediate (4-7) or high (8-12). The gender, age, weight, height, and body mass index were gathered from each participant, as well as the type of residence and the province of origin. Results: The sample comprised 217 men and 353 women aged 18-25 years. 9.5% of the university students had a low Kidmed index, 62.1% intermediate, and 28.4%high. Those students living at their parental home had a high percentage of adherence (35.6%), significantly higher (p < 0.05) to that of those living at a student’s residence(11.1%) or at a student’s apartment (11.2%). Overweighed students had a low percentage of adherence(15.5%), significantly higher (p < 0.05) to those with a normal nutritional situation (8.5%).Conclusions: 71.6% of university students need to improve their dietary pattern (low to intermediate adherence to the Mediterranean diet), and we could observe a certain family factor of preservation of the traditional dietary habits. Those university students with low adherence had a higher risk for being overweighed. It would be convenient to develop nutritional education programs in the university curricula (AU)

Infantile convulsions with mild gastroenteritis: a retrospective study of 25 patients.

BACKGROUND: The aim of this study was to analyze the epidemiologic, clinical, and evolutional characteristics in patients who presented convulsions with mild gastroenteritis (CwG) to facilitate the diagnosis in daily clinical practice. METHODS: Twenty-five medical records of patients diagnosed with CwG were reviewed, and the epidemiological and clinical features, results of complementary studies, and evolutional data were collected. RESULTS: Age of onset ranged between 12 and 24 months in 76% of patients. Female/male ratio was 2.6 (18 women and seven men). Seizures were mostly brief (<5 min) and apparently generalized, and often repetitive occurring in cluster (2.2 seizures per episode). One patient with status epilepticus was recorded. The average interval between the onset of gastroenteritis and seizures was 3.8 days, even though seizure preceded diarrhea in three cases. Mean rectal temperature at the moment of seizure was 37.1°C. Rotavirus antigen was positive in stool in 17 episodes (55.8%). There were no abnormalities in serum biochemistry tests and cerebrospinal fluid studies. Four patients showed anomalies in the interictal electroencephalogram. The period of follow-up was 4.2 years. Five patients (20%) experienced recurrences when suffering a new gastroenteritis episode. One patient developed epilepsy during the follow-up period. CONCLUSIONS: CwG would constitute a well-differentiated convulsive syndrome. Prognosis is excellent, but a relatively important percentage of patients relapse when suffering a new diarrhea episode.