[Relationship between lipid profile and body mass index. Five-year follow-up in children aged 6-11 years old. The Rivas-Vaciamadrid study]. / Relación entre el perfil lipídico y el índice de masa corporal. Seguimiento de los 6 a los 11 años. Estudio Rivas-Vaciamadrid.

BACKGROUND: To study the relationship between lipid profile and body mass index (BMI) in children after a 5-year follow-up. METHOD: A total of 281 children were evaluated at the ages of 6 and 11 years. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and apoproteins A1 (Apo A) and B100 (Apo B) were measured. Low-density lipoprotein cholesterol (LDL-C) was determined and the Apo B/Apo A, TC/HDL-C, LDL-C/HDL-C indexes, and the atherogenic index were calculated. BMI was also calculated (BMI 5 kg/m2). Evolution parameters were calculated (EVO 5 value 11 years - value 6 years). Associations between BMI and lipid profile were studied. RESULTS: The prevalence of obesity (according to the criteria of the International Obesity Task Force) was 4.98 % (6 years) and 16,72 % (11 years). In children who were in the fourth BMI quartile at the age of 11 years, LDL-C/HDL-C and TC/HDL-C levels were significantly higher and than those in children in the first quartile but HDL-C and Apo A levels were lower. A significant positive correlation was found between the evolution of BMI and the four indexes studied and TG, but this correlation was negative for HDL-C and Apo A. The evolution of the indexes was positive in 11-year-old obese children and negative in nonobese children. CONCLUSIONS: Lipid profile was worse in 11-year-old children in the fourth BMI quartile than in the remaining children. Obese children had higher values of the indexes studied, supporting the importance of obesity as a cardiovascular risk factor.

Relación entre el perfil lipídico y el índice de masa corporal. Seguimiento de los 6 a los 11 años. Estudio Rivas-Vaciamadrid / Relationship between lipid profile and body mass index. Five-year follow-up in children aged 6-11 years old. The Rivas-Vaciamadrid study

Antecedentes Estudiar la relación entre perfil lipídico e índice de masa corporal en niños tras un seguimiento de 5 años. Método Se estudiaron 281 niños a los 6 y 11 años. Se midió el colesterol total (CT), triglicéridos (TG), colesterol de las lipoproteínas de alta densidad (c-HDL) y apoproteínas A1 (Apo A) y B100 (Apo B). Se calculó el colesterol de las lipoproteínas de baja densidad (c-LDL) e índices Apo B/Apo A, CT/c-HDL, c-LDL/c-HDL y aterogénico. La evolución de los parámetros se calculó: valor a los 11 años-valor a los 6. Se calculó el índice de masa corporal (IMC 5 kg/m 2) y se estudió su relación con el perfil lipídico. Resultados La prevalencia de obesidad (según criterios del International Obesity Task Force) fue del 4,98 % (6 años) y del 16,72 % (11 años). A los 11 años, existen valores significativamente más altos de CT/c-HDL, c-LDL/c-HDL y más bajos de c-HDL y Apo A en niños del cuarto cuartil de IMC. Se encontró una correlación significativa positiva entre la evolución del IMC y la de los 4 índices estudiados y los TG, y negativa para c-HDL y Apo A. La evolución de los índices estudiados presentó un valor positivo en los niños obesos a los 11 años y negativo en los no obesos. Conclusiones Existe un peor perfil lipídico en niños que están en el cuarto cuartil de IMC a los 11 años, así como un aumento de los índices estudiados en niños obesos reforzando el papel de la obesidad como factor de riesgo cardiovascular

Background To study the relationship between lipid profile and body mass index (BMI) in children after a 5-year follow-up. Method A total of 281 children were evaluated at the ages of 6 and 11 years. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and apoproteins A1 (Apo A) and B100 (Apo B) were measured. Low-density lipoprotein cholesterol (LDL-C) was determined and the Apo B/Apo A, TC/HDL-C, LDL-C/HDL-C indexes, and the atherogenic index were calculated. BMI was also calculated (BMI 5 kg/m 2). Evolution parameters were calculated (EVO 5 value 11 years ­ value 6 years). Associations between BMI and lipid profile were studied. Results The prevalence of obesity (according to the criteria of the International Obesity Task Force) was 4.98 % (6 years) and 16,72 % (11 years). In children who were in the fourth BMI quartile at the age of 11 years, LDL-C/HDL-C and TC/HDL-C levels were significantly higher and than those in children in the first quartile but HDL-C and Apo A levels were lower. A significant positive correlation was found between the evolution of BMI and the four indexes studied and TG, but this correlation was negative for HDL-C and Apo A. The evolution of the indexes was positive in 11-year-old obese children and negative in nonobese children. Conclusions Lipid profile was worse in 11-year-old children in the fourth BMI quartile than in the remaining children. Obese children had higher values of the indexes studied, supporting the importance of obesity as a cardiovascular risk factor

[Lipid profile in children from Rivas-Vaciamadrid. Two-year follow-up]. / Perfil lipídico en niños de Rivas-Vaciamadrid. Seguimiento de 2 años.

AIM: Evaluate the lipid profiles in children after two years of follow-up. METHODS: Longitudinal cohort study. A two years follow-up of a group of children since they were 6 years old. Blood analysis were carried in every children measuring total cholesterol, triglycerides, cLDL, cHDL, apoproteins A and B. It also included TD/cHDL, cLDL/cHDL, Apo B/A ratios and atherogenic index. RESULTS: 200 mg/dl, cLDL > 135 mg/dl and Apo B > 100 mg/dl in the follow-up was of 9.51, 5.18 and 8 for those children who had in the initial study these same values. The values of lipid profile and of the index studied improved in the two years of follow-up. This improvement has an statistical signification only in men. CONCLUSIONS: There is a significant correlation between the values of the lipid profile and the index measured in those children who were six years old in the beginning of the two years follow-up.

Perfil lipídico en niños de Rivas-Vaciamadrid. Seguimiento de 2 años / Lipid profile in Rivas-Vaciamadrid children. Two years follow-up

OBJETIVO: Evaluar el perfil lipídico en niños después de 2 años de seguimiento. MÉTODOS: Se trata de un estudio de cohorte longitudinal. Seguimiento a los 2 años de un grupo de niños estudiados inicialmente a los 6 años de edad. A todos se les determinó en analítica sanguínea el colesterol total, triglicéridos, cLDL, cHDL, apoproteínas A y B, y los índices CT/cHDL, cLDL/cHDL, Apo B/A e índice aterogénico. RESULTADOS: 200 mg/dl, cLDL > 135 mg/dl y Apo B > 100 mg/dl en el seguimiento fue de 9,51, 5,18 y 8 para quienes tenían en el estudio inicial estos mismos valores. Los valores del perfil lipídico y de los índices estudiados fueron mejores en el control a los 2 años, pero sólo tuvieron significación estadística en los varones. CONCLUSIÓN: En los niños que tenían en el estudio inicial 6 años de edad, a los 2 años de seguimiento existe una buena relación entre los valores del perfil lipídico y los índices evaluados (AU)

A longitudinal study of blood pressure in Spanish schoolchildren. Working Group of Cardiovascular Risk Factors in Childhood and Adolescence.

Blood pressure (BP) values and the phenomenon of tracking were evaluated in a group of 481 schoolchildren over a nine year period starting at age 6 years. BP values were obtained yearly by taking the mean of two measurements at one visit, measurements were taken by only two observers during the study. For both systolic and diastolic BP, correlation coefficients between year 9 and previous measurements increased as the year of examination approached year 9, and ranged from 0.79 to 0.81 for systolic BP, and from 0.52 to 0.55 for diastolic BP. For children in the upper quartile of systolic BP at any previous examination, more than 70% remained in the upper quartile at the year 9 examination. More than 90% of children who were not in the upper quartile of systolic BP at any previous examination remained in non-upper quartiles at year 9. This novel longitudinal study of BP in a cohort of Spanish schoolchildren suggests that the degree of tracking of BP during childhood years could be higher than described previously.

Progenitor cell subsets and engraftment kinetics in children undergoing autologous peripheral blood stem cell transplantation.

The main objective of the present study was to determine the role of CD34+ cell subsets in the haemopoietic recovery of children undergoing peripheral blood stem cell transplantation. For this purpose, 38 leukaphereses from 33 children with malignancies mobilized with G-CSF were analysed. Using dual-colour flow cytometry, different subpopulations of CD34+ cells were quantified and the number of each reinfused subsets correlated with haemopoietic resurgence. Multivariate analysis showed that the number of CD34+CD38- cells and CD34+CD38+ cells correlated better with time to neutrophil and platelet recovery, respectively, than the total number of CD34+ cells. Threshold values for rapid haemopoietic recovery, determined by the receiver operating characteristic analysis, were found to be 0.5 X 10(6) CD34+CD38- cells for neutrophil engraftment, and 2.0x10(6) CD34+CD38+ cells for platelet recovery. It is suggested that the analysis of CD34+ cell subsets could increase understanding of the repopulation capacity of a given leukapheresis product in peripheral blood stem cell transplantation procedures in children. In particular, this procedure could be extremely useful when low numbers of CD34+ cells are collected.

Serum lipids and apolipoproteins in Spanish children and adolescents: a 5 year follow-up.

This study was designed to assess "tracking" of serum lipids and apolipoproteins in three age groups of Spanish children over a 5 year period. A total of 84 6-year-old, 89 10-year-old and 64 14-year-old children were evaluated in 1989 (with measurement of serum total cholesterol, triglycerides, lipoproteins and apolipoproteins A1 and B), and re-evaluated in 1994. Correlation coefficients between initial and final lipid and apolipoprotein values were as follows: total cholesterol, 0.66; low-density lipoprotein (LDL) cholesterol, 0.65; high-density lipoprotein (HDL) cholesterol, 0.61; triglycerides, 0.61; apolipoprotein A1, 0.60; apolipoprotein B, 0.66. When age groups were analysed separately, children who were 14 years old at the beginning of the study showed higher correlation coefficients, particularly for total cholesterol and LDL cholesterol ( > 0.7 in both cases). More than 70% of children who were in the top quintile of total, LDL or HDL cholesterol as well as apolipoprotein A1 or B in 1989 remained in the top quintile 5 years later.

Relations between nutrient intake and serum lipid and apolipoprotein levels.

OBJECTIVE: To study the relation between diet and serum lipid and apolipoprotein levels in a large, homogeneous group of Spanish children. DESIGN: Survey. SETTING: Eleven schools chosen at random in Madrid City and the surrounding area. SUBJECTS AND METHODS: Subjects comprised 1682 children, 2 to 12 years of age. Dietary data were obtained with a 24-hour record performed by the child's main caregiver. For statistical analysis the sample was divided into tertiles on the basis of calorie-adjusted consumption of dietary components. RESULTS: Children in the highest tertile of total fat consumption, compared with children in the lowest tertile, had significantly higher mean serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I (Apo A) and apolipoprotein B-100 (Apo B). When compared with children in the lowest tertile, children in the highest tertile of saturated fat consumption had significantly higher mean levels of TC, LDL-C, and Apo B, and lower mean levels of HDL-C and Apo A. Children in the highest tertile of monounsaturated fat consumption, compared with children in the lowest tertile, had significantly higher mean levels of HDL-C and Apo A, and lower mean levels of TC, LDL-C, and Apo B. CONCLUSIONS: Our findings suggest that diet composition strongly influences lipid profile in children and point out the importance of monounsaturated fatty acids as modulators of serum lipid and apolipoprotein levels.

Diet therapy for hypercholesterolemia in children and adolescents. A follow-up.

OBJECTIVE: To determine the effectiveness and compliance of dietary restriction in a group of children and adolescents with hypercholesterolemia. RESEARCH DESIGN: Prospective clinical trial. SETTING: Pediatric hospital in Madrid, Spain. PARTICIPANTS: Four hundred fifty-one children and adolescents of both sexes aged 2 to 18 years diagnosed as having hypercholesterolemia and treated with dietary restriction (American Heart Association Step-One and Step-Two Diets). The follow-up period ranged from 6 months to 2 years and was performed by one pediatrician. RESULTS: Total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B-100 levels as well as the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio decreased significantly (P < .01) from the first month of dietary restriction, whereas the high-density lipoprotein cholesterol level increased (P < .01). The apolipoprotein A-I level increased significantly (P < .01) only after 6 months of diet therapy. After 12 months of follow-up, 30.7% (58/189) of patients did not follow the diet strictly. In this group, significantly higher levels of total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B-100 were found. CONCLUSIONS: Diet therapy is effective in the treatment of hypercholesterolemia in children and adolescents. Dietary restriction has a beneficial effect not only on total cholesterol and low-density lipoprotein cholesterol levels but also on apolipoprotein A-I and B-100 levels.

Is a parental history of coronary arterial disease in children as discriminating as their lipoprotein profile? Niño Jesus Group.

The relationship between hyperlipidemia and a parental history of heart attack and other related disorders was studied in 2224 two- to 18-yr-old children in Madrid (Spain). Children were divided into three groups: those with a parental history of heart attack (first group), a parental history of stroke, hypertension, diabetes mellitus or hypercholesterolemia (second group), and no parental history of disease (third group). The number of children with higher than normal levels of total cholesterol (greater than 200 mg/dl), LDL-cholesterol (greater than 135 mg/dl) and/or apolipoprotein B100 (greater than 75 mg/dl) was significantly higher in the first and second group (positive parental history) than in the third (no parental history). Children and adolescents with a parental history of heart attack (first group) had significantly higher mean levels of total cholesterol and LDL-cholesterol; in the 2- to 13-yr age group a significantly higher level of apolipoprotein B was also found. Children and adolescents belonging to the second group had a significantly higher level of LDL-cholesterol, and a significantly higher level of apolipoprotein B was also found in the 2- to 13-yr age group. However, only 15% of children with hypercholesterolemia had a parental history of heart attack or other related disorders. This percentage was 41% when second-degree relatives were included in the family history. We conclude that a parental history is not enough to detect children with an abnormal lipid profile who might be at risk for early development of coronary arterial disease.

Smoking and apolipoproteins in adolescents. The Niño Jesus Group.

The relation between smoking and blood lipids and apolipoproteins (A1,B100) were studied in a group of 1024 12- to 18-year-old school children in the Comunidad de Madrid. The percentage of smokers was 19% (17% for girls and 21% for boys). The average consumption of cigarettes per day was 7.83 +/- 5.06 in boys and 6.04 +/- 3.49 in girls (p less than 0.05). As compared with male nonsmokers, male smokers showed a higher mean level of low-density lipoprotein (LDL) cholesterol (112 versus 100 mg/dL, p less than 0.05), a higher LDL cholesterol to HDL-cholesterol ratio (2.27 versus 1.94, p less than 0.001), a higher mean level of apolipoprotein B100 (59 versus 53 mg/dL, p less than 0.05), and a higher apolipoprotein B100 to apolipoprotein A1 ratio (0.45 versus 0.40, p less than 0.01). Female smokers tended to show the same results, although significant differences were only found for LDL cholesterol to HDL cholesterol ratio and apolipoprotein B100 to apolipoprotein A1 ratio (1.8 versus 1.59 and 0.41 versus 0.38 respectively, both p less than 0.05). This work provides new data about the effects of smoking on apolipoproteins in adolescents and emphasizes on the need for preventive programs.

[Pediatric primary care seen through a hospital emergency service]. / La asistencia primaria pediátrica vista a través de un servicio de urgencias hospitalario.

We have studied the procedures for taking care of the 1,044 patients who arrived in the Emergency Room at the Niño Jesus Hospital on weekday mornings, in order to evaluate the operation of primary pediatric care as the possible generator of the demand for emergency hospital care. We also took into account the motivations which the parents of the children gave for not having gone to their doctors. The diagnosis and/or prior treatment were considered adequate in 83.81% of cases, and in 64.63% of cases in which these were known for a fact. 35.7% of the children were periodically checked out by their doctors even though they were not ill. Among the motives given by the parents for going directly to the Emergency Room, only 5.69% and 8.41% respectively said that it was due to an emergency situation or a worsening of the patient's state. 35.89% pointed out that their pediatricians had afternoon hours, and 20.91% that they went to the Emergency Room systematically regardless of the problem. Only 10.27% said that they were unhappy with their doctor. From our data it would seem that the demand for emergency pediatric hospital care is due more to a lack of health education of the population than to deficiencies in primary care.