Interplay of Postprandial Triglyceride-Rich Lipoprotein Composition and Adipokines in Obese Adolescents.

In the context of the alarming rise of infant obesity and its health implications, the present research aims to uncover disruptions in postprandial lipid metabolism and the composition of triglyceride-rich lipoproteins in obese adolescents. A double-blind, controlled clinical trial in the postprandial phase on 23 adolescents aged 12 to 16 years was carried out. Twelve participants were categorized as obese (BMI > 30 kg/m2 and percentile > 95) and 11 as normal-weight (BMI = 20-25 kg/m2, percentile 5-85). Blood samples were collected after a 12-h overnight fast and postprandially after consumption of a standardized breakfast containing olive oil, tomato, bread, orange juice, and skimmed milk. Obese adolescents exhibited elevated triglyceride concentrations in both fasting and postprandial states and higher TG/apo-B48 ratios, indicating larger postprandial triglyceride-rich lipoprotein (TRL) particle size, which suggests impaired clearance. Obese subjects also exhibited higher n-6 PUFA concentrations, potentially linked to increased TRL hydrolysis and the release of pro-inflammatory adipokines. In contrast, TRL from normal-weight individuals showed higher concentrations of oleic acid and DHA (n-3 PUFA), with possible anti-inflammatory effects. The results indicate an interplay involving postprandial TRL metabolism and adipokines within the context of adolescent obesity, pointing to potential cardiovascular implications in the future.

Potential Molecular Targets of Oleanolic Acid in Insulin Resistance and Underlying Oxidative Stress: A Systematic Review.

Oleanolic acid (OA) is a natural triterpene widely found in olive leaves that possesses antioxidant, anti-inflammatory, and insulin-sensitizing properties, among others. These OA characteristics could be of special interest in the treatment and prevention of insulin resistance (IR), but greater in-depth knowledge on the pathways involved in these properties is still needed. We aimed to systematically review the effects of OA on the molecular mechanisms and signaling pathways involved in the development of IR and underlying oxidative stress in insulin-resistant animal models or cell lines. The bibliographic search was carried out on PubMed, Web of Science, Scopus, Cochrane, and CINHAL databases between January 2001 and May 2022. The electronic search produced 5034 articles but, after applying the inclusion criteria, 13 animal studies and 3 cell experiments were identified, using SYRCLE's Risk of Bias for assessing the risk of bias of the animal studies. OA was found to enhance insulin sensitivity and glucose uptake, and was found to suppress the hepatic glucose production, probably by modulating the IRS/PI3K/Akt/FoxO1 signaling pathway and by mitigating oxidative stress through regulating MAPK pathways. Future randomized controlled clinical trials to assess the potential benefit of OA as new therapeutic and preventive strategies for IR are warranted.

Short Breastfeeding Duration is Associated With Premature Onset of Female Breast Cancer.

Currently, there is controversy concerning potential factors that contribute to the development of breast cancer. Our study analyzed the possible association between weight status, cigarette consumption, lactation period, serum estrogen levels, family history of breast cancer, and age at breast cancer diagnosis. We conducted a retrospective study at a University Hospital in Granada (Spain) by consulting the medical records of 524 women aged 19 to 91 years, all of them diagnosed and treated for breast cancer from 2011 to 2019. Our findings indicated that in non-morbidly obese females who were also non-smokers, a maternal lactation period of more than 3 months (p = .013) and the absence of family antecedents of cancer (p = .025) were statistically significant factors that led to a more advanced age at breast cancer diagnosis. Thus, maternal lactation seems to have a potential protective effect on breast cancer.

cMetS Based on Z-Scores as an Accurate and Efficient Scoring System to Determine Metabolic Syndrome in Spanish Adolescents.

The definition of metabolic syndrome (MetS) based on dichotomous cut-off points is efficient in the adult population. However, to date, there is no international consensus on how to define MetS in the pediatric population. For that reason, a continuous MetS score (cMetS) has been proposed for the pediatric population. However, despite multiple attempts, cMetS has not been fully validated as there is no agreement about the most accurate score to calculate it. The purpose of the present study was to compare the validity of different scores (three siMS scores, z-score, principal components analysis (PCA), the sum of PCA, and confirmatory factor analysis) to calculate cMetS and determine MetS in Spanish adolescents. There were 981 subjects, ranging 11-16 years old, recruited for this cross-sectional study. Seven different approaches to pediatric cMetS scores were calculated. All cMetS scores calculated strongly correlated with each other, especially siMS scores. The area under the curve obtained from receiving operating characteristic curves was particularly elevated for z-scores 0.81 (95% CI: 0.784-0.838), showing a specificity of 64.4%. Our study shows that cMetS based on z-scores is accurate and efficient to be used for research instead of the dichotomized definition of MetS in adolescents; and cMetS based on siMS scores is useful for clinical practice.

Effects of COVID-19 lockdown on the dietary habits and lifestyle in a population in southern Spain: a cross-sectional questionnaire.

BACKGROUND/OBJECTIVE: Few studies have assessed the effect of lockdown on physical activity and eating behaviours in a population from the Autonomous Community of Andalusia in southern Spain. The aim of our study was to describe the effect of COVID-19 pandemic home lockdown on eating habits and lifestyle in the Andalusian population. SUBJECTS/METHODS: A cross-sectional observational study was carried out on a population from southern Spain, Andalusian population. An online questionnaire was shared through social networks and snowball sampling. A total of 1140 people filled in the questionnaire. The questionnaire consisted of 34 items classified into three sections: sociodemographic data, work and leisure activities and questions on food consumption. Each item offered pre- and post-lockdown information. RESULTS: The participants were classified into three age groups: 18-35, 36-65 and over 65. Statistically significant differences were found between the three groups, with the younger age group undergoing greater changes, increasing their physical activity and consumption of fresh food, and decreasing both their consumption of fast food at home and alcohol intake. CONCLUSIONS: These findings suggest that, in the current social and health crisis, the citizens of southern Spain have become aware of the importance of maintaining an appropriate lifestyle to remain healthy, particularly the younger population with less well-consolidated habits.

Assessment of Different Atherogenic Indices as Predictors of Metabolic Syndrome in Spanish Adolescents.

Background: Inconsistent results due to age, ethnic, and geographic differences have been found on the predictive capacity of atherogenic indices in previous studies. The aim of this study was to assess the predictive value of 6 atherogenic indices for MetS in a Spanish adolescent population. Methods: A cross-sectional study was performed on 981 adolescents (13.2 ± 1.2y) that were randomly recruited from schools in Southeastern Spain. Anthropometric and biochemical parameters were evaluated to identify the presence of MetS. The following atherogenic indices were calculated: triglyceride-glucose (TyG) index, atherogenic index of plasma (AIP), non-HDL cholesterol, triglycerides to HDL-cholesterol ratio (TG/HDL-c), LDL-cholesterol to HDL-cholesterol ratio (LDL-c/HDL-c), and total cholesterol to HDL-cholesterol ratio (TC/HDL-c). Results: The area under the curve (AUC) of receiver operating characteristic curves was used for discrimination purposes. AIP was the atherogenic index most strongly associated with MetS with an unadjusted odds ratio (OR) of 37.98 in boys and of 28.75 in girls. A high OR was maintained after adjustment by different factors. AUC values for all atherogenic indices were above 0.83 and 0.88 in boys and in girls, respectively. Conclusions: Among the 6 atherogenic indices studied, AIP was the one most strongly associated with MetS in Spanish adolescents. The AUC values obtained from ROC analyses suggest that all atherogenic indices have the ability to predict MetS. These atherogenic indices are interesting and useful predictive indicators for MetS. However, more studies are needed to explore in-depth this predictive capacity.

Exercise dose on hepatic fat and cardiovascular health in adolescents with excess of adiposity.

OBJECTIVE: The HEPAFIT study was aimed at examining the impact of a 6-month physical education intervention, considering various levels of exercise intensity, on hepatic fat and cardiometabolic health outcomes in adolescents with excess adiposity. METHODS: Adolescents (n = 120), 11-17 years with excess adiposity by body fat >30%, were randomly assigned to one of the following 4 groups for 6 months: (1) standard physical education lessons, control (CTRL); (2) high-intensity physical education (HIPE); (3) low-to-moderate intensity physical education (LIPE) and (4) combined HIPE and LIPE (PLUS). The primary outcome was hepatic fat content measured by vibration-controlled transient elastography (controlled attenuation parameter [CAP]). Secondary outcomes were traditional cardiovascular health markers (body composition, serum lipids, aminotransferases and health-related physical fitness components). RESULTS: Adjusted mixed effects linear models revealed a significant decrease in CAP levels in HIPE (-20.02 dB/m, p < 0.0001) (p = 0.001 vs. CTRL group) and PLUS (-16.25 dB/m, p = 0.005) groups. Body fat decreased in the HIPE (-2.88%, p < 0.001) (p = 0.001 vs. CTRL group) and LIPE (-1.26%, p = 0.022) groups. The physical fitness components were increased in the HIPE and PLUS group relative to the baseline (p < 0.05), and the HIPE group showed a reduction in the total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels (p < 0.05). CONCLUSIONS: Implementation of a 6-month physical education exercise program, particularly high-intensity or combined high and low-intensity, improves hepatic fat storage and significantly reduces cardiometabolic markers in adolescents with excess of adiposity. Interventions involving supervised physical exercise may help to improve metabolism and fat deposition at the hepatic level, thus preventing the development of non-alcoholic fatty liver disease in adolescents.

Low intakes of vitamins C and A are associated with obesity in early adulthood.

To evaluate the relationships between the intake of individual antioxidants as well as the dietary antioxidant quality score and obesity-related measures. A cross-sectional study was conducted on 562 young adults. Fat mass, fat-mass percentage, and fat-free mass were measured using a body composition analyzer. The intake of antioxidant nutrients including vitamins C, E, and A, selenium, zinc, and magnesium were calculated based on a 72-hour diet recall interview. We observed significant differences in the vitamin C (88.6 ± 72.6 mg/day vs. 70.7 ± 60.6 mg/day, p = 0.010), vitamin A (635.8 ± 519.8 µg/day vs. 492.6 ± 318.9 µg/day, p = 0.014), and selenium (135.3 ± 88.7 µg/day vs. 139.3 ± 79.3 µg/day, p = 0.034) intake between normal-weight and overweight or obese young adults. When the Dietary Antioxidant Quality Score (DAQS) was analyzed, there were no significant differences between normal-weight versus overweight or obese young adults after adjusting for confounders. Logistic regression analysis revealed that vitamin C intake (odds ratio (OR) 0.995, 95% CI 0.992-0.999, p = 0.013) and vitamin A intake (OR 0.999, 95% CI 0.999-1.000, p = 0.016) were independent predictors of overweight/obesity after adjusting for age, sex and energy intake. In contrast, a higher selenium intake was associated with an increased risk of overweight/obesity (OR 1.003, 95% CI 1.000-1.006, p = 0.034). Future longitudinal investigations of dietary antioxidant intake in relation to the development of obesity would be of interest to better understand the effect of dietary antioxidants on obesity.

Self-Care by Muslim Women during Ramadan Fasting to Protect Nutritional and Cardiovascular Health.

The practice of Ramadan involves a series of changes in lifestyle, mainly in eating habits. The research aim of this study is to determine the prevalence of overweight-obesity, the degree of compliance with dietary recommendations and the effects of religious fasting on cardiovascular health among a population of Muslim women living in Melilla, a Spanish city in North Africa. A follow-up cohort study was conducted on 62 healthy adult women (33.6 ± 12.7 years). Anthropometric and body composition parameters were obtained using bioimpedance and dietary records. All of the participants were overweight or obese, especially due to the non-compliance with dietary recommendations; however, more than 60% considered their weight was appropriate or even low. By the end of Ramadan, the women's body mass index and fat component values had fallen significantly (p < 0.001), but this loss was later recovered. Dietary records revealed an excessive consumption of lipids and sodium, and the presence of a high waist-to-hip ratio. All of these factors are related to cardiovascular risk. In conclusion, promoting nutritional health and encouraging year-round self-care among adult Muslim women is necessary in order to ensure healthy fasting during Ramadan.

Oleanolic Acid-Enriched Olive Oil Alleviates the Interleukin-6 Overproduction Induced by Postprandial Triglyceride-Rich Lipoproteins in THP-1 Macrophages.

Oleanolic acid (OA), a triterpene that is highly present in olive leaves, has been proposed as a component of functional foods for the prevention of metabolic syndrome, due to its anti-inflammatory activity. We analyzed the effects of OA on inflammatory parameters and signaling proteins in LPS-stimulated THP-1 macrophages. Thus, THP-1 macrophages were incubated with LPS for 48 h after pretreatment with OA at different concentrations. Pretreatment with OA was significantly effective in attenuating IL-6 and TNF-α overproduction induced by LPS in macrophages, and also improved the levels of AMPK-α. We also evaluated the effects of human triglyceride-rich lipoproteins (TRLs) derived from individuals consuming an OA-enriched functional olive oil. For this purpose, TRLs were isolated from healthy adolescents before, 2 and 5 h postprandially after the intake of a meal containing the functional olive oil or common olive oil, and were incubated with THP-1 macrophages. THP-1 macrophages incubated with TRLs isolated at 2 h after the consumption of the OA-enriched olive oil showed significant lower levels of IL-6 compared to the TRLs derived from olive oil. Our results suggest that OA might have potential to be used as a lipid-based formulation in functional olive oils to prevent inflammatory processes underlying metabolic syndrome in adolescents.

Serum leptin as a mediator of the influence of insulin resistance on hepatic steatosis in youths with excess adiposity.

BACKGROUND AND AIMS: The relationship between insulin resistance (IR) and hepatic steatosis (fatty liver) is well known; however, the extent to which the satiety hormone leptin acts as a confounder or mediator in this relationship is uncertain. We examined whether the association between IR and hepatic steatosis is mediated by leptin in Colombian adolescents with excess adiposity. METHODS AND RESULTS: A total of 122 adolescents (mean age: 13.4 years; 68% girls) participated in the study. We assessed body composition, hepatic steatosis (as defined by the controlled attenuation parameter [CAP]), cardiometabolic risk factors (body mass index, waist circumference, body composition), biochemical variables (leptin, insulin, glucose, lipid profile, cardiometabolic Z-score, transaminases, etc.), and physical fitness (cardiorespiratory fitness and grip strength). Partial correlation, regression, and mediation analyses were conducted using the Barron and Kenny framework. RESULTS: Ninety-two youths (75.4%) had IR. Mediation analysis revealed a positive relationship between Homeostasis Model Assessment-IR (HOMA-IR) and CAP (ßdir = 3.414, 95% confidence interval [CI]: 1.012 to 5.816, p < 0.001), which was attenuated when leptin was included in the model, thus indicating that leptin mediates this relationship (ßind = 1.074, 95% CI: 0.349 to 2.686, p < 0.001). The percentage of the total effect mediated by leptin was 21%. Regarding sex, the mediation effect of leptin remains significant among boys (ßind = 0.962, 95% CI: 0.009 to 2.615, p < 0.001), but not in girls (ßind = 0.991, 95% CI: 1.263 to 5.483, p = 0.477). CONCLUSIONS: The findings are clinically relevant to consider leptin levels as a surrogate marker of insulin sensitivity when assessing youths with excess adiposity and/or suspected Nonalcoholic hepatic steatosis or nonalcoholic fatty liver disease (NAFLD).

Peer Debriefing Versus Instructor-Led Debriefing for Nursing Simulation.

BACKGROUND: Debriefing is the reflective process following the simulation experience. We aimed to compare the debriefing assessment and debriefing satisfaction perceived by nursing students who underwent different debriefing methods. METHOD: An experimental study conducted on three groups (instructor-led debriefing, peer debriefing, and combined debriefing) was performed for 177 nursing students. Differences in the debriefing satisfaction were assessed using the Clinical Experience Simulation scale, the Visual Analogue scale, and the Debriefing Assessment for Simulation in Healthcare (DASH). RESULTS: VAS scores for satisfaction differed significantly between the instructor-led debriefing, peer debriefing, and combined debriefing groups. In the Clinical Experience Simulation scale, the combined debriefing group was significantly higher compared with instructor-led debriefing. The total score for DASH was significantly higher in the combined debriefing group compared with instructor-led debriefing, and in instructor-led debriefing compared with peer debriefing. CONCLUSION: Combining debriefing after a simulation session improves the debriefing satisfaction and the perceived debriefing assessment among nursing students. [J Nurs Educ. 2021;60(2):90-95.].

Dietary Energy Density is Associated with Body Mass Index and Fat Mass in Early Adulthood.

A cross-sectional study was conducted to investigate the association between body composition parameters as well as body mass index (BMI), and dietary energy density in a population of 538 young adults. Fat mass, fat mass percent, fat-free mass, and visceral fat were measured using a body composition analyzer. Daily energy intake was assessed using a 72-hr diet recall, and dietary energy density was calculated. Significant differences in dietary energy density among underweight, normal-weight and overweight/obesity young adults were identified (M = 1.42, SD = 0.26 vs. M = 1.52, SD = 0.46 vs. M = 1.66, SD = 0.53, p = .002). Dietary energy density was associated with BMI (ß = .961; CI 95% = 0.335, 1.586; p = .0030), fat mass percent (ß = 1.921; CI 95% = 0.707, 3.135; p = .002), and fat mass (ß = 2.146; CI 95% = 0.827, 3.466; p = .001). Dietary energy density might be considered as an important aspect in the obesity nutritional education programs in young people.

Concordance among diagnostic criteria for metabolic syndrome is inconsistent in Spanish adolescents.

BACKGROUND: The metabolic syndrome (MetS), although more frequent in adults, is a growing health problem in adolescent population. There are different criteria for the diagnosis, however without a consensus of which is the best to be used in this population. The heterogeneity of the different diagnostic criteria makes it necessary to carry out more studies that analyse the degree of agreement among these criteria. The present study was aimed to evaluate the agreement between different criteria for diagnosis of MetS in adolescents. MATERIALS AND METHODS: A cross-sectional study was performed on 981 adolescents (13.2 ± 1.2 years) randomly recruited from 18 schools in south-east Spain. MetS was diagnosed by eight different criteria. RESULTS: The criteria proposed by the IDF showed the highest mean values for WC and systolic blood pressure in boys and girls with MetS, and the lowest for glucose and triglycerides in boys. Depending on the diagnostic criteria used, the prevalence of MetS cases in boys ranged from 5.5% to 14.9%, while in girls varied from 3.4% to 32.6%. Both in boys and girls, the criteria proposed by the IDF was the less concordant with the other suggested criteria, while those proposed by Duncan et al, Rodriguez-Moran et al and Cruz and Goran, were very concordant among each other. However, in girls, concordance values were not as high as those found for boys. CONCLUSION: The variability observed in the agreement among the existing criteria suggests the need to validate uniform criteria for the diagnosis of MetS in adolescents.

Ansiedad y estrategias de afrontamiento ante el estrés en primeros intervinientes y personal sanitario de emergencias extrahospitalarias previas a la pandemia de COVID19 / Anxiety and strategies for coping with stress used by first responders and out-of-hospital emergency health care staff before the COVID-19 pandemic

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Stricter Adherence to Dietary Approaches to Stop Hypertension (DASH) and its Association with Lower Blood Pressure, Visceral Fat, and Waist Circumference in University Students.

How diet affects blood pressure (BP) in young adults has not been studied in sufficient depth. For this purpose, we analyzed adherence to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and BP in Spanish university students. The sample population of our cross-sectional study consisted of 244 subjects (18-31 years old), who were in good health. Measurements were taken of their systolic and diastolic BP. A food frequency questionnaire and 72 h food record were used to assess their dietary intake in the previous year. The resulting DASH score was based on foodstuffs that were emphasized or minimized in the DASH diet. Analysis of covariance adjusted for potential confounding factors showed that the mean values for systolic BP, visceral fat rating, and waist circumference (WC) of the subjects in the upper third of the DASH score were significantly lower than those of the subjects in the lower third (for systolic BP: mean difference -4.36 mmHg, p = 0.004; for visceral fat rating: mean difference -0.4, p = 0.024; for waist circumference: mean difference -3.2, p = 0.019). Stricter adherence to the DASH dietary pattern led to a lower BP, visceral fat rating, and WC values in these university students. Nevertheless, further prospective studies are needed to confirm these results.

Attitudes Toward Organ Donation: Differences Between Medical and Nursing Andalusian Students.

INTRODUCTION: A favorable attitude toward organ donation and transplantation (ODT) is fundamental among health professionals at the time of transplant promotion. In this sense, the training and awareness of professionals are fundamental. OBJECTIVE: To analyze the differences in the attitude toward ODT and the factors that condition it among Andalusian medical and nursing students. METHODS AND DESIGN: The study is a sociologic, multicenter, observational study. The population includes medical and nursing students in Andalusian universities. Database of the Collaborative International Donor Project is used and data are stratified by geographic area and academic course. The instrument of measurement was a validated questionnaire (PCID-DTO-RIOS) that was handed out to every student in a compulsory session. Completion of the questionnaire was anonymous and self-administered. The sample included Andalusian medical and nursing students (99% confidence and precision of ±1%) stratified by geographic area and year of study. RESULTS: There was a completion rate of 91%; 79% (n = 2879) of Andalusian students were in favor of donation and 21% were not in favor. The attitude toward ODT is more favorable in medical compared with nursing students (80% vs 77%; P = .021). The psychosocial profile toward donation is similar in both groups relating to the following variables (P < .05): knowing a transplant patient, having received information about the subject, attitude toward family donation, and having discussed transplantation with family and friends. CONCLUSION: Andalusian medical students favored organ donation more than Andalusian nursing students, and the favorable attitude is associated with having an awareness of the subject.

Dietary Inflammatory Index Scores Are Associated with Pressure Pain Hypersensitivity in Women with Fibromyalgia.

OBJECTIVE: Pain hypersensitivity has been described as one of the most disabling symptoms of fibromyalgia syndrome (FMS). Here we analyzed the relationship between an anti-inflammatory diet profile and the pressure pain thresholds (PPTs) of tender point sites and other fibromyalgia-related symptoms in patients with FMS. METHODS: This cross-sectional study included 95 women diagnosed with FMS and 98 menopause-status matched controls. The Dietary Inflammatory Index (DII) was calculated by conducting a 24-hour diet recall interview. The PPTs of tender point sites and self-reported global pain levels were evaluated by algometry and the visual analog scale, respectively. Disease severity, fatigue, sleep anxiety, and central sensitization were also evaluated. RESULTS: Linear regression analysis revealed that the PPTs of tender point sites including the occiput (ß = 0.234, 95% confidence interval [CI] = 0.016-0.452, P = 0.036), trapezius (ß = 0.299, 95% CI = 0.083-0.515, P = 0.007), zygapophyseal joint (ß = 0.291, 95% CI = 0.022-0.559, P = 0.035), second rib (ß = 0.204, 95% CI = 0.060-0.348, P = 0.006), gluteus (ß = 0.591, 95% CI = 0.110-1.072, P = 0.017), greater trochanter (ß = 0.379, 95% CI = 0.016-0.742, P = 0.041), and knee (ß = 0.482, 95% CI = 0.117-0.850, P = 0.011) were associated with DII score after adjustments for the age, menopausal status, and global energy levels reported by the patients with FMS. No significant differences were found for the cases or controls between the DII score and the remaining clinical symptoms. Analyses of covariance showed that the PPTs of the aforementioned tender point sites were also significantly associated (P < 0.05) with the DII score quartiles in patients with FMS, but no significant differences were found between these quartiles and the other clinical symptoms. CONCLUSIONS: A pro-inflammatory diet was associated with pain hypersensitivity in patients with FMS.

Influence of Calcium and Vitamin D Intakes on Body Composition in Children and Adolescents.

Identifying nutritional strategies to maintain a healthy body weight and reduce the comorbidities associated with obesity is extremely important. We aimed to investigate whether calcium and vitamin D intakes are associated with body composition measurements in a population of children and adolescents. A cross-sectional study was conducted involving 1,060 children and adolescents (65.8% females; 34.2% males) aged 9 to 19 years. Fat mass, percentage of fat mass, and fat-free mass were measured using a body composition analyzer (TANITA BC-418MA®). The mean dietary calcium and vitamin intakes were 829.66 ± 328.34 mg/day and 200.78 ± 400.91 IU/day. Linear regression analysis revealed a lack of significant association between daily calcium and vitamin D intakes and body composition measurements, after adjusting the model for age, sex, maturation status, and energy intake. Dietary calcium and vitamin D intakes do not appear to be associated with higher adiposity measurements in children and adolescents.