Estudio nutricional en población infantil de España (EsNuPI) / Nutritional study in Spanish pediatric population (EsNuPI)

INTRODUCCIÓN: es necesaria la promoción de estilos de vida saludables desde la edad pediátrica para la prevención de enfermedades a corto, medio y largo plazo. OBJETIVOS: conocer los patrones de alimentación y hábitos dietéticos, actividad física e inactividad en niños de uno a nueve años españoles urbanos, no veganos, así como sus diferencias entre los consumidores de leche estándar (RS) y de fórmulas adaptadas, enriquecidas o suplementadas (AMS). MÉTODOS: estudio prospectivo, observacional, transversal en 1.514 niños. Se analizan mediante cuestionario la frecuencia de consumo de alimentos, la actividad física, la inactividad y la ingesta dietética mediante dos registros de 24 horas, el primero presencial y el segundo telefónico. RESULTADOS: entre los resultados ya obtenidos, la ingesta energética diaria fue significativamente superior en el grupo RS (1.503 kcal vs. 1.404 kcal). El aporte de proteínas y grasas en relación al valor calórico total de la dieta es elevado, siendo en el caso de las primeras significativamente mayor en RS (16,5 % vs. 15,6 %). Sin embargo, el de hidratos de carbono es bajo y significativamente mayor en AMS (46,7 % vs. 45,5 %). La contribución de los grupos de alimentos al aporte energético presenta diferencias significativas entre los grupos. CONCLUSIONES: los niños españoles de uno a nueve años tienen una ingesta energética adecuada, aunque ligeramente superior a las recomendaciones. Hay una alta contribución de las proteínas y las grasas y una baja contribución de los hidratos de carbono al valor calórico total. Los niños AMS tienen una mayor adherencia a las guías alimentarias y recomendaciones nutricionales y, por tanto, potencialmente una mejor calidad de la dieta

INTRODUCTION: promoting healthy lifestyles already from the pediatric age for prevention of diseases at a short, mid and long-term is compulsory worldwide. OBJECTIVES: to know eating patterns and dietary habits, physical activity and sedentary behaviours in urban Spanish children aged one to nine years old, no vegan, by evaluating the differences between standard milk consumers (RS) and milk formula (AMS). METHODS: prospective, observational, cross-sectional study with 1,514 children. A food frequency questionnaire, a physical activity and sedentary behaviour questionnaire, and two 24-hour dietary recalls (one face-to-face and one by phone) were used. RESULTS: the daily energy intake was significantly higher in the RS group (1,503 kcal vs 1,404 kcal). The contribution of protein and fat to the total caloric value of the diet is high, being for the first one significantly higher in RS (16.5 % vs 15.6 %). However, for carbohydrate is low and significantly higher in AMS (46.7 % vs 45.5 %). The contribution of the food groups to the energy intake present significant differences between the groups. CONCLUSIONS: Spanish children between 1-9 years old have an adequate, but slightly elevated energy intake than the recommendations. There is a high contribution of protein and fat, and low of carbohydrate to the total caloric value. AMS children have a higher adherence to dietary guidelines and nutritional recommendations and, therefore, a suggested higher diet quality

Recomendaciones de alimentación complementaria según los Comités de Nutrición de la AAP, ESPGHAN y AEP / Complementary Feeding according ESPGHAN, AAP and AEP Nutrition Committees recommendations

Las recomendaciones en la introducción de la alimentación complementaria (AC) han ido variando a lo largo de las últimas décadas, y aun hoy en día existen algunas diferencias entre regiones y sociedades científicas, unas veces motivadas por la ausencia de suficiente evidencia científica y otras muchas por diferencias culturales en relación con la alimentación. El objetivo principal de esta revisión es recopilar las últimas recomendaciones sobre AC de los Comités de Nutrición de las principales sociedades científicas pediátricas de influencia en nuestro entorno (Asociación Española de Pediatría [AEP], Sociedad Europea de Gastroenterología, Hepatología y Nutrición Pediátrica [ESPGHAN] y Academia Americana de Pediatría [AAP]), haciendo especial énfasis en las diferencias que entre ellas pudieran existir. La definición de AC es compartida por las tres sociedades, y las recomendaciones en relación con su introducción son muy similares entre sí. Establecen que debería iniciarse no antes de los 4 meses pero tampoco más allá de los 6, principalmente por motivos nutricionales y de desarrollo neurológico. De acuerdo con las últimas evidencias científicas publicadas, todas ellas propugnan que tanto los alimentos potencialmente alergénicos como el gluten pueden introducirse con el resto de la AC, en cualquier momento a partir de los 4 meses. Asimismo, ninguna de las tres sociedades realiza recomendaciones acerca de cuál es el mejor método de alimentación para introducir la AC, si bien la ESPGHAN y la AEP comentan la necesidad de que se realicen más estudios comparativos a largo plazo

Recommendations regarding the introduction of complementary feeding (CF) have been changing over the last decades and even today there are some differences between regions and scientific societies. Sometimes discrepancy is motivated by insufficient scientific evidence or differences between food culture. The main aim of this review is to summarize the latest recommendations of the Nutrition Committees of the main pediatric scientific societies with influence in our environment (Spanish Pediatric Association [AEP], European Society of Pediatric Gastroenterology, Hepatology and Nutrition [ESPGHAN] and American Academy of Pediatrics [AAP]) in order to emphasize the differences between them. The definition of CF is the same for the three societies and the introduction recommendations are very similar. They establish the beginning not before 4 months and not beyond 6, mainly due to nutritional and neurological developmental reasons. According to the latest published scientific evidence all of them advocate that both potentially allergenic foods and gluten can be introduced whenever desired, after 4 months of age. None of them recommend any particular method for food introduction, although ESPGHAN and AEP highlight the need for more long-term comparative studies

Cardiovascular risk biomarkers and metabolically unhealthy status in prepubertal children: Comparison of definitions.

BACKGROUND AND AIMS: The early onset of cardio-metabolic abnormalities, known as metabolically unhealthy (MU) status, is highly associated with obesity and cardiovascular disease (CVD), as well as with increased morbidity and mortality later in life. Given the lack of a consensus MU classification for prepubertal children, we aimed to compare available MU definitions in terms of their association with CVD risk biomarkers. METHODS AND RESULTS: A total of 930 prepubertal children (622 with overweight/obesity, 462 males) aged 5-10.9 years were recruited, anthropometric measures were taken and biomarkers were analyzed. Children were classified using eight MU definitions based on different cut-offs for blood pressure, triacylglycerides, high-density lipoprotein cholesterol, glucose and homeostasis model assessment for insulin resistance (HOMA-IR). MU prevalence in children with overweight/obesity ranged between 30% and 60% across definitions. Plasma concentrations of resistin, leptin, myeloperoxidase (MPO) and total plasminogen activator inhibitor 1 (tPAI-1) were higher, and those of adiponectin were lower, in MU compared to MH children with overweight/obesity. Linear regression analyses confirmed the contribution of MPO and tPAI-1 concentrations to MU status, with most significant results derived from definitions that use age and sex-specific criteria and that account for HOMA-IR. CONCLUSION: Plasma concentrations of MPO and tPAI-1 are increased in prepubertal MU children irrespective of having normal-weight or overweight/obesity. Inclusion of age and sex-specific cut-offs for cardio-metabolic components as well as insulin resistance criteria increases the quality of MU definitions as seen by their stronger association with CVD biomarkers concentrations.

FNDC5 is produced in the stomach and associated to body composition.

The fibronectin type III domain-containing protein 5 (FNDC5) discovered in 2002 has recently gained attention due to its potential role in protecting against obesity. In rat, no data exist regarding FNDC5 production and regulation in the stomach. The aim of the present work was to determine the expression of FNDC5 in the rat stomach and its potential regulation by body composition. The present data shows FNDC5 gene expression in the gastric mucosa. Immunohistochemical studies found FNDC5 immunopositivity in chief cells of gastric tissue. By the use of three different antibodies FNDC5 was found expressed in gastric mucosa and secreted by the stomach. The rate of gastric FNDC5 secretion parallels the circulating levels of FNDC5. The body fat mass increase after intervention with high fat diet coincided with a decrease in the secretion of FNDC5 from the stomach and a diminution in the FNDC5 circulating levels. In summary, the present data shows, for the first time, the expression of FNDC5 in the stomach of rats and its regulation by body composition, suggesting a potential role of gastric FNDC5 in energy homeostasis.

Uroguanylin levels in intestine and plasma are regulated by nutritional status in a leptin-dependent manner.

PURPOSE: Uroguanylin (UGN) is a 16 amino acid peptide produced mainly by intestinal epithelial cells. Nutrients intake increases circulating levels of prouroguanylin that is processed and converted to UGN to activate the guanylyl cyclase 2C receptor (GUCY2C). Given that the UGN-GUCY2C system has been proposed as a novel gut-brain endocrine axis regulating energy balance, the aim of the present study was to investigate the regulation of UGN protein levels in duodenum and circulating levels in lean and obese mice under different nutritional conditions and its potential interaction with leptin. METHODS: Swiss, C57BL/6 wild-type and ob/ob male adult mice under different nutritional conditions were used: fed ad libitum standard diet (control); 48 h fasting (fasted); 48 h fasting followed by 24 h of feeding (refed); and fed high-fat diet (45 %) during 10 weeks. In addition, peripheral leptin administration was performed. Intestinal uroguanylin expression was studied by Western blot analysis; plasma levels were measured by ELISA. RESULTS: Food deprivation significantly reduced plasma UGN levels, which were correlated with the lower protein levels of UGN in duodenum. These effects were reverted after refeeding and leptin challenge. Consistently, in ob/ob mice UGN expression was decreased, whereas leptin treatment up-regulated UGN levels in duodenum in these genetically modified mice compared to WT. Diet-induced obese mice displayed increased UGN levels in intestine and plasma in comparison with lean mice. CONCLUSIONS: Our findings suggest that UGN levels are correlated with energy balance status and that the regulation of UGN by nutritional status is leptin-dependent.

[Prebiotics: concept, properties and beneficial effects]. / Prebiotics: concept, properties and beneficial effects.

Prebiotics are non-digestible food ingredients (oligosaccharides) that reach the colon and are used as substrate by microorganisms producing energy, metabolites and micronutrients used for the host; in addition they also stimulate the selective growth of certain beneficial species (mainly bifidobacteria and lactobacilli) in the intestinal microbiota. In this article, a multidisciplinary approach to understand the concept of prebiotic carbohydrates, their properties and beneficial effects in humans has been carried out. Definitions of prebiotics, reported by relevant international organizations and researchers, are described. A comprehensive description of accepted prebiotics having strong scientific evidence of their beneficial properties in humans (inulin-type fructans, FOS, GOS, lactulose and human milk oligosaccharides) is reported. Emerging prebiotics and those which are in the early stages of study have also included in this study. Taken into account that the chemical structure greatly influences carbohydrates prebiotic properties, the analytical techniques used for their analysis and characterization are discussed. In vitro and in vivo models used to evaluate the gastrointestinal digestion, absorption resistance and fermentability in the colon of prebiotics as well as major criteria to design robust intervention trials in humans are described. Finally, a comprehensive summary of the beneficial effects of prebiotics for health at systemic and intestinal levels is reported. The research effort on prebiotics has been intensive in last decades and has demonstrated that a multidisciplinary approach is necessary in order to claim their health benefits.

Los prebióticos son ingredientes alimentarios no digeribles (oligosacáridos) que llegan al colon y sirven de sustrato a los microorganismos, originando energía, metabolitos y micronutrientes utilizados por el hospedador y estimulando el crecimiento selectivo de determinadas especies beneficiosas (principalmente, bifidobacterias y lactobacilos) de la microbiota intestinal. En este artículo se realiza una revisión sobre los carbohidratos prebióticos desde diferentes perspectivas, comenzando por las definiciones de prebióticos formuladas a lo largo de los últimos treinta años por científicos y diferentes organismos internacionales. Se realiza una descripción detallada de los prebióticos aceptados, como tales, que presentan propiedades beneficiosas fundamentadas en estudios llevados a cabo en humanos (fructanos tipo inulina y FOS; GOS, lactulosa y oligosacáridos de leche humana), los que se consideran prebióticos emergentes y aquellos que se encuentran en fases iniciales de estudio. Además y teniendo en cuenta que la estructura química de los carbohidratos influye notablemente en sus propiedades prebióticas, se describen las técnicas más utilizadas para su análisis y caracterización. Asimismo, se detallan los modelos in vitro e in vivo más utilizados para estudiar la resistencia de los prebióticos a la digestión y la absorción gastrointestinal, la fermentación de los prebióticos en el colon así como los criterios a tener en cuenta para llevar a cabo ensayos de intervención en humanos. Por último se realiza una amplia descripción de los efectos beneficiosos de los prebióticos para la salud a nivel intestinal y sistémico. Como conclusión, podría decirse que la investigación existente hasta el momento, sobre prebióticos, es extensa y pone de manifiesto que es necesario considerar un gran número de factores para poder atribuir alegaciones de salud a un prebiótico.

Prebióticos; concepto, propiedades y efectos beneficiosos / Prebiotics: concept, properties and beneficial effects

Los prebióticos son ingredientes alimentarios no digeribles (oligosacáridos) que llegan al colon y sirven de sustrato a los microorganismos, originando energía, metabolitos y micronutrientes utilizados por el hospedador y estimulando el crecimiento selectivo de determinadas especies beneficiosas (principalmente, bifidobacterias y lactobacilos) de la microbiota intestinal. En este artículo se realiza una revisión sobre los carbohidratos prebió- ticos desde diferentes perspectivas, comenzando por las definiciones de prebióticos formuladas a lo largo de los últimos treinta años por científicos y diferentes organismos internacionales. Se realiza una descripción detallada de los prebióticos aceptados, como tales, que presentan propiedades beneficiosas fundamentadas en estudios llevados a cabo en humanos (fructanos tipo inulina y FOS; GOS, lactulosa y oligosacáridos de leche humana), los que se consideran prebióticos emergentes y aquellos que se encuentran en fases iniciales de estudio. Además y teniendo en cuenta que la estructura química de los carbohidratos influye notablemente en sus propiedades prebióticas, se describen las técnicas más utilizadas para su análisis y caracterización. Asimismo, se detallan los modelos in vitro e in vivo más utilizados para estudiar la resistencia de los prebióticos a la digestión y la absorción gastrointestinal, la fermentación de los prebióticos en el colon así como los criterios a tener en cuenta para llevar a cabo ensayos de intervención en humanos. Por último se realiza una amplia descripción de los efectos beneficiosos de los prebióticos para la salud a nivel intestinal y sistémico. Como conclusión, podría decirse que la investigación existente hasta el momento, sobre prebióticos, es extensa y pone de manifiesto que es necesario considerar un gran número de factores para poder atribuir alegaciones de salud a un prebiótico (AU)

Prebiotics are non-digestible food ingredients (oligosaccharides) that reach the colon and are used as substrate by microorganisms producing energy, metabolites and micronutrients used for the host; in addition they also stimulate the selective growth of certain beneficial species (mainly bifidobacteria and lactobacilli) in the intestinal microbiota. In this article, a multidisciplinary approach to understand the concept of prebiotic carbohydrates, their properties and beneficial effects in humans has been carried out. Definitions of prebiotics, reported by relevant international organizations and researchers, are described. A comprehensive description of accepted prebiotics having strong scientific evidence of their beneficial properties in humans (inulin-type fructans, FOS, GOS, lactulose and human milk oligosaccharides) is reported. Emerging prebiotics and those which are in the early stages of study have also included in this study. Taken into account that the chemical structure greatly influences carbohydrates prebiotic properties, the analytical techniques used for their analysis and characterization are discussed. In vitro and in vivo models used to evaluate the gastrointestinal digestion, absorption resistance and fermentability in the colon of prebiotics as well as major criteria to design robust intervention trials in humans are described. Finally, a comprehensive summary of the beneficial effects of prebiotics for health at systemic and intestinal levels is reported. The research effort on prebiotics has been intensive in last decades and has demonstrated that a multidisciplinary approach is necessary in order to claim their health benefits (AU)

Drug development strategies for the treatment of obesity: how to ensure efficacy, safety, and sustainable weight loss.

The prevalence of obesity has increased worldwide, and approximately 25%-35% of the adult population is obese in some countries. The excess of body fat is associated with adverse health consequences. Considering the limited efficacy of diet and exercise in the current obese population and the use of bariatric surgery only for morbid obesity, it appears that drug therapy is the only available method to address the problem on a large scale. Currently, pharmacological obesity treatment options are limited. However, new antiobesity drugs acting through central nervous system pathways or the peripheral adiposity signals and gastrointestinal tract are under clinical development. One of the most promising approaches is the use of peptides that influence the peripheral satiety signals and brain-gut axis such as GLP-1 analogs. However, considering that any antiobesity drug may affect one or several of the systems that control food intake and energy expenditure, it is unlikely that a single pharmacological agent will be effective as a striking obesity treatment. Thus, future strategies to treat obesity will need to be directed at sustainable weight loss to ensure maximal safety. This strategy will probably require the coadministration of medications that act through different mechanisms.

Effects of neonatal programming on hypothalamic mechanisms controlling energy balance.

The prevalence of overweight and obesity in most developed countries has markedly increased during the last decades. In addition to genetic, hormonal, and metabolic influences, environmental factors like fetal and neonatal nutrition play key roles in the development of obesity. Interestingly, overweight during critical developmental periods of fetal and/or neonatal life has been demonstrated to increase the risk of obesity throughout juvenile life into adulthood. In spite of this evidence, the specific mechanisms underlying this fetal/neonatal programming are not perfectly understood. However, it is clear that circulating hormones such as insulin and leptin play a critical role in the development and programming of hypothalamic circuits regulating energy balance. Here, we review what is currently known about the impact of perinatal malnutrition on the mechanisms regulating body weight homeostasis. Understanding these molecular mechanisms may provide new targets for the treatment of obesity.

Paraoxonase 1 activities and genetic variation in childhood obesity.

Changes in paraoxonase 1 (PON1) activities have been observed in a variety of diseases involving oxidative stress, such as CVD. However, its role in obesity has not been fully established. In the present study, we aimed (1) to genotype sixteen PON1 SNP, (2) to measure serum PON1 activities and (3) to correlate these findings with the incidence of childhood obesity and related traits. We conducted a case-control study of 189 normal-weight and 179 obese prepubertal children, and we measured four different PON1 activities: lactonase; paraoxonase; arylesterase; diazoxonase. Although none of these activities was significantly different between the obese and normal-weight children, lactonase activity was found to be positively correlated with HDL-cholesterol and ApoA1 levels and negatively correlated with myeloperoxidase and fatty acid-binding protein 4 levels. Among the sixteen genotyped PON1 SNP, only the intronic SNP rs854566 exhibited a significant association with obesity (OR 0·61, 95 % CI 0·41, 0·91; P= 0·016). This genetic variant was also associated with increased diazoxonase, lactonase and arylesterase activities and decreased paraoxonase activity. Other genetic variants exhibited different association patterns with serum activities based on their location within the PON1 gene, and SNP that were located within the promoter were strongly associated with lactonase, arylesterase and diazoxonase activities. The functional variant Q192R exhibited the greatest effect on paraoxonase activity (P= 5·88 × 10(-42)). In conclusion, SNP rs854566 was negatively associated with childhood obesity and with increased serum PON1 activities in prepubertal children. We determined that lactonase is a reliable indicator of PON1 activities and should be included in future studies of PON1 function.

A gene variant of 11ß-hydroxysteroid dehydrogenase type 1 is associated with obesity in children.

BACKGROUND: The 11ß-hydroxysteroid dehydrogenase type 1 (11ß-HSD1) enzyme catalyses the regeneration of active cortisol from inert cortisone and plays a critical role in tissue-specific corticosteroid reactions; therefore, 11ß-HSD1 is a key molecule associated with the development of obesity. Despite evidence for its role in obesity, no genetic polymorphisms have been significantly associated with the disease per se. OBJECTIVE: The aim of this study was to evaluate whether HSD11B1 gene variants, which have never been studied before, are associated with obesity and its related traits, as well as its relation to biomarkers of inflammation, liver damage and cardiovascular disease in a cohort of Spanish children. DESIGN: We performed a prospective case-control study. SUBJECTS: A total of 534 children were examined and classified as being obese (n=292) or normal weight (n=242). Anthropometric and biochemical measurements related to obesity, including inflammation, liver damage and cardiovascular disease, were determined. Genomic DNA was extracted and 10 HSD11B1 gene single-nucleotide polymorphisms (SNPs) were genotyped. RESULTS: A novel SNP, rs3753519, was strongly associated with obesity and this SNP was the only statistically significant HSD11B1 gene SNP remaining after a Bonferroni correction (odds ratio=1.97 for allelic effect, 95% confidence interval 1.23-3.16; P=0.004 and Bonferroni corrected P=0.046). In addition, this SNP was significantly and positively associated with increased body mass index (BMI), BMI z-score, weight, waist circumference, plasma γ-glutamyl transpeptidase and plasma active plasminogen activator inhibitor 1. The SNP was negatively associated with plasma adiponectin and cortisol after adjusting for sex and age. None of the inflammation biomarkers tested were associated with the risk allele. CONCLUSION: These data, which link an HSD11B1 genotype with both disease prevalence and its related phenotypes, strongly support a role for the rs3753519 polymorphism in the pathogenesis of pediatric-onset obesity.

Presence of the metabolic syndrome in obese children at prepubertal age.

BACKGROUND/AIMS: There is a strong debate on the diagnosis and early phenotypic expression of the metabolic syndrome in children. The aim of the present study was to examine the frequency of the metabolic syndrome using various definitions in obese prepubertal and pubertal children. METHODS: 478 (213 females and 265 males) obese children were recruited in three provinces of Spain. Blood pressure (BP), waist circumference, and weight and height were measured, and body mass index was calculated. Glucose, insulin, high-density lipoprotein cholesterol and triacylglycerols were determined. We classified the children according to seven different proposed definitions of the metabolic syndrome. RESULTS: Regardless of the definition used, the prevalence of the metabolic syndrome (8.3-34.2%) was relatively high in obese children in the prepubertal period as well as in pubertal children (9.7-41.2%). We performed a principal-factor analysis to explain correlations among features of the metabolic syndrome and found that glucose metabolism (factor 1), dyslipidemia (factor 2) and obesity/BP (factor 3) explained 72% of the total variance. CONCLUSION: Irrespective of the classification used, the metabolic syndrome is not only present in pubertal but also in prepubertal children. International definitions of the metabolic syndrome should also consider criteria specific for children in the prepubertal period, i.e. children aged <10 years.

Asociación entre infección por virus de la Hepatitis B y Poliarteritis nodosa / Association between Hepatitis B virus infection and Polyarteritis Nodosa

Introducción: la Poliarteritis nodosa (PAN) se define como una vasculitis necrotizante que compromete a las arterias de mediano calibre, y causa un compromiso sistémico. Existe una asociación entre la PAN y la infección por el virus de la Hepatitis B, en relación principalmente con el depósito de inmunocomplejos virales circulantes. Las manifestaciones clínicas son inespecíficas y requiere un alto índice de sospecha. Se han usado varios regímenes de inmunosupresores (corticoides-ciclofosfamida) plasmaféresis y drogas antivirales, con respuestas variables. Objetivo: presentación de un caso clínico de PAN asociado con infección por virus de Hepatitis B, y revisión de la literatura. Caso clínico: paciente masculino de 40 años, con manifestaciones severas de Poliartritis nodosa, asociado con infección por Hepatitis B. Conclusiones: la PAN es una enfermedad poco frecuente, la asociación con infección por Hepatitis B está bien documentada y las estrategias terapéuticas difieren de las de la PAN clásica. Es una patología potencialmente fatal cuando no se reconoce y trata adecuadamente

Backgraound: Polyarteritis nodosa (PAN) is defined by a necrotizing vasculitis of medium sized arteries that causes a systemic inflammatory disease. There is an association between PAN and hepatitis B virus (HBV) infections, related mostly with viral circulting immune complexes. Clinical manifestations are not specific and require a high index of suspicion. Several immunosuppressive regimens (corticoids-ciclophosphamide), plasmapheresis and antiviral drugs have been used with varying response. Objective: Report of a clinical case of PAN associated with Hepatitis B virus infection and review of the literature. Case-reporte: A 40 year old man with severe manifestations of Polyarteritis nodosa, associated with Hepatitis B infection. Conclusions: PAN is uncommon disease, the association with hepatitis B virus infection is well documented, and the treatment strategies differs from the classic PAN. It is a potentially fatal disease when unrecognized and untreated

Predictors of the persistence of childhood asthma.

BACKGROUND: The factors relevant to the prognosis of childhood asthma differ from one population to another. OBJECTIVES: To characterize the course of childhood asthma in the catchment area of our hospital, and to identify prognostic factors for this population. METHODS: All children given a diagnosis of asthma in the paediatric pulmonology service of a tertiary hospital were followed up for 5 years. RESULTS: Satisfactory control of asthma was achieved in 69 % of cases. The factors identified as associated with poor control were allergy to cats and pollen, a large number of crises in the year prior to diagnosis, and younger age at onset. CONCLUSIONS: In our region, childhood asthma has a relatively favourable prognosis. The subsequent course of the disease appears to be determined in childhood. The persistence of symptoms appears to depend to a significant extent on the degree of atopy.

Predictors of the persistence of childhood asthma

Background. The factors relevant to the prognosis of childhood asthma differ from one population to another. Objectives. To characterize the course of childhood asthma in the catchment area of our hospital, and to identify prognostic factors for this population. Methods. All children given a diagnosis of asthma in the paediatric pulmonology service of a tertiary hospital were followed up for 5 years. Results. Satisfactory control of asthma was achieved in 69 % of cases. The factors identified as associated with poor control were allergy to cats and pollen, a large number of crises in the year prior to diagnosis, and younger age at onset. Conclusions. In our region, childhood asthma has a relatively favourable prognosis. The subsequent course of the disease appears to be determined in childhood. The persistence of symptoms appears to depend to a significant extent on the degree of atopy

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Estrategias para la prevención y tratamiento del exceso de pesoy la obesidad / No disponible

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Atherogenic diet and blood lipid profile in children and adolescents from Galicia, NW Spain. The Galinut Study.

We studied serum levels of total cholesterol, lipoproteins and triglycerides in venous blood samples and the intake of nutrients using the subject's daily record of food eaten during a period of 7 d. The material comprised 7367 children and adolescents. The overall average lipid levels (4.55 +/- 0.91 mmol/L for TC, 1.42 +/- 0.47 mmol/L for HDL-C, 2.74 +/- 0.96 mmol/L for LDL-C) are high and similar to those found in other regions of Spain in the 1990s. The proportion of children with TC > or = 5.17 mmol/L (200 mg/dl) was 19%; that of children with HDL-C < or = 0.91 mmol/L (35 mg/dL) 6.5%. There is a striking and statistically significant difference between the proportions of boys and girls aged 15-20 y who have HDL-C levels in this range (15.8% for boys and only 4.2% for girls). We also demonstrate a high total fat (44% of TCV), saturated fat (16% TCV) and cholesterol (387 mg) intake. Because of the elevated fat and saturated fat intake and the increment of a more atherogenic lipid profile in our children, preventive nutritional measures are necessary, and life habits such as physical exercise and actively reducing fat and saturated fat intake have to be applied and inculcated in children from an early age.

Prevalence of lactose malabsorption in Galicia.

BACKGROUND: The aim of the current study was to evaluate the prevalence of lactose malabsorption (LM) in Galicia (NW Spain) in order to design nutritional intervention and/or public education strategies for high risk groups. METHODS: We conducted a study of LM by breath-hydrogen carbohydrate absorption test (BH2 test) in 850 healthy subjects. All subjects underwent BH2 tests following ingestion of a aqueous solution of 2 g lactose/kg body weight up to a maximum of 50 g. Subjects with LM were retested after ingesting 250 ml of milk and/or 250 ml of yogurt. RESULTS: The frequency of LM in the subjects who ingested 2 g lactose/kg body weight was 32.5%. This percentage decreased significantly with a decrease in the quantity of administered lactose and the vehicle was milk or yogurt-only 13.7% was LM after 250 ml of milk and 3.8% after 250 ml of yogurt. Gastrointestinal symptoms also depend on dosage of lactose and vehicle, decreasing from 54.3% after 2 g lactose/kg to 18.5% after milk and to 0% after yogurt. The frequency and number of gastrointestinal symptoms were significantly higher (p < 0.001) in LM than in lactose absorption (LA). CONCLUSIONS: Lactose malabsorption is prevalent in the population of Galicia. An important number of subjects identified as LM with usual clinical testing become LA when the ingestion of dairy products is limited so that the amount of lactose consumed is similar to that contained in a usual serving. Our results suggest the importance of BH2 testing following ingestion of usual consumed amounts of lactose per serving.