Association between biomarkers of iron status and cardiometabolic risk in Spanish children aged 9-10 years. The ELOIN study.

The relationship between iron metabolism and cardiometabolic risk factors has been scarcely studied in children, and the results are controversial. The objective of this study was to evaluate the association between iron parameters and lipid, glycemic and blood pressure alterations in the pediatric population. This was a cross-sectional study of 1954 children between 9 and 10 years of age in Madrid (Spain), participants in a longitudinal study of childhood obesity. Iron metabolism parameters, i.e., serum iron (Is), ferritin (Fs), transferrin (Tf) and transferrin saturation (STf) and lipid, glycemic and blood pressure profiles were evaluated. Odds ratios (ORs) were estimated using logistic regression models adjusted for sociodemographic characteristics, diet, physical activity, C-reactive protein and body mass index. Compared with the participants in the low Is and STf tertiles, those in the upper tertiles had a lower risk of low HDL-Chol (OR: 0.34; 95%CI: 0.17; 0.67) and OR: 0.44 (95%CI: 0.23; 0.84), respectively, and children in the upper Fs tertile had an OR of 2.07 (95%CI: 1.16; 3.68) for low HDL-Chol. Children in the highest Is and STf tertiles had a lower risk of prediabetes [OR: 0.63 (95%CI: 0.41; 0.97) and OR: 0.53 (95%CI: 0.34; 0.82)] and insulin resistance (IR) (OR: 0.37; 95%CI: 0.22; 0.64), and those in the upper Tf tertile had a higher risk of IR (OR: 1.90; 95%CI: 1.16; 3.12). An increased risk of hypertension was found only in children in the upper Fs tertile (OR: 1.46; 95%CI: 1.01; 2.13). CONCLUSIONS: Biomarkers of iron metabolism are associated with cardiometabolic alterations in the pediatric population, with a variable direction and magnitude depending on the indicators used. WHAT IS KNOWN: • Iron metabolism is related to important cardiometabolic alterations such as metabolic syndrome and its components. • Association between biomarkers of iron status and cardiometabolic risk have been less explored in children. WHAT IS NEW: • Biomarkers of iron metabolism are associated with cardiometabolic alterations in the pediatric population. • Iron parameters in the pediatric population could be of great help to detect and prevent cardiometabolic abnormalities early.

Changes in general and abdominal obesity in children at 4, 6 and 9 years of age and their association with other cardiometabolic risk factors.

Temporary changes in childhood obesity and their association with cardiometabolic risk factors have been receiving increased attention. The objective of this study was to evaluate changes in general (GO) and abdominal (AO) obesity in children from 4 to 9 years of age and their associations with cardiometabolic risk factors at 9 years of age. This study includes 1344 children from the Longitudinal Childhood Obesity Study (ELOIN). Physical examinations performed at 4, 6 and 9 years of age and a blood sample was only taken at 9 years of age. Changes in obesity from 4 to 9 years of age were estimated using Body Mass Index and waist circumference. Participants were classified into four groups according to GO and AO: (1) stable without obesity (no obesity at all three measurements); (2) remitting obesity at 9 years (obesity at 4 and/or 6 years but not at 9 years); (3) incident or recurrent obesity at 9 years (obesity only at 9 years, at 4 and 9 years or at 6 and 9 years); and (4) stable or persistent with obesity (obesity at 4, 6 and 9 years). Dyslipidemia and dysglycemia were defined by the presence of at least one altered parameter of the lipid or glycemic profile. Odds ratios (OR) were estimated using logistic regression. Compared with children without GO at all ages, those with persistent GO had an OR of 3.66 (95% CI: 2.06-6.51) for dyslipidemia, 10.61 (95% CI: 5.69-19.79) for dysglycemia and 8.35 (95% CI: 4.55-15.30) for high blood pressure. The associations were fairly similar in the case of AO, with ORs of 3.52 (95% CI: 1.96-6.34), 17.15 (95% CI: 9.09-32.34) and 8.22 (95% CI: 4.46-15.15), respectively, when comparing persistent versus stable without AO. Children with incident obesity at 9 years presented a moderate cardiometabolic risk that was nevertheless higher compared to those stable without obesity, whereas those with remitting obesity did not show any significant associations. CONCLUSION: Incident, and especially, persistent obesity, is associated with an increased cardiometabolic risk. The very early prevention of obesity, with a focus on nutrition, physical activity and sedentary behaviour, as well as tracking growth from birth to age 5, should be a priority to prevent the burden of cardiometabolic disease with consequences for adulthood. WHAT IS KNOWN: • General and abdominal obesity has been shown to be associated with other cardiometabolic risk factors such as dyslipidemia, insulin resistance and hypertension. • Temporary changes in obesity and their associations with cardiometabolic risk factors have not been sufficiently explored in childhood. WHAT IS NEW: • Children with incident, and especially persistent, general and/or abdominal obesity, had an increased risk of dyslipidemia, dysglycemia and high blood pressure. •Remitting obesity was not associated with an increased cardiometabolic risk.

Household food insecurity and its association with overweight and obesity in children aged 2 to 14 years.

BACKGROUND: The objective was to estimate the prevalence of household food insecurity (HFI) depending on sociodemographic factors and its association with lifestyle habits and childhood overweight and obesity. METHODS: Data was collected from 1,938 children aged 2 to 14 years who participated in the "Study about Malnutrition" of the Community of Madrid. Weight and height were obtained through physical examination. Body mass index was calculated as weight/height2 (kg/m2) and the criteria of the WHO were used for determining conditions of overweight and obesity. The participants' parents answered a structured questionnaire about their diet, lifestyle (physical activity and screen time), and food insecurity. The diet quality was assessed with the Healthy Eating Index in Spain and food insecurity, defined as the lack of consistent access to sufficient food for a healthy life, was measured via three screening questions and the Household Food Insecurity Access Scale (HFIAS). Odds Ratios (ORs) and Relative Risk Ratios (RRRs) were estimated using logistic regression models and adjusted for confounding variables. RESULTS: The overall prevalence of HFI was 7.7% (95% CI: 6.6‒9.0), with lower values in children 2 to 4 years old (5.7%, 95% CI: 4.0‒8.1) and significantly higher values in households with low family purchasing power [37.3%; OR: 8.99 (95% CI: 5.5‒14.6)]. A higher prevalence of overweight (33.1%) and obesity (28.4%) was observed in children from families with HFI, who presented a lower quality diet and longer screen time compared to those from food-secure households (21.0% and 11.5%, respectively). The RRR of children in families with HFI relative to those from food-secure households was 2.41 (95% CI: 1.5‒4.0) for overweight and 1.99 (95% CI: 1.2‒3.4) for obesity. CONCLUSION: The prevalence of HFI was high in the paediatric population, especially in households with low family purchasing power. HFI was associated with lower diet quality and higher prevalence of childhood overweight and obesity. Our results suggest the need for paediatric services to detect at-risk households at an early stage to avoid this dual burden of child malnutrition.

Changes in obesity and iron deficiency between 4 and 9 years of age. Longitudinal study of childhood obesity (ELOIN).

BACKGROUND: Recent studies revealed that children who are overweight have a higher risk of iron deficiency, although the etiology of this relationship remains unclear. The aim of the study was to evaluate the association between changes in obesity status between 4 and 9 years of age and iron deficiency. SUBJECTS: This population-based cohort study included 1347 children from the ELOIN study, conducted in Madrid, Spain. Follow-up with physical examinations and a computer-assisted telephone interview were carried out at 4, 6 and 9 years of age, and a blood test was performed at 9 years. METHODS: Changes in obesity were estimated based on body mass index and waist circumference, according to the persistence or variation in obesity rates at 4, 6 and 9 years and were classified as follows: (1) Stable without obesity; (2) Remitting obesity at 9 years; (3) Incident obesity or relapse at 9 years; and (4) Stable with obesity. Iron deficiency was defined as transferrin saturation value below 16%. Odds ratios (ORs) for iron deficiency were estimated according to obesity status using logistic regression and adjusted for confounding variables, including C-reactive protein (CRP). RESULTS: The prevalence of iron deficiency in the stable general obesity (GO) and abdominal obesity (AO) groups was 38.2% and 41.2%, versus 23.6% and 23.4% in the stable without obesity groups, respectively. The ORs for iron deficiency were 1.85 (95% CI: 1.03-3.32) in the stable GO group and 2.34 (95% CI: 1.29-4.24) in the stable AO group. This association disappeared when CRP was included in the analysis. CONCLUSIONS: An extended state of obesity during the first stages of life is associated with iron deficiency, and this association may be mediated by CRP. Prevention and early detection of obesity in children should be a priority to avoid a double burden of malnutrition.

Tracking and risk of abdominal and general obesity in children between 4 and 9 years of age. The Longitudinal Childhood Obesity Study (ELOIN).

BACKGROUND: Studies have shown that overweight and obesity conditions tend to be stable from childhood and adolescence to adulthood. Unfortunately, little is known about the evolution of abdominal obesity during childhood. The aim of this study was to evaluate the temporal variations and risk of general and abdominal obesity between 4, 6, and 9 years of age. METHODS: Measurements of children in the ELOIN study taken at the three follow-ups of 4, 6, and 9 years of age were included (N = 1,902). Body mass index and waist circumference were recorded via physical examination. General obesity was determined according to the criteria of the World Health Organization (WHO) and abdominal obesity according to the cut-off points proposed by the International Diabetes Federation (IDF). Prevalence ratios (PRs) were estimated by sex and family affluence using generalized estimating equation models and relative risks (RRs) of obesity were obtained via Poisson regression. RESULTS: The prevalence of general obesity was 5.1%, 9.1%, and 15.6% at 4, 6, and 9 years, respectively, yielding a PR of 3.05 (95%CI: 2.55-3.60) (9 years old relative to 4 years). The prevalence of abdominal obesity was 6.8%, 8.4%, 14.5% at 4, 6, and 9 years, respectively, and the PR was 2.14 (95%CI: 1.82-2.51) (9 years old relative to 4 years). An inverse correlation was observed between both general and abdominal obesity and socioeconomic status. Among participants with general or abdominal obesity at 4 years of age, 77.3% and 63.6% remained in their obesity classification at 9 years, respectively, and 3.4% and 3.5% presented general or abdominal obesity also at 6 and 9 years of age, respectively. The RRs of general and abdominal obesity at 9 years were 4.61 (95%CI: 2.76-7.72) and 4.14 (95%CI: 2.65-6.48) for children classified with obesity at 4 years of age, increased to 9.36 (95%CI: 7.72-11.35) and 9.56 (95%CI: 7.79-11.74) for children who had obesity at 6 years, and up to 10.27 (95%CI: 8.52-12.37) and 9.88 (95%CI: 8.07-12.11) for children with obesity at both 4 and 6 years, respectively. CONCLUSIONS: General and abdominal obesity begin at an early age and increase over time, showing an inverse correlation with socioeconomic status. In addition, general and abdominal obesity at 9 years are strongly associated with being classified with obesity at 4 and 6 years, so preventive interventions should be established at very early ages.

Childhood obesity and risk of SARS-CoV-2 infection.

OBJECTIVE: To estimate the association between childhood obesity and the risk of SARS-CoV-2 infection in a cohort followed from 4 to 12 years of age. METHODS: The data were obtained from two independent sources: the Longitudinal Childhood Obesity Study (ELOIN) and the epidemiological surveillance system data from the Community of Madrid (Spain), which served to identify the population within the cohort with confirmed SARS-CoV-2 infection. The SARS-CoV-2 registry was cross-checked with the cohort population at 11-12 years of age. A total of 2018 eligible participants were identified in the cohort, who underwent physical examinations at 4, 6, and 9 years of age during which weight, height, and waist circumference were recorded. General obesity (GO) was determined according to the WHO-2007 criteria whereas abdominal obesity (AO) was defined based on the International Diabetes Federation (IDF) criteria. The relative risks (RRs) of infection were estimated using a Poisson regression model and adjusted by sociodemographic variables, physical activity, and perceived health reported by the parents. RESULTS: The accumulated incidence of SARS-CoV-2 infection was 8.6% (95% CI: 7.3-9.8). The estimated RR of SARS-CoV-2 infection was 2.53 (95% CI: 1.56-4.10) and 2.56 (95% CI: 1.55-4.21) for children 4-9 years old with stable GO and AO, respectively, compared with those who did not present GO. CONCLUSIONS: Childhood obesity is an independent risk factor for SARS-CoV-2 infection. This study provides new evidence that indicates that obesity increases the vulnerability of the paediatric population to infectious diseases.

Evolución de la incidencia de diabetes mellitus tipo 1 (0-14 años) en la Comunidad de Madrid, 1997-2016 / Evolution of the incidence of type 1 diabetes mellitus in the Community of Madrid, 1997-2016

Introducción: El objetivo fue estimar la incidencia de diabetes tipo 1 (DM1) en la población infantil de la Comunidad de Madrid (CM) y su evolución entre 1997 y 2016, a partir de los datos médicos-administrativos del registro regional de DM1. Métodos: Fueron incluidos los casos de DM1 de menores de 15 años, notificados al registro regional o captados de fuentes secundarias: Asociación Diabéticos Españoles (1997-2013) y a partir de 2014 del conjunto mínimo básico de datos (CMBD) hospitalario. Se estimaron las tasas de incidencia anual por 100.000 personas-año. La comparación de las tasas se analizó mediante modelos de regresión de Poisson a través de razones de incidencia (RI). Resultados: Un total de 2658 casos fueron identificados como nuevos diagnósticos de DM1. La tasa de incidencia media de 1997-2013 fue de 13,7 casos por 100.000 personas-año. En el periodo 2014-2016, utilizando el CMBD se registraron 20,0 casos por 100.000. El grupo de edad con mayor incidencia fue el de 10-14 años en los 2periodos (16,6 vs. 25,5). En los niños, la edad de mayor incidencia fue de 10 a 14 años en ambos periodos (17,9 vs. 30,4) y en las niñas el de 5 a 9 años (17,0 vs. 25,1). Las tasas de incidencia descendieron ligeramente en ambos sexos hasta 2013 (de 15,0 a 11,6); en 2014-2016 la tasa de incidencia anual varió entre 18,4 y 21,1 casos (RI: 1,77). La incidencia permaneció estable en menores de 5 años y aumentó de 5 a 14 años. Conclusiones: La CM se sitúa entre las regiones de alta incidencia de DM1. En su primera fase, el registro regional infraestimaba la incidencia de DM1. Con la incorporación del CMBD como fuente de información, las estimaciones del segundo periodo (2014-2016) son posiblemente más próximas a la incidencia real de DM1. Los datos que presentamos sugieren la necesidad de conocer la evolución real de la incidencia de la enfermedad incorporando los registros digitales sanitarios. (AU)

Introduction: The objective of this article was to estimate the type 1 diabetes mellitus (DM1) incidence in the child population of the Community of Madrid (CM) and its evolution between 1997 and 2016, using the medical-administrative data of the regional registry of DM1. Methods: DM1 cases of children under 15 years of age, reported to the regional registry or collected from secondary sources were included: Spanish Diabetics Association (1997-2013), and from 2014 on the Basic Minimum Data Set (BMDS). Annual incidence rates were estimated per 100 000 person-years. The comparison of the rates was analysed using Poisson regression models using incidence ratios (IR). Results: A total of 2658 cases were identified as new diagnoses of DM1. The mean incidence rate for 1997-2013 was 13.7 cases per 100 000 person-years. In the 2014-2016 period, 20 cases per 100 000 persons-years were registered using the BMDS. The age group with the highest incidence was 10-14 years in the 2periods (16.6 vs. 25.5). In boys, the age with the highest incidence was 10 to 14 years in both periods (17.9 vs 30.4), and in girls, the age of 5 to 9 years (17.0 vs 25.1). Incidence rates decreased slightly in both genders until 2013 (from 15.0 to 11.6). In 2014-2016, the annual incidence rate varied between 18.4 and 21.1 cases (IR: 1.77). The incidence remained stable in children under 5 years old and increased from 5 to 14 years old. Conclusions: The CM is among the regions with a high incidence of DM1. In its first phase, the regional registry underestimated the incidence of DM1, and with the incorporation of the MBDS as a source of information, the estimates for the second period (2014-2016) are possibly closer to the actual incidence of DM1. The data presented suggests the need to know the real evolution of the incidence of the disease by incorporating computerised health records. (AU)

Evolution of the incidence of type 1 diabetes mellitus in the Community of Madrid, 1997-2016.

INTRODUCTION: The objective of this article was to estimate the type 1 diabetes mellitus (T1DM) incidence in the child population of the Community of Madrid (CM) and its evolution between 1997 and 2016, using the medical-administrative data of the regional registry of T1DM. METHODS: T1DM cases of children under 15 years of age, reported to the regional registry or collected from secondary sources were included: Spanish Diabetics Association (1997-2013), and from 2014 on the Basic Minimum Data Set (BMDS). Annual incidence rates were estimated per 100 000 person-years. The comparison of the rates was analysed using Poisson regression models using incidence ratios (IR). RESULTS: A total of 2658 cases were identified as new diagnoses of T1DM. The mean incidence rate for 1997-2013 was 13.7 cases per 100 000 person-years. In the 2014-2016 period, 20 cases per 100 000 persons-years were registered using the BMDS. The age group with the highest incidence was 10-14 years in the two periods (16.6 vs. 25.5). In boys, the age with the highest incidence was 10-14 years in both periods (17.9 vs 30.4), and in girls, the age of 5-9 years (17.0 vs 25.1). Incidence rates decreased slightly in both genders until 2013 (from 15.0 to 11.6). In 2014-2016, the annual incidence rate varied between 18.4 and 21.1 cases (IR: 1.77). The incidence remained stable in children under 5 years old and increased from 5 to 14 years old. CONCLUSIONS: The CM is among the regions with a high incidence of T1DM. In its first phase, the regional registry underestimated the incidence of T1DM, and with the incorporation of the MBDS as a source of information, the estimates for the second period (2014-2016) are possibly closer to the actual incidence of T1DM. The data presented suggests the need to know the real evolution of the incidence of the disease by incorporating computerised health records.

[Evolution of the incidence of type 1 diabetes mellitus in the Community of Madrid, 1997-2016]. / Evolución de la incidencia de diabetes mellitus tipo 1 (0-14 años) en la Comunidad de Madrid, 1997-2016.

INTRODUCTION: The objective of this article was to estimate the type 1 diabetes mellitus (DM1) incidence in the child population of the Community of Madrid (CM) and its evolution between 1997 and 2016, using the medical-administrative data of the regional registry of DM1. METHODS: DM1 cases of children under 15 years of age, reported to the regional registry or collected from secondary sources were included: Spanish Diabetics Association (1997-2013), and from 2014 on the Basic Minimum Data Set (BMDS). Annual incidence rates were estimated per 100 000 person-years. The comparison of the rates was analysed using Poisson regression models using incidence ratios (IR). RESULTS: A total of 2658 cases were identified as new diagnoses of DM1. The mean incidence rate for 1997-2013 was 13.7 cases per 100 000 person-years. In the 2014-2016 period, 20 cases per 100 000 persons-years were registered using the BMDS. The age group with the highest incidence was 10-14 years in the 2periods (16.6 vs. 25.5). In boys, the age with the highest incidence was 10 to 14 years in both periods (17.9 vs 30.4), and in girls, the age of 5 to 9 years (17.0 vs 25.1). Incidence rates decreased slightly in both genders until 2013 (from 15.0 to 11.6). In 2014-2016, the annual incidence rate varied between 18.4 and 21.1 cases (IR: 1.77). The incidence remained stable in children under 5 years old and increased from 5 to 14 years old. CONCLUSIONS: The CM is among the regions with a high incidence of DM1. In its first phase, the regional registry underestimated the incidence of DM1, and with the incorporation of the MBDS as a source of information, the estimates for the second period (2014-2016) are possibly closer to the actual incidence of DM1. The data presented suggests the need to know the real evolution of the incidence of the disease by incorporating computerised health records.

Parental perception of child health status and quality of life associated with overweight and obesity in early childhood.

PURPOSE: The aim was to assess perceived health status and health-related quality of life (HRQL) according to persistence of and variation in weight status among children from the age of 4 to 6 years. METHODS: Longitudinal study of 1883 participants in the ELOIN cohort (Madrid Region, Spain), with physical examination at ages 4 and 6 years. Perceived health status and HRQL were assessed using parent-reported Kidscreen-10 scores, with excess weight being defined on the basis of body mass index (BMI) using the WHO reference tables (z-BMI > 1 standard deviation), and abdominal obesity being defined on the basis of waist circumference (percentile ≥ 90) using the tables proposed by Fernández et al. Variation in these two parameters at age 6 years was associated with incident cases of suboptimal health by logistic regression, and with HRQL by linear regression. RESULTS: Compared to children without excess weight or abdominal obesity in both periods, incident cases of excess weight or abdominal obesity had odds ratios (ORs) of suboptimal health of 2.41 (95% CI 1.21 to 4.80) and 2.99 (95% CI 1.31 to 6.84) respectively. In terms of HRQL, children with remission of excess weight had a higher Kidscreen-10 score: ß coefficient = 2.02 (95% CI 0.36 to 3.68), whereas new cases of abdominal obesity had a lower Kidscreen-10 score: ß = - 2.22 (95% CI - 4.40 to - 0.03). CONCLUSIONS: Incident cases of excess weight and abdominal obesity had a higher risk of suboptimal health. Incident cases of abdominal obesity were also associated with worse HRQL.

Demand for health services and drug prescriptions among overweight or obese preschool children.

OBJECTIVES: To evaluate the association between excess weight and the demand of health services in preschool children compared with healthy weight. METHODS: The data come from the Longitudinal Study of Childhood Obesity cohort (1884 4-year-old children, residing in the Madrid region, Spain) who provided information through telephone questionnaire, physical examination and electronic medical records. We defined overweight, general and abdominal obesity based on body mass index, waist circumference and waist-to-height ratio. Using mixed models of multivariable negative binomial regression we calculated the incidence rate ratio (IRR) regarding primary care (PC) doctor visits, drug prescriptions and hospital admissions by weight status at the end of the 2-year follow-up. RESULTS: Childhood general obesity was associated with a higher demand for PC services related to psychological problems (IRR=1.53; 95% CI 1.02 to 2.28) and childhood abdominal obesity, according to waist-to-height ratio, was related to more frequent problems of the musculoskeletal system (IRR=1.27; 95% CI 1.00 to 1.62). Drugs were prescribed more frequently to children falling under all three definitions of excess weight, compared with healthy weight children. No differences in the number of hospital admissions were observed. CONCLUSIONS: The demand of health services related to early childhood obesity was small. Nevertheless, obesity was associated with a slightly greater demand for drug prescriptions and for PC doctor visits related to psychological and musculoskeletal problems.

Accuracy of anthropometric measurements and weight status perceptions reported by parents of 4-year-old children.

OBJECTIVE: To assess the validity of self-reported height and weight by parents of 4-year-old children and subjective weight perception. DESIGN: Descriptive cross-sectional study. SETTING: Paediatric population living in the Autonomous Community of Madrid. PARTICIPANTS: Children born in 2008-2009 examined at 47-59 months of age. Data were collected by paediatricians of the Madrid Primary Care Physicians Sentinel Network. Parents reported weight and height data. Prevalence of weight status categories was calculated using WHO and International Obesity Task Force (IOTF) reference criteria. Sensitivity, specificity and positive predictive value (PPV) were estimated. The appraisal of their child's weight perception and parental misperception were assessed. RESULTS: For 2914 children, reported height was underestimated by -1·38 cm, weight by -0·25 kg and BMI was overestimated by +0·41 kg/m2 on average. The prevalence of obesity estimated with reported data was 2·7 times higher than that calculated with measured data (16·2 v. 6·0 %) according to WHO classification, and 3·6 times higher with IOTF classification. Sensitivity to identify obesity was 70·5 %, specificity was 87·3 % and PPV was 26·2 % (WHO classification). Half of the parents of pre-schoolers with obesity failed to identify their child's weight status. Parental misperception among children classified as having overweight or obesity reached 93·0 and 58·8 %, respectively. CONCLUSIONS: Parents underestimated children's height and weight, leading to an overestimation of the prevalence of obesity. Small inaccuracies in reported measures have an important effect for the estimation of population prevalences. Parents' report of child weight status is unreliable. Parental awareness and acknowledgement of child weight status should be improved.

Association between general and central adiposity and development of hypertension in early childhood.

OBJECTIVES: To evaluate the association of general and abdominal obesity with high blood pressure in young children. METHODS: A longitudinal study including 1796 participants from the Madrid region (Spain) with baseline at age 4 years and a follow-up 2 years later. Blood pressure, body mass index and waist circumference were measured during a physical examination. We evaluated the association between obesity at baseline and weight changes between the ages of 4 and 6 years and high blood pressure. Data were analysed using linear and logistic regressions adjusted for covariates. RESULTS: Obese 4 year olds (general or abdominal obesity) experienced an average 4-5 mmHg increase in systolic blood pressure and a 2.5-3 mmHg increase in diastolic blood pressure by the age of 6 years. Compared to children maintaining a non-excess weight (based on body mass index) during follow-up incident and persistent cases of excess weight (overweight or obesity) had an odds ratio (OR) for high blood pressure of 2.49 (95% confidence interval (CI) 1.50-4.13) and OR 2.54 (95% CI 1.27-5.07), respectively. Regarding abdominal obesity we estimated OR 2.81 (95% CI 0.98-8.02) for incident cases and OR 3.42 (95% CI 1.38-8.49) for persistent cases. Similar estimates for the waist-height ratio were observed. Individuals who experienced remission to non-excess weight did not have an increased risk of high blood pressure. CONCLUSIONS: We observed an increased risk for high blood pressure among 4-year-olds who presented with persistent or incident cases of excess weight (body mass index) or abdominal obesity after 2 years of follow-up. Children with excess weight or obesity at baseline who remitted to non-excess weight did not exhibit an increased risk of high blood pressure.

Persistencia y variación del sobrepeso y la obesidad en la población preescolar de la Comunidad de Madrid tras dos años de seguimiento. Cohorte ELOIN / Persistence and variation in overweight and obesity among the pre-school population of the community of Madrid after 2 years of follow-up. The ELOIN cohort

Introducción y objetivos: La epidemia de obesidad infantil es un problema de salud pública mundial que se inicia a edades muy tempranas. El objetivo del estudio es determinar la persistencia y la variación del sobrepeso y la obesidad en una cohorte de niños seguidos de los 4 a los 6 años de edad. Métodos: Los datos proceden del ELOIN (Estudio Longitudinal de Obesidad Infantil), cohorte de base poblacional de la Comunidad de Madrid, en el que participaron 2.435 niños. Midieron el peso y la talla 31 pediatras, de manera objetiva y estandarizada, a los 4 años (2012-2013) y a los 6 años de edad (2014-2015). Se utilizaron 3 criterios de referencia para definir «sin exceso de peso», sobrepeso y obesidad: Organización Mundial de la Salud (OMS-2006), International Obesity Task Force (IOTF-2000) y tablas españolas de la Fundación Orbegozo-2004. Resultados: La prevalencia de sobrepeso a los 4 y los 6 años, según los 3 criterios de clasificación, aumentó del 5,7-16,5% (intervalo de los 3 criterios) al 8,9-17,0% y la de obesidad, del 3,0-5,4% al 6,1-10,1%. De cada 4 niños obesos a los 4 años, 3 seguían con obesidad a los 6 años, mientras que un 20,6-29,3% que tenían sobrepeso pasaron a ser obesos. Entre el 8,0 y el 16,1% mantuvieron el «exceso de peso» (sobrepeso/obesidad) entre los 4 y los 6 años, un 7,9-11% fueron nuevos casos y un 2,2-5,9% remitieron. Conclusiones: El exceso de peso aumentó de los 4 a los 6 años. Se observaron variaciones importantes en el estado ponderal susceptibles de intervención en el control pediátrico del niño sano

Introduction and objectives: The childhood obesity epidemic is a worldwide public health problem which starts at very early ages. The aim of this study was to determine the persistence of and variation in overweight and obesity among a cohort of children followed up from 4 to 6 years of age. Methods: The data were drawn from the ELOIN (Longitudinal Childhood Obesity Study), a population-based cohort in the Community of Madrid, Spain. A total of 2435 children were involved. Weight and height were objectively measured and standardised at 4 (2012-2013) and 6 years of age (2014-2015) by 31 purpose-trained pediatricians. Three reference criteria were used: the World Health Organization (WHO-2006), International Obesity Task Force (IOTF-2000), and Spanish tables of the Orbegozo Foundation 2004, were used to define "absence of excess weight", overweight and obesity. Results: According to the above three classification criteria, between the ages of 4 and 6 years the prevalence of overweight increased from 5.7%-16.5% (range of the 3 criteria) to 8.9%-17.0%, and obesity increased from 3.0%-5.4% to 6.1%-10.1%. Three out of every 4 obese children at age 4 years persisted with obesity at age 6 years, whereas 20.6%-29.3% who were overweight became obese. A total of 8.0% to 16.1% of children maintained "excess weight" (overweight/obesity), 7.9% to 11% were new cases, and 2.2% to 5.9% showed remission. Conclusions: Excess weight increased between the ages of 4 and 6 years. Important variations were observed in weight status susceptible to intervention during well-child visits

Prevalencia de la lactancia materna y factores asociados con el inicio y la duración de la lactancia materna exclusiva en la Comunidad de Madrid entre los participantes en el estudio ELOIN / Prevalence of breastfeeding and factors associated with the start and duration of exclusive breastfeeding in the Community of Madrid among participants in the ELOIN

INTRODUCCIÓN: La lactancia materna tiene importantes beneficios para la salud poblacional. Los objetivos de este estudio son: a) conocer la prevalencia y duración de la lactancia materna y lactancia materna exclusiva; b) analizar las razones de no inicio y de abandono de la lactancia materna, y c) describir los factores asociados a la lactancia materna exclusiva y con su mantenimiento durante 6meses. MATERIAL Y MÉTODOS: Estudio transversal a partir de datos basales de la cohorte ELOIN, obtenidos por cuestionario epidemiológico. Se estudió una muestra de 2.627 niños de 4años nacidos en 2008-2009 de la Comunidad de Madrid. Se utilizaron modelos de regresión logística. RESULTADOS: La prevalencia de lactancia materna exclusiva y lactancia materna fue del 77,6 y del 88%, respectivamente; la lactancia materna exclusiva a los 6 meses fue del 25,4%, y la lactancia materna a los 2 años, del 7,7%. Las razones principales de finalización de la lactancia fueron la producción insuficiente de leche (36%) y la incorporación al trabajo (25,9%). Las variables asociadas con el inicio o mantenimiento de la lactancia materna exclusiva fueron: madre de más de 35años, estatus económico medio-alto, extranjera con menos de 10 años de residencia en España y haber participado en taller de lactancia tras el parto. CONCLUSIONES: La prevalencia de lactancia materna en la Comunidad de Madrid no alcanzó en 2008-2009 las recomendaciones internacionales. Es necesario intensificar estrategias de promoción, protección y apoyo a la lactancia materna, incluyendo su monitorización periódica

INTRODUCTION: Breastfeeding has important benefits for population health. The aims of this study are: (I) to determine the prevalence and duration of breastfeeding and exclusive breastfeeding; (II) analyse the reasons for not starting or abandoning of breastfeeding, and (III) describe the factors associated with the initiation and duration of exclusive breastfeeding. MATERIAL AND METHODS: Cross sectional study using the baseline data of the ELOIN cohort, obtained using an epidemiological questionnaire. A sample of 2,627 children born in 2008-2009 from the Community of Madrid was studied. Logistic regression models were used. RESULTS: Prevalence of exclusive breastfeeding and breastfeeding was 77.6% and 88% respectively; prevalence of exclusive breastfeeding at 6 months 25.4%, and prevalence of breastfeeding at 2 years was 7.7%. The most common reasons for abandoning breastfeeding were insufficient milk (36%), and incorporation to work (25.9%). The variables associated with starting or maintaining of exclusive breastfeeding were: mother older than 35 years, medium-high economic status, foreigner residing in Spain less than 10 years, and having participated in a breastfeeding workshop. CONCLUSIONS: Breastfeeding prevalence in the Community of Madrid did not reach the international recommendations in 2008-2009. It is necessary to intensify strategies for breastfeeding promotion, protection, and support, including their periodic monitoring

Persistence and Variation in Overweight and Obesity Among the Pre-school Population of the Community of Madrid After 2 Years of Follow-up. The ELOIN Cohort.

INTRODUCTION AND OBJECTIVES: The childhood obesity epidemic is a worldwide public health problem which starts at very early ages. The aim of this study was to determine the persistence of and variation in overweight and obesity among a cohort of children followed up from 4 to 6 years of age. METHODS: The data were drawn from the ELOIN (Longitudinal Childhood Obesity Study), a population-based cohort in the Community of Madrid, Spain. A total of 2435 children were involved. Weight and height were objectively measured and standardised at 4 (2012-2013) and 6 years of age (2014-2015) by 31 purpose-trained pediatricians. Three reference criteria were used: the World Health Organization (WHO-2006), International Obesity Task Force (IOTF-2000), and Spanish tables of the Orbegozo Foundation 2004, were used to define "absence of excess weight", overweight and obesity. RESULTS: According to the above three classification criteria, between the ages of 4 and 6 years the prevalence of overweight increased from 5.7%-16.5% (range of the 3 criteria) to 8.9%-17.0%, and obesity increased from 3.0%-5.4% to 6.1%-10.1%. Three out of every 4 obese children at age 4 years persisted with obesity at age 6 years, whereas 20.6%-29.3% who were overweight became obese. A total of 8.0% to 16.1% of children maintained "excess weight" (overweight/obesity), 7.9% to 11% were new cases, and 2.2% to 5.9% showed remission. CONCLUSIONS: Excess weight increased between the ages of 4 and 6 years. Important variations were observed in weight status susceptible to intervention during well-child visits.

[Prevalence of breastfeeding and factors associated with the start and duration of exclusive breastfeeding in the Community of Madrid among participants in the ELOIN]. / Prevalencia de la lactancia materna y factores asociados con el inicio y la duración de la lactancia materna exclusiva en la Comunidad de Madrid entre los participantes en el estudio ELOIN.

INTRODUCTION: Breastfeeding has important benefits for population health. The aims of this study are: (i)to determine the prevalence and duration of breastfeeding and exclusive breastfeeding; (ii)analyse the reasons for not starting or abandoning of breastfeeding, and (iii)describe the factors associated with the initiation and duration of exclusive breastfeeding. MATERIAL AND METHODS: Cross sectional study using the baseline data of the ELOIN cohort, obtained using an epidemiological questionnaire. A sample of 2,627 children born in 2008-2009 from the Community of Madrid was studied. Logistic regression models were used. RESULTS: Prevalence of exclusive breastfeeding and breastfeeding was 77.6% and 88% respectively; prevalence of exclusive breastfeeding at 6months 25.4%, and prevalence of breastfeeding at 2years was 7.7%. The most common reasons for abandoning breastfeeding were insufficient milk (36%), and incorporation to work (25.9%). The variables associated with starting or maintaining of exclusive breastfeeding were: mother older than 35years, medium-high economic status, foreigner residing in Spain less than 10 years, and having participated in a breastfeeding workshop. CONCLUSIONS: Breastfeeding prevalence in the Community of Madrid did not reach the international recommendations in 2008-2009. It is necessary to intensify strategies for breastfeeding promotion, protection, and support, including their periodic monitoring.

Estudio Longitudinal de Obesidad Infantil (ELOIN): diseño, participación y características de la muestra / The Longitudinal Childhood Obesity Study (ELOIN): design, participation and characteristics of the baseline sample

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On the problem of type 2 diabetes-related mortality in the Canary Islands, Spain. The DARIOS Study.

AIMS: To compare diabetes-related mortality rates and factors associated with this disease in the Canary Islands compared with other 10 Spanish regions. METHODS: In a cross-sectional study of 28,887 participants aged 35-74 years in Spain, data were obtained for diabetes, hypertension, dyslipidemia, obesity, insulin resistance (IR), and metabolic syndrome. Healthcare was measured as awareness, treatment and control of diabetes, dyslipidemia, and hypertension. Standardized mortality rate ratios (SRR) were calculated for the years 1981 to 2011 in the same regions. RESULTS: Diabetes, obesity, and hypertension were more prevalent in people under the age of 64 in the Canary Islands than in Spain. For all ages, metabolic syndrome and insulin resistance (IR) were also more prevalent in those from the Canary Islands. Healthcare parameters were similar in those from the Canary Islands and the rest of Spain. Diabetes-related mortality in the Canary Islands was the highest in Spain since 1981; the maximum SRR was reached in 2011 in men (6.3 versus the region of Madrid; p<0.001) and women (9.5 versus Madrid; p<0.001). Excess mortality was prevalent from the age of 45 years and above. CONCLUSIONS: Diabetes-related mortality is higher in the Canary Islands population than in any other Spanish region. The high mortality and prevalence of IR warrants investigation of the genetic background associated with a higher incidence and poor prognosis for diabetes in this population. The rise in SRR calls for a rapid public health policy response.