[Home enteral nutrition in Spain. Results of the register of the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition in 2003]. / Nutrición enteral domiciliaria en España. Resultados del registro de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica del año 2003.

INTRODUCTION: The number of children receiving prolonged home enteral nutrition (HEN) is increasing. However, precise information on the incidence and prevalence of HEN in Spain is lacking. Consequently, the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition created a patients' register (NEPAD). The aim of the present study was to analyze the results of the first year of the NEPAD register (2003). MATERIAL AND METHODS: The NEPAD is an on-line register that gathers information on the indications for HEN, route of access, type of diet and duration of nutritional support. Quantitative data are expressed as mean and standard deviation, and qualitative data as percentages. RESULTS: In 2003, 124 children from 6 hospitals were registered. The mean age at the beginning of HEN was 3.6 years. The underlying disease was gastrointestinal in 20%, neurological or mental retardation in 20%, cystic fibrosis in 14.5%, tumor in 11%, innate error of metabolism in 10%, congenital cardiac disease in 6%, severe primary malnutrition in 6%, and other causes in 13%. A nasogastric tube was used as the first route of access in 56%, and gastrostomy was used in 42%. Sixty percent of the children received continuous nocturnal enteral nutrition and 90% used an infusion pump. The type of feeding consisted of blenderized natural food in 14%, polymeric pediatric formula in 50%, and infant formulae in 18%. On December 31st, 84 children continued to receive enteral nutrition (68%). CONCLUSIONS: Despite the efforts made to maintain the on-line national register, it has been underused in its first year of existence (2003). Patients with gastrointestinal or neurological diseases constitute the main group of patients in the register. There is a slight preference for the use of nasogastric tube over gastrostomy.

[Epidemiology of type 1 diabetes in children and adolescents aged less than 15 years in the provinces of Castilla y León]. / Epidemiología de la diabetes tipo 1 en menores de 15 años en las provincias de Castilla y León.

INTRODUCTION: The incidence of type 1 diabetes shows wide geographical variability and heterogeneity. The aim of this study was to determine the incidence and prevalence of type 1 diabetes in children and adolescents ages less than 15 years in the different provinces of Castilla-León. MATERIAL AND METHODS: To determine incidence, all new cases of type 1 diabetes with onset under 15 years of age in 2003-2004 were obtained. Incidence was expressed as the crude value with the corresponding confidence interval and as standardized incidence. The capture-recapture method was used to calculate the completeness of ascertainment. To determine prevalence, all cases of type 1 diabetes in persons ages less than 15 years at 31 December 2004 were obtained. RESULTS: Incidence showed wide variability among the different provinces of Castilla-León. The highest values were found in Segovia (38.77/100,000/year), Valladolid (32.07/100,000/ year) and Avila (23.21/100,000/year) and the lowest in Zamora (8.14/100,000/year). Incidences were highest in the 5-9 years age group in all provinces except Burgos. Prevalence was highest in Segovia (1.54/1,000), Valladolid (1.41/1,000), Avila (1.38/1,000) and Zamora (1.32/1,000) and lowest in Burgos (0.91/1,000). CONCLUSIONS: Castilla-León seems to have one of the highest incidences of type 1 diabetes in Spain; several of its provinces have values similar to those in Northern Europe.

[Growth in healthy infants aged 0-2 years and comparison with reference charts]. / Crecimiento de niños sanos de 0 a 2 años y comparación con las gráficas de referencia.

BACKGROUND: Growth reference charts should be periodically adapted to the population in which they will be applied, according to ethnic variation, secular growth change, and current feeding patterns. OBJECTIVE: To perform an anthropometric analysis of healthy contemporary infants aged 0-24 months and to compare the results with the most commonly used reference values. PATIENTS AND METHODS: We performed an observational, longitudinal and retrospective study of weight and length measured in the routine health checks of all infants born between 1998 and 2001 in the same Health Area and who received the infant formula beikost at a similar age. Exclusion criteria were low-birth-weight (< 2,500 g), prematurity, and chronic disease. Infants who did not complete the follow-up until the age of 2 years were also excluded. We calculated the means for each age, sex and variable. The Z-score represented by these means in the longitudinal charts most commonly used in Spain (Fundación Orbegozo) and in the Euro-Growth study were calculated and were compared with Student's one-sample t-test. RESULTS: Of the 256 infants born in the study period, 30 were excluded (11.71%) and 226 infants were finally enrolled (52.2% boys). In relation to the Spanish reference values, in boys the weight Z-score at 12 and 24 months was +0.28 (95% CI: +0.10/+0.45) and +0.33 (95% CI: +0.15/+0.52) respectively, and the length Z-score was +0.59 (95% CI: +0.43/+0.76) and +0.52 (95% CI: +0.33/+0.72). In girls the weight z-score was similar to that for boys (+0.24 [95% CI: +0.08/+0.40] and +0.37 [95% CI: +0.17/+0.57]) but growth in length was greater (+0.86 [95%CI: +0.66/+1.06] and +0.73 [95% CI: +0.52/+0.94]). This difference was statistically significant in all cases. At the age of 2 years, 17.75 % of girls and 8.47 % of boys were above the 97th percentile in length. No differences in length at 2 years were found in either boys or girls in relation to the Euro-Growth study. CONCLUSIONS: Anthropometric measurements in the first 2 years of life showed a significant increase in relation to the charts designed 20 years ago, especially in length and in girls.

[The suitability of the current recommendations for introducing gluten to the diet]. / Adecuación de los hábitos de introducción del gluten a las recomendaciones actuales.

INTRODUCTION: The habits of introducing gluten and the implementation of the ESPGHAN-2008 recommendations are evaluated. MATERIALS AND METHODS: A retrospective cohort study was conducted in 2011 using a questionnaire containing various epidemiological variables and supplementary feeding that was completed by the parents of children between 12-18 months who were seen by the pediatrician. Central tendency measures were calculated for the quantitative variables, and non-parametric tests used for comparison of means (Mann-Whitney and Kruskal-Wallis). The Chi-squared or exact tests were used for analyzing the qualitative variables, analysis of frequencies and comparisons. Multivariate adjustment techniques were used for the significant variables. RESULTS: A total of 46 primary care pediatricians, who collected 1,015 questionnaires, collaborated. The mean age of the introduction of gluten was 6.99 months (standard deviation 1.46, median 7). Only 45.1% (95% confidence interval [CI 95%]: 41.8-48.3) introduced it between 4-6 months, 0.2% before 4 months, and 54.7% after 7 months. Only 13.9% (CI 95% 11.6-16.1) introduced gluten between 4-6 months with breastfeeding. Multivariate analysis showed that the variables linked to lower compliance with the introduction between 4-6 months are mothers of 35 years of age or older (adjusted Odds ratio (aOR 1.44; CI95%: 1.11-1.88), celiac family (aOR 2.04; CI 95%: 1.11-3.72) and breastfeeding (aOR 1.55; CI 95%: 1.06-2.26), and for the introduction between 4-6 months coinciding with breastfeeding, breastfeeding and mothers who had studied at university (aOR 1.72; CI 95%: 1.17-2.53). CONCLUSIONS: The ESPGHAN recommendation on the introduction of gluten among pediatricians in our sector has not yet been sufficiently implemented.

Increased resting energy expenditure by fat-free mass in children and teenagers with constitutional leanness.

BACKGROUND/OBJECTIVES: To compare the resting energy expenditure (REE) and the REE/Fat-free-mass (FFM) quotient in children with constitutional leanness (CL) and children with normal body weight, and to describe the within-family clustering of CL. SUBJECTS/METHODS: We have studied 18 children and teenagers with CL, 10 girls and 8 boys, and 18 gender and age matched normal controls, with the same pubertal stage. All were recruited from the outpatient pediatric clinic nutrition unit. None of the children with CL showed symptoms of chronic illness, they had normal laboratory results, they had a normal caloric food intake, and they did not agree with the DSM-IV-TR criteria for anorexia nervosa. We describe the body mass index (BMI) of children and their parents. The children were classified according to Cole's recently published BMI cut-offs for thinness: under 18.5 points in CL group, stable at least in the last year, and between 18.5 and 25 cutt-offs in the control group. The body composition was calculated by anthropometric methods (skinfold thickness measurements). In addition REE was measured using fasting indirect calorimetry. RESULTS: The CL group had a higher mean percentage of FFM, and a mean FM significantly less, relative to controls (p < 0.001). The average absolute REE was significantly lower in the CL group (1,106.55 ± 240.72 kcal) than the control group (1,353.33 ± 270.01 kcal/dia) (p < 0.01). However, the REE adjusted for FFM showed a mean significantly greater in the CL group (41.39 ± 2.26 kcal/kg FFM) (Mean confidence interval (CI) 95 %: 40.33-42.45) than the controls (37.37 ± 3.06 kcal/kg FFM) (Mean CI 95 %: 35.93-38.81) (p < 0.001). Finally, in the family study, the mean BMI of fathers of CL group was significantly lower (p < 0.01), but there were not any differences in the mean BMI of mothers. Among parents with BMI known, 8 of 35 parents of CL group had an BMI lower 18.5, and only 2 of 36 parents in the control group (p < 0.05). CONCLUSIONS: This increased energy expenditure-to-FFM ratio differentiates between CL and controls. These metabolic differences are probably genetically determined.

[Epidemiological study of nocturnal enuresis: analysis of associated factors]. / Estudio epidemiológico sobre enuresis nocturna en escolares: análisis de factores asociados.

OBJECTIVE: The purpose of this study was to analyze the different pathogenic factors in a large population of children. PATIENTS AND METHODS: A transverse epidemiological study was performed. Schoolchildren in the province of Leon between 6 and 10 years of age were studied during the 1991-1992 academic year. A randomly chosen sample of 2,165 children was used. The study was carried out by means of an anonymous survey given to the children's parents by the school. RESULTS: In addition to family antecedents of enuresis, the main associated factors were the mother's cultural status, with enuresis more frequent if the status was low, and the child's birth order. CONCLUSIONS: This study shows that certain family conditions favor the development of nocturnal enuresis.

[Primary and secondary nocturnal enuresis. Are they different entities?]. / Enuresis nocturna primaria y secundaria. Son entidades diferentes?

The aim of this study was to know the prevalence and predominant factors of primary and secondary enuresis in schoolchildren. For this purpose, a randomized epidemiological study was performed on a representative sample of the general population of children, aged 6 and 10 years, living in the province of Leon. Their parents responded to a questionnaire that evaluated, in both forms of enuresis, what are the predominant factors, including: familiar, socioeconomic, personal, education and psychological factors. We found that in a selected population of 1,307 children, 171 presented nocturnal enuresis when they were 6 years old (13.09% +/- 0.93%). Of these, 133 had primary (10.18 +/- 0.84%) and 38 (2.91 +/- 0.46%) secondary enuresis. We found no significant differences between the two forms in regards to familiar, socioeconomic, personal education or psychological factors. The only differences were that in secondary enuresis, the parents were older (p < 0.05) and less education (p < 0.01) on the subject of bladder control, and a later onset of the same (p < 0.05), was given. We conclude that the prevalence of primary enuresis is 10.18% +/- 0.84% and that of secondary enuresis is 2.91% +/- 0.46%. We do not find clear differences that permit us to consider these two types of enuresis as different forms.

[An epidemiological analysis of the sequence of bladder control and nocturnal enuresis prevalence in the children of the province of León]. / Análisis epidemiológico de la secuencia de control vesical y prevalencia de enuresis nocturna en niños de la provincia de León.

The objective of this study was to better understand the development of nocturnal bladder control in our population of children and to analyze the different factors that influence this process. A transversal epidemiological study in a randomly chosen sample of schoolchildren, between the ages of 6 and 10 years, in the province of Leon was performed. The study was carried out by means of an anonymous survey given to the children's parents through the school center. The survey was comprised of personal, environmental and sphincter control development questions. We define nocturnal enuresis as at least one wet night per month in children older than 6 years of age. Of the surveys distributed, 65.1% were answered. The prevalence of primary, secondary and total nocturnal enuresis was 10.18%, 2.91% and 13.09%, respectively, for children 6 years of age and 6.59%, 0.9% and 7.49%, respectively in 10 year old children. Among the children without nocturnal enuresis, in the event of family antecedents of nocturnal enuresis, in absence of toilet training, or when sphincter education was started later than 15 months of age, slower maturation of sphincter control was observed. We conclude, that the nocturnal enuresis prevalence is similar to that reported in other related countries and that bladder control maturation among children without bed-wetting tendencies is related to the educational attitude of the parents and family antecedents of nocturnal enuresis.