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Unlabelled: What is already known about this subject Eating disorders are among the public health issues facing adolescents. An excess of body fat has been associated with an increased risk of these disorders. The association of physical fitness with eating disorders has not yet been analysed in adolescents. What this study adds This study confirms that the overweight and obesity increase the risk of developing eating disorders. The present study shows that there is an inverse association between physical fitness levels and the risk of eating disorders. This study suggests that physical fitness might attenuate the influence of overweight on the development of eating disorders in adolescents., Background: Eating disorders together with the overweight and obesity are important health concerns in adolescents., Objective: To analyse the individual and combined influence of overweight and physical fitness on the risk of developing eating disorders in Spanish adolescents., Methods: The sample consisted of 3571 adolescents (1864 females), aged 13 to 18.5 years, from Spain who participated in the AVENA and AFINOS studies. The risk of eating disorders was evaluated using the SCOFF questionnaire. Body mass index was calculated and the adolescents were classified into two groups: overweight (including obesity) and non-overweight according to Cole's cut-off points. Cardiorespiratory fitness in the AVENA Study was assessed by the 20-m shuttle-run test and the overall physical fitness level was self-reported in the AFINOS Study., Results: Overweight adolescents had a higher risk of developing eating disorders than non-overweight adolescents (odds ratio [OR] = 4.91, 95% confidence interval [CI]: 3.63-6.61 in the AVENA Study and OR = 2.45, 95% CI: 1.83-3.22 in the AFINOS Study). Also, adolescents with medium and low levels of physical fitness had a higher risk of developing eating disorders (OR = 1.51, 95% CI: 1.05-2.16, and OR = 2.25, 95% CI: 1.60-3.19, respectively, in the AVENA Study, and OR = 1.73, 95% CI: 1.37-2.17, and OR = 4.11 95% CI: 2.98-5.65, respectively, in the AFINOS Study) than adolescents with high levels of physical fitness. In both studies, the combined influence of overweight and physical fitness showed that adolescents with lower levels of physical fitness had an increased risk of developing eating disorders in both non-overweight and overweight groups., Conclusions: Physical fitness might attenuate the influence of overweight on the development of eating disorders in adolescents., (© 2013 The Authors. Pediatric Obesity © 2013 International Association for the Study of Obesity.)

Background: Some health behaviours are liable to affect the incidence of allergies and/or common infections in young people; however, the extent and ways in which these might occur are mostly unknown. This study examines the association of health behaviours related to physical activity, sedentariness, diet and sleep with allergy and infection symptoms in adolescents, and also with biological markers that might mediate disease incidence., Methods: The study comprised a total of 2054 adolescents (50.7% girls) from the Madrid region of Spain. The incidence of infection and allergy symptoms three months prior to the study was obtained from a self-administered questionnaire. Physical and sedentary activities, height and weight, food habits and sleep duration were also self-reported and their influence on infection and allergy incidence was assessed by logistic regression analysis. Blood biomarkers (IgE, eosinophil percentage, leptin, interleukin (IL)-2, IL-4, IL-5 and IL-10) were evaluated in a subsample of 198 subjects., Results: Adequate sleep duration (OR = 0.79, 95%CI: 0.64 to 0.97) and unhealthy weight status (overweight/obesity) (OR = 1.35, 95%CI: 1.04-1.74) were independently associated with decreased and increased allergy incidence, respectively. No significant association was observed with infection incidence. IgE and leptin differed between adolescents with and without allergy symptoms. In regression models IgE was significantly associated with inadequate sleep duration and leptin with weight status., Conclusion: Excess weight and inadequate sleep duration are independently associated with the incidence of allergy symptoms in adolescents. Adequate sleep duration and weight during adolescence might be relevant for a decreased risk of suffering allergy symptoms.

In recent years, epigenetic markers emerged as a new tool to understand the influence of lifestyle factors on obesity phenotypes. Adolescence is considered an important epigenetic window over a human's lifetime. The objective of this work was to explore baseline changes in DNA methylation that could be associated with a better weight loss response after a multidisciplinary intervention program in Spanish obese or overweight adolescents. Overweight or obese adolescents (n=107) undergoing 10 wk of a multidisciplinary intervention for weight loss were assigned as high or low responders to the treatment. A methylation microarray was performed to search for baseline epigenetic differences between the 2 groups (12 subjects/group), and MALDI-TOF mass spectrometry was used to validate (n=107) relevant CpG sites and surrounding regions. After validation, 5 regions located in or near AQP9, DUSP22, HIPK3, TNNT1, and TNNI3 genes showed differential methylation levels between high and low responders to the multidisciplinary weight loss intervention. Moreover, a calculated methylation score was significantly associated with changes in weight, BMI-SDS, and body fat mass loss after the treatment. In summary, we have identified 5 DNA regions that are differentially methylated depending on weight loss response. These methylation changes may help to better understand the weight loss response in obese adolescents.

Background: Dietary treatment for obese adolescents should aim to ensure adequate growth and development, by reducing excessive fat mass accumulation, avoiding loss of lean body mass, improving well-being and self-esteem and preventing cyclical weight regain. The aim of this article is to describe the dietary intervention design and the methods used to evaluate nutritional knowledge and behavior in the EVASYON study (Development, implementation and evaluation of the efficacy of a therapeutic programme for overweight/obese adolescents)., Methods/design: EVASYON is a multi-centre study conducted in 5 Spanish hospital settings (Granada, Madrid, Pamplona, Santander and Zaragoza), where 204 overweight/obese Spanish adolescents were treated in groups of 9 to 11 subjects over 20 visits. The study was implemented in two stages: an intensive, calorie-restricted period for the first 9 weeks, and an extensive body-weight follow-up period for the last 11 months. A moderate energy intake restriction was applied in the intensive period according to the degree of obesity, on the basis of a balanced diet supplying 50-55% of daily energy as carbohydrates; 30-35% as fats and 10-15% as proteins. In the intensive period, adolescents were prescribed both a fixed full-day meal plan for the first three weeks and a full day meal plan with different food-choices for 6 weeks. Later, adolescents received a flexible meal plan based on food exchanges for the follow-up period until the end of the trial. Data on food intake, dietary and meal-related habits and behavior were collected by means of dietary questionnaires. To analyse nutritional knowledge, adolescents were examined regarding nutrient concepts and food adoitems for a healthy diet with the appropriate tools. Participants were given nutritional information with complementary teaching material, which was available on the EVASYON website (www.estudioevasyon.com)., Discussion: The dietary intervention of the EVASYON programme with a moderate calorie restriction for a limited period of time could be a good strategy in treating overweight and obese adolescents and that will be tested further. Moreover, combining fixed plan with free-choice menus may help adolescents and their families to make right decisions for every day meals.

Background and Objective: Overweight and obesity, together with eating disorders, are important public health concerns in adolescence. The aim of this study was to assess the association between excessive body fat and the risk of eating disorders., Subjects and Method: The sample consisted of 195 adolescents (97 girls) aged 13 to 18 years. Eating-disorder risk was evaluated by applying the SCOFF questionnaire. Body mass index, sum of 6 skinfolds, waist and hip circumferences and waist-hip and waist-height ratios were used to assess body fat., Results: 24.7% of girls and 17.3% of boys were at risk of eating disorders, and 31.6% of boys and 21.6% of girls presented overweight (including obesity) according to Cole's cut-off points. Those adolescents classified above the 85th percentile on all the anthropometric measurements, as well as overweight adolescents, were at increased risk of developing an eating disorder (OR: 2.8-4.30, all p < 0.01)., Conclusion: Regardless of the anthropometric measurements used, adolescents with excessive body fat showed a higher risk of having eating disorders than those with normal weight., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

This study investigated differences in health-related fitness (20-m shuttle run, handgrip, bent arm hang, standing long jump, shuttle run 4 x 10 m and sit and reach tests) in 2474 Spanish adolescents (1196 boys and 1278 girls; age 13-18.5 years) classed as underweight, normal weight, overweight or obese according to body mass index. Body fat and fat-free mass were derived from skinfold thickness. The prevalence of underweight was higher than obesity in girls (4.8% vs 3.0%, respectively; P<0.05) and the opposite in boys (3.9% vs 5.8%, respectively; P<0.05). Underweight was associated with a higher performance in the bent arm hang test in girls (P<0.05) and a lower performance in handgrip in both genders (P<0.01) compared with normal weight. Overweight and obese adolescents presented a lower performance in 20-m shuttle run, bent arm hang, standing long jump and shuttle run 4 x 10 m tests (P<0.001), but a higher performance in handgrip strength (P<0.001) compared with normal weight. In weight-bearing tests, the association became non-significant after adjusting for fat mass. In conclusion, not only overweight and obesity but also underweight seem to be determinants of health-related fitness in adolescents. The associations could be related to differences in body composition.

Background: Prior studies addressing the impacts of regular physical activity or sedentary habits on the immune system have been conducted in adults and laboratory settings. Thus, it is practically unknown how a healthy active lifestyle could affect low-grade inflammation processes, infections or allergies in young persons. The AFINOS Study was designed to determine the relationship between the regular physical activity levels of adolescents and overweight, infection, and allergies along with the presence of metabolic and immunological biomarkers of a deteriorated health status. A further objective of the AFINOS Study is to assess the health status and lifestyle habits of an adolescent population in an effort to identify any protective factors that could be used as preventive measures, since many chronic diseases and their associated co-morbidities often persist from adolescence into adulthood., Methods/design: This study was conducted as three separate sub-studies in three different populations as follows: (a) Study 1 was performed on a population sample of adolescents; (b) Study 2 on the adolescents' parents; and (c) Study 3 on a subset of the adolescents from Study 1. Study 1 assessed health and lifestyle indicators through a questionnaire administered to a representative sample of adolescents from the Madrid Region (n = 2400) aged 13 to 16 years. In Study 2, the parents of the teenagers participating in Study 1 were required to fill out a questionnaire. Finally in Study 3, body composition, physical activity, health-related physical fitness, and blood measurements were determined in a subset (n = 200) of the individuals included in Study 1., Discussion: This paper describes the rationale, design, and methodologies used in the AFINOS Study. This multidisciplinary, multicenter study seeks to evaluate several aspects of existing relationships between routine physical activity/sedentary behaviour and several health status markers, specifically those related to the immune system. The results of this cross-sectional study will serve for comparisons with the available data obtained in laboratory settings and in adults. In addition, knowledge regarding the health status and lifestyle habits of Spanish adolescents and their parents will be useful for designing preventive measures.

Introduction: Low-grade inflammation and increased immunity related to cardiovascular diseases have been described in children and adults, however, studies in Mexican adolescents are being done at present. Objective: To evaluate inflammatory proteins and indicators of immunity in adolescents by gender and body mass index. Material and methods: 115 Mexican adolescents, 15-18 years old (36 men), were divided into non-overweight, risk of overweight and overweight by CDC pediatric criteria by body mass index. Serum concentrations of ceruloplasmin, C3 and C4 were quantified by nephelometry; IL-6 and TNF-α from stimulated supernatant were analyzed with Human Th1-Th2 cytokine CBA II kit (BD Biosciences Pharmigen, San Diego, CA), and detected by flow cytometry. Data were analysed by Mann-Whitney U. Results: Gender differences were found in C3 (men: median 118.8, mean rank: 41.0; women: median: 143.9, mean rank: 65.7, p = 0.001) and ceruloplasmin (men: median: 31.01, mean rank: 47.06; women: median: 31.0, mean rank: 62.9, p = 0.015). Differences by BMI were found in C3 (women non-overweight: median: 137.00 mena rank: 36.52; women with risk of overweight/overweight: median: 175.80, mean rank: 57.69, p = 0.002) and C4 (men non-overweight: median: 23.40, mean rank: 16.60; men with risk of overweight/overweight: median: 26.40, mean rank: 26.36, p = 0.028; women non-overweight: median: 24.25, mean rank: 37.16 and women with risk of overweight/overweight: median: 32.80, mean rank: 54.42, p = 0.013). Conclusion: Inflammatory proteins are increased in adolescents with risk of overweight and overweight, particularly in women.Introducción: La inflamación de bajo grado y el aumento en la inmunidad relaciondas con las enfermedades cardiovasculares se han descrito en niños y adultos, sin embargo, estudios en adolescentes mexicanos se están haciendo en la actualidad. Objetivo: Evaluar las proteínas inflamatorias e indicadores de la inmunidad en los adolescentes por género e índice de masa corporal. Material y métodos: 115 adolescentes mexicanos, 15-18 años (36 niños), fueron clasificados como sin sobrepeso, riesgo de sobrepeso y sobrepeso según los criterios pediátricos de la CDC para índice de masa corporal. Las concentraciones séricas de ceruloplasmina, C3 y C4 se cuantificaron por nefelometría, IL-6 y TNF-α a partir de sobrenadante de cultivo de linfocitos estimulados con mitógeno, se analizaron con Human cytokines Th1-Th2 CBA kit II (BD Biosciences Pharmigen, San Diego, CA), y se detectaron por citometría de flujo. Los datos fueron analizados estadísticamente por la prueba de U Mann-Whitney. Resultados: Las diferencias de género se encontraron en C3 (Hombres: mediana de 118,8 rango promedio: 41,0; Hombres: mediana: 143,9, rango promedio: 65,7, p = 0,001) y ceruloplasmina (Hombres: media: 31,01, rango promedio: 47,06; Hombres: mediana: 31,0, rango promedio: 62,9, p = 0,015). Las diferencias por IMC se encontraron en C3 (Mujeres sin sobrepeso: mediana: 137,00 rango promedio: 36,52; Hombres con riesgo de sobrepeso y sobrepeso: mediana: 175,80, rango promedio: 57,69, p = 0,002) y C4 (Hombres sin sobrepeso: mediana: 23,40, rango promedio: 16,60; Hombres con riesgo de sobrepeso y sobrepeso: media: 26,40, rango promedio: 26,36, p = 0,028; Hombres sin sobrepeso: media: 24,25, rango promedio: 37,16 y Mujeres con riesgo de sobrepeso/sobrepeso: media: 32,80, rango promedio: 54,42, p = 0,013). Conclusiones: Las proteínas inflamatorias aumentan en los adolescentes con riesgo de sobrepeso y sobrepeso, particularmente en mujeres.