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EVASYON Study Group., [Background & aims]: In recent years, obesity has reached alarming levels among children and adolescents. The study of plasma fatty acid (FA) composition, as a reflection of diet, and its associations with other parameters, that are closely linked to obesity and the cardiometabolic profile, may be useful for setting nutritional goals for obesity treatment and prevention. This study explored the relationship between plasma FA levels and body fat and cardiometabolic risk markers, in overweight adolescents. [Methods]: A multidisciplinary weight loss program was followed by 127 overweight and obese adolescents aged 12–17 years old. Plasma FA composition, anthropometric indicators of adiposity and biochemical parameters were analyzed at baseline, two months (the end of the intensive intervention phase) and six months (the end of the extensive phase). [Results]: While saturated fatty acid (SFA) and n-6 polyunsaturated fatty acid (PUFA) levels decreased significantly during the intervention, monounsaturated fatty acid (MUFA) and n-3 PUFA showed the opposite trend. The decrease in SFA C14:0 was associated with a reduction in total and LDL cholesterol, apolipoprotein B and insulin. The increase in MUFAs, especially C18:1n-9, was related to a reduction in weight, fat mass, fat mass index and glucose. Regarding PUFAs, changes in the n-3 series were not associated with any of the parameters studied, whereas the reduction in n-6 PUFAs was directly related to weight, fat mass, total and HDL cholesterol, apolipoprotein A1, glucose and insulin, and inversely associated with diastolic blood pressure. The adolescents with greater weight loss presented significant changes in MUFAs, n-6 PUFAs and C14:0. [Conclusions]: Modifications in plasma FA composition were associated with adiposity reduction and cardiometabolic profile improvement in an anti-obesity program aimed at adolescents. The changes observed in FA composition were related to the success of the treatment, since the individuals most affected by these variations were those who presented the greatest weight loss., This work is part of the EVASYON study funded by the Spanish Ministry of Health and Consumption (Carlos III Institute of Health. FIS. Grant PI 051579).

The EVASYON Study Group., [Background & aim]: A diet quality index (DQI) is a tool that provides an overall score of an individual's dietary intake when assessing compliance with food-based dietary guidelines. A number of DQIs have emerged, albeit their associations with health-related outcomes are debated. The aim of the present study was to assess whether adherence to dietary intervention, and the overall quality of the diet, can predict body composition changes., [Methods]: To this purpose, overweight/obese adolescents (n = 117, aged: 13–16 years; 51 males, 66 females) were recruited into a multi-component (diet, physical activity and psychological support) family-based group treatment programme. We measured the adolescents' compliance and body composition at baseline and after 2 months (intensive phase) and 13 months (extensive phase) of follow-up. Also, at baseline, after 6 months, and at the end of follow-up we calculated the DQI., [Results]: Global compliance with the dietary intervention was 37.4% during the intensive phase, and 14.3% during the extensive phase. Physical activity compliance was 94.1% at 2-months and 34.7% at 13months and psychological support compliance were growing over the intervention period (10.3% intensive phase and 45.3% during extensive phase). Adolescents complying with the meal frequency criteria at the end of the extensive phase had greater reductions in FMI z-scores than those did not complying (Cohen's d = 0.53). A statistically significant association was observed with the diet quality index. DQI-A variation explained 98.1% of BMI z-score changes and 95.1% of FMI changes., [Conclusions]: We conclude that assessment of changes in diet quality could be a useful tool in predicting body composition changes in obese adolescents involved in a diet and physical activity intervention programme backed-up by psychological and family support., The study was supported by the Ministry of Health, Social Services and Equality via the Carlos III Institute of Health (FIS Grant PI051080, PI051579). The EVASYON study received the award for the best applied research project in 2009 from AESAN (Spanish Agency for Food Safety and Nutrition from the Spanish Ministry of Health and Consumer Affairs. The study was supported by Aragon's Regional Government (DGA, Diputación General de Aragón) and European Regional Development Fund.

Background & aims: The main objectives of weight loss interventions in children and adolescents are to decrease fat mass while maintaining fat-free mass. Several methods are available to assess childhood and adolescence obesity, such as weight and height, bioelectrical impedance, skin-fold thickness measurements and other laboratory methods. The aim was to assess simple anthropometric indices as predictors of body-fat changes, using dual-energy X-ray absorptiometry measurements as reference method. Methods: Multi-intervention approach (diet, physical activity and psychological support in a family group- based treatment) was implemented with a one-year follow-up in 13- to-16-year-old overweight or obese Spanish adolescents. A total of 83 adolescents were recruited from Granada and Zaragoza, males (n=43) (31.6 kg/m2) and females (n=40) (32.0 kg/m2). We measured body composition with anthropometry and dual-energy X-ray absorptiometry. All measurements were made at baseline, and after 2 and 13 months. Random coefficient regression model was used to calculate the proportion of body composition changes during follow-up that would be explained by simple body composition indices based on anthropometric measures. Results: After controlling for age and Tanner stage, body mass index explained 76.5% of body composition changes in males and 90.1% in females, while fat mass index (assessed by skin-folds) explained 78.9% of body composition changes in males and 84.0% of body composition changes in females. Conclusions: In conclusion, we found that BMI was a good indicator of body fat composition changes in children and adolescents, although FMI assessed by anthropometry was also a good indicator., the Ministry of Health, Social Services and Equality; the Spanish Government (Carlos III Institute of Health. FIS. Grant PI051080, PI051579); European Regional Development Fund (MICINN-FEDER).

EVASYON Study Group., [Background & aims]: In vivo and in vitro evidence suggests that antioxidant vitamins and carotenoids may be key factors in the treatment and prevention of obesity and obesity-associated disorders. Hence, the objective of the present study was to determine the relationship between plasma lipid-soluble antioxidant vitamin and carotenoid levels and adiposity and cardio-metabolic risk markers in overweight and obese adolescents participating in a multidisciplinary weight loss programme. [Methods]: A therapeutic programme was conducted with 103 adolescents aged 12–17 years old and diagnosed with overweight or obesity. Plasma concentrations of α-tocopherol, retinol, β-carotene and lycopene, anthropometric indicators of general and central adiposity, blood pressure and biochemical parameters were analysed at baseline and at 2 and 6 months of treatment. [Results]: Lipid-corrected retinol (P < 0.05), β-carotene (P = 0.001) and α-tocopherol (P < 0.001) plasma levels increased significantly, whereas lipid-corrected lycopene levels remained unaltered during the treatment. Anthropometric indicators of adiposity (P < 0.001), blood pressure (P < 0.01) and biochemical parameters (P < 0.05) decreased significantly, whereas fat free mass increased significantly (P < 0.001). These clinical and biochemical improvements were related to changes in plasma lipid-corrected antioxidant vitamin and carotenoid levels. The adolescents who experienced the greatest weight loss also showed the largest decrease in anthropometric indicators of adiposity and biochemical parameters and the highest increase in fat free mass. Weight loss in these adolescents was related to an increase in plasma levels of lipid-corrected α-tocopherol (P = 0.001), β-carotene (P = 0.034) and lycopene (P = 0.019). [Conclusions]: Plasma lipid-soluble antioxidant vitamin and carotenoid levels are associated with reduced adiposity, greater weight loss and an improved cardio-metabolic profile in overweight and obese adolescents., This work is part of the EVASYON study funded by the Spanish Ministry of Health and Consumption (Carlos III Institute of Health. FIS. Grant PI 051579).

The aims of this study were to identify the cognitive and behavioral predictors of dropping out and to estimate the attrition rate during different phases of an intervention program to treat overweight and obesity in adolescents. Overweight/obese adolescents (n=156, aged: 13–16 years; 71 male and 85 female subjects) were included in a multicomponent (diet, physical activity and psychological support) family-based group treatment program. At baseline and after 2 months (intensive phase) and 13 months (extensive phase) of follow-up, we measured adolescents’ cognitive and behavioral dimensions, together with the parents’ perception of their child’s behavior. Of the 156 adolescents selected, 112 completed the full program (drop-out rate of 28.2%). The risk of dropping out during the extensive phase increased by 20% for each unit increase in the adolescent’s social insecurity score (odds ratio=1.20, 95% confidence interval=1.07–1.34, P=0.002). The adolescents who had a high interoceptive awareness showed a significant decrease of 13.0% in the probability of dropping out (odds ratio=0.87, 95% confidence interval=0.77–0.99, P=0.040). Adolescents’ social insecurity was the main predictor of drop-out in a multicomponent family-group-based obesity treatment program. To reduce attrition rates in these programs, the individual’s social insecurity level needs to be reduced, whereas the family’s awareness of eating-related behavior needs adjustment., The study was supported by the Ministry of Health, Social Services and Equality via the Carlos III Institute of Health (FIS Grant PI051080, PI051579, PI052369). We gratefully acknowledge the enthusiasm and commitment of all the participating adolescents and their families. The EVASYON Group also acknowledges the fieldwork staff for their efforts and dedication. The EVASYON study received the award for the best applied research project in 2009 from AESAN (Spanish Agency for Food Safety and Nutrition from the Spanish Ministry of Health and Consumer Affairs). LAM, JMG, CM and PDM-E conceived and designed this study; LAM, AM, CC, JMG and JMCA-S conceived and designed the original EVASYON Study; PDM-E, JS, RL-A and CM analyzed and interpreted the data; CM, GM and PDM-E carried out measurements. All authors were involved in drafting the manuscript and had final approval of the version submitted for publication. The EVASYON Study Group provided technical and logistic support during the study. Editorial assistance was by Dr Peter R Turner of Tscimed.com. The EVASYON study received the award for the best applied research project in 2009 from AESAN (Spanish Agency for Food Safety and Nutrition from the Spanish Ministry of Health and Consumer Affairs. The study was supported by Aragon‘s Regional Government (DGA, Diputación General de Aragón) and European Regional Development Fund.

10 pages, 4 tables, 3 figures.-- Online version published 9 December 2008, [Objective]: To evaluate the effects of a multidisciplinary obesity treatment programme on fecal microbiota composition and immunoglobulin-coating bacteria in overweight and obese adolescents and their relationship to weight loss., [Design]: Longitudinal intervention study based on both a calorie-restricted diet (calorie reduction=10–40%) and increased physical activity (calorie expenditure=15–23 kcal/kg body weight per week) for 10 weeks., [Participants]: Thirty-nine overweight and obese adolescents (BMI mean 33.1 range 23.7–50.4; age mean 14.8 range, 13.0–16.0)., [Measurements]: BMI, BMI z-scores and plasma biochemical parameters were measured before and after the intervention. Fecal microbiota was analyzed by fluorescent in situ hybridization. Immunoglobulin-coating bacteria were detected using fluorescent-labelled F(ab')2 antihuman IgA, IgG and IgM., [Results]: Reductions in Clostridium histolyticum and E. rectale-C. coccoides proportions significantly correlated with weight and BMI z-score reductions in the whole adolescent population. Proportions of C. histolyticum, C. lituseburense and E. rectale-C. coccoides dropped significantly whereas those of the Bacteroides-Prevotella group increased after the intervention in those adolescents who lost more than 4 kg. Total fecal energy was almost significantly reduced in the same group of adolescents but not in the group that lost less than 2.5 kg. IgA-coating bacterial proportions also decreased significantly in participants who lost more than 6 kg after the intervention, paralleled to reductions in C. histolyticum and E. rectale-C. coccoides populations. E. rectale-C. coccoides proportions also correlated with weight loss and BMI z-score reduction in participants whose weight loss exceeded 4 kg., [Conclusions]: Specific gut bacteria and an associated IgA response were related to body weight changes in adolescents under lifestyle intervention. These results suggest interactions between diet, gut microbiota and host metabolism and immunity in obesity., This work was supported by grants AGL2005- 05788-C02-01 from the Spanish Ministry of Education (MEC) and AP 002/07 from Consejería de Sanidad (Valencia, Spain). The EVASYON study was supported by grants from Spanish Ministry of Health (PI051574).

The incidence of type 1 diabetes in children from Aragon (a population of the North of Spain) is reported determining the relations between the onset of type 1 diabetes and gender, age at diagnosis, genetic risk (HLA class II genes) or climatology factors. The population at risk was all 0-14 year-old inhabitants. Patients were identified from five sources: hospitals, primary assistance, endocrinologists, diabetic associations and diabetes camps. The degree of ascertainment was 98.93%. HLA genetic study was performed. Annual incidence was 16.4 per 100,000 per year (95% CI: 14.7-18.2). This incidence was significantly higher in males than in females, 18.7 versus 14.2 (p0.02), and increased with age. The haplotypes (DR3)-DQB1*0201/(DR4)-DQB1*0302 and (DR3)-DQB1*0201/(DR7)-DQB1*0202 conferred the highest risk of type 1 diabetes. A relative high incidence of type 1 diabetes mellitus has been demonstrated in the Northeast of Spain, and it does not support south-to-north incidence gradient in Europe. Haplotypes that conferred a higher risk of disease agree with those founded in other Caucasic populations.

The aim of the study was to establish the best cut-off value for the homeostatic model assessment (HOMA) index in identifying children and adolescents with the metabolic syndrome. The study included 72 non-obese and 68 obese children aged 7 to 16 years. Obesity is defined using the criteria proposed by Cole et al., being included as metabolic syndrome variables waist circumference, systolic blood pressure, diastolic blood pressure and seric values of glucose, uric acid, fasting insulin, leptin, triglycerides and HDL-cholesterol. Children were considered as having the metabolic syndrome when four or more characteristics showed abnormal values. The HOMA index was calculated as the product of the fasting plasma insulin level (microU/mL) and the fasting plasma glucose level (mmol/L), divided by 22.5. HOMA index cut-offs from the 5th to the 95th percentile were used. A receiver operating characteristic (ROC) curve was generated using the different HOMA cut-offs for the screening of the metabolic syndrome. The areas under the ROC curve, 95% confidence intervals, and the point to the ROC curve closest to 1, were calculated. The area under the ROC curve was 0.863 (95% C.I.: 0.797, 0.930). The point closest to 1 corresponds to the 60th percentile of the HOMA index distribution in our sample. HOMA index value at the 60th percentile was 2.28. Cut-off values corresponding to a range of HOMA index from the 50 to the 75 percentile, showed similar distances to 1. HOMA index values for percentiles 50 to 75 ranged from 2.07 to 2.83. In conclusion, HOMA index could be a useful tool to detect children and adolescents with the metabolic syndrome. HOMA cut-off values need to be defined in the paediatric population; however, values near to 3 seem to be adequate.

In children and adolescents from developed countries, obesity prevalence has strongly increased in the last decades and insulin resistance and impaired glucose tolerance are frequently observed. Some dietary components such as low glycemic index foods and dietary fibre could be used in order to improve glucose homeostasis in these children. Psyllium or ispaghula husk (the husk of the seeds ofPlantago ovata) is a mixture of neutral and acid polysaccharides containing galacturonic acid with a ratio of soluble / insoluble fibre of 70 / 30. Some foods could potentially be enriched with psyllium, like breads, breakfast cereals, pasta and snack foods. The aim of this review was to assess the usefulness of psyllium in the management of obese children and adolescents with abnormalities of carbohydrate and lipid metabolism. After psyllium supplementation, the percentage change in postprandial glucose in type 2 diabetes patients, ranged from −12.2 to −20.2%. In hypercholesterolemic children, the effect of psyllium in LDL-cholesterol serum concentrations ranged from 2.78 to −22.8%; the effect in HDL-cholesterol from −4.16 to 3.05%; and the effect on triglycerides from 8.49 to −19.54%. The reviewed evidence seems to show that psyllium improves glucose homeostasis and the lipid and lipoprotein profile; however, more well controlled trials and further studies are needed to clarify it’s effects and the mechanisms involved.

The aim of this study was to ascertain the incidence of Type 1 diabetes mellitus in Navarre, an autonomous community in northern Spain. Subjects were patients who presented with diabetes between 1975 and 1991, age range 0-16 years, resident in Navarre at the onset of symptoms. Endocrinologists in outpatient centres and hospitals (both public and private) in Navarre were the primary source of data, while secondary sources were: independent general practitioners, health centre paediatricians and the Child-Youth Diabetics Parents' Association of Navarre. The degree of ascertainment was 97.8%. Average annual incidence of diabetes detected was 9.54/100000 (95% CI 8.2-11.1) in the 0-14 year-old group. The least incidence was observed in 1976 and highest in 1990. The incidence in males (9.71/100000) was higher than in females (7.83/100000). The highest incidence was observed in the 10-14 year-old group (13.70/100000) when analysed by groups. No seasonal variation in the onset of diabetes was observed. These results suggest a significant increase in the incidence of type 1 diabetes between 1975 and 1991.

Childhood obesity remains an important public health concern and prevention programmes should be the priority in order to decrease the prevalence of obesity. The aim of this review is to summarize the most effective types of intervention for treating obesity in children and adolescents. A number of identified strategies used to treat childhood obesity range from lifestyle approaches, pharmacotherapy to surgical intervention. Dietary treatment of obese children and 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. Management protocols involve behaviour modifications, family support, and lifestyle changes which are difficult to put into practice and may require multidisciplinary professional teams. The cornerstone of weight loss programmes is to achieve a negative energy balance. There is evidence that dietary interventions are more effective in achieving weight loss when combined with other strategies, such as increasing physical activity levels and/or psychological interventions to promote behavioural changes. Psychological interventions have been employed in an effort to achieve long-term maintenance of behavioural change. Childhood obesity treatments should involve a combination of lifestyle changes including strategies to reduce energy intake, increase physical activity, reduce sedentary activities, facilitate family involvement and change behaviours associated with eating and physical activity. However, drug therapy in obese children must not be used as isolated treatment but as complementary to the traditional treatments of diet, physical activity and lifestyle changes. Besides, surgical procedures have been used to treat severe morbid obesity in children and adolescents when more conservative treatments have proven to be inadequate.

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.

To determine the prevalence of overweight in paediatric patients with cystic fibrosis (CF) and to analyse its role as diabetogenic insulin resistance factor and risk of hypertriglyceridaemia.A total of 109 CF patients (47% males) between 5 and 18 years were divided into 3 groups according to body mass index (BMI): underweight, normal and overweight. Total cholesterol, triglycerides, C- reactive protein (CRP), glycosylated haemoglobin, HOMA-IR and QUICKI index were determined. Insulinogenic index, ISI composite and areas under the curve (AUC) for glucose and insulin were obtained by oral glucose tolerance test (OGTT).Six patients (5.5%) were overweight. All groups had similar distribution by age, sex and CFTR mutation, although the proportion of pancreatic sufficient (3/6, 50%) was higher in overweight patients (P=.003). The prevalence of glycaemic disorders was similar between groups. Baseline insulin, HOMA-IR, and insulin during the OGTT (peak and AUC) were higher in overweight patients. All patients had a delayed insulin response in OGTT.Overweight CF patients do not have a higher incidence of glycaemic disorders, but their hyperinsulinism and insulin resistance may be additional diabetogenic risk factors.

We assessed the anthropometric characteristics of symmetric (SGA-S) and asymmetric (SGA-A) term newborns and describe their subcutaneous fat differences. We assessed perinatal data, maternal characteristics and anthropometric variables (including skinfold thicknesses) in 139 small for gestational age (SGA) term infants, classified as symmetric and asymmetric according to their ponderal index (using the 10(th) percentile as the cut-off criterion). Despite an overall small body size and lower amounts of subcutaneous fat than the reference population, SGA-S term newborns showed a proportionate body fat distribution and SGA-A were thinner and had a lower percentage of central subcutaneous fat than SGA-S. These findings, resulting from intrauterine growth restriction, could be associated with different early and later postnatal outcomes among SGA groups.

Objective: We investigated the effects of the EVASYON program on body fatness, cardiometabolic risk factors, gut appetite-controlling hormones and serum levels of cytokines in adolescents with overweight or obesity (OW/OB). Methods: This study comprised 13 boys (10 obese) and 12 girls (8 obese), aged 13-16 years, from a Madrid Hospital. The EVASYON program was based on a calorie-restricted diet (10-40%), increased physical activity (at least 60 min/day 5 days a week), psychological therapy and nutritional education for 13 months. Anthropometric and blood pressure measurements were measured before and after intervention. Serum glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, leptin, total peptide YY and insulin levels were determined before and after intervention. Serum levels of cytokines IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, and TNF-α were also assessed before and after intervention. Results: A decrease in body mass index (BMI), BMI z-score, skinfolds (triceps, biceps, subscapular, thigh, and calf), sum of six skinfolds and body circumferences (arm relaxed and flexed, waist, hip, and proximal thigh) values were observed after the intervention program (all p < 0.05). In addition, diastolic blood pressure also decreased (p < 0.05). A decrease in serum leptin levels (-48.4%, p < 0.001) was observed after intervention without changes in total peptide YY and insulin levels. Levels of IL-8, IL-10, and TNF-α also decreased (all p < 0.05) after the intervention program. Conclusions: These preliminary results evidence that the EVASYON program may improve body fat, leptin, and some pro-inflammatory cytokines in adolescents with OW/OB. © 2011 John Wiley & Sons A/S.

The purpose of this study was to apply the new approach for Metabolic Individual Risk-factor And Clustering Estimation (MIRACLE) score in a group of Spanish obese children and adolescents and to describe its relationship with other metabolic risk factors. 153 children with simple obesity were studied: 79 males and 74 females, mean age 11.2 +/- 2.2. Obesity was defined when BMI was higher than the age and sex specific equivalent to 30 kg/m2 in adults. MIRACLE score included: family history (early cardiovascular disease, type 2 diabetes, and hypertension), individual history (small for gestational age and ethnic origin), clinical features (BMI, waist circumference90th percentile and blood pressure95th percentile) and metabolic abnormalities (glucose intolerance or type 2 diabetes). It was assigned a value of 1 to "presence" and 0 to" absence" in every patient. The children were considered as having metabolic risk when at least 5 items were present. Triglycerides, HDL-cholesterol, apolipoprotein B, apolipoprotein A1, glucose and HOMA index, were measured too. The most frequent clinical features of MIRACLE score were: excess waist circumference (95.4%) and hypertension (41.8%). Family history criteria were frequent (55.3% for type 2 diabetes, 39.1% for hypertension and 31.3% for early cardiovascular disease). Individual risk factors were not frequent. Glucose intolerance was detected in 22.2% of the obese patients. A MIRACLE scoreor = 5 was found in 37.4% of the children studied, being associated with a significant risk of dyslipidemia (triglycerides, p = 0.040; HDL-cholesterol, p = 0.006; LDL-cholesterol p = 0.038; apolipoprotein B, p = 0.008) only in females. In conclusion, the MIRACLE score is useful in order to detect metabolic risk in obese children but it seems necessary to improve the score, by including other features of the metabolic syndrome like lipid profile or indirect indicators of insulin resistance.

The intent of this study was to assess whether the effect of birth weight on later body composition is modified by Pro12Pro, Pro12Ala, and Ala12Ala genotypes of the peroxisome proliferator-activated receptor γ-2 (PPARγ-2) gene. The PPARγ-2 gene polymorphism was genotyped in 273 adolescents aged 13-18.5 y, born at term and whose birth weight was known. They were selected from a cross-sectional multicenter study conducted in five Spanish cities in 2000-2002. Body mass index (BMI) was calculated from weight and height measurements, and body composition and fat distribution were estimated from skinfold thickness. A total of 229 subjects (111 males and 118 females) carried the Pro12Pro genotype and 44 (22 males and 22 females) the Pro12Ala and Ala12Ala PPARγ-2 genotypes. In the Pro12Pro group, birth weight Z score was positively associated with both fat-free mass (FFM) (p < 0.05) and fat mass (FM) (p < 0.05), but these relationships disappeared after controlling for age, gestational age, socioeconomic status (SES), physical activity, Tanner stage, sex, and BMI. In the Ala12 group, birth weight Z score was positively associated with FFM (p < 0.01), and this relationship remained significant after controlling for confounding variables (p < 0.05). Small body weight at birth may program lower FFM in adolescents carrying the Ala12 allele in the PPARγ-2 gene. © International Pediatrics Research Foundation, Inc. 2007. All Rights Reserved., The AVENA study was funded by the Spanish Ministry of Health (FIS no. 00/0015), CSD grants 109/UPB31/03 and 13/UPB20/04, the Spanish Ministry of Education (AP2003-2128; AP-2004-2745), and grants from Panrico S.A., Madaus S.A., and Procter and Gamble S.A and Linea Especial Nutrition, Obesity and Health (University of Navarra).

The aim of this study was to investigate the frequency of metabolic syndrome (MS) variables in a group of spanish obese children and adolescents, to asses MS prevalence in this population and to describe it’s relationship with other metabolic risk factors. 103 children were studied: 54 male and 49 female, mean age 10.08±2.3 with exogenous obesity. Obesity was defined when BMI was higher than the age and sex specific equivalent to 30 kg/m2 in adults. MS variables considered were waist circumference, blood pressure, fasting blood triglycerides, fasting glucose/insulin and HDL-cholesterol. The children were considered as having the MS when three or more characteristics showed abnormal values according to Cook and De Ferranti definitions. HOMA index, ApoB and ApoA1 were studied too. The most frequent features of the metabolic syndrome were excess waist circumference and hypertension. The MS markers with the lowest frequency were dyslipidemia and fasting hyperglicemia. MS prevalence was 29,9% (Cook et al. criteria) and 50% (De Ferranti et al. criteria). Fasting insulin and HOMA index values increased significantly (p < 0.05) when three or more abnormalities of the MS variables were present. Apo B increased significantly only in females (p < 0.05) and Apo A1 decreased significantly (p < 0.05) in both sexes when MS was present. Adequate metabolic syndrome risk factors criteria, mainly cut-off values, need to be defined in the European paediatric population.

INTRODUCTION: Adolescence is a decisive period in human life in which important body composition changes occur. Increase of total body mass and its relative distribution are mainly related to gender and pubertal development. OBJECTIVE: This review explores the specific measurements that may be used in this age group to assess excess body fat and to define obesity and overweight. RESULTS: Identification of subjects at risk for adiposity requires simple anthropometric cutoffs for the screening of overweight and obesity. In this context, BMI criterion is the most frequently used but, in spite of its high sensitivity and specificity, an important number of adolescents classified as overweight or obese do not have really high adiposity (32.1% of females and 42% of males). Excess total body fat and intra-abdominal visceral fat are related to metabolic abnormalities that increase the risk of cardiovascular diseases. Waist circumference seems to be the best simple anthropometric predictor for the screening of the metabolic syndrome in children and adolescents. CONCLUSIONS: Early identification of adolescents at risk for adiposity and its related metabolic complications requires reliable, simple and specific measures of excess body fat for this age group.

In children and adolescents from developed countries, obesity prevalence has strongly increased in the last decades and insulin resistance and impaired glucose tolerance are frequently observed. Some dietary components such as low glycemic index foods and dietary fibre could be used in order to improve glucose homeostasis in these children. Psyllium or ispaghula husk (the husk of the seeds of Plantago ovata) is a mixture of neutral and acid polysaccharides containing galacturonic acid with a ratio of soluble/insoluble fibre of 70/30. Some foods could potentially be enriched with psyllium, like breads, breakfast cereals, pasta and snack foods. The aim of this review was to assess the usefulness of psyllium in the management of obese children and adolescents with abnormalities of carbohydrate and lipid metabolism. After psyllium supplementation, the percentage change in postprandial glucose in type 2 diabetes patients, ranged from -12.2 to -20.2%. In hypercholesterolemic children, the effect of psyllium in LDL-cholesterol serum concentrations ranged from 2.78 to -22.8%; the effect in HDL-cholesterol from -4.16 to 3.05%; and the effect on triglycerides from 8.49 to -19.54%. The reviewed evidence seems to show that psyllium improves glucose homeostasis and the lipid and lipoprotein profile; however, more well controlled trials and further studies are needed to clarify it's effects and the mechanisms involved.

In developed countries, obesity prevalence has strongly increased in the last decades. This has also been observed in children and adolescents. Until recently, type 2 diabetes mellitus was considered very rare among children and adolescents; however, in the last decades, some cases have been observed mainly in obese adolescents of some minority populations. The aim of our study was to assess the prevalence of type 2 diabetes, impaired glucose tolerance (IGT) and insulin resistance, and the metabolic features, in obese children and adolescents. We have studied 95 obese children and adolescents, 53 males and 42 females, aged 4-16 years. The prevalence of IGT in obese children and adolescents studied was 7.4%; there was not any child with type 2 diabetes. Fasting glucose and insulin serum concentrations did not show significant differences between obese children with or without IGT; however, 120 minutes after an oral glucose tolerance test, glucose and insulin serum concentrations showed statistically significant differences between both groups. Insulin resistance is defined as a HOMA index higher than 4. The prevalence of insulin resistance in obese children studied was 35.8%. Trygliceride serum concentrations were higher and HDL-C serum concentrations were lower in obese children with IGT than in those without IGT, but the differences were not statistically significant. IGT and insulin resistance are frequent in obese children and adolescents; early treatment in obese children and adolescents with IGT constitutes a strategy of reversing progression to beta-cell failure and in preventing type 2 diabetes.

INTRODUCTION: The number of patients with glucose tolerance alterations associated with cystic fibrosis (CF) has increased, probably due to the greater survival rate among sufferers of this disease. We studied impaired glucose tolerance (IGT) in patients with CF and investigated whether its appearance has any relationship with age, sex, genetic mutation and/or the degree of clinical involvement. We assessed the parameters that might allow early detection. PATIENTS AND METHODS: In 28 patients with CF (14 M, 14 F; aged 22 months to 18 years), sex, genetic mutation, nutritional status and the degree of pancreatic and pulmonary involvement were recorded. The metabolic study included glycosylated hemoglobin (HbA1c) determination, oral glucose tolerance test (OGTT) and intravenous glucose tolerance tests (IVGTT). RESULTS: In the patients with CF, 35.71% showed impaired glucose tolerance (IGT) and 3.57% had diabetes mellitus. The patients with IGT and CF were 3.2 years older than those with normal glucose tolerance (NGT; p

To assess physical activity and leisure time activities in relation to socioeconomic status.We have studied 1,078 boys and girls from 24 schools from areas of different geographical and socioeconomical status. Physical activity and leisure time activities were assessed by a questionnaire.We have observed that adolescents spend more time watching T.V. than doing physical activity (p = 0.0001). In general, boys prefer strong physical activity. Children from the lowest socioeconomic families did less physical activity than children from the highest socioeconomic families (por = 0.05). In girls, those with the lowest socioeconomic status spent the greatest amount of time watching T.V. (p = 0.0001).From our results, we deduce that we must improve physical activity habits in children, especially in those from the lowest socioeconomic families.

To investigate the relationship between physical activity, leisure time activities and dietary habits in adolescents.We have studied 541 girls and 537 boys from 24 schools. Physical activity, leisure time activities and dietary habits were assessed by 3 different questionnaires, taking into account one week of normal activity and diet.Foods such as milk, fish, meat, egg, fruits, vegetables, pasta and snacks were consumed more frequently in children who spent more time doing sport, but difference were not statistically significant. Boys who spent more time watching T.V. ate greater amounts of almost all foods (p0.05). In girls, we have observed the same results, but differences were not statistically significant.Sports and T.V. watching are both related to a greater amount of food intake From our results we can deduce that in order to prevent obesity, and other cardiovascular risk factors, we must improve food intake related with sedentary habits.

We report the first observation of sclerosteosis in Spain. To the best of our knowledge, this is the first case of sclerosteosis in a person of Mediterranean origin with no known Dutch ancestors. He has the characteristic phenotype of the disease with right facial nerve palsy and syndactyly and the typical radiological features, including generalised bone sclerosis and cortical widening of the tubular bones.

Our purpose was to assess the relationship of obesity and body fat distribution to serum glucose values, insulin concentration and insulin resistance in obese prepubertal boys. Thirteen obese and 15 control prepubertal boys were studied. Biceps, triceps, subscapular and supra-iliac skin fold thicknesses were measured. Percentage of body fat and total body fat were calculated. Body fat distribution was assessed by analyzing the central (supra-iliac, subscapu-lar)/peripheral (biceps, triceps) ratios. During an oral glucose tolerance test, serum glucose and insulin were measured and insulin/glucose was calculated. Body fat data and body fat distribution indices were significantly higher in the obese group. The obese population presented significantly elevated values of insulin and insulin/glucose. In the obese group insulin showed significant correlations with percentage of body fat, total body fat and subscapular skin fold thickness, whereas insulin/glucose had significant positive correlations with percentage of body fat, total body fat and supra-iliac skin fold thickness. In obese boys significant positive correlations were also shown by subscapular/supra-iliac with insulin and insulin/glucose, and by subscapular/triceps with insulin. In prepubertal boys obesity is centripetal and an upper central body fat distribution seems to be first associated with an abnormal glucose-insulin homeostasis.

The purpose of this study is to assess the relative effects of body fat distribution and obesity "per se" on serum glucose, insulin, and insulin resistance. Seventeen obese and nine nonobese control prepubertal girls were studied. Biceps, triceps, subscapular, and suprailiac skinfold thickness were measured. Percentage of body fat (% BF) and total body fat (TBF) were calculated. Body fat distribution was assessed by analyzing the central (suprailiac, subscapular)/peripheral (biceps, triceps) ratios. Oral glucose tolerance test was performed. Serum glucose and insulin were measured and insulinogenic index (insulin/glucose) was calculated. Body fat anthropometric data and body fat distribution indexes were significantly higher (p less than 0.001) in the obese group. The obese population presented significantly elevated values of glucose, insulin, and insulinogenic indexes (p less than 0.01-p less than 0.001). In the obese group, insulin showed significant positive correlations (p less than 0.05-p less than 0.001) with biceps, subscapular, and suprailiac skinfolds, % BF and TBF, whereas the insulinogenic index had positive correlations with suprailiac skinfold and TBF (p less than 0.05). Obese girls showed positive correlations between the body fat distribution indexes and insulin or insulinogenic indexes (p less than 0.05-p less than 0.001). In prepubertal girls obesity is of the centripetal (central) type. This pattern has an important role in determining the alterations in the glucose-insulin homeostasis that characterize the childhood nutritional obesity.

The authors report a case of Wolfram's syndrome and discuss the evolution of the symptoms in relation with the data in the literature. The possibility of an association of Wolfram's syndrome with the HLA system is suggested. The use of carbamazepine in the treatment of the diabetes insipidus present in this syndrome is discussed.

A study of 98 cases of true sexual precocity in girls shows a frequency three times higher between 5 and 7 years than before age 5. Detectable causes (intracranial lesion and Mac Cune-Albright syndrome) were found in 56% of cases before 5 years and only 18% after age 5. The plasma levels of estradiol and gonadotropins and the gonadotropins response to LHRH did not differ significantly from those found at the corresponding stages of normal puberty. Plasma dehydroepiandrosterone was lower. Pelvic ultrasonography sometimes discovered follicular cysts. 44 patients treated with medroxyprogesterone acetate were followed for one or several years. Results on sexual development and plasma estradiol were good in most of them, with individual variations, Improvement in the ratio of bone age as height age and in the expected adult height was obtained but without statistical significance.

Secretion of insulin in a group of children with normal stature and without endocrine-metabolic (47 cases), versus another group with constitutional short stature (35 cases). Is study authors made a glucose tolerance test (1 g/kg) to both groups and they study the fisiologic secretion of insulin during 24 hours. It was observed that rates of insulin were similar after glucose tolerance test in both groups, but study of fisiologic secretion of insulin during 24 hours shows low rates of insulin in the group of constitutional short stature (p less than 0.005). The problem group rises higher rates of insulin after a glucose tolerance test than after the study of fisiologic secretion of insulin in 24 hours, but the other group shows similar answer in both tests.

In order to confirm the diagnosis of hormonal deficiency,upon inducing the secretion of GH by stimulation tests, dependable stimuli and more than one test must be employed.Numerous samples must be drawn with their consequent drawbacks. A total of 79 patients (45 males, 34 females), 72 of whom suffering short stature and 7 obesity, underwent a double stimulation with L-Dopa plus Arginine (L-D+A) and Propranolol+Glucagon (P+G) following the methodology of Weldon et al. and Rochiccioli et al., respectively. The patient's ages ranged from 0 2/12 to 22 3/12 years old. There were no false negatives after P+G (0%) and 13.08% false negatives following L-D+A. After statistical analysis of the results, it was seen that the P+G stimulation test maintained its sensitivity upon reducing the number of samples used from 8 to only those drawn at 120′ and 150′ . The L-D+A stimulation test remained valide upon using only 4 ( 0′, 20′, 40′ and 60′ ) of the 7 proposed samples. These results shorten the stimulation tests considerably.

Male 13,2/12 years old.Height: 187,0 cm (P 97 Tanner). Abnormal growth since seven years of age. Emergency admision by intracraneal hypertension. After neuroradiological (neumo and arterial) and gammagraphic studies, a diagnosis of supraselartumor was done. Hormonal studies showed hyperproduction of GH (basal: 220-max: 277,5 ngr/ml; insulin test). After oral administration of glucose there was not supression of serum GH levels (basal: 220-minimal: 150 ngr/ml). After surgical intervention the conventional and ultraestructural studies of the tumor demonstrated the presence of a GH-hypersecretor adenoma Seven months latter, the GH levels were high and other pituitary hormones were low.

a GENUD (Growth, Exercise, NUtrition and Development) Research Group. Universidad de Zaragoza. Espana b Departamento de Fisiatria y Enfermeria. Facultad de Ciencias de la Salud. Universidad de Zaragoza. Espana c Departamento de Pediatria, Radiologia y Medicina Fisica. Facultad de Medicina, Universidad de Zaragoza. Espana d Departamento de Medicina Preventiva y Salud Publica. Facultad de Ciencias de la Salud y del Deporte. Universidad de Zaragoza. Espana e Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Ministerio de Ciencia e Innovacion. Madrid f Departamento de Educacion fisica y Deportiva. Facultad de Ciencias del Deporte. Universidad de Granada. Espana g PROFITH (PROmoting FITness and Health through physical activity) Research Group h Unidad de Endocrinologia pediatriaca. Departamento de Pediatria. Clinica Universidad de Navarra i Departamento de Ciencias de la Alimentacion, Nutricion y Fisologia. Universidad de Navarra j Departamento de Pediatria. Facultad de Medicina, Universidad de Granada. Espana k EURISTIKOS Excellence Centre for Paediatric Research. Biomedical Research Centre. Parque Tecnologico de Ciencias de la Salid. Universidad de Granada. Espana l Immunonutrition Research Group, Departamento de Metabolismo y Nutricion, Instituto de Ciencia y Tecnologia de Alimentos y Nutricion. Consejo Superior de Investigaciones Cientificas. Madrid, Espana Correo electronico: pilardm@unizar.es (P. De Miguel-Etayo).