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The article presents a study which aims to determine the perinatal and socio-cultural characteristics of small gestational age (SGA) infants during their first six months of life. It states that the study evaluates diet and anthropometry during six months in a sample of 1596 newborns in Aragon, Spain. Results show that infants born SGA stayed smaller during the first six months of life. It is inferred that infants born SGA have converged nmany characteristics that lead to health risks.

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Fundamento: El nivel de autonomía para las actividades del cuidado personal en personas mayores y la necesidad de apoyo no cubiertas dependen de diferentes factores poco conocidos en nuestro medio. Los cuidados en la dependencia se facilitan principalmente por el sistema informal de cuidados. El propósito del estudio es estimar la prevalencia de dependencia para las actividades del cuidado personal y los factores asociados, e identificar los factores asociados con las necesidades de cuidados no cubiertas en personas dependientes, en población mayor de 75 años de Zaragoza. Método: Se realizó un estudio transversal en una muestra representativa de la población no institucionalizada mayor de 75 años, en una Zona de Salud de Zaragoza, en el año 1998 (n=351). Los datos se cumplimentaron a través de una entrevista directa. Se utilizó el índice de Katz para valorar la capacidad funcional para las actividades del cuidado personal y un cuestionario ad hoc para el apoyo informal y el resto de variables. El apoyo informal, las características sociodemográficas, autopercepción de salud y depresión (Escala de Depresión de Yesavage) se consideraron como variables independientes. Se aplicó la regresión logística para identificar los factores asociados a la dependencia y necesidades de cuidados no cubiertas. Resultados: La prevalencia de dependencia para las actividades del cuidado personal es de un 37,3%. Las variables que predicen la dependencia para las actividades del cuidado personal son una mala percepción de salud, depresión establecida, ser mujer y ser mayor de 85 años. La prevalencia de necesidades de apoyo no cubiertas en personas dependientes para las actividades del cuidado personal es de 22,1%. El apoyo informal lo presta la familia. Ser mujer y vivir sola se presenta como un factor de riesgo para no tener las necesidades cubiertas, así como también no estar deprimido. Conclusiones: El porcentaje de personas mayores con dependencia es elevado. El apoyo informal es insuficiente y limitado a la familia. El modelo de atención a las personas mayores en España debería desarrollar servicios de apoyo emocional, económicos y sociales a la familia y establecer una especial atención sobre las personas con dependencia que viven solas y con escasos recursos materiales.

Background: Individuals from families at high-risk for type 2 diabetes mellitus (T2DM) are also at high risk for hypertension (HTN) and cardiovascular disease. Studies identifying lifestyle patterns (LPs) combining dietary, physical activity or sedentary variables and examining their possible role with respect to developing blood pressure (BP) are limited. The present study aimed to examine the association of different LPs with BP levels in families at high risk for T2DM in Europe., Methods: In total, 1844 adults (31.6% males) at high-risk for T2DM across six European countries were included in this cross-sectional study using data from the baseline assessment of the Feel4Diabetes Study. BP measurements and dietary and physical activity assessments were conducted, and screen times were surveyed. LPs were revealed with principal component analysis of various data regarding diet, physical activity, screen time and smoking., Results: Three LPs were identified. LP3 (high consumption of sweet and salty snacks, sugar sweetened soft drinks and juices, and high amount of screen time) was positively associated with diastolic BP (B, 0.52; 95% confidence interval = 0.05-0.99) and the existence of HTN (odds ratio = 1.12; 95% confidence interval = 1.00-1.25). Participants in the highest tertile of LP3 spent mean 3 h of screen time, consumed 1.5 portions of sweet and/or salty snacks and 1 L of soft drinks on a daily basis, were associated with 12% higher risk of HTN., Conclusions: Focusing on the combination of eating and lifestyle behaviours may more accurately identify, and therefore guide preventive measures tailored to the specific needs of high-risk populations., (© 2023 The British Dietetic Association Ltd.)

Childhood obesity is one of the main public health concerns in Europe. The aim was to identify possible risk factors associated with overweight/obesity in Spanish preschool and school-age children. The sample (1075 (50.7% girls) children aged 3 to 12) is part of the project 'Alimentando el Cambio' whose objective is to promote healthy lifestyles in schools. Child height and weight were measured, and parents filled out questionnaires related to the children's lifestyle. There was a positive and significant association between sweetened beverage consumption and body mass index (BMI) z-score in both sexes and age groups. There was a negative and significant association between BMI z-score and dairy products in girls of both age groups. There was also a protective effect of regular nut consumption on overweight/obesity in girls 6-12 y. Night-time sleep during weekdays showed a negative association with BMI z-score for older boys and girls. A positive and significant association was found between total screen time and BMI z-score during weekdays. Regarding emotional well-being and self-esteem, having girls 6-12 y laughing and feeling happy and good about themselves in the last week was a protective factor against overweight/obesity. Childhood obesity prevention efforts may benefit from targeting these key risk factors.

Introduction: Water is an essential nutrient for life and the most abundant component in the human body. However, its dietary recommendations or clinical management guidelines do not receive as much attention as they deserve. In addition, there are some obstacles to establishing optimal values, both for the amount of water the body must contain and for water ingestion. Water intake and elimination depend on unsteady factors that are difficult to measure and, at the same time, compensated by the body's ability to regulate homeostasis. Since scientific evidence is lacking for establishing recommendations, "adequate intakes" (to maintain an adequate hydration state) have been estimated using data on water intake from groups of healthy people. The European Food Safety Authority (EFSA) also considers desirable the use of urine osmolarity to estimate the adequacy of water intake in adults. Clinical studies have generally shown the benefits of adequate hydration and the damage caused by water imbalance, whether quantitative (dehydration and overhydration) or qualitative (extracellular and intracellular water). Unfortunately, these studies are few and often have poor cross-sectional, case-control, or prospective designs, and use small samples or indirect methods to assess hydration status. This article presents up-to-date information on subjects such as: 1) compliance with water consumption recommendations and suggestions for improvement; 2) techniques available to measure hydration status and their clinical applications; 3) effects of hydration/dehydration on physical or cognitive activities and chronic diseases; and 4) existing Spanish regulations on the quality and salubrity of water.

Introduction: Increasing prevalence of both thinness and excess weight during childhood and adolescence is a significant public health issue because of short-term health consequences and long-term tracking of weight status. Monitoring weight status in Europe may serve to identify countries and regions where rates of these disorders are either slowing down or increasing to evaluate recent policies aimed at appropriate body weight, and to direct future interventions. This study protocol provides a standardised and transparent methodology to improve estimating trends of thinness, overweight and obesity in children aged 3-18 years and adolescents across the European region between 2000 and 2017., Methods and Analysis: This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the Cochrane Collaboration Handbook. To identify relevant studies, a search will be conducted in MEDLINE, EMBASE, Cochrane Library, CINAHL and Web of Science databases. From the selected studies, relevant references will be screened as supplemental sources. Finally, open search in websites from health institutions will be conducted to identify weight status data not published in scientific journals. Cross-sectional, follow-up studies and panel surveys reporting weight status (objectively measured height and weight) according to the International Obesity Task Force criteria, and written in English or Spanish will be included. Subgroup analyses will be carried out by gender, age, study year and country or European region., Discussion: This study will provide a comprehensive description of weight status of children and adolescents across Europe from 2000 to 2017. The results will be disseminated in a peer-reviewed journal. This study will use data exclusively from published research or institutional literature, so institutional ethical approval is not required., Prospero Registration Number: CRD42017056917., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background and Aims: Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents., Methods and Results: As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several individual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls., Conclusion: Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention., (Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Introduction: A sufficient intake of calcium enables correct bone mineralization. The bioavailability of calcium in water is similar to that in milk., Objective: To determine the concentration of calcium in public drinking water and bottled mineral water., Methods: We used ion chromatography to analyse the calcium concentrations of public drinking waters in a representative sample of 108 Spanish municipalities (21,290,707 people) and of 109 natural mineral waters sold in Spain, 97 of which were produced in Spain and 12 of which were imported., Results: The average calcium concentration of public drinking waters was 38.96 ± 32.44 mg/L (range: 0.40- 159.68 mg/L). In 27 municipalities, the water contained 50-100 mg/L of calcium and in six municipalities it contained over 100 mg/L. The average calcium concentration of the 97 Spanish natural mineral water brands was 39.6 mg/L (range: 0.6-610.1 mg/L). Of these, 34 contained 50-100 mg/L of calcium and six contained over 100 mg/L. Of the 12 imported brands, 10 contained over 50 mg/L. Assuming water consumption is as recommended, water containing 50-100 mg/L of calcium provides 5.4-12.8% of the recommended intake of calcium for children aged one to thirteen, up to 13.6% for adolescents, 5.8-17.6% for adults, and up to 20.8% for lactating mothers. Water with 100-150 mg/L of calcium provides 10-31% of the recommended dietary allowance, depending on the age of the individual., Discussion: Public drinking water and natural mineral water consumption in a third of Spanish cities can be considered an important complementary source of calcium., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Objective: To identify socio-cultural, obstetric and perinatal characteristics associated with complete breastfeeding (CBF) during the first 4 months of age, depending on maternal origin., Material and Methods: Socio-cultural, obstetric and perinatal aspects associated with breastfeeding depending on maternal origin were evaluated in a longitudinal study in a representative infant population from Aragon (n = 1452)., Results: The prevalence of CBF was higher in immigrant mothers than in those from Spain. CBF was maintained in 37.2% of mothers from Spain at 4 months, compared with 43% of immigrants (P=.039) (RR Spanish/immigrants=0.76; 95% CI: 0.58-0.99); at 6 months this occurred in 13.9% vs. 23.8%, respectively (P<.001) (RR Spanish/immigrants=0.52; 95% CI: 0.37-0.72). The factors associated with CBF at 4 months are different between both groups. Mothers born in Spain are older (P=.002), have higher academic level (P=.001), greater parity (P=.003), and a higher probability of vaginal delivery (P=.005); and their children have the highest anthropometric values at birth. However, in immigrant mothers, the maintenance of CBF was associated with a higher maternal body mass index and with working at home. In both groups, CBF remains more frequently in those mothers who do not smoke (P=.001)., Conclusions: The prevalence of CBF during the first months of life is higher in immigrant mothers than in those from Spain, and socio-cultural, obstetric and perinatal factors are different, depending on maternal origin., (Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Introduction: Being born small for gestational age (SGA) has short and long term risks. The aim of this study was to describe perinatal and socio-cultural characteristics, and the pattern of growth and diet of SGA infants during their first 6 months of life., Materials and Methods: Anthropometry and diet were evaluated during six months in a representative sample of 1596 newborns the population of Aragon (Spain)., Results: Mothers of SGA (N=94) infants gained less weight during pregnancy (10.5±5.8 vs 12.0±5.07 kg, P=.012), gestational age at birth was lower (37.84±1.7 vs 39.06±1.6 weeks, P<.001), and the probability of cesarean delivery was higher (37.2% vs 20.5%, P=.001). The height of the mother was lower in the SGA group (1.61±0.58 vs 1.63±0.06 metres, P=.004), but their body mass index was similar. No differences were found between groups in social or cultural aspects. Mothers of SGA infants smoked more during pregnancy (32.3% vs 18.5%, P=.003) (RR = 1.92; 95% CI; 1.31 to 3.02). Infants born SGA remained smaller during the first 6 months of life, and the monthly weight gain was similar to the rest. In the SGA group, the prevalence of breastfeeding was lower at 4 months of age (54.9% vs 68.2%, RR = 0.58, 95% CI; 0.38 to 0.89)., Conclusions: Infants born SGA are more likely to converge a number of characteristics that must be considered together because they may lead to health risks. SGA do not show a rapid recovery pattern of postnatal growth, and their smaller size persists at six months., (Copyright © 2011 Asociación Española de Pediatría. Published by Elsevier España. All rights reserved.)

Introduction: One in every four women smoke at the beginning of the pregnancy in Spain; of these, 25-50% give up smoking during gestation and most of them smoke again after childbirth. Maternal smoking has harmful effects on babies, such as low birth-weight with its resulting morbidity. The objective of this study is to compare the anthropometric and socio-cultural characteristics between newborns from smoking motheŕs and those from non- smoking ones., Materials and Methods: Smoking habits and the socio-cultural characteristics were assessed from a sample of 1499 pregnant women, as well as their newborn anthropometric variables of their newborn babies during 2009 in the Aragon region of Spain., Results: In the sample of 1499 pregnant women the prevalence of smoking during pregnancy was 19.6%; among the Spanish women, 23% of them smoked during the gestation compared with only 11% in women from other countries. The smoker mothers were younger and they had a lower educational level than the non smoker ones; however, there were no statistical differences between their anthropometric characteristics. Newborns from smoker women in Aragon had a lower weigh at delivery (3155 vs. 3295 grams: p<.001) and a relative risk of low weight at birth for their gestational age of 2.1 (95% CI: 1.35 - 2.97). The length and the rest of newborn anthropometric variables were also affected., Conclusion: The prevalence of smoking during gestation is high in Aragon. The mothers who smoke are younger and have different socio-cultural characteristics compared with non-smoker mothers. Maternal smoking habits have a harmful effect on newborn nutritional status, representing an avoidable risk of low weight at birth., (Copyright © 2011 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Introduction: Maternal nutritional status is an important factor of adequate intrauterine growth and neonatal weight. The aim of this study is to evaluate the relationship between pre-gestational BMI (Body Mass Index) and breastfeeding duration, as well as infant anthropometric measurements during their first six months of life., Materials and Methods: Anthropometric measurements and the type of feeding were evaluated in a representative sample of 1,547 newborns from our population during 2009, according to their maternal BMI, and also in a sub-cohort of 759 infants followed up to 6 months of life., Results: A total of 72.9% of women had a normal weight, 18.7% were overweight and 8.4% obese. Women with a BMI ≥ 25 kg/m(2) had lower weight gain during pregnancy (P < .001), lower socioeconomic and cultural level (P < .001), and their infants had higher weight at delivery (P=.003) and at 6 months of life, with no differences in body length. Newborn weight increased in relation to maternal BMI, but over 35 kg/m(2) it decreased progressively (P < .001). Breastfeeding prevalence in obese women was 58.5% at hospital postpartum discharge, and 8.6% at six months of life; as opposed to 70.8% and 13.9%, respectively in women with normal BMI., Conclusions: In our sample, maternal obesity is associated with a low socioeconomic and cultural level, higher infant weight at delivery and at 6 months of life, and less prevalence of exclusive breastfeeding; all of them nutritional risk factors in the short and long term., (Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Background: Dependency to carry out the activities of daily living (ADL) and home care needs of older adults depend upon factors which are not well understood. Caregiving is mainly provided by the family. The aim of this study is to estimate the prevalence of ADL dependence and associated factors among older adults and to identify associated factors with unmet home care needs in people over age 75 in Zaragoza (Spain)., Method: A cross-sectional study was conducted on a representative sample of the community dwelling population over age, 75 in one Health Care District in Saragossa in 1998 (n = 351). Data were collected during a personal interview. ADL dependency was assessed by the Katz index. Home care needs were assessed using prevalent norms for desired frequency of care. Sources of informal care, socio-demographic characteristics, self-rated health and depression (Yesavage Geriatric Depression Scale) were considered independent variables. Logistic regression was used to identify factors associated with both ADL dependency and unmet home care needs., Results: Prevalence of ADL dependence is 37.3%. The variables predicting ADL dependence are the perception of poor health, depression, being a female and being over 85 years of age. The prevalence of unmet care needs among ADL dependent individuals is 22.1%. Sources of help are limited to the families. Being a woman and living alone are the stronger risk factors for unmet needs., Conclusions: A high percentage of older adults are dependent. Informal support is insufficient and confined to the family. The social and health care system in Spain should provide to the family, emotional, financial and social support and special care for disabled people living alone and with limited material resources.

Objective: To determine whether there is a significant difference between anthropometric measurements of prepubertal children and the measurements of another sample with similar characteristics, studied fifteen years ago., Material and Methods: We studied 859 children, 453 males and 406 females, from the age of 5.0 to 10.0 years. Weight, height, arm circumference and skinfold thicknesses in the biceps, triceps, subscapular and suprailiac were determined. Body mass index, body density, total fat and percentage fat were calculated and their values compared with those obtained 15 years ago in 1,617 children with similar characteristics. Difference between means were calculated with Student's single-sample t-test., Results: Weight increased in all the ages, with significant differences in males at 7, 8 and 9 years (p<0.001) and in females after the age of 6 years (p< 0.05). Height significantly increased at all ages and in both sexes, except in females at the age of 5 years. Body mass index increased only at the ages of 8 and 9 years in males (p<0.01). Skinfold thicknesses significantly increased in both sexes and at all ages (p<0.05). Body density decreased (p<0.01) and body fat increased, both in kilograms and in percentage (p<0.01)., Conclusions: During the 15 years studied, height and weight increased significantly. Body mass index did not increase significantly, whereas body fat (skinfold thicknesses and fat compartment) significantly increased.

Background: To quantify the differences between anthropometric measurements obtained nowadays in male and female adolescents and those obtained 15 years ago in a sample of similar characteristics., Subjects and Methods: We have studied 658 healthy individuals, 329 males and 329 females from 10.0 to 15.0 years of age, from different socioeconomic levels. Weight, height, arm circumference and left skinfold thickness (biceps, triceps, subscapular and suprailiac) have been measured. We have calculated the body mass index (BMI), density, total body fat, percentage of body fat and the body adipose muscular index (BAMI), which is the ratio between body fat (kg) and non fat mass (kg). The values obtained have been compared with those obtained fifteen years ago, in another sample of 1,465 children with similar characteristics. The research team and the material used were the same in both studies. Mean differences were compared using the unpaired t-test., Results: Weight has increased significantly (p < 0.05), except for males at 12 years and females at 13 and at 14 years. Height has increased significantly at all ages and in males and females (p < 0.05). BMI has only increased significantly at 10 and at 11 years in males, and at 10 years in females. Skinfold thicknesses have also increased significantly, except for biceps in males between ages of 12 and 14 years and biceps and subscapular in females at 14 years. Body fat mass and percentage of body fat have also increased significantly and, in consequence, the density has decreased and BAMI has increased both significantly (p < 0.05)., Conclusions: Secular increase in weight and height during fifteen years has occurred. In general, BMI has not increased but skinfold thicknesses and body fat have increased significantly, this fact demonstrates that there has been increase in the body fat compartment.

Objective: To describe the proportion of body fat mass, quantified from the measurement of 4 skinfold thickness, in a sample of male children of Zaragoza., Methods: In 1995, we have studied 701 males aged 6.0 to 14.9 years, from 6 schools of the province of Zaragoza. We have measured: weight, height, and biceps, triceps, subscapular and suprailiac skinfold thicknesses. Body density has been calculated from the 4 skinfold measurements, with the formulas of Sarría et al. Fat mass (%), was calculated with the Weststrate and Deurenberg's formulas. In each age group, we present mean, standard deviation and 5, 25, 50, 75 and 95th percentiles., Results: We present mean, standard deviation and 5, 25, 50, 75 and 95th percentiles of body fat mass (%), in each age group. Body fat mass (%) progressively increased until 10.5 years and, after, progressively decrease at least until 14.5 years., Conclusions: We present data of body fat mass (%), calculated from the measurement of 4 skinfold thicknesses, obtained from a reference population in the province of Zaragoza. These data are useful as more rationale criteria in the diagnosis of obesity in children and adolescents.

Objective: Our objective was to determine if apo E phenotypes have any effect on the serum lipoprotein response to dietary intervention in children with hypercholesterolemia., Patients and Methods: We have selected 76 children with total serum cholesterol levels higher than 200 mg/dL. At diagnosis, each patient met with a member of our clinic that established dietary recommendations (total and saturated fat intake: 30 and 10%, respectively, of total energy intake). At diagnosis and after 6 months of therapy we determined a lipoprotein profile., Results: After 6 months of therapy, there was only a significant change in children with phenotype E3/E4, with significant decreases in serum total cholesterol (from 247 +/- 43 to 231 +/- 47 mg/dL, p = 0.002), LDL-cholesterol (from 164 +/- 47 to 149 +/- 48 mg/dL, p = 0.002) and triglycerides (from 81 +/- 36 to 71 +/- 31 mg/dL, p = 0.028) concentrations. Absolute and % delta differences in serum lipoprotein concentrations before and after dietary treatment do not show significant differences between apo E phenotype groups., Conclusions: In the group studied, apo E phenotypes do not determine the response to a low-fat, low-cholesterol diet in children with hypercholesterolemia. To know the factors that determine the variability in the response to dietary intervention in children with hypercholesterolemia it would be interesting to study other familial and genetic factors.

Objective: To describe the main anthropometric characteristics of a young adult population, to compare some measurements obtained with different formulas, and to compare these results with a reference population., Material and Methods: We have studied 72 healthy female university students aged 19.0 to 20.9 years (mean age 19.63). We have measured weight, height, body mass index (BMI), cervical and arm circumferences, and biceps, triceps, and submandibular skinfolds. We have calculated total arm area, fat arm area and muscular arm area using traditional formulas and others recently published. Means were compared using Student's t test and we also calculated Pearson correlations., Results: Concerning anthropometric measurements, they were similar to those of the reference population. Arm areas were different when calculated with different formulas (p < 0.000). All the anthropometric characteristics measured correlated with each other, except with height. Submandibular skinfold correlated with biceps skinfold (0.467), triceps skinfold (0.513), BMI (0.503), weight (0.476), cervical circumference (0.511) and arm circumference (0.505). Submandibular skinfold also showed a significant correlation with arm measurements, especially fat area (0.519, p < 0.001)., Conclusions: Fat and muscular arm areas were different depending on the different formulas used to be calculated. Submandibular skinfold is easy to obtain and is related with the other indexes of body fat. This measure could be included in nutritional surveys.

Objective: The aim of this study was to examine if there were differences in the assessment of the nutritional status between values of bioelectric impedance (BI) measured in the morning (08:30) and in the afternoon (17:00)., Patients and Methods: We have studied 30 boys between 6.5 and 10.9 years of age. Weight, stature, skinfold thickness and total body impedance (Z) were measured at 08:30 and at 17:00 on the same day., Results: In 28 of 30 boys, Z at 17:00 was lower than Z at 08:30. The mean decrease in Z was 4.64% of the morning result (p = 0.0001). At 17:00 there was an increase in total body water (TBW) and fat-free mass (FFM) measured by BI, 0.681, and 0.93 Kg, respectively (p = 0.0001), compared with morning values. We did not find differences between skinfold thickness values in the morning and in the afternoon, except for the suprailiac skinfold, which was a bit larger in the afternoon (p = 0.05). In the morning and afternoon there was a high correlation between FFM measured by skinfold thickness and values of TBW and FFM measured by BI., Conclusions: Z in boys decrease in the afternoon (17:00) compared with morning values (08:30). This fact must be considered by the pediatrician when IB is used for the assessment of nutritional status in children.

Objective: The aim of this study was to describe anthropometric indexes of fat distribution in 6.0 to 14.9 year old children and to estimate the timing of differentiation of fat patterning in male and female children and adolescents., Patients and Methods: We have studied a sample of 1,360 children (701 boys and 659 girls) from Zaragoza, Spain. We have measured triceps and subscapular skinfold thicknessess and waist and hip circumferences. With these measurements, we have calculated the indexes of fat distribution including waist-to-hip circumference ratio and triceps-to-subscapular skinfold thickness ratio. We present the percentiles of these indexes., Results: All percentiles of the waist-to-hip ratio were higher in males than in females. Percentiles 5, 50 and 95 of the triceps-to-subscapular skinfold thickness ratio showed similar values in males and females, except that percentile 95 was higher in males than in females after 10.5 years., Conclusions: The waist-to-hip ratio seems to define earlier the pattern of fat distribution in children than does the triceps-to-subscapular skinfold thickness ratio. If we take into account the waist-to-hip ratio, the pattern of fat distribution is already present in school age children.

Objective: Diet, physical activity, physical fitness and body composition are factors that contribute to lipid disorders; however, we do not know whether they are relevant in children of the general population and in children with dyslipoproteinemias., Patients and Methods: We have studied all of these factors in 89 children, aged 4.0 to 20.0 years. Children were divided into two groups: 1) Normocholesterolemics (total cholesterol < 225 mg/dL) and 2) Hypercholesterolemics (total cholesterol > or = 225 mg/dL)., Results: In normocholesterolemic children, the main determinants of total and low-density lipoprotein cholesterol were height and cholesterol intake, which explained both 50 and 32% of its variability, respectively. The main determinants of high density lipoprotein cholesterol were blood pressure after submaximal loading and fat mass, which explained 50% of the variability. In hypercholesterolemic children, fat and carbohydrate intake and physical activity explained more than 90% of the variability of total and low density lipoprotein cholesterol. Resting energy expenditure explained 40% of the variability of high density lipoprotein cholesterol., Conclusions: In the treatment of children and adolescents with dyslipoproteinemias, we must emphasize not only dietary intake, but also physical activity. To increase high density lipoprotein cholesterol we must also improve physical fitness and decrease the amount of body fat mass.

Objective: The aim of this study was to show the validity of a new skinfold thickness for measuring nutritional status in children. We also compare submandibular skinfold thickness with other anthropometric measures and indices., Patients and Methods: We have studied 899 boys and 837 girls between 3.0 and 15.1 years of age. All of them were healthy and from different socioeconomic statuses. We measured weight, height, obesity indices, circumferences, indices of body fat distribution and indices of body fat. Data were divided according to age and sex. We calculated the percentiles of submandibular skinfold thickness and correlations between this parameter and all other measurements were performed. The mean values of the two sexes were compared by using Student's t-test., Results: Submandibular skinfold is an easy and fast skinfold to measure. Its value is maximum at 10 and 11 years in girls and boys, respectively. This measurement is higher in girls than in boys at 5, 7, 10, 13 and 14 years of age (p < 0.05). There was a high correlation between this skinfold value and almost all of the measurements and indices studied, especially with the body mass index (r = 0.589), the sum of the four conventional skinfolds (r = 0.844), arm circumference (r = 0.513), arm fat area (r = 0.776) and percentage body fat (r = 0.830)., Conclusions: Submandibular skinfold thickness in children and adolescents shows a high correlation with body fat indices. It is for this reason that it could be used as a new measurement to assess nutritional status and obesity in children.

Objective: To assess physical activity and leisure time activities in relation to socioeconomic status., Patients and Methods: 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., Results: 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 (p < or = 0.05). In girls, those with the lowest socioeconomic status spent the greatest amount of time watching T.V. (p = 0.0001)., Conclusions: From our results, we deduce that we must improve physical activity habits in children, especially in those from the lowest socioeconomic families.

Objective: To investigate the relationship between physical activity, leisure time activities and dietary habits in adolescents., Patients and Methods: 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., Results: 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 (p < 0.05). In girls, we have observed the same results, but differences were not statistically significant., Conclusions: 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 have studied serum lipid levels and dietetic intake in 38 children whose parents had ischemic heart disease (HPCI) before 55 years of age and in a control group (n = 114). In the HPCI group, 25% had serum levels of total cholesterol higher than 200 mg/dl; only 2 children presented elevated levels of LDL and apo B. Dietetic intakes in both groups were similar, with a high protein (16-17% of calories) and fat (39-42% of calories) intake and a low carbohydrate intake (40.46% of calories). In both groups the percentage of monounsaturated fat was higher than other types of fat. The most frequent phenotype in the HPCI group was IIa (8 children). Only 1 child showed a IIb phenotype. This finding may be due to the variability of this phenotype in the same individual throughout life. In the families (n = 8), we have detected 2 families with polygenic hypercholesterolemia (HP), 2 others with familial combined hyperlipidemia (HFC) and 4 without family history of hyperlipidemia. Taking into account the lipid profile in children of the HPCI group, we have detected the presence of familial dysliproproteinemias. It appears that dietetic intake is not an atherogenic risk factor in these patients.

A series of 439 children (245 boys and 194 girls) ranged between 2.0 and 18.0 years of age have been studied January 1987 to April 1990. They belonged to four groups: I) 306 children (163 boys and 143 girls), "control group"; II) 31 children (22 boys and 9 girls) whose parents had some type of dyslipoproteinemia (HPDLP); III) 38 children (24 boys and 14 girls) whose fathers were survivors of myocardial infarction occurred before 55 years of age (HPCI); and IV) 43 children (23 boys and 20 girls) who had, at least in two occasions, more than three months of time separated between then, over 200 mg/dL of total serum cholesterol levels detected by opportunist search (HDC). For children's identification of risk factors to develop atherosclerotic disease during adult life, two different types of strategy has been utilised. One, "selective search", taking into account children of groups II (HPDLP) and III (HPCI). Other, "opportunist search", taking into consideration children of group IV (HDC). The most frequent primary dyslipoproteinemia between the families of children with high serum levels has been Polygenic Hypercholesterolemia (HP). In the second place were both Familial Hypercholesterolemia (HF) an Familial Combined Hyperlipidemia (HFC). A family with Mixed Hyperlipidemia (HM) was also identified. Familial aggregation, with relation to serum lipid levels, were detected in children of the three groups: HPDLP, HPCI and HDC, as it is reported by another authors. Our results suggest the genetic alterations may contribute to the presence of different types of dyslipoproteinemia in children.

Apolipoprotein (apo)-beta is an atherosclerotic risk factor in adults and children. In families with Familial Combined Hyperlipidemia (FCH) it has been described as a lipoprotein phenotype called Hyperapobetalipoproteinemia (Hyperapo-beta) and characterized by increased numbers of small, dense and apo-beta enriched low density lipoproteins. In our Lipids Clinic, we have studied 267 children, but for the purpose of this paper we have only taken into account the 19 of these children who showed increased plasma total apo-beta levels (Hyperapo-beta-emina). To investigate the type of dyslipoproteinemia of these children, we divided them into two groups: 1) Group 1: 10 children with apo-beta levels greater than mean + 2 standard deviations (SD); 2) Group 2: 9 children with apo-beta levels greater than mean + 3 SD. We have also studied the fathers, mothers, brothers and sisters of all the children. Only one child (Group 1) had type IIb hyperlipoproteinemia. The other children had type IIa hyperlipoproteinemia. In each group, 4 families had FCH and the others had either Familial Hypercholesterolemia or Polygenic Hypercholesterolemia. Families with FCH could also have hyperapo-beta. It is possible that in the future some children of FCH families and those with type IIa hyperlipoproteinemia will have increased plasma triglyceride levels. This could be prevented by a proper diet.

Atherosclerosis and its consequences are a significant cause of death in industrialized countries. In recent years, due to modern techniques which permit DNA analysis, a series of alleles associated with dyslipoproteinemia and heart disease have been identified. In this study these genetic markers, in particular those found at the level of the genes of apolipoproteins, are reviewed. The knowledge of these facts is important for the paediatrician, since these disturbances can be identified in the first days of an individual's life, thus a positive influence can be made over the lifestyle habits.

Congenital adrenal hyperplasia caused by a deficiency of 21-hydroxylase is an inherited disorder of adrenal steroidogenesis. In this study, the deficiency incidence is presented according to different author's and countries' results. Nowadays knowledge concerning its genetics are reviewed, especially HLA linkage. Allelic variants of deficiency and the "linkage disequilibrium" with HLA complete antigens are described. Finally, the main applications of that knowledge are presented: heterozygote detection and prenatal diagnosis.