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Over the last several decades, there has been a tendency towards a predominance of less symptomatic forms of coeliac disease (CD) and an increase in the patient age at diagnosis. This study aimed to assess the clinical presentation and diagnostic process of paediatric CD in Spain.A nationwide prospective, observational, multicentre registry of new paediatric CD cases was conducted from January 2011 to June 2017. The data regarding demographic variables, type of birth, breast-feeding history, family history of CD, symptoms, height and weight, associated conditions, serological markers, human leukocyte antigen (HLA) phenotype, and histopathological findings were collected.In total, 4838 cases (61% girls) from 73 centres were registered. The median age at diagnosis was 4 years. Gastrointestinal symptoms were detected in 71.4% of the patients, and diarrhoea was the most frequent symptom (45.9%). The most common clinical presentation was the classical form (65.1%) whereas 9.8% ofthe patients were asymptomatic. There was a trend towards an increase in the age at diagnosis, proportion of asymptomatic CD cases, and usage of anti-deamidated gliadin peptide antibodies and HLA typing for CD diagnosis. There was, however, a decreasing trend in the proportion of patients undergoing biopsies. Some of these significant trend changes may reflect the effects of the 2012 ESPGHAN diagnosis guidelines.Paediatric CD in Spain is evolving in the same direction as in the rest of Europe, although classical CD remains the most common presentation form, and the age at diagnosis remains relatively low.

The authors would like to thank the children and their parents for their participation in the study., High blood pressure (BP) is a risk factor for cardiovascular disease and sodium consumption is related to high BP. Moreover, sugar-sweetened beverages (SSB) and the Dietary Approach to Stop Hypertension (DASH) influence BP. For this reason, we investigated whether: 1) children with risk of elevated BP had a higher consumption frequency (CF) of energy-dense salty foods (EDSF), high-sugary foods (HSF) and SSB or a low DASH score; and 2) children with a higher CF of EDSF showed a worse anthropometric and metabolic profile. Anthropometry, BP and general biochemical parameters were measured in 687 Spanish children (5–16 years) with normal or excess weight. A food frequency questionnaire was used to calculate EDSF, HSF and SSB consumption, and modified DASH score. Results showed that sex and pubertal stage influenced modified DASH score. Diastolic hypertension was associated to higher CF of EDSF in the whole sample and to higher CF of SSB in pubertal children, both independently of nutritional status. In addition, CF of EDSF was positively associated with CF of HSF and SSB and inversely associated with modified DASH score. Targeted policies and intervention programs, specific for different age ranges, should be established that aim to reduce salt consumption from snacks and processed foods, which could reduce HSF and SSB consumption as well., Funded by the Ministry for Science and Innovation (GENOBOX PI11/01425, PI11/02042, PI11/02059; PUBMEP PI16/00871, PI16/01301, PI16/012) and SAMID (RD08/0072/0028) and CIBEROBN (CB15/00131, CB15/00043) networks. AIR was funded by a Juan de la Cierva-Formación stipend (FJCI-2014-19795). GPG was funded by a predoctoral fellowship from the Government of Aragón.

La actividad física (AF) y el ejercicio físico (EF) mejoran la calidad de vida global, previenen la aparición de enfermedades en niños y adolescentes sanos, y sirve para el tratamiento de enfermedades crónicas prevalentes en la infancia. Si la AF y el EF son medicina, el sedentarismo y la inactividad provocan enfermedad. Se revisa en este artículo la evidencia científica existente al respecto y se ponen al día las recomendaciones para los profesionales involucrados en la salud del niño, ya que es necesario un buen conocimiento de cómo prescribir EF y AF en pediatría en diferentes enfermedades. Las intervenciones para evitar la inactividad del niño y del adolescente deben estar sustentadas en el apropiado aumento del nivel de AF, mediante programas de integración y capacitación, que consigan una mejora conjunta de la condición física neuromuscular y del rendimiento físico, cognitivo y psicosocial. La Asociación Española de Pediatría, a través del Comité de Promoción de la Salud, propone estrategias que faciliten este objetivo para mejorar la salud de nuestros pacientes a través de la práctica de EF y el aumento de la AF. Physical activity (PA) and exercise improve the overall quality of life, as well as prevent the onset of diseases in healthy children and adolescents, and as an aid to treat prevalent chronic diseases in childhood. PA and exercise are like medicine, but sedentary lifestyle and inactivity cause disease. In this article, the existing scientific evidence in this field is reviewed and recommendations for professionals involved in child health are updated. A good knowledge of how to prescribe exercise and PA in paediatrics in different diseases is necessary. Interventions to avoid inactivity of children and adolescents must be supported by the appropriate increase in the level of PA, through integration and training programs, which achieve both an overall improvement of the neuromuscular physical condition and also physical, cognitive, and psychosocial performance. The Health Promotion Committee of Spanish Paediatric Association proposes strategies that help to obtain this objective, aiming to improve the health of our patients through the practice of exercise and the increase in PA. Sin financiación 1.500 JCR (2020) Q4, 100/129 Pediatrics 0.226 SJR (2020) Q3, 201/301 Pediatrics, Perinatology and Child Health No data IDR 2019 UEM

Resumen: Introducción: La obesidad infantil es un problema de salud de alta prevalencia. Aunque existen guías clínicas para su manejo, la variabilidad en su abordaje clínico es un hecho. El objetivo de este estudio es describir la práctica clínica habitual en unidades de Endocrinología Pediátrica y evaluar su adecuación a la guía recomendada. Material y métodos: Se realizó un estudio observacional, transversal y descriptivo mediante encuesta a endocrinólogos infantiles de la Sociedad Española de Endocrinología Pediátrica. Las preguntas fueron formuladas en base a las recomendaciones de la «Guía de Práctica Clínica sobre la Prevención y el Tratamiento de la Obesidad Infantojuvenil» del Ministerio de Sanidad español. Resultados: Se obtuvieron 125 encuestas de todas la Comunidades Autónomas. Se observó variabilidad en el número de pacientes atendidos al mes y en la frecuencia de las visitas. El 70% de los encuestados no dispone de un nutricionista ni de psicólogo o psiquiatra al que derivar a los pacientes. En el tratamiento, las medidas dietéticas son las más empleadas; un 69% nunca ha prescrito fármacos para perder peso. De los que prescriben, el 52,6% no utilizan el consentimiento informado como paso previo a su empleo. Conclusiones: Pocos centros cumplen las recomendaciones de la Guía de Práctica Clínica sobre la Prevención y el Tratamiento de la Obesidad Infantil en un plan de calidad establecido. La práctica clínica difiere mucho entre los endocrinólogos pediátricos encuestados, sin existir protocolos unificados de actuación, y con escasa disponibilidad de recursos para el tratamiento integral que precisa esta enfermedad. Abstract: Introduction: Childhood obesity is a high prevalence health problem. Although there are clinical guidelines for its management, there is variability in its clinical approach. The aim of this study is to describe the usual clinical practice in Paediatric Endocrinology Units in Spain and to evaluate if it resembles the recommended guidelines. Material and methods: An observational, cross-sectional and descriptive study was carried out by means of a questionnaire sent to paediatric endocrinologists of the Spanish Society of Paediatric Endocrinology. The questions were formulated based on the recommendations of “Clinical Practice Guidelines on the Prevention and Treatment of Childhood Obesity” issued by the Spanish Ministry of Health. Results: A total of 125 completed questionnaires were obtained from all Autonomous Communities. Variability was observed both in the number of patients attended and in the frequency of the visits. The majority (70%) of the paediatricians who responded did not have a dietitian, psychologist or psychiatrist, in their centre to share the treatment for obese children. As regards treatment, dietary advice is the most used, and 69% have never prescribed weight-loss drugs. Of those who have prescribed them, 52.6% did not use informed consent as a prior step to them being used. Conclusions: There are few centres that comply with the recommendations of the clinical practice guidelines on prevention and treatment of childhood obesity as an established quality plan. Clinical practice differs widely among the paediatric endocrinologists surveyed. There are no uniform protocols of action, and in general there is limited availability of resources for the multidisciplinary treatment required by this condition.

Introduction: Childhood obesity is a high prevalence health problem. Although there are clinical guidelines for its management, there is variability in its clinical approach. The aim of this study is to describe the usual clinical practice in Paediatric Endocrinology Units in Spain and to evaluate if it resembles the recommended guidelines. Material and methods: An observational, cross-sectional and descriptive study was carried out by means of a questionnaire sent to paediatric endocrinologists of the Spanish Society of Paediatric Endocrinology. The questions were formulated based on the recommendations of “Clinical Practice Guidelines on the Prevention and Treatment of Childhood Obesity” issued by the Spanish Ministry of Health. Results: A total of 125 completed questionnaires were obtained from all Autonomous Communities. Variability was observed both in the number of patients attended and in the frequency of the visits. The majority (70%) of the paediatricians who responded did not have a dietitian, psychologist or psychiatrist, in their centre to share the treatment for obese children. As regards treatment, dietary advice is the most used, and 69% have never prescribed weight-loss drugs. Of those who have prescribed them, 52.6% did not use informed consent as a prior step to them being used. Conclusions: There are few centres that comply with the recommendations of the clinical practice guidelines on prevention and treatment of childhood obesity as an established quality plan. Clinical practice differs widely among the paediatric endocrinologists surveyed. There are no uniform protocols of action, and in general there is limited availability of resources for the multidisciplinary treatment required by this condition. Resumen: Introducción: La obesidad infantil es un problema de salud de alta prevalencia. Aunque existen guías clínicas para su manejo, la variabilidad en su abordaje clínico es un hecho. El objetivo de este estudio es describir la práctica clínica habitual en unidades de Endocrinología Pediátrica y evaluar su adecuación a la guía recomendada. Material y métodos: Se realizó un estudio observacional, transversal y descriptivo mediante encuesta a endocrinólogos infantiles de la Sociedad Española de Endocrinología Pediátrica. Las preguntas fueron formuladas en base a las recomendaciones de la «Guía de Práctica Clínica sobre la Prevención y el Tratamiento de la Obesidad Infantojuvenil» del Ministerio de Sanidad español. Resultados: Se obtuvieron 125 encuestas de todas la Comunidades Autónomas. Se observó variabilidad en el número de pacientes atendidos al mes y en la frecuencia de las visitas. El 70% de los encuestados no dispone de un nutricionista ni de psicólogo o psiquiatra al que derivar los pacientes. En el tratamiento, las medidas dietéticas son las más empleadas; un 69% nunca ha prescrito fármacos para perder peso. De los que prescriben, el 52,6% no utilizan el consentimiento informado como paso previo a su empleo. Conclusiones: Pocos centros cumplen las recomendaciones de la Guía de Práctica Clínica sobre la Prevención y el Tratamiento de la Obesidad Infantil en un plan de calidad establecido. La práctica clínica difiere mucho entre los endocrinólogos pediátricos encuestados, sin existir protocolos unificados de actuación, y con escasa disponibilidad de recursos para el tratamiento integral que precisa esta enfermedad.

Childhood obesity rates are increasing as well as chronic disease and cardiovascular risk factors for patients at young ages. In this study, we evaluate the correlation between cardiac parameters, body mass index (BMI), and other body composition indicators in children and adolescents.In this cross-sectional study, we evaluated anthropometric measurements, bioelectrical impedance parameters, and echocardiographic measurements including the left ventricular mass (LVM), LVM index (LVMI), and left atrial diameter (LAD) in children and adolescents ages 7 to 15 y. We performed linear and multivariate regression analyses and analyzed the correlations between cardiac parameters, BMI, and other body composition parameters.We analyzed 96 children and adolescents and found 40.6% to be obese and 29.2% overweight. LVMI and LAD indexed to height were significantly higher in individuals who were obese. LVMI increased significantly with increasing BMI (r = 0.717; P 0.001), waist circumference (r = 0.670; P 0.001), waist-to-height ratio (r = 0.650; P 0.001), and body surface (r = 0.570; P 0.001). Only BMI was significant in the multivariate analysis. LVMI was directly and positively correlated with fat mass (FM) and percentage of visceral and abdominal FM and negatively correlated with percentage of lean body mass. LAD was significantly correlated with body surface (r = 0.728; P 0.001), BMI (r = 0.611; P 0.001), waist circumference (r = 0.614; P 0.001), and waist-to-height ratio (r = 0.341; P 0.01). When indexed to height, LAD was only correlated with BMI and waist-to-height ratio.Obesity is associated with cardiac disturbances at a very early age and these changes are closely related to the degree of adiposity. Cardiac structural parameters are significantly correlated with BMI and waist circumference in pediatric patients ages 7 to 15 y.

The diet of Galicia is the result of a perfect combination between the quality and diversity of the products of their lands and seas and a simple and healthy elaboration. To the benefits of the Galician products already known by the Celts, the Romans or the Early Medieval pilgrims have been added the inheritances received from the American shore of this ocean that we share, constituting the bases of the Atlantic diet. Galician food is characterized by an abundance of seasonal foods from plants (fruits, vegetables, potatoes, bread and cereals, nuts, chestnuts, honey and legumes), high consumption of fish and shellfish, moderate milk, veal meat fed exclusively with breast milk and pastures, olive oil, use of sauces with low energy load and high-quality fat and homemade desserts composed mainly of flour, eggs and nuts. The Galician Atlantic diet is healthy, functional and bioactive, and without doubt along with a favorable genetic profile, and adequate lifestyles, physical activity and inactivity, favored by our urbanism, with a distribution of the population in small rural areas, has collaborated so that we have one of the longest living populations with a high quality of life. Currently, the data reflect alarming figures of overweight and obesity, especially in the infant-juvenile age, most likely in relation to, among others, the loss of adherence to our traditional diet. To continue as before, Galician children and adolescents could live less than their grandparents, but also with more associated comorbidities. It is necessary to establish strategies to promote recovery and adherence of our Atlantic diet in north-western Spain.La dieta de Galicia es el resultado de una conjunción perfecta entre la calidad y la diversidad de los productos de sus tierras y mares y una elaboración sencilla y saludable. A las bondades de los productos gallegos, ya conocidas por los celtas, los romanos o los peregrinos altomedievales, se han sumado las herencias recibidas desde la orilla americana de este océano que compartimos hasta constituir las bases de la llamada dieta atlántica. La alimentación gallega se caracteriza por la abundancia de alimentos de temporada (plantas, frutas, vegetales, patatas, pan y cereales, nueces, castañas, miel y leguminosas), por el elevado consumo de pescados y mariscos y por el moderado consumo de lácteos; por la carne de terneras alimentadas exclusivamente con leche materna y pastos; por el aceite de oliva, por el uso de salsas con baja carga energética y de alta calidad de la grasa y por los postres caseros compuestos principalmente por harina, huevos y frutos secos. La dieta atlántica gallega es saludable, funcional y bioactiva, y, sin duda, junto a un perfil genético beneficioso y unos estilos de vida, una actividad física e inactividad adecuados, favorecidos por nuestro urbanismo –con una población distribuida en pequeños núcleos rurales–, ha contribuido a que tengamos una de las poblaciones más longevas y con una alta calidad de vida. Actualmente, los datos reflejan cifras alarmantes de sobrepeso y obesidad, especialmente en la etapa infantil-juvenil, relacionadas, muy probablemente, entre otros aspectos, con la pérdida de adherencia a nuestra dieta tradicional. De seguir como hasta ahora, los niños y adolescentes gallegos podrían vivir menos que sus abuelos y, además, con más comorbilidades asociadas. Se hace necesario establecer estrategias de promoción para la recuperación y fidelización de nuestra dieta atlántica del noroeste de España.

La dieta de Galicia es el resultado de una conjunción perfecta entre la calidad y la diversidad de los productos de sus tierras y mares y una elaboración sencilla y saludable. A las bondades de los productos gallegos, ya conocidas por los celtas, los romanos o los peregrinos altomedievales, se han sumado las herencias recibidas desde la orilla americana de este océano que compartimos hasta constituir las bases de la llamada dieta atlántica. La alimentación gallega se caracteriza por la abundancia de alimentos de temporada (plantas, frutas, vegetales, patatas, pan y cereales, nueces, castañas, miel y leguminosas), por el elevado consumo de pescados y mariscos y por el moderado consumo de lácteos; por la carne de terneras alimentadas exclusivamente con leche materna y pastos; por el aceite de oliva, por el uso de salsas con baja carga energética y de alta calidad de la grasa y por los postres caseros compuestos principalmente por harina, huevos y frutos secos. La dieta atlántica gallega es saludable, funcional y bioactiva, y, sin duda, junto a un perfil genético beneficioso y unos estilos de vida, una actividad física e inactividad adecuados, favorecidos por nuestro urbanismo –con una población distribuida en pequeños núcleos rurales–, ha contribuido a que tengamos una de las poblaciones más longevas y con una alta calidad de vida. Actualmente, los datos reflejan cifras alarmantes de sobrepeso y obesidad, especialmente en la etapa infantil-juvenil, relacionadas, muy probablemente, entre otros aspectos, con la pérdida de adherencia a nuestra dieta tradicional. De seguir como hasta ahora, los niños y adolescentes gallegos podrían vivir menos que sus abuelos y, además, con más comorbilidades asociadas. Se hace necesario establecer estrategias de promoción para la recuperación y fidelización de nuestra dieta atlántica del noroeste de España. The diet of Galicia is the result of a perfect combination between the quality and diversity of the products of their lands and seas and a simple and healthy elaboration. To the benefits of the Galician products already known by the Celts, the Romans or the Early Medieval pilgrims have been added the inheritances received from the American shore of this ocean that we share, constituting the bases of the Atlantic diet. Galician food is characterized by an abundance of seasonal foods from plants (fruits, vegetables, potatoes, bread and cereals, nuts, chestnuts, honey and legumes), high consumption of fish and shellfish, moderate milk, veal meat fed exclusively with breast milk and pastures, olive oil, use of sauces with low energy load and high-quality fat and homemade desserts composed mainly of flour, eggs and nuts. The Galician Atlantic diet is healthy, functional and bioactive, and without doubt along with a favorable genetic profile, and adequate lifestyles, physical activity and inactivity, favored by our urbanism, with a distribution of the population in small rural areas, has collaborated so that we have one of the longest living populations with a high quality of life. Currently, the data reflect alarming figures of overweight and obesity, especially in the infant-juvenile age, most likely in relation to, among others, the loss of adherence to our traditional diet. To continue as before, Galician children and adolescents could live less than their grandparents, but also with more associated comorbidities. It is necessary to establish strategies to promote recovery and adherence of our Atlantic diet in north-western Spain. SI

Growth and development are determined by genetic and environmental factors since the very early embryonic life. Long-term health risks, as obesity and other non-communicable diseases (NCD), could be programmed since these early stages. Early life, characterized by plasticity, is the ideal time to intervene and to prevent the risk of suffering a NCD (window of opportunity). Optimal nutrition during the first 1,000 days, since conception to the end of the second year of life, has a determinant role for long-term health. Pregnancy, infancy and toddler periods have specific nutritional requirements. Intestinal microbiota enhances maturation and functioning of the immune system. The interactions between host and intestinal microbiota are potential factors influencing early programming of the intestinal function. Alterations in intestinal colonization are associated to a higher risk of allergic diseases in childhood. Scientific evidence supports the fact that the first 1,000 days are crucial to achieve a better long-term health and represents a strategic period to intervene under the perspective of prevention and public health.El crecimiento y desarrollo de un individuo está determinado desde la etapa embrionaria por su genética y los factores ambientales con los que interactúa. Los riesgos para la salud infantil y adulta pueden programarse durante las etapas fetal-neonatal y esta programación metabólica precoz puede afectar al desarrollo posterior de enfermedades como la obesidad y otras enfermedades no transmisibles (ENT) asociadas. La vida temprana, por la gran plasticidad que la caracteriza, constituye el momento ideal para intervenir y prevenir el riesgo de ENT (ventana de oportunidad). Una nutrición óptima durante los primeros 1000 días, que comprende desde la concepción hasta los dos años, es clave para la salud a lo largo de la vida. El rápido crecimiento y desarrollo del organismo y sus funciones durante el embarazo, la lactancia y el niño de corta edad conlleva requisitos nutricionales específicos en cada una de estas etapas. La microbiota del tracto gastrointestinal desempeña una labor fundamental en la función y el desarrollo del sistema inmune. Las interacciones entre el hospedador y su microbiota intestinal se consideran factores potenciales en la programación temprana de las funciones intestinales, con una evidencia creciente de que las alteraciones de la colonización bacteriana en el neonato se asocian con un mayor riesgo de enfermedad, incluidas las enfermedades alérgicas. La evidencia científica acumulada muestra que los primeros 1000 días son cruciales para alcanzar el mejor desarrollo y salud a largo plazo, y constituyen un periodo estratégico en términos de prevención y salud pública.

The objective of this prospective cohort study was to compare fructose malabsorption in patients with functional chronic abdominal pain and in healthy children. The sample was divided into two groups: asymptomatic children and pain-predominant functional gastrointestinal disorders according to the Rome IV criteria. All children were tested for fructose malabsorption by a standardized breath hydrogen test. Hydrogen and methane were measured and the test was presumed positive when it exceeded 20 ppm above baseline. If positive, patients were given a low-fructose diet and the response was evaluated. One hundred five children were included (34 healthy children, 71 with functional chronic abdominal pain), with similar demographic characteristics in both groups (35.2% male, age 9.5 ± 2.8 years). Hydrogen levels in breath were tested through a hydrogen test for fructose demonstrating malabsorption in 58.8% of healthy children (95%CI 40.8%-76.8%) and in 40.8% of children with chronic abdominal pain (95%CI 28.7%-53.0%), removing those who had bacterial overgrowth. Twenty-one of 31 patients with symptoms and a positive test (72.4%) reported an improvement on a low-fructose diet.Conclusion: Fructose malabsorption is more common in asymptomatic children than in patients with chronic abdominal pain. Better standardized test conditions are necessary to improve accuracy of diagnosis before using this test in clinical practice. What is Known: • Although fructose malabsorption is believed to be related with chronic abdominal pain, high-quality evidence is lacking. • Concerns have raised regarding the use of breath hydrogen test for fructose malabsorption in children with chronic abdominal pain. What is New: • Fructose malabsorption is not more common in children with pain-predominant functional gastrointestinal disorders than in asymptomatic children. • Improvement in symptoms with low-fructose diet may indicate that, although patients with pain-predominant functional gastrointestinal disorders did not have a higher percentage of malabsorption, they had greater fructose intolerance.

El crecimiento y desarrollo de un individuo está determinado desde la etapa embrionaria por su genética y los factores ambientales con los que interactúa. Los riesgos para la salud infantil y adulta pueden programarse durante las etapas fetal-neonatal y esta programación metabólica precoz puede afectar al desarrollo posterior de enfermedades como la obesidad y otras enfermedades no transmisibles (ENT) asociadas. La vida temprana, por la gran plasticidad que la caracteriza, constituye el momento ideal para intervenir y prevenir el riesgo de ENT (ventana de oportunidad). Una nutrición óptima durante los primeros 1000 días, que comprende desde la concepción hasta los dos años, es clave para la salud a lo largo de la vida. El rápido crecimiento y desarrollo del organismo y sus funciones durante el embarazo, la lactancia y el niño de corta edad conlleva requisitos nutricionales específicos en cada una de estas etapas. La microbiota del tracto gastrointestinal desempeña una labor fundamental en la función y el desarrollo del sistema inmune. Las interacciones entre el hospedador y su microbiota intestinal se consideran factores potenciales en la programación temprana de las funciones intestinales, con una evidencia creciente de que las alteraciones de la colonización bacteriana en el neonato se asocian con un mayor riesgo de enfermedad, incluidas las enfermedades alérgicas. La evidencia científica acumulada muestra que los primeros 1000 días son cruciales para alcanzar el mejor desarrollo y salud a largo plazo, y constituyen un periodo estratégico en términos de prevención y salud pública., Esta publicación ha sido promovida y financiada por el Instituto Danone.

Physical activity (PA) and exercise improve the overall quality of life, as well as prevent the onset of diseases in healthy children and adolescents, and is an aid to treat prevalent chronic diseases in childhood. PA and exercise are like medicine, while sedentary lifestyle and inactivity cause disease. In this article, the existing scientific evidence in this field is reviewed and recommendations for professionals involved in child health are updated. A good knowledge of how to prescribe exercise and PA in paediatrics in different diseases is necessary. Interventions to avoid inactivity of children and adolescents must be supported by the appropriate increase in the level of PA, through integration and training programs, which achieve both an overall improvement of the neuromuscular physical condition and also physical, cognitive, and psychosocial performance. The Health Promotion Committee of Spanish Paediatric Association proposes strategies that help to obtain this objective, aiming to improve the health of our patients through the practice of exercise and the increase in PA. Resumen: La actividad física (AF) y el ejercicio físico (EF) mejoran la calidad de vida global, previenen la aparición de enfermedades en niños y adolescentes sanos, y sirve para el tratamiento de enfermedades crónicas prevalentes en la infancia. Si la AF y el EF son medicina, el sedentarismo y la inactividad provocan enfermedad. Se revisa en este artículo la evidencia científica existente al respecto y se ponen al día las recomendaciones para los profesionales involucrados en la salud del niño, ya que es necesario un buen conocimiento de cómo prescribir EF y AF en pediatría en diferentes patologías. Las intervenciones para evitar la inactividad del niño y del adolescente deben estar sustentadas en el apropiado aumento del nivel de AF, mediante programas de integración y capacitación, que consigan una mejora conjunta de la condición física neuromuscular y del rendimiento físico, cognitivo y psicosocial. La AEP, a través del Comité de Promoción de la Salud, propone estrategias que faciliten este objetivo para mejorar la salud de nuestros pacientes a través de la práctica de EF y el aumento de la AF.

Introduction: the recent economic and financial crisis has affected most Western countries, especially families of low socioeconomic classes. We speculate that worsening of socioeconomic condition associated with the crisis would increase obesity, mainly in disadvantaged families. Material and methods: cross-sectional study of the 290,111 children aged three to 12 years old attending public school during the term 2014-2015 in Madrid City, by means of a stratified weighted sample randomly chosen, taking into account age (grade), city district and schools. The questionnaire included weight and height (auto-reported), dietary report (weekly frequency of intake), as well as socioeconomic variables. Results: 1,208 questionnaires were evaluated from 64 classes. Half of participants were boys; 42% were younger than five years old, 35% were between six and eight years old, and 23% older than eight. Undernutrition was present in 5.0%, and excess of weight (overweight + obesity) in 36.7%. Undernutrition was higher in children under the age of six (9.1%). No relationship was found between undernutrition and the characteristics of the families but was slightly higher in families where both parents were unemployed. Excess of weight was higher in children of non-Spaniard parents (44% vs 32%, p < 0.0001), as well as in those families with economic problems (41% vs 31%, p = 0.0005). Only for meat, grains and dairy, the weekly intake was close to the recommendations. Conclusions: children from lower income households were at a higher risk of being overweight compared with their peers. Participation in a school-based food aid program may reduce food insecurity for children and their families.

childhood obesity is one of the main public health concerns. The multifactorial and multilevel causes require complex interventions such the community based interventions (CBI). Thao-Child Health Programme is a CBI implemented in Spain since 2007.show the Thao methodology and the latest cross-sectional and longitudinal results.longitudinal cohort study (4 years of follow- up) and cross sectional study.the longitudinal study found an increase of 1% in the overweight prevalence after a follow-up of 4 years of Thao-Programme implementation in 10 municipalities with 6 697 children involved. The cross-sectional study carried out with 20 636 children from 22 municipalities found a childhood overweight prevalence of 26.6%.currently a brake in the increase of childhood overweight prevalence is considered a success due to the high prevalence worldwide. More studies well methodologically performed are needed to know the efficacy of the CBI's in this field.Introducción: la obesidad infantil es una de las principales preocupaciones de salud pública. La etiología multifactorial y multinivel requiere de intervenciones complejas como las intervenciones de base comunitaria (CBI). El Programa Thao-Salud Infantil es una CBI implementada en España desde 2007. Objetivo: mostrar la metodología Thao y los últimos resultados transversales y longitudinales. Métodos: estudio de cohortes longitudinal (4 años de seguimiento) y estudio transversal. Resultados: el estudio longitudinal encontró un incremento del 1% en la prevalencia de exceso de peso tras 4 años de implementación del Programa Thao en 10 municipios con 6.697 niños y niñas involucrados. El estudio transversal llevado a cabo con 20.636 niños y niñas de 22 municipios encontró una prevalencia de exceso de peso infantil del 26,6%. Discusión: actualmente un freno en el incremento de la prevalencia de exceso de peso infantil es considerado como un éxito debido a la alta prevalencia a nivel mundial. Son necesarios más estudios metodológicamente bien realizados para conocer la eficacia de las CBI en este campo.

evaluate vitamin D status and its association with chronic lung colonisation in Cystic Fibrosis patients.descriptive cross-sectional multicenter study. From November 2012 to April 2014, at 12 national hospitals, 377 patients with Cystic Fibrosis were included. Vitamin D levels30 ng/ml were classified as insufficient. Chronic colonisation was considered if they had at least two positive cultures in the past year.the median age was 8.9 years (2 months to 20 years). 65% had insufficient levels of vitamin D. There was an inverse correlation between age and vitamin D levels (r = -0.20 p0.001). Those diagnosed by screening, were younger and had higher levels of vitamin D. There was an inverse correlation between the number of colonisations and vitamin D levels (r = -0.16 p = 0.0015). Adjusting for age, pancreatic status and diagnosis by screening, colonization by S. aureus in 6 years, increased the risk of insufficient levels of vitamin D: OR 3.17 (95% CI 1.32 to 7.61) (p = 0.010) and OR 3.77 (95% CI 1.37 to 10 , 37) (p = 0.010), respectively.despite adequate supplementation, more than half of our patients did not achieve optimal levels of vitamin D. Regardless of age, diagnosis by screening or pancreatic status, chronic colonization by Pseudomonas sp. in children and adolescents and S. Aureus in infants and preschoolars increases the risk of developing vitamin D deficiency in these patients.Introducción y objetivos: conocer la situación en la que se encuentran los pacientes con fibrosis quística en relación con sus niveles de vitamina D y su asociación con las colonizaciones pulmonares crónicas. Material y métodos: estudio multicéntrico transversal. Participaron 12 hospitales nacionales. De noviembre a abril del 2012 al 2014 se incluyeron 377 pacientes con fibrosis quística. Se consideraron insuficientes niveles de vitamina D30 ng/ml. Presentar al menos dos cultivos positivos en el último año fue considerado un criterio de colonización crónica. Resultados: los pacientes tenían una mediana de edad de 8,9 años (2 meses—20 años). Un 65% presentaban niveles insuficientes de vitamina D. Se observó una correlación inversa entre edad y niveles de vitamina D (r = -0,20 p0,001). Los diagnosticados por cribado eran más jóvenes y tenían niveles de vitamina D más altos. Los niveles de vitamina D presentaron una correlación inversa con el número de colonizaciones pulmonares (r = -0,16 p = 0,0015). Ajustando por edad, función pancreática y diagnóstico mediante cribado, la colonización por S. Aureus en menores de seis años y por Pseudomonas sp. en los mayores de esa edad, incrementaban el riesgo de presentar niveles insuficientes de vitamina D: OR 3,17 (IC95% 1,32-7,61) (p=0,010) y OR 3,77 (IC95% 1,37- 10,37)(p = 0,010), respectivamente. Conclusiones: a pesar de una suplementación adecuada, más de la mitad de nuestros pacientes no alcanzan niveles óptimos de vitamina D. La colonización crónica por Pseudomonas sp. en escolares y adolescentes y por S. Aureus en lactantes y preescolares se asocia de forma independiente con la deficiencia de vitamina D.

Introduction: The primary objective of this study was to find out the prevalence of overweight and obese status, as well as their association to pulmonary function, total cholesterol and vitamin D in patients with cystic fibrosis (CF). Materials and methods: This is a multicenter descriptive and cross-sectional study. Twelve Spanish hospitals participated. 451 patients with CF were included. Adults were classified according to body mass index (BMI) and children were classified according to BMI percentiles (WHO tables). Pearson’s correlation, Anova, Student’s t-test and multiple linear regression were conducted. Results: Mean age was 12.3 (range 4-57) years old, 51% were male and 18% had pancreatic sufficiency. Participants were classified in five nutritional status categories: 12% were malnourished; 57%, at nutritional risk; 24%, normally nourished; 6%, overweight; and 1%, obese. Pulmonary function in overweight or obese patients (91 ± 19%) was better than in malnourished patients (77 ± 24%) (p = 0.017). However, no difference was observed between those at nutritional risk (86 ± 19%) or normally nourished (90 ± 22%) groups. Overweight and obese patients had higher levels of total cholesterol (p = 0.0049), a greater proportion of hypercholesterolemia (p = 0.001), as well as lower levels of 25 OH vitamin D (p = 0.058). Conclusions: Prevalence of overweight and obese was 6 and 1%. Excess weight status does not offer any benefit in pulmonary function in comparison to normally nourished patients, Introducción y objetivos: conocer la prevalencia de sobrepeso y obesidad, así como su asociación con la función pulmonar, el colesterol total y la vitamina D en pacientes con fi brosis quística (FQ). Material y métodos: estudio multicéntrico descriptivo y transversal. Participaron 12 hospitales españoles. Fueron incluidos 451 pacientes con FQ, clasifi cados según el índice de masa corporal (IMC) en adultos y el IMC percentilado (tablas OMS) en niños. Análisis estadístico: C.Pearson, Anova, t de Student y regresión lineal múltiple. Resultados: la mediana de edad fue 12,3 (rango 4-57) años. Un 51% eran varones y el 18%, sufi cientes pancreáticos (SP). El 12% estaba desnutrido; el 57%, en riesgo nutricional; el 24%, normonutrido; el 6% presentaba sobrepeso; y un 1%, obesidad. La función pulmonar en los pacientes con sobrepeso (91 ± 19%) era mejor que en los desnutridos (77 ± 24%) (p = 0,017), sin embargo, no se observaron diferencias con respecto a los que estaban en riesgo nutricional (86 ± 19%) o normonutridos (90 ± 22%). Los pacientes con sobrepeso tenían más elevado el colesterol total (p = 0,0049), mayor proporción de hipercolesterolemia (p = 0,001), así como niveles más bajos de 25 OH vitamina D (p = 0,058). Conclusiones: la prevalencia de sobrepeso y obesidad fue del 6 y el 1%. El sobrepeso y la obesidad no ofrecen benefi cio sobre la función pulmonar en comparación con los normonutridos