Recomendaciones diagnósticas y terapéuticas en el sobrepeso y la obesidad durante la adolescencia

[Diagnostic accuracy of the tri-ponderal mass index in identifying the unhealthy metabolic obese phenotype in obese patients]

INTRODUCTION

The metabolically healthy obese (MHO) phenotype defines obese patients who have preserved insulin sensitivity and absence of metabolic complications. This phenotype is associated with a lower risk of cardiovascular disease and type2 diabetes in adulthood.

OBJECTIVES

To determine the prevalence of MHO and the metabolically unhealthy obesity (MUO) phenotype in a cohort of obese children and adolescents and to establish the predictive capacity of the tri-ponderal mass index (TMI) and other anthropometric parameters in order to identify these patients.

PATIENTS AND METHODS

A cross-sectional study was conducted on 239 obese patients (125males) from 8 to 18years of age. Grade3 obesity was present in 45.9% of the patients. ROC curves were used to find the best cut-off point for: TMI, body mass index (BMI), BMI z-score (BMIzs), and waist/height index (WHI). MHO components: plasma blood glucose, plasma triglycerides, HDL-cholesterol, and blood pressure.

RESULTS

The prevalence of MUO in the study cohort was 62.4%. No differences between genders were observed, and it was increasing with the age and obesity degree. The TMI has a sensitivity of 75.8 and a specificity of 42.2 to identify the MUO patients. The best cut-off point for TMI is 18.7kg/m³, for BMI it was 30.4kg/m², for BMIzs +3.5SD, and 0.62 for WHI.

CONCLUSIONS

The diagnostic accuracy of TMI in identifying obese adolescents with metabolic risk was similar to BMI and WHI. However, the TMI is much simpler to use and simplifies the categorization of the obesity in both genders.

Initial Approach to Childhood Obesity in Spain. A Multisociety Expert Panel Assessment

PURPOSE

In recent years, the incidence of childhood obesity in Europe, and Spain in particular, has increased dramatically. Bariatric surgery could play a major role in treating of adolescents with severe obesity. However, no specific guidelines for bariatric surgery currently exist in Spain.

METHODS

The Board of the Spanish Society for Obesity Surgery and Metabolic Diseases (SECO) proposed a study of childhood obesity by using the Delphi method. This prospective study involved 60 experts from nine national societies. Each society leader recruited experts from their society in obesity-related fields. Two online questionnaires were taken, and consensus on guidelines for various obesity treatments was reached according to the percentage of answers in favor or against inclusion of a given guideline. Based on these results, preoperative, surgical management and follow-up of childhood obesity management among others were analyzed.

RESULTS

The survey results indicated significant concern among all societies regarding obesity. There was strong consensus with regard to adolescents and obesity, medical treatment, dietary recommendations, environmental and social factors, and goals for adolescents with obesity. Consensus on the use of intragastric balloons and other techniques was not reached. However, biliopancreatic diversion was rejected as a primary treatment, and mandatory psychological/psychiatric assessment was agreed upon. Inclusion criteria accepted were similar to those for adults with the exception of surgery in those with a body mass index <40.

CONCLUSIONS

Spanish obesity-related societies are aware of the societal problem of childhood obesity. Multisociety development of national approaches may arise from consensus-building studies among specialists.

Dietary pattern among schoolchildren with normal nutritional status in Navarre, Spain

A nutrition survey was carried out (food intake registration of three consecutive school days) in a randomly selected group of 353 schoolchildren (188 males and 165 females) with normal nutritional status. The average age of the surveyed students was 10.5 years (CI 95%: 10.3–11.7). There were no significant differences between both sexes in mean values for calorie intake (males: 2072.7 ± 261.7 and females: 2060.9 ± 250.6) and intake of macronutrients, minerals and vitamins. Cereals (34%), dairy products (19%) and meats (17%) were responsible for approximately 70% of total calorie intake. Protein accounted for 20.3% of energy intake, carbohydrates for 48.8%, total fat for 30.9%, and saturated fat for 12.6%. Cholesterol intake was excessive and over two-thirds of protein intake was from animal sources. The mean intakes of calcium, iodine and Vitamins A, D and E were below recommended levels. The dietary patterns of the schoolchildren with normal nutritional status differed from the Mediterranean diet. Intakes of meat were too high and dairy products and cereals consumption was relatively limited; while that of vegetables; legumes; fruits and fish were insufficient; leading to excessive protein and fat intake from animal sources and insufficient mineral (calcium and iodine) and Vitamins A; D and E intake.

[Natural evolution of excess body weight (overweight and obesity) in children]

OBJECTIVE

To analyze the chronological evolution of excess body weight (overweight and obesity) in order to raise public awareness within the different areas of intervention (family, school, business environment, health services) and to take effective actions.

MATERIAL AND METHODS

Weight, height and body mass index (BMI) of 604 healthy subjects (307 males and 297 females) have been recorded at birth and at the age of 1, 2, 3, 4, 6, 8, 10, 12 and 14 years. The excess body weight has been calculated according to national references from Ferrández et al.

RESULTS

Prevalence of excess body weight at age 14 years was significantly higher (P<.05) in males (29%) than in females (12.8%). BMI (kg/m2) was significantly higher (P<.05) for both sexes in every age period, except for birth and age 1 year, in those patients with excess body weight at age 14, with respect to patients with normal nutritional status of the same age. Those groups with excess body weight at age 14 showed a BMI (Z-score) reaching overweight or obesity levels at age 4, and progressively increasing.

CONCLUSIONS

Excess body weight probably starts at early stages in life, when dietary habits of the child depends almost exclusively on family habits, and may be aggravated during school attendance. Finally, a disproportionate weight increase occurs in adolescence that is probably related to unhealthy dietary habits and way of life.

[Obesity and cardiovascular risk factors in adolescents. Association with cardiovascular risk factors in first degree relatives]

BACKGROUND AND OBJECTIVE

Obesity is a major concern in public health. The fact that most teenagers stop contacting the health system during this period of life prevents detection of this problem and its associated morbidity. The aim of this study is to measure the prevalence of obesity at 18. We also aimed to detect overweight, cardiovascular risk factors (CVRF) and association with CVRF in parents and siblings.

PATIENTS AND METHOD

The research includes 153 children followed up to 18 years old in a community health center. Measures of body mass index (BMI), waist perimeter, CVRF, and familiar history were taken.

RESULTS

The prevalence of obesity in our study group was 7.18%, (IC: 3.0-11.0), (6.25% male and 7.86% female). The prevalence of overweight was 18.3% (IC: 11.9-24.0), (26.56% male and 12.35% female). A familiy history of CVRF was found in 53.9% (IC: 46.1-61.9) of cases, including high blood pressure (25%), obesity (23.6%), dyslipemia (21.7%), and diabetes (7.2%). This finding was more prevalent in the obesity group (72.72%) than in those with overweight only (64.2%), or with normal weight (49.59%). A family history of obesity and diabetes in first-degree relatives was associated to obesity in the study group. Also, a family history of high blood pressure was associated to the presence of high blood pressure in this group.

CONCLUSIONS

In order to detect obesity, overweight, and associated complications in young adults, specific attention to children and siblings of persons who present risk factors is recommended. Those with high blood pressure, diabetes or obesity have the higher risk.