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Chang YH, Lin CR, Shih YL, Shih CC, Chen JY. The Relationship between Self-Reported Sitting Time and Vitamin D Levels in Middle-Aged and Elderly Taiwanese Population: A Community-Based Cross-Sectional Study. Nutrients 2023; 15:4766. [PMID: 38004158 PMCID: PMC10674870 DOI: 10.3390/nu15224766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Many studies have revealed a relationship between serum 25-hydroxy vitamin D and physical activity. This study aimed to investigate the relationship between self-reported sitting time and serum 25-hydroxy vitamin D levels in middle-aged and elderly adults in Taiwan. (2) Methods: A total of 396 people were enrolled in our study during a community health examination in Taiwan in 2019. We grouped participants from low to high according to their tertile of serum 25-hydroxy vitamin D levels, using the following categories: deficiency, insufficiency, and sufficiency. Parameters including self-reported sitting time were analyzed between each group. Pearson correlation coefficients were calculated to explore the relationships of serum 25-hydroxy vitamin D levels with age-adjusted risk factors. A scatter plot demonstrated the relationship between serum 25-hydroxy vitamin D levels and self-reported sitting time. The association between serum 25-hydroxy vitamin D levels and self-reported sitting time was assessed by multivariate linear regression with adjustment for age, sex, waist circumference, low-density lipoprotein, triglycerides, and smoking and drinking status. (3) Results: We analyzed the data from 396 participants. A total of 41.4% of participants were male, and the average age of all participants was 64.91 (±8.80) years. The participants in the high serum 25-hydroxy vitamin D group were more likely to have shorter self-reported sitting time. Serum 25-hydroxy vitamin D was negatively correlated (Pearson's r) with self-reported sitting time, even after adjustment for age. According to the results of multivariate linear regression, vitamin D levels showed a negative association with self-reported sitting time (β = -0.131, p = 0.006) after adjustment for age, sex, waist circumference, low-density lipoprotein, triglycerides, and smoking and drinking status. (4) Conclusions: According to our research, self-reported sitting time was inversely correlated with serum 25-hydroxy vitamin D in middle-aged and elderly people in Taiwan. Meanwhile, longer self-reported sitting time can be an independent risk factor for lower serum 25-hydroxy vitamin D levels.
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Affiliation(s)
- Yu-Hsuan Chang
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (Y.-H.C.)
| | - Chun-Ru Lin
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (Y.-H.C.)
| | - Yu-Lin Shih
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan;
| | - Chin-Chuan Shih
- General Administrative Department, United Safety Medical Group, New Taipei City 242, Taiwan
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
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Di Felice G, D’Alessandro A, Pastore A, Mariani M, Fintini D, Aureli A, Pezzi S, Montemari AL, Rocco BB, Borseti A, Onetti Muda A, Manco M, Porzio O. Plasminogen Activator Inhibitor-1 and Vitamin D Association in the Overweight and Obese Pediatric Population. Nutrients 2023; 15:3717. [PMID: 37686748 PMCID: PMC10489928 DOI: 10.3390/nu15173717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Childhood overweight and obesity have been described by the World Health Organization as noncommunicable diseases and among the greatest public health threats since they have reached epidemic proportions. A child with obesity risks becoming an adult with obesity and developing metabolic and hemostatic disorders which are the basis for the development of coronary heart diseases. Recently, a number of clinical reports have demonstrated that both an increase in plasminogen activator inhibitor-1 (PAI-1) and a deficiency in 25OH-vitamin D3 (VD) are associated with an increase in thrombotic episodes. METHODS PAI-1 and VD levels were measured in 259 clinically overweight and obese children aged between 2 and 18 years enrolled in the Nutritional Education Program of the Bambino Gesù Children's Hospital and Research Institute of Rome (Italy) and 80 normal-weight subjects. RESULTS We observed increased HOMA-IR, PAI-1, and other inflammation indices associated with decreased VD levels when compared to normal-weight children. CONCLUSIONS Our results demonstrated that overweight and obesity are correlated with higher levels of the inflammation index. Moreover, our patients show high PAI-1 and low VD levels, confirming the high thrombotic risk in our pediatric population.
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Affiliation(s)
- Giovina Di Felice
- Clinical Laboratory Unit, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | | | - Anna Pastore
- Research Area of Management Innovations, Diagnostics and Clinical Pathways, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Michela Mariani
- Endocrinology Unit, University Pediatric Clinical Department, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Danilo Fintini
- Endocrinology Unit, University Pediatric Clinical Department, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Alessia Aureli
- Endocrinology Unit, University Pediatric Clinical Department, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Simona Pezzi
- Clinical Laboratory Unit, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Anna Lisa Montemari
- Clinical Laboratory Unit, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | | | - Andrea Borseti
- Clinical Laboratory Unit, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Andrea Onetti Muda
- Research Area of Management Innovations, Diagnostics and Clinical Pathways, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Melania Manco
- Research Unit of Multifactorial and Complexes Phenotype Diseases, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
| | - Ottavia Porzio
- Clinical Laboratory Unit, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy
- Department of Experimental Medicine, Tor Vergata University, 00133 Rome, Italy
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Hofman-Hutna J, Hutny M, Matusik E, Olszanecka-Glinianowicz M, Matusik P. Vitamin D Deficiency in Obese Children Is Associated with Some Metabolic Syndrome Components, but Not with Metabolic Syndrome Itself. Metabolites 2023; 13:914. [PMID: 37623858 PMCID: PMC10456245 DOI: 10.3390/metabo13080914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/22/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
Vitamin D deficiency in children is a common nutritional issue in many populations worldwide, associated not only with skeletal malformations but, as recent studies suggest, also with the development of obesity and metabolic syndrome. The aim of this observational study was to assess the nutritional status of vitamin D in a group of Polish children with obesity and different grades of metabolic syndrome, with a consequent analysis of the correlation between vitamin D levels and the components of metabolic syndrome. For that purpose, the group of 78 participants (mean age: 14.18 ± 2.67 years) was recruited and further grouped in relation to vitamin D status into two groups of children with and without vitamin D deficiency. The biochemical parameters associated with obesity as well as anthropometric measures were assessed and analysed in search of significant differences between the groups. In the current group of children with obesity and vitamin D deficiency, HDL (45.00 ± 9.29) and adiponectin (7.21 ± 1.64) were found to be significantly lower than in their peers without vitamin D deficiency, whereas W/HtR (0.60 ± 0.04) and TG (171.31 ± 80.75) levels proved to be significantly higher. Body composition analysis using bioelectrical impedance returned no significant findings. The above findings suggest that vitamin D deficiency may influence lipid and glucose metabolism in children, leading to the development of abnormalities characteristic of the metabolic syndrome. A W/HtR parameter was shown to be a sensitive marker of abdominal obesity, which might provide an important means of assessing the correlation between vitamin D and this type of obesity. Independently, vitamin D deficiency may also influence the endocrinological function of adipose tissue, leading to lower concentrations of adiponectin. These in turn presented a linear correlation with the high results of the OGTT in the second hour of the test, hinting at its potential role in the pathophysiology of insulin resistance.
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Affiliation(s)
- Jagoda Hofman-Hutna
- Scientific Society of Medical Students, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Michał Hutny
- Scientific Society of Medical Students, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Edyta Matusik
- Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Magdalena Olszanecka-Glinianowicz
- Unit of Public Health and Obesity, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Pawel Matusik
- Department of Paediatrics, Paediatric Obesity and Metabolic Bone Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
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Calcaterra V, Verduci E, Milanta C, Agostinelli M, Todisco CF, Bona F, Dolor J, La Mendola A, Tosi M, Zuccotti G. Micronutrient Deficiency in Children and Adolescents with Obesity-A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040695. [PMID: 37189944 DOI: 10.3390/children10040695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023]
Abstract
Childhood obesity represents a serious public health burden. Despite excessive dietary consumption, children with obesity present high rates of micronutrient deficiencies, such as deficiencies in minerals and specific vitamins; micronutrient deficiencies may have a pathogenic role in obesity-related metabolic comorbidities. In this narrative review, we analyzed the main deficiencies associated with obesity, their clinical consequences, and the evidence about a possible supplementation. Iron; vitamins A, B, C, D, and E; folic acid; zinc; and copper deficiencies represent the most common deficient microelements. The relationship between obesity and multiple micronutrient deficiencies remains unclear, and different mechanisms have been proposed. The medical care plan for pediatric obesity should include food choices with high nutritional content as part of a crucial approach to obesity-related complications. Unfortunately, only a few studies are available regarding the efficacy of oral supplementation or weight loss for treating them; thus, continuous nutritional monitoring is necessary.
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Affiliation(s)
- Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Elvira Verduci
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Chiara Milanta
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | | | | | - Federica Bona
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Jonabel Dolor
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Alice La Mendola
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Martina Tosi
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
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Qi KJ, Zhao ZT, Zhang W, Yang F. The impacts of vitamin D supplementation in adults with metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Front Pharmacol 2022; 13:1033026. [PMID: 36278155 PMCID: PMC9581173 DOI: 10.3389/fphar.2022.1033026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Studies have shown the association of vitamin D status with the development of metabolic syndrome (MetS), which has attracted an extensive research interest with inconsistent results. Therefore, we hypothesized that vitamin D supplementation (VDS) will benefit adults with MetS. Aims: To test our hypothesis, we performed a meta-analysis to evaluate the effect of VDS on MetS in adults using relevant biomarkers such as anthropometric parameters, blood pressure, blood lipid profile, glycemia, oxidative stress and vitamin D toxicity (VDT). Methods: Randomized controlled trials published in PubMed, Web of Science, embase and the Cochrane Library between 2012 and 2022 on the effect of VDS on MetS in adults were searched. The language was limited to English. A meta-analysis performed using RevMan 5.4 and Stata 14.0 software, sensitivity analysis, and evaluation of the risk of bias and general quality of the resulting evidence were conducted. Results: Eventually, 13 articles were included in this meta-analysis. Overall, VDS significantly increased the endline serum 25-hydroxyvitamin D levels as compared to the control [MD:17.41, 95% CI (14.09, 20.73), p < 0.00001]. VDS did not affect waist circumference, body mass index, body fat percentage and VDT biomarkers, but decreased waist-to-hip ratio and blood pressure (p < 0.01). VDS significantly decreased fasting plasma glucose (FPG) [MD: 3.78; 95% CI (−6.52, −1.03), p = 0.007], but did not affect the levels of blood high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglyceride (TG). Pooled estimate of nine papers indicated a significant reduction of fasting insulin (FI) (p = 0.006), and homeostasis model assessment of insulin resistance (p = 0.0001). The quantitative insulin check index levels were moderately increased (p = 0.007) without any impact on the glycosylated hemoglobin type A1C (HbA1c). For the oxidative stress parameters, VDS significantly lowered the levels of malondialdehyde and hypersensitive C-reactive protein (p < 0.05). Conclusion: Results of this meta-analysis demonstrate that VDS only reduces insulin resistance and hypertension but not the blood lipid profile and HbA1c. It appears that the evidence for the benefit of VDS in adults with MetS is inconclusive. Further clinical studies are still needed.
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Çelik N, Doğan HO, Zararsiz G. Different threshold levels of circulating total and free 25-hydroxyvitamin D for the diagnosis of vitamin D deficiency in obese adolescents. Eur J Pediatr 2021; 180:2619-2627. [PMID: 34117551 DOI: 10.1007/s00431-021-04137-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
The total serum 25-hydroxyvitamin D [25(OH)DT] level is lower in obese individuals than in their nonobese peers, despite similar bone turnover markers and bone mineral density. This study aimed to investigate whether the threshold level of 25(OH)D for the diagnosis of vitamin D deficiency (VDD) in obese adolescents was lower than that in controls and to compare 25(OH)DT, free [25(OH)DF] and bioavailable [25(OH)DB] vitamin D with VDBP levels in obese individuals and their controls. A total of 173 adolescents (90 obese individuals and 83 controls) aged 12-18 years were included in the study. The metabolic and anthropometric parameters of the participants were recorded, the 25(OH)DT, 25(OH)DF, and VDBP levels were measured, and the 25(OH)DB levels were calculated. The cutoff values for VDD were estimated according to the level of 25(OH)D below which parathyroid hormone begins to rise. The obese subjects had lower 25(OH)DT (12.1 ± 5.8 vs. 16.4 ± 9.3 ng/mL, p < 0.001), 25(OH)DF (12.6 ± 4.2 vs. 16.7 ± 7.6 pg/mL, p < 0.001), 25(OH)DB [4.8 (2.3) vs. 6.1 (5.2) ng/mL, p = 0.012], and VDBP [112.2 (51.3) vs. 121.9 (95.5) μg/mL, p < 0.001] levels than the controls. The cutoff values for 25(OH)DT and 25(OH)DF levels for VDD were lower in the obese group than in the control group (9.4 vs. 14.1 ng/mL; 12.2 vs. 16.8 pg/mL, respectively).Conclusion: The vitamin D cutoff values for the diagnosis of VDD were different in the obese and control groups. Using the same cutoff value for VDD may cause overtreatment in obese adolescents. What is Known: • Vitamin D deficiency is more prevalent in obese children than nonobese controls, despite the same bone turnover markers and bone mineral density • The cutoff value of vitamin D level for the diagnosis of VDD is based on the PTH elevation What is New: • In obese adolescents, total and free vitamin D cutoff value for the diagnosis of VDD was lower than nonobese peers • Using the same cutoff value for vitamin D deficiency in both obese and nonobese adolescents may cause overtreatment.
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Affiliation(s)
- Nurullah Çelik
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Cumhuriyet University, Eğri Köprü Mah. Koç Platform Sitesi, A-Blok No: 15, Sivas, Türkiye.
| | - Halef Okan Doğan
- Department of Biochemistry, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Gökmen Zararsiz
- Department of Biostatistics, Faculty of Medicine, Erciyes University, Kayseri, Turkey.,Erciyes University Drug Application and Research Center, PMAA Research Group, Kayseri, Turkey
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Sherief LM, Ali A, Gaballa A, Abdellatif GM, Kamal NM, Afify MR, Abdelmalek DH, El-Emari SA, Soliman AS, Mokhtar WA. Vitamin D status and healthy Egyptian adolescents: Where do we stand? Medicine (Baltimore) 2021; 100:e26661. [PMID: 34398026 PMCID: PMC8294863 DOI: 10.1097/md.0000000000026661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 06/25/2021] [Indexed: 01/04/2023] Open
Abstract
Vitamin D deficiency is a worldwide public health problem. Low vitamin D and its consequences among children and adolescents could be considered as one of the most important health-related problems. This study aimed to estimate the prevalence of vitamin D deficiency in healthy Egyptian adolescents and investigate factors associated with vitamin D status.A cross-sectional study was conducted on 572 school children (270 males and 302 females) aged 14 to 18 years, who were randomly selected from high schools in one governorate in Egypt. Data were collected through a self-administered questionnaire. Vitamin D level, serum calcium, phosphorus, alkaline phosphates were measured.Vitamin D deficiency was almost present in all the studied Egyptian healthy adolescents (99%), 94.8% had vitamin D deficiency and 4.2% had vitamin D insufficiency. Girls had a higher prevalence of vitamin D deficiency than boys. There was a significant association between lack of physical activity, sun exposure, and vitamin D deficiency.Vitamin D deficiency and insufficiency are highly prevalent. In sunny countries, the special pattern of conservative clothing and the lack of outdoor physical activity might be the underlying factors for the high prevalence in females. Vitamin D supplementation seems to be mandatory to halt the problem.
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Affiliation(s)
| | - Adel Ali
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Gaballa
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Mona R. Afify
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
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Melguizo-Rodríguez L, Costela-Ruiz VJ, García-Recio E, De Luna-Bertos E, Ruiz C, Illescas-Montes R. Role of Vitamin D in the Metabolic Syndrome. Nutrients 2021; 13:830. [PMID: 33802330 PMCID: PMC7999005 DOI: 10.3390/nu13030830] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/11/2022] Open
Abstract
The prevalence of hypovitaminosis D has risen in developed countries over the past few years in association with lifestyle changes and an increase in unhealthy habits. Vitamin D deficiency has been implicated in various diseases, including metabolic syndrome (MetS), which is clinically defined by a set of metabolic and vascular disorders. The objective of this study was to review scientific evidence on the relationship between MetS and vitamin D deficiency to support the development of prevention strategies and health education programs. An inverse relationship has been reported between plasma vitamin D concentrations and the features that define MetS, i.e., elevated serum concentrations of glucose, total cholesterol, low-density lipoproteins, triglycerides, glycosylated hemoglobin, and a high body mass index. Numerous studies have described the benefits of vitamin D supplementation to improve outcomes in individuals with MetS. Interventions to maintain optimal vitamin D concentrations are proposed as a preventive strategy against MetS.
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Affiliation(s)
- Lucía Melguizo-Rodríguez
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.M.-R.); (V.J.C.-R.); (E.G.-R.); (E.D.L.-B.); (R.I.-M.)
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
| | - Víctor J. Costela-Ruiz
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.M.-R.); (V.J.C.-R.); (E.G.-R.); (E.D.L.-B.); (R.I.-M.)
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
| | - Enrique García-Recio
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.M.-R.); (V.J.C.-R.); (E.G.-R.); (E.D.L.-B.); (R.I.-M.)
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
| | - Elvira De Luna-Bertos
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.M.-R.); (V.J.C.-R.); (E.G.-R.); (E.D.L.-B.); (R.I.-M.)
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
| | - Concepción Ruiz
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.M.-R.); (V.J.C.-R.); (E.G.-R.); (E.D.L.-B.); (R.I.-M.)
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
- Institute of Neuroscience, University of Granada, 18016 Granada, Spain
| | - Rebeca Illescas-Montes
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (L.M.-R.); (V.J.C.-R.); (E.G.-R.); (E.D.L.-B.); (R.I.-M.)
- Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain
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