A. Moráis López

Obesidad Infantil. Recomendaciones del Comité de Nutrición de la Asociación Española de Pediatría. Parte I. Prevención. Detección precoz. Papel del pediatra

Obesity is a pathologic entity characterized by an increase in fat body mass and is a global public health problem. In Spain, between 1984 (the Paidos study) and 2000 (the enKid study), the prevalence of childhood overweight and obesity increased and significant differences were found among the autonomous communities. Consequently prophylactic measures were implemented throughout the country and in 2005 the Ministry of Health developed the NAOS strategy (strategy for nutrition, physical activity and obesity prevention). Within the medical area of this intervention, primary care pediatricians acquire a key role. Aware of this, the Spanish Association of Pediatrics, through the Nutrition Committee, aims to provide information on the current situation concerning the etiopathogenesis and early identification of at-risk populations. The epidemiology and risk periods in the pediatric age group are reviewed and recommendations on healthy lifestyle are provided, bearing in mind diet and physical activity throughout childhood, with the aim of preventing overweight and obesity.

Hipercolesterolemia. Abordaje terapéutico

High blood cholesterol levels represent an important cardiovascular risk factor. Hypercholesterolemia is defined as levels of total cholesterol and low-density lipoprotein cholesterol above 95th percentile for age and gender. For the paediatric population, selective screening is recommended in children older than 2 years who are overweight, with a family history of early cardiovascular disease or whose parents have high cholesterol levels. Initial therapeutic approach includes diet therapy, appropriate physical activity and healthy lifestyle changes. Drug treatment should be considered in children from the age of 10 who, after having followed appropriate diet recommendations, still have very high LDL-cholesterol levels or moderately high levels with concomitant risk factors. In case of extremely high LDL-cholesterol levels, drug treatment should be taken into consideration at earlier ages (8 years old). Modest response is usually observed with bile acid-binding resins. Statins can be considered first-choice drugs, once evidence on their efficacy and safety has been shown.

Problemas nutricionales percibidos por los pediatras en niños españoles menores de 3 años

INTRODUCTION Parents are most responsible for nutritional education of children, and pediatricians must advise and help them with their doubts. The purpose of this study was to know the relevance of nutritional topics in daily practice and the main nutritional problems perceived by pediatricians in children under 3 years of age. METHODS Descriptive, cross-sectional study performed in 2 stages. First stage consisted on discussion meetings with 30 random-selected pediatricians from Madrid and Barcelona. Results were used to design the on-line questionnaire of the second stage (76 questions related to nutrition in children under 3 years). A random and representative sample of Spanish pediatricians was selected for this stage. RESULTS One hundred and fifty one pediatricians, among 258 sampled, completed the questionnaire. They referred to see a mean of 588 patients/month. The main perceived nutritional problems in the first year of life were iron and vitamin deficiencies and poor weight gain. In the next months, excess in carbohydrates and lipid intake and overweight were the main problems perceived. Parents were considered the main actors regarding their childrens nutritional health, but their concern in these questions significantly reduced with childrens age (p < 0,0001). Factors considered to have the greatest relevance in the acquisition of good nutritional habits were to provide a diet adjusted for childrens requirements and to observe the appropriate sleeping hours. The proportion of children who receive nutritional counseling varied from 88% (0-6 months) to 61% (24-36 months). CONCLUSIONS Despite of the relevance given by pediatricians, educational intervention regarding nutritional health is not ideal. Nutritional problems perceived by pediatricians varied with childrens age.

Recomendaciones nutricionales para el niño deportista

Several health benefits have been attributed to sports practice, and an adequate nutrition status helps to maintain an optimal performance. Children most frequently practice non-competitive and non-endurance activities in a school setting. The dietary intake of children who practice sports should be similar to the general population, properly meeting their energy and nutrient requirements. During the activity performance, correct hydration should be aimed for, with water appearing to be an adequate source in most cases. General calorie and micronutrient supplementation should not be commonly recommended in children. Paediatricians must control nutritional status and dietary habits of children who practice sports, especially in those cases when weight-loss is aimed for, as well as take into account the psychological implications of competitive sports practice.

Valoración nutricional en Atención Primaria, ¿es posible?

El equipo formado por Pediatria y Enfermeria de Atencion Primaria es el filtro fundamental para detectar las distintas alteraciones nutricionales a traves de los programas preventivos de atencion al nino, cuyo marco operativo esta basado fundamentalmente en los examenes periodicos de salud. A traves de la valoracion nutricional del nino podremos detectar los distintos signos de malnutricion, ya sea por exceso como por defecto, asi como el grado de la misma. Tambien nos servira para conocer el origen del trastorno nutricional y aplicar las estrategias necesarias para abordar el problema. Para esto son fundamentales las sucesivas revisiones para controlar el correcto desarrollo y estado nutricional. La valoracion nutricional se hara integrando los resultados obtenidos fundamentalmente de tres fuentes, la historia clinica, la exploracion fisica y la toma de medidas antropometricas. La historia clinica nos va a aportar datos fundamentales, como los antecedentes personales y familiares, el grado de desarrollo del nino en los diferentes ambitos, la existencia de sintomas acompanantes y la valoracion de la ingesta. La exploracion fisica nos aportara informacion sobre el estado nutricional del nino mediante su observacion directa, su aspecto y su grado de desarrollo fisico, prestando especial importancia a la busqueda de signos de organicidad. Finalmente, la antropometria, mediante el peso, la talla y la medicion de los distintos perimetros y pliegues, nos permite hacernos una idea muy completa del estado nutricional, sin necesidad de utilizar pruebas mas complejas y costosas.