Belén Zapatera

Sleep duration and emerging cardiometabolic risk markers in adolescents. The AFINOS study

OBJECTIVE To examine the associations between sleep duration and emerging inflammatory and endothelial function risk factors in adolescents. METHODS This study included a total of 183 (88 girls) adolescents, aged 13-17 years, without diagnosed sleep-related disorders. White blood cell counts, C-reactive protein (CRP), complement factors 3 and 4, interleukin-6, adiponectin, leptin, inter-cellular adhesion molecule 1, vascular cell adhesion molecule-1, E-selectin, l-selectin, and plasminogen activator inhibitor-1 were measured. Sleep duration and sleep-related disorders were obtained by self-report and moderate-to-vigorous physical activity (MVPA) was objectively measured by accelerometer. Body mass index (BMI) was calculated from measured height and weight. RESULTS A significant inverse association between sleep duration and CRP (β=-0.17, P=0.024) existed only after controlling for sex, age, and pubertal status. The results did not change when MVPA was included into the model. However, the association of sleep duration with CRP was slightly attenuated when BMI was included in the model, though it remained significant (β=-0.15, P=0.044). CONCLUSION Short sleep duration during adolescence might play an important and independent role in cardiovascular and metabolic diseases through CRP.

Validez de cuatro cuestionarios para valorar la actividad física en adolescentes españoles

OBJECTIVES The physical activity (PA) levels of Spanish adolescents must be determined to assess how the lack of PA may affect the increasing prevalence of obesity. Thus, to assess PA in this age range valid measurement instruments are essential. The aim of this study was to evaluate the validity of four easily applied questionnaires (the enKid and FITNESSGRAM questions, the Patient-Centered Assessment and Counselling [PACE] questionnaire, and an activity rating) to assess PA in Spanish adolescents by using an accelerometer as the criterion instrument. METHODS A total of 232 adolescents (113 girls) completed the questionnaires and wore an ActiGraph accelerometer for 7 consecutive days. Spearmans correlation coefficient (rho) was used to compare the questionnaires and total PA, moderate PA, vigorous PA and moderate-to-vigorous PA (MVPA) assessed by the accelerometer. RESULTS All the questionnaires showed moderate correlations when compared against total PA (rho=0.36-0.43) and MVPA (rho=0.34-0.46) obtained by the accelerometer in the total sample. Higher correlations were found when comparing the questionnaires against vigorous PA (rho=0.42-0.51) than against moderate PA (rho=0.15-0.17). The FITNESSGRAM question and the PACE questionnaire obtained weak correlations in girls and the enKid question and activity rating were moderately correlated for boys and girls. CONCLUSIONS The four questionnaires evaluated showed acceptable validity in the assessment of PA in the Spanish adolescent population.

Potential health benefits of moderate alcohol consumption: current perspectives in research

The benefits of moderate amounts of alcohol for a better health and longer life expectancy compared with abstinence have been suggested by the findings of numerous studies. However, controversies have emerged regarding the influence of confounding factors and the systematic errors that might have been inadvertently disregarded in the early studies. This review includes a description of the findings of those research studies published in the last 5 years on the effects of moderate alcohol consumption on all-cause mortality, CVD and inflammation, the immune system, insulin sensitivity, non-alcoholic fatty liver disease (NAFLD) and cancer. Promising evidences exist from both animal studies and human clinical trials regarding intermediate end-points of CHD and insulin sensitivity, such as HDL, adiponectin or fibrinogen. However, controversies and inconsistent findings exist regarding many of these diseases and related functions and biomarkers. Further research and human randomised-controlled trials with adequate standardisation of the study conditions are necessary in order to draw a comparison between studies, establish the causal effect of moderate alcohol intake on disease protection and reach consensus on the circumstances that allow the recommendation of moderate alcohol habitual intakes as a strategy for health maintenance.

Gender-specific influence of health behaviors on academic performance in Spanish adolescents; the AFINOS study

INTRODUCTION New paradigms based on the multifactorial etiology of chronic diseases and behavioral outcomes suggest that a combination of health behaviors may have more impact on the outcome of interest than any single factor. OBJECTIVE To examine the independent and combined influence of four health behaviors on school performance in Spanish adolescents. METHODS A total of 1825 Spanish adolescents reported their grades in Language and Literature (LL) and Math. Body mass index, family structure and school-related factors (attitude to school, need to repeat > 1-yr and absenteeism) were self-reported. Adolescents were dichotomized as healthy or unhealthy based on meeting or not meeting lifestyle recommendations on physical activity, TV viewing, sleep and fruit intake. Each adolescent was also scored according to the number of healthy recommendations fulfilled. RESULTS In boys, there were no associations between health behaviors and academic performance. Good academic performance in girls was associated with physical activity (P < 0.05) or fruit consumption (P < 0.05). Moreover, girls who scored 3-4 health behaviors showed higher odds of passing LL (OR = 3.18, P < 0.001), Math (OR = 1.75, P = 0.028) or LL+Math (OR = 2.32, P = 0.001) compared with those with 0-1 health behaviors. All the analyses were adjusted by weight status, family context and different school-related factors. CONCLUSIONS A combination of health behaviors may have a positive influence on academic performance in adolescent girls.

Design of the nutritional therapy for overweight and obese Spanish adolescents conducted by registered dieticians: the EVASYON study

BACKGROUND Dietary treatment for obese adolescents should aim to ensure adequate growth and development, by reducing excessive fat mass accumulation, avoiding loss of lean body mass, improving well-being and self-esteem and preventing cyclical weight regain. The aim of this article is to describe the dietary intervention design and the methods used to evaluate nutritional knowledge and behavior in the EVASYON study (Development, implementation and evaluation of the efficacy of a therapeutic programme for overweight/obese adolescents). METHODS/DESIGN EVASYON is a multi-centre study conducted in 5 Spanish hospital settings (Granada, Madrid, Pamplona, Santander and Zaragoza), where 204 overweight/obese Spanish adolescents were treated in groups of 9 to 11 subjects over 20 visits. The study was implemented in two stages: an intensive, calorie-restricted period for the first 9 weeks, and an extensive body-weight follow-up period for the last 11 months. A moderate energy intake restriction was applied in the intensive period according to the degree of obesity, on the basis of a balanced diet supplying 50-55% of daily energy as carbohydrates; 30-35% as fats and 10-15% as proteins. In the intensive period, adolescents were prescribed both a fixed full-day meal plan for the first three weeks and a full day meal plan with different food-choices for 6 weeks. Later, adolescents received a flexible meal plan based on food exchanges for the follow-up period until the end of the trial. Data on food intake, dietary and meal-related habits and behavior were collected by means of dietary questionnaires. To analyse nutritional knowledge, adolescents were examined regarding nutrient concepts and food adoitems for a healthy diet with the appropriate tools. Participants were given nutritional information with complementary teaching material, which was available on the EVASYON website (www.estudioevasyon.com). DISCUSSION The dietary intervention of the EVASYON programme with a moderate calorie restriction for a limited period of time could be a good strategy in treating overweight and obese adolescents and that will be tested further. Moreover, combining fixed plan with free-choice menus may help adolescents and their families to make right decisions for every day meals.

Validity of four questionnaires to assess physical activity in Spanish adolescents | Validez de cuatro cuestionarios para valorar la actividad física en adolescentes españoles

OBJECTIVES The physical activity (PA) levels of Spanish adolescents must be determined to assess how the lack of PA may affect the increasing prevalence of obesity. Thus, to assess PA in this age range valid measurement instruments are essential. The aim of this study was to evaluate the validity of four easily applied questionnaires (the enKid and FITNESSGRAM questions, the Patient-Centered Assessment and Counselling [PACE] questionnaire, and an activity rating) to assess PA in Spanish adolescents by using an accelerometer as the criterion instrument. METHODS A total of 232 adolescents (113 girls) completed the questionnaires and wore an ActiGraph accelerometer for 7 consecutive days. Spearmans correlation coefficient (rho) was used to compare the questionnaires and total PA, moderate PA, vigorous PA and moderate-to-vigorous PA (MVPA) assessed by the accelerometer. RESULTS All the questionnaires showed moderate correlations when compared against total PA (rho=0.36-0.43) and MVPA (rho=0.34-0.46) obtained by the accelerometer in the total sample. Higher correlations were found when comparing the questionnaires against vigorous PA (rho=0.42-0.51) than against moderate PA (rho=0.15-0.17). The FITNESSGRAM question and the PACE questionnaire obtained weak correlations in girls and the enKid question and activity rating were moderately correlated for boys and girls. CONCLUSIONS The four questionnaires evaluated showed acceptable validity in the assessment of PA in the Spanish adolescent population.

Behavioural correlates of active commuting to school in Spanish adolescents: the AFINOS (Physical Activity as a Preventive Measure Against Overweight, Obesity, Infections, Allergies, and Cardiovascular Disease Risk Factors in Adolescents) study

OBJECTIVE To examine the associations between lifestyle factors and active commuting to school in Spanish adolescents. DESIGN Cross-sectional study. Lifestyle factors (overall/extracurricular physical activity, television viewing, reading as a hobby, sleep duration, breakfast/fruit intake, smoking and alcohol intake) as well as mode and duration of commuting to school were self-reported. Active commuters were defined as those adolescents who walked or cycled to school. SETTING Secondary schools in Madrid, Spain. SUBJECTS Adolescents (n 2029) aged 13 to 17 years. RESULTS Similar percentages of adolescent boys (57·6 %) and girls (56·1 %) were classified as active commuters to school (P = 0·491). The analysis showed that only adequate sleep duration (OR = 1·35, 95 % CI 1·11, 1·66; P = 0·003) and breakfast consumption (OR = 0·66, 95 % CI 0·49, 0·87; P = 0·004) were independently associated with active commuting to school. CONCLUSIONS Only those behaviours that occur immediately before commuting to school (sleep and breakfast) are associated with active commuting in Spanish adolescents.

Changes in cardiometabolic risk factors, appetite-controlling hormones and cytokines after a treatment program in overweight adolescents: preliminary findings from the EVASYON study.

Romeo J, Martinez‐Gomez D, Diaz LE, Gómez‐Martinez S, Marti A, Martin‐Matillas M, Puertollano MA, Veiga OL, Martinez JA, Wärnberg J, Zapatera B, Garagorri JM, Morandé G, Campoy C, Moreno LA, Marcos A; EVASYON Study Group. Changes in cardiometabolic risk factors, appetite‐controlling hormones and cytokines after a treatment program in overweight adolescents: preliminary findings from the EVASYON study

Association between excessive body fat and eating-disorder risk in adolescents: The AFINOS Study

BACKGROUND AND OBJECTIVE Overweight and obesity, together with eating disorders, are important public health concerns in adolescence. The aim of this study was to assess the association between excessive body fat and the risk of eating disorders. SUBJECTS AND METHOD The sample consisted of 195 adolescents (97 girls) aged 13 to 18 years. Eating-disorder risk was evaluated by applying the SCOFF questionnaire. Body mass index, sum of 6 skinfolds, waist and hip circumferences and waist-hip and waist-height ratios were used to assess body fat. RESULTS 24.7% of girls and 17.3% of boys were at risk of eating disorders, and 31.6% of boys and 21.6% of girls presented overweight (including obesity) according to Coles cut-off points. Those adolescents classified above the 85th percentile on all the anthropometric measurements, as well as overweight adolescents, were at increased risk of developing an eating disorder (OR: 2.8-4.30, all p < 0.01). CONCLUSION Regardless of the anthropometric measurements used, adolescents with excessive body fat showed a higher risk of having eating disorders than those with normal weight.

Immunonutrition: methodology and applications.

Immunonutrition is an emergent and interdisciplinary subject, since it comprises several aspects related to Nutrition, Immunity, Infection, Inflammation, and Injury or tissue damage, what is known as Nutrition and 4 “Is”. Within these interactions the endocrine, nervous and immune systems are involved, microbiota being a part of the last one. Nowadays, gut microbiota has been shown to play an essential role, not only in the gastrointestinal tract but also into the nervous system, because of its bilateral connection. There are several methods to study Immunonutrition, which allow measuring different immunological biomarkers to provide information about the nutritional status. However, it should be taken into account that there is not a single gold standard parameter to evaluate the cause- effect relationship between nutrition and the immune system. On the contrary, a combination of biomarkers have to be assessed depending on the different nutritional situations. Since Immunonutrition is a multidisciplinary matter as mentioned above, the study on the interactions between nutrition and the immune system has not been exclusively focused as such, but bearing in mind other systems of the organisms as well as a wide range of confounding factors and determinants coming from idiosyncratic features, genes and lifestyle of each individual. Therefore, Immunonutrition allows to study the following research fields: 1) Evaluation of nutritional status in presumably healthy people with risk of malnutrition (children, adolescents, adults, pregnant women, elderly, and sportspeople); 2) Assessment of the evolution and progress of patients with nutrition and immune-related diseases, such as food allergies, eating and metabolic disorders; 3) Evaluation of the effects of nutrients, bioactive compounds and both conventional and functional foods on the immune system; 4) Evaluation of impact of lifestyle determinants on the immune system, such as diet, food behaviour, physical activity, sedentariness, sleep quality and quantity, and as a key factor, stress.