Fernando Salcedo Aguilar

Impact of an After-School Physical Activity Program on Obesity in Children

OBJECTIVE To assess the impact of a 2-year recreational physical activity program in 1044 fourth- and fifth-grade primary schoolchildren from the Province of Cuenca, Spain. STUDY DESIGN Cluster-randomized controlled trial with 10 intervention and 10 control schools. The program consisted of 3 90-minute sessions of physical activity per week,during 28 weeks every year.Changes in endpoints between baseline (September 2004) and the end of follow-up (June 2006) were compared between the control and intervention group by using mixed regression models, with adjustment for the baseline endpoint value, age, and the school. RESULTS Compared with control subjects, intervention girls reduced the frequency of overweight (odds ratio, 0.55; 95% CI, 0.39-0.78; P<.001). However, intervention was associated with an increase in the percentage of body fat in boys (0.97%; 95% CI, 0.14-1.81; P=.02). Girls in the intervention group had lower total cholesterol level (-6.86 mg/dL; 95% CI, -9.70--4.01; P<.001) and apolipoprotein B level (-3.61 mg/dL; 95% CI, -6.27--0.95; P=.008) than control subjects. Results were similar in boys. CONCLUSION In 2 years, the physical activity program lowered the frequency of overweight in girls and reduced total cholesterol and apolipoprotein B in both girls and boys.

Validity of a single-factor model underlying the metabolic syndrome in children: a confirmatory factor analysis

OBJECTIVE We used confirmatory factor analysis to test whether a single factor might explain the clustering of the metabolic syndrome (MS) components in children. RESEARCH DESIGN AND METHODS We studied 1,020 children aged 10–13 years from 20 schools in Cuenca, Spain. The single-factor model included: waist circumference (WC), fasting insulin, triglyceride to HDL cholesterol ratio (Triglyl/HDL-C), and mean arterial pressure (MAP). The standardized scores of the four variables in the model were used to develop a continuous MS index. RESULTS Factor loadings were 0.67 for WC, 0.68 for fasting insulin, 0.57 for Triglyl/HDL-C, and 0.37 for MAP. The single-factor model also showed a good fit to the data. As compared with Adult Treatment Panel III criteria, the MS index showed strong validity in the diagnosis of MS (area under the receiver operating characteristic curve = 0.98, 95% CI 0.96–0.99). CONCLUSIONS A single underlying factor has acceptable validity to represent MS in children.

Prevalencia de la obesidad y mantenimiento del estado ponderal tras un seguimiento de 6 años en niños y adolescentes: estudio de Cuenca

Fundamento Estimar la prevalencia de sobrepeso y obesidad en escolares de Cuenca, y examinarel mantenimiento del estado ponderal a lo largo de 6 anos. Metodo Estudio de seguimiento de factores de riesgo cardiovascular, iniciado en 1992 con unestudio transversal en 307 escolares de 9 a 12 anos de edad pertenecientes a tres colegios publicosde Cuenca. En 1998 se examinaron los escolares de 9 a 13 anos de edad de los mismoscolegios publicos y los alumnos de 14 a 17 anos que ya participaron en el estudio de 1992.Ademas de variables de caracter sociodemografico, se determinaron el peso, la talla y el indicede masa corporal (IMC), clasificando a los individuos por estado ponderal como normopeso sobrepesoy obesidad segun los criterios del International Obesity Task Force. Resultados La prevalencia de sobrepeso fue del 26,6%, y la de la obesidad del 3,9%. La prevalencia,tanto de sobrepeso como de obesidad, fue mayor en mujeres que en varones, sin quelas diferencias alcanzaran significacion estadistica. En la cohorte de seguimiento, el coeficientede correlacion de Spearman entre el IMC de 1992 y el de 1998 fue 0,72. El coeficiente decorrelacion intraclase entre el percentil del IMC en 1992 y en 1998 fue de 0,78. El riesgo relativode los que presentaban sobrepeso u obesidad en 1992 de continuar en este estado ponderalen 1998 fue de 2,9 (intervalo de confianza del 95%, 2,21-4,04). Conclusiones La prevalencia de sobrepeso y obesidad en los escolares de Cuenca es de las masaltas publicadas hasta ahora en Europa. El grado de mantenimiento del estado ponderal entrela edad prepuberal y la edad pospuberal es alto.

Trends in excess weight and thinness among Spanish schoolchildren in the period 1992-2004: the Cuenca study.

BACKGROUND In developed countries, there is abundant information on the epidemic of childhood obesity, but only a few studies on trends in the dual burden of body weight (overweight and thinness). OBJECTIVE To examine trends in overweight and thinness among 9-10-year-old Spanish children in the last decade. METHODS Data were taken from cross-sectional studies on schoolchildren in Cuenca (Spain), conducted in 1992, 1996, 1998 and 2004 with similar methods. Weight and height were measured by trained personnel with standardized procedures. Overweight (including obesity) and thinness were defined according with the International Obesity Taskforce BMI cut-offs. RESULTS The overall prevalence of overweight increased from 24.4% in 1992 to 30.9% in 2004 (P = 0.07), rising from 21.2% in 1992 to 32.0% in 2004 (P = 0.03) among boys and from 27.7% to 29.8% (P = 0.67) among girls. The overall prevalence of thinness was 2.7% in 1992 and 9.2% in 2004 (P < 0.001); in the same period, thinness prevalence rose from 1.9% to 9.0% (P = 0.10) among boys and from 3.7% to 9.5% (P < 0.01) among girls. CONCLUSIONS The dual burden of body weight has increased among children in Cuenca in the last decade. Population-based policies addressing childhood obesity, which is the most frequent problem, should not increase the risk of thinness.

Trends in excess of weight, underweight and adiposity among Spanish children from 2004 to 2010: the Cuenca Study.

OBJECTIVE To examine the trends in BMI and adiposity among schoolchildren from Cuenca, Spain, during 2004-2010. DESIGN Two methodologically comparable surveys were carried out in 2004 and 2010. SETTING Primary schools in Cuenca, a province in the middle of Spain. SUBJECTS All schoolchildren aged 8-11 years, belonging to 4th and 5th grades from twenty schools in the Province of Cuenca, were invited to participate in both cross-sectional studies. Weight, height and body fat percentage (BF%) from bioelectrical impedance were measured with standardized procedures. RESULTS The study included 550 boys and 539 girls in 2004, and 569 boys and 531 girls in 2010. In 2010, 8.1 % of children were underweight, 25.9 % overweight and 9.5 % obese. From 2004 to 2010, the prevalence of overweight rose from 21.6 % to 28.0 % (P = 0.004) and BF % increased from 22.6 % to 24.0 % (P = 0.001) among boys. No change was observed in overweight and BF % in girls, or in underweight and obesity in either sex. In boys, most of the distribution of BMI and BF % shifted to the right; in contrast, among girls no substantial change was apparent in the distribution of BMI and BF %. CONCLUSIONS From 2004 to 2010 the prevalence of overweight and adiposity has continued to increase among boys. However, the obesity epidemic may have levelled off in girls. Given that the prevalence of childhood excess weight is still very high, the current evidence-based efforts to halt the obesity epidemic in Spain should be strengthened.

Association of adiposity measures with blood lipids and blood pressure in children aged 8–11 years

Aim: To examine the association of body mass index (BMI), triceps skinfold thickness (TST) and percentage body fat (%BF) from bioelectrical impedance analysis (BIA) with blood lipids, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in children.

Agregación entre hermanos de factores de riesgo cardiovascular: estudio de Cuenca

Fundamento Estimar la agregacion entre hermanos de los factores de riesgo cardiovascular. Sujetos y metodo Segundo estudio transversal incluido en un seguimiento de factores de riesgo cardiovascular en escolares. Se incluyeron 115 parejas de hermanos seleccionadas entre los escolares de la cohorte del estudio de Cuenca y sus hermanos en edad escolar. Se determinaron variables sociodemogrAficas, peso, talla, indice de masa corporal, presion arterial sistolica y diastolica, concentracion plasmAtica en ayunas de colesterol total, cLDL, cHDL, trigliceridos, apolipoproteinas A-I y B 100 y lipoproteina (a). Resultados Los coeficientes de correlacion parcial entre hermanos de las concentraciones plasmaticas de lipidos y lipoproteinas, ajustados por edad e indice de masa corporal, presentan valores positivos bastante elevados en general, con valores entre 0,27 para los trigliceridos y 0,48 para el cHDL, resultando estadisticamente significativos (p 0,005) todos ellos. Asi mismo, el coeficiente de correlacion intraclase ofrece valores moderadamente elevados (entre 0,20 y 0,48). Ambos coeficientes eran mucho mas elevados en las parejas hermano-hermano que en las parejas hermana-hermana. El indice de Quetelet presentaba valores de los coeficientes ligeramente mas bajos y sin diferencias relevantes entre los distintos tipos de parejas. Los coefi-cientes entre valores de presion arterial fueron bajos (p > 0,05). Conclusiones Se evidencia una notable asociacion entre las concentraciones plasmaticas de lipidos entre hermanos, observandose diferencias segun el sexo de las parejas, lo que lleva a pensar en una herencia genetica ligada al sexo de estos valores lipidicos. Tambien se aprecia una asociacion, aunque mas debil, de los valores del indice de masa corporal. Por ultimo, la agregacion entre hermanos de los valores de presion arterial en nuestro estudio se muestra bastante debil.