J.J. Díaz Martín

Presión arterial en la infancia y la adolescencia. Estudio de su relación con variables de crecimiento y maduración

Objetivo Analizar la relacion existente entre la presion arterial en la infancia y adolescencia con el sexo del individuo y con variables de crecimiento y maduracion, como la edad, el peso, la talla, el indice de Quetelet y el estadio de maduracion sexual. Metodos Estudio transversal realizado en 1.278 ninos y ninas de 6 a 18 anos de Oviedo. Se efectuaron dos determinaciones de presion arterial, tomandose el valor medio de las dos determinaciones. Se efectuaron analisis de regresion simple y multiple. Resultados Los valores de presion arterial sistolica (PAS), diastolica IV (PADIV) y V (PADV) analizados mostraron coeficientes significativos con todas las variables en el analisis de correlacion simple, a excepcion del estadio de Tanner en los grupos de ninos y ninas mayores de 14 anos. Los valores de r demostraron ser mas elevados para las medidas de peso (PAS 6-13 anos 0,35; PAS ninas > 14 anos 0,33; PAS ninos > 14 anos, 0,34; PADIV 0,25; PADV 0,24) y talla (PAS 6-13 anos 0,33; PAS ninas > 14 anos 0,23; PAS ninos > 14 anos, 0,29; PADIV 0,25; PADV 0,24) que para la edad (PAS 6-13 anos 0,27; PAS ninas > 14 anos 0,17; PAS ninos > 14 anos 0,15; PADIV 0,23; PADV 0,22). El estudio de regresion multiple determino asociacion significativa dentro del grupo de ninos y ninas de 6 a 13 anos entre la PAS y los valores de talla e indice de Quetelet (p Conclusion Los valores de presion arterial en la infancia y la adolescencia presentan una correlacion positiva con las variables de crecimiento y maduracion analizadas. Es importante valorar la presion arterial del nino no solo en funcion de la edad, sino tambien de su peso, talla e indice de Quetelet.

Factores de riesgo cardiovascular clásicos y emergentes en escolares asturianos

INTRODUCTION Classic cardiovascular risk factors are present in infancy. C-reactive protein, leptin and adiponectin are the most important inflammatory cardiovascular risk markers. PATIENTS AND METHODS A descriptive, cross-sectional study, including children aged 6-12 years old from two local primary schools in the city of Avilés. Body measurements were made to determine the prevalence of obesity and overweight. Systolic and diastolic blood pressure was measured and the presence of metabolic syndrome was determined. Family income, dietary, and life-style habits were collected using the questionnaires GRAFFAR, KIDMED and Self-report instruments for measuring physical activity, respectively. Blood analysis included lipid profile, insulin resistance profile, liver profile, C-reactive protein, leptin and adiponectin. RESULTS A total of 459 schoolchildren were included of whom 31% were overweight and 10.9% were obese. Obese children were heavier with higher levels of body mass index, waist circumference, blood pressure, C- reactive protein, leptin, and lower levels of HDL-cholesterol and apolipoprotein A than non-obese children. No differences were found in physical and sedentary activities, but obese children had a worse quality diet than non-obese children. CONCLUSIONS Prevalence of obesity and overweight is reaching worrying levels in school age children. Obesity is associated with other classic and inflammatory cardiovascular risk factors. Obese children have a worse quality diet, although they do not do any less physical activities or any more sedentary than non-obese children.

Alteraciones de la sensibilidad gustativa a la sal en hijos de hipertensos esenciales

Introduccion Trabajos experimentales sobre animales y humanos sugieren que el desarrollo de los mecanismos integradores centrales o perifericos sensitivos de la ingesta salina estan influidos por la historia hidromineral temprana. Este trabajo estudia en jovenes sanos el perfil gustativo salino y la presion arterial y su relacion con la predisposicion o condicionamiento genetico por ascendentes hipertensos. Material y metodo Cincuenta y un ninos y jovenes sanos con al menos un progenitor afecto de hipertension esencial y 73 sanos sin dicho antecedente. Se determinaron parametros somatometricos y presion arterial y se valoraron las capacidades gustativo-sensoriales salinas: sensibilidad (umbral de deteccion), consistencia (discriminacion), preferencia (eleccion) y tolerancia (rechazo). Resultados La presion arterial en ambos grupos fue similar. El umbral de sensibilidad gustativa salino fue menor (p=0,028) en hijos de hipertensos, mientras la consistencia, preferencia y tolerancia no mostraron diferencias en ninguno de los grupos. El umbral de sensibilidad salino y la presion arterial sistolica se correlacionaron significativamente en controles (p=0,015), pero no en hijos de hipertensos, salvo que se introdujeran edad, sexo e indice de masa corporal como variables de control (coeficiente ?=0,94; p=0,012). El sentido de la correlacion presento valores contrarios en ambos grupos. Conclusiones Ambos grupos de estudio presentaron asociacion significativa entre el umbral de sensibilidad gustativa salina y presion arterial sistolica. El umbral de sensibilidad gustativo salino y la consistencia en individuos control presento correlacion positiva (individuos con mayor sensibilidad gustativa salina mostraron mayor capacidad de discriminacion). La aplicacion de ambas pruebas constituye una herramienta coherente y eficaz para determinar el perfil gustativo y revelo la existencia de cambios tempranos en los hijos de hipertensos.

La introducción del gluten en la dieta del lactante. Recomendaciones de un grupo de expertos

At present there is a degree of uncertainty regarding when, how and in what form gluten should be introduced into the infant diet. For years the recommendations of the ESPGHAN Committee on Nutrition have prevailed, which include avoiding early introduction, before 4 months, and late, after 7 months, and gradually introducing gluten into the diet while the infant is being breastfed, with the aim of reducing the risk of celiac disease, diabetes and gluten allergy. However, 2 independent studies published in The New England Journal of Medicine in October 2014 reached the conclusion that the age of introduction of gluten does not modify the risk of developing celiac disease, and that breastfeeding at any age does not confer protection against celiac disease development. On the other hand, according to available scientific evidence, the introduction of foods other than breast milk or formula into the infants diet is generally recommended around 6 months of age, since the introduction before 4 months could be associated with an increased risk of food allergy and autoimmune diseases, and delaying it beyond 7 months would not have a protective effect. In this context, a group of experts has considered it appropriate to produce a consensus document based on the current scientific evidence and present general recommendations for daily clinical practice on the introduction of gluten into the diet.

Resistencia insulínica en pacientes pediátricos con fibrosis quística y sobrepeso

AIM To determine the prevalence of overweight in paediatric patients with cystic fibrosis (CF) and to analyse its role as diabetogenic insulin resistance factor and risk of hypertriglyceridaemia. PATIENTS AND METHODS A total of 109 CF patients (47% males) between 5 and 18 years were divided into 3 groups according to body mass index (BMI): underweight, normal and overweight. Total cholesterol, triglycerides, C- reactive protein (CRP), glycosylated haemoglobin, HOMA-IR and QUICKI index were determined. Insulinogenic index, ISI composite and areas under the curve (AUC) for glucose and insulin were obtained by oral glucose tolerance test (OGTT). RESULTS Six patients (5.5%) were overweight. All groups had similar distribution by age, sex and CFTR mutation, although the proportion of pancreatic sufficient (3/6, 50%) was higher in overweight patients (P=.003). The prevalence of glycaemic disorders was similar between groups. Baseline insulin, HOMA-IR, and insulin during the OGTT (peak and AUC) were higher in overweight patients. All patients had a delayed insulin response in OGTT. CONCLUSIONS Overweight CF patients do not have a higher incidence of glycaemic disorders, but their hyperinsulinism and insulin resistance may be additional diabetogenic risk factors.Aim To determine the prevalence of overweight in paediatric patients with cystic fibrosis (CF) and to analyse its role as diabetogenic insulin resistance factor and risk of hypertriglyceridaemia.

Obesidad en Oviedo: prevalencia y tendencias temporales de 1992 a 2012

Approximately three years ago, Hammerman et al published their initial experience with pharmacological closure of PDA with oral paracetamol in 5 patients. In the index patient, a newborn with 26 weeks of GA, paracetamol was administered for a different indication at 2/2 weeks of life and it was observed that a hsPDA that had not responded to two courses of ibuprofen had suddenly closed two days later. Following this, another four neonates of 26--29 weeks of GA in whom treatment with ibuprofen was contraindicated or had failed were treated with paracetamol. All patients showed either closure or a significant reduction in the size of the ductus 48 h after administration of paracetamol, and full closure in one week. On the basis of this first experience, other authors have used oral or intravenous paracetamol to treat PDA in small series of patients. A review of these studies has been recently published by Allegaert et al. The main concern raised by these studies has to do with the lack of data on the pharmacokinetics and pharmacodynamics of paracetamol in extremely preterm newborns and the safety of its use in this population. There is also considerable controversy regarding the dosage used, which is double the dose used for analgesia in term newborns. The mechanism of action of paracetamol is not fully understood either, and in many of the published cases its use followed the administration and failure of ibuprofen, so it is not possible to know whether there was a synergistic effect between the two medications. In the only randomised study conducted to date, 80 patients completed the course of treatment. The efficacy in the pharmacological closure of PDA was similar for ibuprofen (77.5%) and paracetamol (72.5%) administered by the oral route, and both drugs proved to be safe. These are relevant findings, since COX inhibitors, despite having a success rate of 70--85%, are not free from side effects, such as, oliguria, gastrointestinal perforations, impaired platelet aggregation, hyperbilirubinaemia, etc. Ibuprofen has also been associated with an increased risk of BPD. In summary, although further prospective, controlled and appropriately designed studies are needed to establish the safety, efficacy and optimal dosage of paracetamol for the treatment of PDA in extremely preterm infants, these last experiences appear promising, at least in cases where traditional drugs fail or are contraindicated, and when avoiding surgery is deemed reasonable.

Uso de azúcares y edulcorantes en la alimentación del niño. Recomendaciones del Comité de Nutrición de la Asociación Española de Pediatría

The term «sweetener» refers to a food additive that imparts a sweet flavour and usually provides no or very low energy. It is used to sweeten foods, medicines and food supplements with no nutritional purposes. For years, no-calorie sweeteners have been used as substitutes for all or part of the sugar content in foods and beverages. In recent decades its consumption has risen to prevent tooth decay, or as an aid in weight control, obesity and diabetes and, in general, to achieve an optimal energy balance. However, consumption of sugary or sweetened food and soft drinks is high, making this situation of special interest in calorie intake and in the poor behavioural pattern of eating habits in children. In addition, questions remain among consumers about the risks to health associated with their use, whether they are artificial or natural. The «artificial sweeteners» are the group of greatest interest in research in order to demonstrate their safety and to provide firm data on their possible therapeutic effects. The aim of the present document is to increase information for paediatricians on the characteristics of different sweeteners, and to advise on the choice of sweeteners, based on their properties.

Oxidative Stress in Cystic Fibrosis

Airway infection leads to progressive damage of the lungs in patients with cystic fibrosis (CF). Oxidative stress has been implicated as a causative factor in the aetiology of that process. Supplementation with antioxidant micronutrients (vitamin E, vitamin C, ß-carotene and selenium), docosahexaenoic acid or glutathione might therefore be helpful in maintaining an adequate redox balance. Current literature suggests a relationship between oxidative status and lung function. In this chapter we will summarize the main pathways of oxidative stress, focusing on results of new antioxidant treatments.

Efectividad de una intervención escolar contra la obesidad

INTRODUCTION Intervention for childhood obesity is a public health priority. The purpose of this study was to evaluate the effectiveness of an elementary school-based intervention against obesity in children. MATERIAL AND METHODS Non-randomised controlled trial was conducted on children from first to fifth grade from two public schools of Avilés (Spain). The intervention lasted for 2 school years comprising healthy diet workshops, educational chats, educational meetings, informative written material, and promotion of physical activities. Primary outcome measure was body mass index z-score. Secondary outcomes included: obesity and overweight prevalence, waist circumference, dietary habits, and physical activity. RESULTS A total of 382 (177 girls, 205 boys) out of 526 pupils of both schools were included in the study. Complete anthropometric data were obtained in 340 of the 382 individuals. Compared to children in control group, those in intervention group decreased body mass index z-score from 1.14 to 1.02 (P=.017), and improved KIDMED score from 7.33 to 7.71 points (P=.045). The percentage of students who carried on an optimal diet increased from 42.6% to 52.3% (P=.021). There were no statistical differences in the prevalence of obesity and overweight, or in waist circumference between the intervention and control groups. CONCLUSIONS This school-based program resulted in modest beneficial changes in body mass index and diet quality.

Original breveResistencia insulínica en pacientes pediátricos con fibrosis quística y sobrepesoInsulin resistance in overweight cystic fibrosis paediatric patients

AIM To determine the prevalence of overweight in paediatric patients with cystic fibrosis (CF) and to analyse its role as diabetogenic insulin resistance factor and risk of hypertriglyceridaemia. PATIENTS AND METHODS A total of 109 CF patients (47% males) between 5 and 18 years were divided into 3 groups according to body mass index (BMI): underweight, normal and overweight. Total cholesterol, triglycerides, C- reactive protein (CRP), glycosylated haemoglobin, HOMA-IR and QUICKI index were determined. Insulinogenic index, ISI composite and areas under the curve (AUC) for glucose and insulin were obtained by oral glucose tolerance test (OGTT). RESULTS Six patients (5.5%) were overweight. All groups had similar distribution by age, sex and CFTR mutation, although the proportion of pancreatic sufficient (3/6, 50%) was higher in overweight patients (P=.003). The prevalence of glycaemic disorders was similar between groups. Baseline insulin, HOMA-IR, and insulin during the OGTT (peak and AUC) were higher in overweight patients. All patients had a delayed insulin response in OGTT. CONCLUSIONS Overweight CF patients do not have a higher incidence of glycaemic disorders, but their hyperinsulinism and insulin resistance may be additional diabetogenic risk factors.Aim To determine the prevalence of overweight in paediatric patients with cystic fibrosis (CF) and to analyse its role as diabetogenic insulin resistance factor and risk of hypertriglyceridaemia.