Rafael Tojo

The association of tooth lead content with dental health factors

The purpose of this study was to determine the relationships of lead content in the human tooth with the prevalence of caries, dental plaque, pH of saliva, levels of Salivalis lactobacilli (SL) and Mutans streptococci (MS), degree of dental abrasion, tooth colour and toothbrushing frequency. A total of 220 teeth (one per person) were analysed using a microwave oven digestion procedure and lead content was measured by atomic absorption spectrometry. Tooth lead content followed a logarithmic-normal distribution and it increased with the prevalence of caries. Tooth lead concentrations were positively correlated with all the considered dental health factors except the pH of saliva, for which there was a significant negative correlation. Coloured teeth and teeth subject to abrasion showed the highest lead content. The highest number of colonies of SL and MS in saliva paralleled the highest lead tooth levels. Teeth obtained from irregular brushers presented higher tooth lead contents than subjects with a regular toothbrushing frequency. Multiple logistic regression analysis showed a significant association between tooth lead levels and dental plaque surface, Salivalis lactobacilli number, dental abrasion and dental colour. We conclude that accumulation of lead in teeth is associated with those dental health factors.

Myeloperoxidase Is an Early Biomarker of Inflammation and Cardiovascular Risk in Prepubertal Obese Children

OBJECTIVE Obesity is associated with a state of chronic low-grade inflammation. Myeloperoxidase (MPO) plays an important role in the initiation and progression of acute and chronic inflammatory diseases, such as cardiovascular disease (CVD). The objectives of the current study were to evaluate plasma MPO levels in prepubertal obese children and to determine whether MPO could be an early biomarker of inflammation and CVD risk. RESEARCH DESIGN AND METHODS In a prospective multicenter case-control study paired by age and sex of 446 Caucasian prepubertal children ages 6–12 years, 223 normal-weight and 223 obese children were recruited. Blood pressure, waist circumference, weight, and height were measured. In addition to MPO, glucose, insulin, metabolic lipid parameters, oxidized low-density lipoproteins, adiponectin, leptin, resistin, C-reactive protein (CRP), interleukin 6, tumor necrosis factor α, matrix metalloproteinase-9 (MMP-9), and plasminogen activator inhibitor 1 were determined. RESULTS We found that MPO was elevated in prepubertal obese children and that this enzyme was associated with such proinflammatory and cardiovascular risk biomarkers as CRP, MMP-9, and resistin. Insulin resistance calculated by the homeostatic assessment model was the best predictor of MPO. CONCLUSIONS MPO is an early biomarker of inflammation associated with CVD risk in obese children at the prepubertal age.

Presence of the Metabolic Syndrome in Obese Children at Prepubertal Age

Background/Aims: There is a strong debate on the diagnosis and early phenotypic expression of the metabolic syndrome in children. The aim of the present study was to examine the frequency of the metabolic syndrome using various definitions in obese prepubertal and pubertal children. Methods: 478 (213 females and 265 males) obese children were recruited in three provinces of Spain. Blood pressure (BP), waist circumference, and weight and height were measured, and body mass index was calculated. Glucose, insulin, high-density lipoprotein cholesterol and triacylglycerols were determined. We classified the children according to seven different proposed definitions of the metabolic syndrome. Results: Regardless of the definition used, the prevalence of the metabolic syndrome (8.3–34.2%) was relatively high in obese children in the prepubertal period as well as in pubertal children (9.7–41.2%). We performed a principal-factor analysis to explain correlations among features of the metabolic syndrome and found that glucose metabolism (factor 1), dyslipidemia (factor 2) and obesity/BP (factor 3) explained 72% of the total variance. Conclusion: Irrespective of the classification used, the metabolic syndrome is not only present in pubertal but also in prepubertal children. International definitions of the metabolic syndrome should also consider criteria specific for children in the prepubertal period, i.e. children aged <10 years.

Vitamins in Spanish food patterns: The eVe Study

OBJECTIVE To describe vitamin intakes in Spanish food patterns, identify groups at risk for inadequacy and determine conditioning factors that may influence this situation. DESIGN Pooled-analysis of eight cross-sectional regional nutrition surveys. SUBJECTS Ten thousand two hundred and eight free-living subjects (4728 men, 5480 women) aged 25-60 years. Respondents of population nutritional surveys carried out in eight Spanish regions (Alicante, Andalucia, Balearic Islands, Canary Islands, Catalunya, Galicia, Madrid and Basque Country) from 1990 to 1998. The samples were pooled together and weighted to build a national random sample. METHODS Dietary assessment by means of repeated 24-hour recall using photograph models to estimate portion size. Adjusted data for intra-individual variation were used to estimate the prevalence of inadequate intake. A Diet Quality Score (DQS) was computed considering the risk for inadequate intake for folate, vitamin C, vitamin A and vitamin E. DQS scores vary between 0 (good) and 4 (very poor). Influence of lifestyle (smoking, alcohol consumption and physical activity) was considered as well. RESULTS Inadequate intakes (<2/3 Recommended Dietary Intake) were estimated in more than 10% of the sample for riboflavin (in men), folate (in women), vitamin C, vitamin A, vitamin D and vitamin E. More than 35% of the sample had diets classified as poor quality or very poor quality. Factors identified to have an influence on a poor-quality diet were old age, low education level and low socio-economical level. A sedentary lifestyle, smoking, usual consumption of alcohol and being overweight were conditioning factors for a poor-quality diet as well. CONCLUSION Results from The eVe Study suggest that a high proportion of the Spanish population has inadequate intakes for at least one nutrient and nearly 50% should adjust their usual food pattern towards a more nutrient-dense, healthier diet.

Prevalence of lactose malabsorption in Galicia.

BACKGROUND The aim of the current study was to evaluate the prevalence of lactose malabsorption (LM) in Galicia (NW Spain) in order to design nutritional intervention and/or public education strategies for high risk groups. METHODS We conducted a study of LM by breath-hydrogen carbohydrate absorption test (BH2 test) in 850 healthy subjects. All subjects underwent BH2 tests following ingestion of a aqueous solution of 2 g lactose/kg body weight up to a maximum of 50 g. Subjects with LM were retested after ingesting 250 ml of milk and/or 250 ml of yogurt. RESULTS The frequency of LM in the subjects who ingested 2 g lactose/kg body weight was 32.5%. This percentage decreased significantly with a decrease in the quantity of administered lactose and the vehicle was milk or yogurt-only 13.7% was LM after 250 ml of milk and 3.8% after 250 ml of yogurt. Gastrointestinal symptoms also depend on dosage of lactose and vehicle, decreasing from 54.3% after 2 g lactose/kg to 18.5% after milk and to 0% after yogurt. The frequency and number of gastrointestinal symptoms were significantly higher (p < 0.001) in LM than in lactose absorption (LA). CONCLUSIONS Lactose malabsorption is prevalent in the population of Galicia. An important number of subjects identified as LM with usual clinical testing become LA when the ingestion of dairy products is limited so that the amount of lactose consumed is similar to that contained in a usual serving. Our results suggest the importance of BH2 testing following ingestion of usual consumed amounts of lactose per serving.

Risk of inadequate intakes of vitamins A, B1, B6, C, E, folate, iron and calcium in the Spanish population aged 4 to 18.

A meta-analysis of the most representative Spanish nutrition studies was carried out to identify inadequate intakes of vitamins, A, B1, B6, C, E, folate, iron, and calcium in children aged 4 to 18. Information on vegetable, fruit and fruit juice/beverage intake was also solicited. Data drawn from the selected studies yielded a total of 6540 children and adolescents in eight geographical areas. The sample was stratified by age (children: 4 to 14 years old and adolescents: 13-18 years old) and sex. Inadequate intakes (below two-thirds of the recommended values) were notable in children for vitamin E, vitamin C, and vitamin A and in girls, iron. In adolescents, low intakes were especially marked for vitamin E and vitamin A, and in girls, calcium, folate, and iron. Adolescents consumed more vegetables, fruit juice, and fruit drinks whereas children had higher fruit intakes. Regional differences in consumption were also detected. Strategies for improving nutrient intake in these vulnerable populations are discussed.

Waist-to-height ratio, inflammation and CVD risk in obese children

OBJECTIVE To evaluate the association between waist-to-height ratio (WHtR) and specific biomarkers of inflammation, CVD risk and endothelial dysfunction in prepubertal obese children. DESIGN Prospective, multicentre case-control study matched by age and sex. SETTING Children were recruited between May 2007 and May 2010 from primary-care centres and schools in three cities in Spain (Cordoba, Santiago de Compostela and Zaragoza). SUBJECTS Four hundred and forty-six (223 normal weight and 223 obese) Caucasian prepubertal children aged 6-12 years. RESULTS WHtR was higher in the obese than in the normal-weight children. Blood pressure, waist circumference, weight, height, insulin, plasma lipids, leptin, resistin, abnormal neutrophil and monocyte counts, C-reactive protein, IL-6, IL-8, TNF-α, myeloperoxidase, soluble intercellular adhesion molecule-1, selectin and plasminogen activator inhibitor-1 levels were higher in the obese than in the normal-weight group. Adiponectin and HDL-cholesterol were lower and glucose and metalloproteinase-9 showed no differences. Resistin, TNF-α and active plasminogen activator inhibitor-1 were associated with WHtR, a sensitive indicator of central obesity. CONCLUSIONS Our results lead to the hypothesis that changes in biomarker levels of insulin resistance, inflammation and CVD risk before puberty might induce metabolic consequences of obesity in obese children before reaching adulthood.

Atherogenic diet and blood lipid profile in children and adolescents from Galicia, NW Spain. The Galinut Study

We studied serum levels of total cholesterol, lipoproteins and triglycerides in venous blood samples and the intake of nutrients using the subjects daily record of food eaten during a period of 7 d. The material comprised 7367 children and adolescents. The overall average lipid levels (4.55 ± 0.91 mmol/L for TC, 1.42 ± 0.47 mmol/L for HDL‐C, 2.74 ± 0.96 mmol/L for LDL‐C) are high and similar to those found in other regions of Spain in the 1990s. The proportion of children with TC ≥5.17 mmol/L (200mg/dl) was 19%; that of children with HDL‐C ≤0.91 mmol/L (35 mg/dL) 6.5%. There is a striking and statistically significant difference between the proportions of boys and girls aged 15‐20 y who have HDL‐C levels in this range (15.8% for boys and only 4.2% for girls). We also demonstrate a high total fat (44% of TCV), saturated fat (16% TCV) and cholesterol (387 mg) intake. Because of the elevated fat and saturated fat intake and the increment of a more atherogenic lipid profile in our children, preventive nutritional measures are necessary, and life habits such as physical exercise and actively reducing fat and saturated fat intake have to be applied and inculcated in children from an early age.

Influence of variants in the NPY gene on obesity and metabolic syndrome features in Spanish children

Variants in the neuropeptide Y (NPY) gene have been associated with obesity and its traits. The objective of the present study was to evaluate the association of single nucleotide polymorphisms (SNPs) in the NPY gene with obesity, metabolic syndrome features, and inflammatory and cardiovascular disease (CVD) risk biomarkers in Spanish children. We recruited 292 obese children and 242 normal-body mass index (BMI) children. Height, weight, BMI, waist circumference, clinical and metabolic markers, adipokines, and inflammatory (PCR, IL-6, IL-8 and TNF-α) and CVD risk biomarkers (MPO, MMP-9, sE-selectin, sVCAM, sICAM, and PAI-1) were analyzed. Seven SNPs in the NPY gene were genotyped. The results of our study indicate that anthropometric measurements, clinical and metabolic markers, adipokines (leptin and resistin), and inflammatory and CVD risk biomarkers were generally elevated in the obese group. The exceptions to this finding included cholesterol, HDL-c, and adiponectin, which were lower in the obese group, and glucose, LDL-c, and MMP-9, which did not differ between the groups. Both rs16147 and rs16131 were associated with the risk of obesity, and the latter was also associated with insulin resistance, triacylglycerols, leptin, and HDL-c. Thus, we confirm the association of rs16147 with obesity, and we demonstrate for the first time the association of rs16131 with obesity and its possible impact on the early onset of metabolic syndrome features, mainly triacylglycerols, in children.

Dental lead levels in the Galician population, Spain

The aim of this study was to investigate tooth lead concentrations in a Spanish population living in Coruña, Spain. A total of 220 teeth were analysed using a microwave oven digestion procedure and lead content was measured by atomic absorption spectrometry. Samples were classified according to age, sex, type of tooth, cause of extraction and place of residence. Tooth lead levels followed a logarithmic-normal distribution. The general geometric mean was 10.36 micrograms/g of tooth. There was a significant increase in teeth lead levels with advancing age. Permanent teeth showed higher values (13.09 +/- 1.07 micrograms/g, mean +/- S.E.M.) than deciduous teeth (3.96 +/- 1.07 micrograms/g). However, no differences were found between sexes. High lead concentrations were detected in pathological teeth, particularly in those with periodontal pathology, suggesting a relation between lead levels and dental disease. Nevertheless, teeth with caries did not show any significant lead increase. People living in urban areas of the coast had the highest lead teeth contamination. This is the first study in Spain which describes the tooth lead levels as a marker of lead exposure.