Tratamiento integral de la obesidad infantil: Efecto de una intervención psicológica / Effects of psychological support as an adjunct to a weight reducing program among obese children

Background: Disrupted eating behaviors and psychological issues can have a role in the development of childhood obesity. Aim: To assess the effects of psychological support as an adjunct to the treatment of obesity among children. Material and Methods: Retrospective analysis of a group of 152 obese children aged 3 to 16 years, who received medical, Nutritional and physical training treatment. Seventy three (Group I) were invited to participate in a protocol of psychological support and 79 formed the control group (Group 2). Body mass index, body fat mass, waist circumference, insulin sensitivity, lipid profile, eating and physical activity habits were evaluated. Family structure, history of food rejection, psychological, physical and social development, and adherence to the program were also analyzed. To analyze responses to treatment, Group I was further divided into those who attended the psychology sections (intervened group) and those who did not attend (non intervened group). Results: At baseline, there were no differences in anthropometric, metabolic, familial and psychological profile among Groups I and 2. Family structure, eating behaviors and physical and social development were normal. Those associated with lack of control appeared as negative characteristics. There was a significant improvement in eating habits and physical activity among intervened children of Group 1 and Group 2. No significant change in weight was recorded in all three groups. Compliance with the program was significantly better among intervened children in Group 1 (62.1 percent at sixth months), compared with non intervened children of Group 1 (15.9 percent) and Group 2 (30.3 percent). Conclusions: Obese children who attended psychological support therapy as an adjunct to a weight reducing program, had a better compliance with treatment but did not achieve a higher weight loss.

Hábitos de ingesta y actividad física en escolares, según tipo de establecimiento al que asisten / Dietary intake and physical activity in school age children

Background: The increased infantile obesity rates are related to faulty dietary intake (DI) and physical activity (PA) habits, that are probably related to a prolonged stay at school during the day. Aim: To investigate DI and PA among elementary and high school students and their association with type of school that they attend. Material and Methods: Quality of DI and PA was assessed, using specially designed questionnaires, in 1136 elementary school and 1854 high school children attending public schools managed by city halls (ME), subsidized private (SE) and private (PE) of the Metropolitan Region. The responses to the questionnaires, were qualified using a numeric scale that ranged from 0 to 10 points. A higher score indicated a better habit. Results: Percentile 25 (p 25 th) PA score was 4 and 3 in elementary and high school children respectively and the p 25 th for DI were 5.7 and 4.3, respectively. No differences in DI scores, according to the type of school, were observed. However, physical activity scores were significantly lower in children and adolescents from ME schools than from PE schools. Sixty percent of ME schools had ¡ess than 2 hours per week of programmed physical activity compared to more than 3 hours, in 70 percent of PE schools. Elementary school children and high school adolescents expended 8 and 11 hours per day, respectively, in minimum expenditure activities. Conclusions: There is a greater deterioration of PA than DI among school age children and adolescents. Those attending ME schools have the worst physical activity scores. This fact must be addressed in future healthy lifestyle encouragement policies.

Perfil metabólico de riesgo cardiovascular en niños y adolescentes obesos con menor sensibilidad insulínica / Cardiovascular risk and metabolic profile in obese children and adolescents with low insulin sensitivity

Background:Infantile obesity is associated with metabolic disturbances (hiperinsulinism, impaired glucose, dislypidemia) that determine a higher risk of type 2 diabetes, high blood pressure and atherosclerotic vascular disease in adulthood. Insulin resistance is a central mechanism of complications of obesity and is associated to body fat mass. Aim: To investigate insulin sensitivity and its association with anthropometric and metabolic variables in obese children. Patients and methods: We studied 314 children aged 6 to 15 years. Of these, 235 had a body mass index (BMI) over the 95 percentile for age and sex (classified as obese) and 79 had a normal body mass index; 161 were pre-pubescent and 153 were pubescent. Weight, height, percentage of total body fat (% TBF) using the sum of 4 skinfolds, blood pressure (BP), waist circumference (WC), basal glucose (Glu) and insulin (Ins) were measured. Insulin sensitivity (IS) was calculated with the homeostasis model assessment (HOMA) and QUICKI index. Serum lipids, postprandial Glu and Ins were measured only in obese children. Results: BMI, WC and % TBF had an inverse and significant correlation with basal IS (p <0.001). Obese children had higher BP, basal Ins, and HOMA and a lower QUICKI index, compared to normal weight children. A low basal IS was present in 58% of obese children. Obese children with low IS had higher WC, % TBF, triglycerides, total/HDL-cholesterol ratio, basal and 2-h post glucose Gli and Ins and lower HDL-cholesterol than obese children with normal IS. In prepubescent children, the risk of a low IS was 2.43 times higher with a TBF over 33%. In pubescent children, it was 2.92 times higher with a TBF over 37%. Conclusions: Low IS in prepubescent and pubescent obese children is associated with central obesity and a higher cardiovascular risk.

La mantención de peso en humanos podría ser equivalente a la restricción calórica de los modelos animales? / Weight maintenance in humans. Could it mimic calorie restriction of animal models?

BACKGROUND: Energy restriction (ER) extends life span in animals, by decreasing oxidative stress. AIM: To compare adiposity, metabolic variables and DNA oxidative damage, among adults, reporting a constant body weight (weight maintainers), versus those reporting a progressive increase (weight gainers). SUBJECTS AND METHODS: Clinical history, dietary recall, anthropometric measures, abdominal CT scan and fasting blood samples (to measure lipoproteins, glucose and insulin), were obtained in 44 males. These subjects were classified as weight maintainers if they had a change in weight of 3 kg or less in the last 10 years, or weight gainers, if they had a weight increment of more than 6 kg, in the same lapse. Oxidative damage was assessed by 8-hydroxydeoxyguanosine (8-OHdG), in DNA extracted from circulating lymphocytes, in 5 weight maintainers, 8 weight gainers and 5 healthy elders. RESULTS: Energy Intake was 18% higher in weight gainers (p <0.01). Adiposity and central fat were higher among weight gainers (p <0.01). Abdominal fat correlated with serum lipoproteins, glucose and insulin sensitivity, assessed by the Homeostasis Model Assessment (HOMA). 8-OHdG levels did not differ between groups. CONCLUSIONS: The analysis of weight change based on the clinical history correlates with actual body composition, thus it may be a reliable indicator of long term energy Intake. This method could be comparable to weight clamp models employed in animals to study aging.

Características biológicas, familiares y metabólicas de la obesidad infantil y juvenil / Familial and metabolic characteristics of infantile and juvenile obesity

Background: Obesity is the most prevalent nutritional disease in people of less than 20 years old. Aim: To report biological, familial and metabolic characteristics in obese children. Patients and methods: A retrospective review of 187 children seen at obesity clinics and that had a complete metabolic study. Results: Ninety five prepuberal and 92 puberal children, aged 8.7ñ2.2 and 12.6ñ2.2 years old respectively, were studied. Body mass index was over 4 standard deviations in 48.4 per cent of prepuberal children and in 39.1 per cent of puberal children. Paternal obesity was twice more prevalent (30.2 per cent) than in the general population. The daily caloric intake and basal metabolic rate (BMR) were within the normal range; nevertheless there was a positive caloric balance due to minimal physical activity. The mean daily fat intake was normal (26.4ñ8.5 and 25.3ñ9.1 per cent of total calories in prepuberal and puberal children respectively). The daily fiber intake was under 70 per cent of recommendation. The total cholesterol was over 200 mg/dl in 26.6 and 23.9 per cent of prepuberal and puberal children. LDL cholesterol was over 130 mg/dl in 27.3 and 26.6 per cent and triacylglycerol was over 150 mg/dl in 16.9 and 25 per cent of prepuberal and puberal children respectively. Basal serum insulin was over 20 uIU/ml in 27.7 and 42.2 per cent of prepuberal and puberal children, respectively. Post glucose serum insulin was over 60 uIU/ml in 40 and 63 per cent of prepuberal and puberal children, respectively. Conclusions: Infantile and juvenile obesity is a chronic disease with a high incidence of metabolic alterations

Propiedades y composición química de la leche / Properties and chemical composition of cow milk

Muchos alimentos superan a la leche en su contenido de un determinado nutriente, sin embargo, como fuentes equilibradas de la mayor parte de las necesidades dietéticas del hombre, la leche no tiene igual. Se la define como el producto entero, fresco y limpio, extraído por ordeña regular y completa de vacas sanas, adecuadamente alimentadas y deprovisto de calostro. Los componentes típicos de la leche son caseína, lactosa y grasa, lacto-albúmina, lacto-globulina, las vitaminas y minerales. La leche de vaca es una fuente balanceada de la mayoría de los requerimientos dietéticos del hombre, faltándole solo hierro y parte del ácido ascórbico. Contiene proteínas de alta calidad; el aminoácido limitante de la caseína es la metionina. Es rica en calcio, con una buena relación Ca/P; en riboflavina, y en caretone. La ración diaria de 1/2 litro de leche suministra unos 15 gramos de proteínas; 0,5 g de calcio; 0,7 mg de riboflavina; 0,3 mg de tiaminas; 5,5 mg de ácidoarcórbico y unas 500 U.I de vitamina A. Es pobre en vitamina D, pero constituye un buen vehículo para suministrarla. La leche es también, pobre en niacina, pero la lactoalbúmina y la globulina son ricas en su provitamina, el triptófano. Por su riqueza en calcio, la leche puede disminuir la acumulación en los huesos, de estroncio 90, proveniente de alguna contaminación radioactiva

Diferencias en la oxidación de substratos energéticos entre mujeres obesas y normopeso / Differences in energy substrate oxidation between obese and normal weight women

Se compara la oxidación de lípidos y de CHO en mujeres controles y obesas, en condiciones de ayuno y luego de un desayuno de prueba conteniendo ácidos grasos enriquecidos con 13C. Dieciséis mujeres de 40-55 años, saludables, con peso estable en los tres meses previos y durante el estudio fueron agrupadas según índice de masa corporal (IMC): 8 obesas) y 8 normopeso (IMC 30-40 y 20-25 respectivamente). El metabolismo oxidativo se estudió en tres oportunidades en cada sujeto bajo condiciones de reposo: 1) bajo condiciones post absortivas (TMR), 2) luego de un desayuno (aporte energético equivalente al 40 por ciento del TMR) con adición de 13C-ácido octanoico y 3) idem, pero con adición de 13C-ácido palmítico en reemplazo del ác. octanoico. El gasto energético y la oxidación total de sustratos se evaluó con calorimetría indirecta (CAL). La oxidación de los sustratos marcados, se evaluó por espectrometría de masas y CAL. Bajo condiciones de ayuno, ambos grupos utilizaron como principal combustible metabólico a las grasas (66,38 ñ 35,08 por ciento las obesas y 56,83 ñ 28,18 por ciento las normopeso). Bajo condiciones de alimentación, las obesas oxidaron mayor cantidad de lípidos (55,23 ñ 20,44 por ciento vs 40,84 ñ 17,39 por ciento en controles), tanto en forma total como ajustado por la cantidad de grasa ingerida, peso y composición corporal (p<0,05). La oxidación de lípidos estuvo en directa asociación con la masa grasa de los sujetos (r=0,66). Luego de 3 horas, la oxidación de ácido 13C-octanoico, fue similar en ambos grupos (21,3 ñ 10,4 en obesas y 26,5 ñ 9,0 por ciento en controles). La oxidación de 13C-palmítico fue muy baja en ambos grupos, aunque significativamente menor en las obesas (0,5 por ciento ñ 0,2 por ciento vs 0,9 por ciento ñ 0,4 por ciento). La mayor oxidación de lípidos según CAL, en obesos de peso estable, puede responder a un mecanismo destinado a prevenir nuevas ganancias de peso o pudiera representar una complicación metabólica del exceso de peso

Estado nutritivo y gasto energético en ancianos de distinto nivel socioeconómico / Nutritional status and energy expenditure in elders of differing socioeconomic level

Background: Income and socioeconomic status can influence nutritional status of individuals. Since elders are a more vulnerable group to nutritional deficiencies, socioeconomic status could have a special relevance on nutrition of elderly people. Aim: To assess the influence of socioeconomic status on the nutritional status of elders. Material and methods: Elders of both sexes of high socioeconomic level and age and sex matched elders of low socioeconomic status were studied. Anthropometry, body composition using double beam X ray absorptiometry, resting energy expenditure using an open circuit indirect calorimeter, routine biochemistry, blood levels of folic acid, vitamin B12 and homocysteine were measured in all subjects. Results: Fourteen female elders of high socioeconomic level, 14 females of low level and 12 males of each level were studied. Mean age of females and males was 71.5 ñ 3.7 and 73.9 ñ 4.2 years old respectively. Males and females of high socioeconomic status were taller than their counterparts of low status. Females of high socioeconomic status had a lower body mass index than their pairs of low status (26.3 ñ 3.8 and 30.2 ñ 5.6 kg/m2 respectively p <0.02). Men of high economic status had a higher fat mass than their pairs of low level (20.3 ñ 3.5 and 15.1 ñ 5.5 kg respectively, p <0.005). No differences in resting energy expenditure in women of differing socioeconomic level were observed. Men of high level had a higher energy expenditure than their counterparts of low level (36.0 ñ 4.9 and 32.8 ñ 2.2 Kcal/kg lean body mass/day respectively, p<0.02). Low level male elders had higher serum total cholesterol and triglycerides. Folic acid, vitamin B12 and homocysteine levels were within normal limits. Dietary intake showed deficiencies in calorie, protein and vitamin intake in all subjects. Conclusions: In this group of elders, low socioeconomic level did not produce a significant impact on nutritional status

Análisis comparativo de métodos de evaluación de la composición corporal en varones adultos sanos / Comparative analysis of body composition assessment methods in healthy adult men

Background: The degree of agreement bbetween different methods to assess total body composition is not well known. Aim: To determine the level of agreement for total body fat mass measurement by dual-photon absorptiometry (DEXA), bioelectrical impedance (BIA) and anthropometry using the deuterium dilution method as the gold-standard technique, in normal male volunteers. Subjects and methods: Total body fat mass was measured by DEXA, BIA, anthropometry and deuterium dilution in thirty one healthy men, aged 41.9 ñ 8.6 years old. Results: Mean differences in percentage of total body fat compared with deuterium dilution were 0.3 percent ñ 2.2, 1.3 percent ñ 3.4 and 1.8 ñ 2.3 percent for DEXA had the lower difference with deuterium dilution and the confidence intervals for this difference (ñDS) showed that, at the individual leve, the maximum difference was 4.4 percent. Conclusions: All the methods evaluated gave similar average measurements for total body fat mass, but with different individual variability. In this group of healthy male subjects, DEXA was the best method in terms of agreement with the gold-standard

Actividad física en escolares chilenos normales y de talla baja / Physical activity in normal and low height for age chilean school children

En 70 niños y niñas escolares de 7 a 9 años de edad, normales y con talla baja (T/Eñ1 DE y <-1 DE), se evaluó la actividad física habitual mediante entrevistas estructuradas y por método factorial o de tiempo movimiento. La mayoría de las actividades de estos escolares eran sedentarias. El tiempo dedicado a horas de sueño o en cama, en días de la semana y festivos fue muy alto, los promedios (talla normal y baja) en los varones eran de 11,5ñ1,1 a 12ñ1,4 horas y en las niñas 11,9ñ1,2 y 12,2ñ1,6 respectivamente. El tiempo destinado a ver televisión era, en varones y niñas, promedio tres horas diarias, aumentando a cuatro horas en los días festivos. Los varones normales destinaron 58.6 por ciento de su tiempo a actividades físicas intensas, porcentaje significativamente mayor que sus pares de talla baja y los dos grupos de niñas (p<0,05). Un comportamiento similar se observó en las niñas normales frente a sus pares de talla baja, pero esta diferencia no alcanzó significación. Así pues, los escolares de talla baja se involucraron menos en actividades intensas que los normales, y que el tiempo destinado a ver televisión y la escasa actividad física desarrollada por estos niños, refleja un estilo de vida sedentario por parte de este grupo de edades

Absorción de minerales de una nueva fórmula láctea propuesta para el Programa Nacional de Alimentación Complementaria / Mineral absortion in a new modified milk formula proposed to the complementary feeding national programme

La leche de vaca tiene un contenido excesivo de calcio y fósforo e insuficiencia de zinc y cobre. En la formulación de una leche modificada se han cambiado las concentraciones de estos minerales, para acercarlas a las recomendaciones normales. Se estudió la absorción de estos nutrientes en 9 lactantes hospitalizados en recuperación nutricional (x P/T: *85%). Cada niño recibió leche de vaca y leche modificada por 6 días, usándose los tres últimos días de cada período para balance. Encontramos ingestas inadecuadas de cobre (50%) y zinc (50%) y absorciones bajas de cobre (13 *g*kg*d), en relación a las correspondientes recomendaciones, cuando se empleó leche de vaca no modificada. Con la leche modificada sólo la ingesta de zinc (60%) fue insuficiente. Las ingestas de calcio (140%) y fósforo (117%) fueron excesivas mientras los niños recibían leche de vaca, pero adecuadas con leche modificada. La leche modificada empleada en este estudio asegura ingestas y absorciones más adecuadas que la leche de vaca no modificada para los minerales evaluados

Nueva fórmula láctea para el Programa Nacional de Alimentación Complementaria: balance nitrogenado y calórico / A new cow-s milk formula to Complementary Feeding National Program: nitrogen and caloric balance

Estudiamos las relaciones nitrogenada, de energía y grasa en 10 lactantes (edad promedio 6,8 meses) con desnutrición proteínico-energética en recuperación, que fueron alimentados con dos fórmulas: una basada en leche de vaca entera (LP) y la segunda con una leche de vaca modificada (LPM). Estos niños tenían en promedio relación peso/edad 72%y peso/talla 95%. Fueron estudiados en dos períodos consecutivos de 6 días cada uno (3 para adaptación y 3 para balance) comenzando con cualquier fórmula aleatoriamente. Ambas fórmulas tenían 85 kcal-dl con 11%de calorías proteicas en LPM y 13%en LP. La ingestión, la absorción y la retención de energía fueron levemente mayores con LPM que con LP. Hubo mayor ingestión de grasa con LPM (5,4 vs. 4,5 g*kg*día, p < 0,025) con menor excreción urinaria de N (304 vs. 417 mg*kg*día, p < 0,001). La retención aparente promedio de N fue de 115 mg*kg*día para LPM y 69 mg*kg*día para LP (NS). Se observó una correlación significativa entre consumo y retención de nitrógeno: r= 0,70 con LPM (p < 0,05) y r= 0,77 con LP (p < 0,01). También hubo correlación entre ingesta de energía y ganancia de peso: r= 0,55 con LPM (NS) y r= 0,88 con LP (p < 0,001). Concluimos que la fórmula basada en leche de vaca modificada muestra un mejor balance nitrogenado y de grasas que la fórmula en base a leche entera en lactantes desnutridos en recuperación