Ultraprocessed Food Consumption and Cardiometabolic Risk Factors in Children.

Importance: High intake of ultraprocessed foods (UPFs) has been associated with higher cardiometabolic risk in adults; however, the evidence in children is limited. Objective: To investigate the association between UPF consumption and cardiometabolic risk factors in the Childhood Obesity Risk Assessment Longitudinal Study (CORALS). Design, Setting, and Participants: This baseline cross-sectional analysis was conducted using the data of CORALS participants recruited between March 22, 2019, and June 30, 2022. Preschool children (aged 3-6 years) were recruited from schools and centers in 7 cities in Spain. Inclusion criteria included informed consent signed by parents or caregivers and having a completed a set of questionnaires about the child's prenatal history at home. Exclusion criteria included low command of Spanish or unstable residence. Exposure: Energy-adjusted UPF consumption (in grams per day) from food frequency questionnaires and based on the NOVA food classification system. Main Outcomes and Measures: Age- and sex-specific z scores of adiposity parameters (body mass index [BMI], fat mass index, waist-to-height ratio, and waist circumference) and cardiometabolic parameters (diastolic and systolic blood pressure, fasting plasma glucose, homeostasis model assessment for insulin resistance, high-density and low-density lipoprotein cholesterol, and triglycerides) were estimated using linear regression models. Results: Of 1509 enrolled CORALS participants, 1426 (mean [SD] age, 5.8 [1.1] years; 698 boys [49.0%]) were included in this study. Mothers of children with high UPF consumption were younger, had a higher BMI, were more likely to have overweight or obesity, and had lower education levels and employment rates. Compared with participants in the lowest tertile of energy-adjusted UPF consumption, those in the highest tertile showed higher z scores of BMI (ß coefficient, 0.20; 95% CI, 0.05-0.35), waist circumference (ß coefficient, 0.20; 95% CI, 0.05-0.35), fat mass index (ß coefficient, 0.17; 95% CI, 0.00-0.32), and fasting plasma glucose (ß coefficient, 0.22; 95% CI, 0.06-0.37) and lower z scores for HDL cholesterol (ß coefficient, -0.19; 95% CI, -0.36 to -0.02). One-SD increments in energy-adjusted UPF consumption were associated with higher z scores for BMI (ß coefficient, 0.11; 95% CI, 0.05-0.17), waist circumference (ß coefficient, 0.09; 95% CI, 0.02-0.15), fat mass index (ß coefficient, 0.11; 95% CI, 0.04-1.18), and fasting plasma glucose (ß coefficient, 0.10; 95% CI, 0.03-0.17) and lower HDL cholesterol (ß coefficient, -0.07; 95% CI, -0.15 to -0.00). Substituting 100 g of UPFs with 100 g of unprocessed or minimally processed foods was associated with lower z scores of BMI (ß coefficient, -0.03; 95% CI, -0.06 to -0.01), fat mass index (ß coefficient, -0.03; 95% CI, -0.06 to 0.00), and fasting plasma glucose (ß coefficient, -0.04; 95% CI, -0.07 to -0.01). Conclusions and Relevance: These findings suggest that high UPF consumption in young children is associated with adiposity and other cardiometabolic risk factors, highlighting the need for public health initiatives to promote the replacement of UPFs with unprocessed or minimally processed foods.

Administración de corticoides a los pacientes con sepsis grave y mejora de su mortalidad intrahospitalaria: Una revisión sistemática / Administration of corticosteroids to patients with severe sepsis and improvement of in-hospital mortality: A systematic review

Objetivo: Averiguar si existe evidencia científica que demuestre un efecto beneficioso del tratamiento con corticoides en los pacientes con sepsis grave o shock séptico. También precisar la mejor práctica clínica en el uso de los corticoides para el tratamiento de los pacientes que presentan sepsis grave o shock séptico. Nos proponemos determinar el perfil del paciente séptico con enfermedad crítica que puede beneficiarse de la administración de corticoides para su tratamiento. Metodología: Búsqueda en bases de datos de gran evidencia, estableciendo unos criterios de inclusión y exclusión para obtener una mayor especificidad del tema. En la selección se siguieron las premisas del programa CASPe, y se incluyeron 9 artículos en nuestra revisión sistemática. Resultados y conclusiones: La mayoría de las evidencias muestran que la administración de corticoides presenta un beneficio en la reversión del shock, pero no disminuye la mortalidad de los pacientes. Se observó que los pacientes que se benefician de este tipo de tratamiento, son aquellos que están más críticos, con puntuaciones en la escala APACHE II más altas. Por otro lado, la bibliografía muestra unos mejores resultados en relación al beneficio de este tratamiento, si se inicia de una forma precoz en los pacientes candidatos a recibir dicho tratamiento, y la mejor forma de administrarlos es en bomba de perfusión continua. Una posible causa de la heterogeneidad en los resultados en cuanto a los beneficios de la administración de los corticoides, podría relacionarse con una variación genética, tal y como mostró Schäfer et al

Objective: To determine if there is scientific evidence to demonstrate a beneficial effect of corticosteroid treatment in patients with severe sepsis or septic shock. Also, to indicate the best clinical practice in the use of corticosteroids for the treatment of patients with severe sepsis or septic shock. We propose to determine the profile of the septic patient with critical illness that can benefit from the administration of corticosteroids for their treatment. Methodology: Search in databases of great evidence, establishing criteria of inclusion and exclusion to obtain a greater specificity of the subject. In the selection, the premises of the CASPe program were followed, and 9 articles were included in our systematic review. Results and conclusions: Most of the evidence shows that the administration of corticosteroids has a benefit in the reversion of shock, but does not decrease the mortality of patients. It was observed that patients who benefit from this type of treatment are those that are more critical, with APACHE II scores higher. On the other hand, the literature shows better results in relation to the benefit of this treatment, if it is started early in patients candidates for such treatment, and the best way to administer them is in a continuous infusion. A possible cause of the heterogeneity in the results regarding the benefits of corticosteroid administration could be related to a genetic variation, as shown by Schäfer et al