White fish reduces cardiovascular risk factors in patients with metabolic syndrome: the WISH-CARE study, a multicenter randomized clinical trial.

BACKGROUND AND AIMS: Reduction of cardiovascular risk with high consumption of fish in diet is still a matter of debate, and concerns about heavy metal contamination have limited consumption of oily fish. We aimed to evaluate the effect of regular ingestion of white fish on cardiovascular risk factors in patients with metabolic syndrome. METHODS AND RESULTS: Multicenter randomized crossover clinical trial including 273 individuals with metabolic syndrome. An 8-week only-one dietary intervention: 100 g/d of white fish (Namibia hake) with advice on a healthy diet, compared with no fish or seafood with advice on a healthy diet. Outcomes were lipid profile, individual components of the metabolic syndrome, serum insulin concentrations, homeostasis model of insulin resistance, serum C-reactive protein and serum fatty acid levels. We found a significant lowering effect of the intervention with white fish on waist circumference (P < 0.001) and diastolic blood pressure (P = 0.014). A significant lowering effect was also shown after the dietary intervention with fish on serum LDL concentrations (P = 0.048), whereas no significant effects were found on serum HDL or triglyceride concentrations. A significant rise (P < 0.001) in serum EPA and DHA fatty acids was observed following white fish consumption. Overall adherence to the intervention was good and no adverse events were found. CONCLUSION: In individuals with metabolic syndrome, regular consumption of hake reduces LDL cholesterol concentrations, waist circumference and blood pressure components of the metabolic syndrome. CLINICAL TRIAL REGISTRY: White Fish for Cardiovascular Risk Factors in Patients with Metabolic Syndrome Study, Registered under ClinicalTrials.gov Identifier: NCT01758601.

Prevalencia del trastorno por atracón en una muestra clínica de obesos / Prevalence of binge eating disorder among a clinical sample of obese children

Introducción: El trastorno por atracón se caracteriza por presencia de episodios de sobreingesta recurrentes en un periodo corto, acompañados de pérdida de control. Este trastorno es el más frecuente de entre todos los trastornos de la conducta alimentaria en población obesa, tanto en adultos como en niños. Objetivo: El objetivo de este estudio fue obtener datos prevalencia del trastorno por atracón en una muestra de niños y adolescentes obesos, usuarios de una unidad de pediatría especializada en el tratamiento de la obesidad infantil. Material y métodos: Se contó con una muestra 70 niños y adolescentes con edades comprendidas entre los 9 y los 16 años, con una edad media de 12 años, que acudían a una unidad de pediatría en el Hospital General de Valencia. Para llevar a cabo la evaluación se utilizaron los siguientes instrumentos: entrevista diagnóstica para trastorno por atracón (SCID-IV), la escala de trastorno por atracón infantil (C-BED) y el cuestionario de patrones de ingesta y peso (QEWP). Resultados: Tras la evaluación, el 6% de la muestra clínica fue diagnosticada con trastorno por atracón siguiendo los criterios establecidos por el DSM-IV-TR, y un 14% manifestaban formas subclínicas de dicho diagnóstico. Conclusiones: Los resultados van en la línea de estudios previos que resaltan la necesidad de evaluar este tipo de trastornos en unidades especializadas en el tratamiento de la obesidad(AU)

Introduction: Binge eating disorder is characterised by the presence of recurrent binge eating episodes in a short period of time, accompanied by loss of control. This disorder is the most frequent of all eating disorders in obese people, both adults and children. Objective: The objective of this study was to obtain prevalence data for binge eating disorder in a sample of obese children who attended a paediatric unit specialised in the treatment of childhood obesity. Material and methods: A sample included 70 children and adolescents aged 9 to 16, with a mean age of 12 years attending a paediatric clinic in the General Hospital of Valencia. The following tools were used in the assessment: Diagnostic Interview for Binge Eating Disorder (SCID-IV), Binge Eating Disorder Scale Child (C-BED) and Questionnaire of eating patterns and weight (QEWP). Results: After the assessment, 6% of the clinical sample was diagnosed with binge eating disorder according to criteria established by the DSM-IV-TR, and 14% showed subclinical forms of the disorder. Conclusions: The results are in line with previous studies that highlight the necessity of assessing these disorders in units specialised in the treatment of obesity(AU)

[Prevalence of binge eating disorder among a clinical sample of obese children]. / Prevalencia del trastorno por atracón en una muestra clínica de obesos.

INTRODUCTION: Binge eating disorder is characterised by the presence of recurrent binge eating episodes in a short period of time, accompanied by loss of control. This disorder is the most frequent of all eating disorders in obese people, both adults and children. OBJECTIVE: The objective of this study was to obtain prevalence data for binge eating disorder in a sample of obese children who attended a paediatric unit specialised in the treatment of childhood obesity. MATERIAL AND METHODS: A sample included 70 children and adolescents aged 9 to 16, with a mean age of 12 years attending a paediatric clinic in the General Hospital of Valencia. The following tools were used in the assessment: Diagnostic Interview for Binge Eating Disorder (SCID-IV), Binge Eating Disorder Scale Child (C-BED) and Questionnaire of eating patterns and weight (QEWP). RESULTS: After the assessment, 6% of the clinical sample was diagnosed with binge eating disorder according to criteria established by the DSM-IV-TR, and 14% showed subclinical forms of the disorder. CONCLUSIONS: The results are in line with previous studies that highlight the necessity of assessing these disorders in units specialised in the treatment of obesity.

Las múltiples facetas de la hipertrofia ventricular izquierda en la obesidad e hipertensión arterial / Left ventricular characteristics in obesity and hypertension

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Diagnóstico, evaluación y tratamiento de la hipertensión arterial en niños y adolescentes / Diagnosis, evaluation and treatment of arterial hypertension in children and adolescents

La perspectiva clínica de la presión arterial en edad pediátrica ha cambiado en los últimos años como consecuencia de la medida regula de la presión arterial y de un mejor conocimiento de los valores de normalidad que son variables a lo largo del crecimiento y desarrollo. El diagnóstico de hipertensión arterial debe basarse en varias mediciones de la presión arterial, realizadas en la consulta en distintos momentos. Si bien deben tomarse como referencia las mediciones de la presión arterial realizadas en la consulta, los valores de presión arterial obtenidos fuera de la consulta pueden contribuir a realizar una evaluación más precisa de los individuos. El abordaje terapéutico de la hipertensión arterial debe contemplar no sólo el uso de fármacos sino también la aplicación de medidas no farmacológicas. La consideración de su uso, fármacos y/o medidas no farmacológicas, se realizará en función de los valores de presión arterial, de la presencia de una etiología definida, y de la evaluación de los posibles factores de riesgo asociados (AU)

The clinical perspective of arterial blood pressure in pediatric age has changed in recent years due to the regular measurement of blood pressure and better knowledge about the normality values that are variable during growth and development. The diagnosis of arterial hypertension should be based on several measurements of blood pressure performed in the medical office at different times. Although the measurements of blood pressure made in the medical office should be used as reference, the blood pressure values obtained outside of the office can contribute to making a more precise evaluation of the individuals. The therapeutic approach to arterial hypertension should not only contemplate the use of drugs but also the application of non-pharmacological measures. The consideration of its use, drugs and/or non-pharmacological measures, will be made based on the blood pressure values, the presence of a defined etiology, and the evaluation of the possible associated risk factors (AU)

[Management of high blood pressure in children and adolescents: Recommendations of the European Society of hypertension]. / Manejo de la hipertensión arterial en niños y adolescentes: recomendaciones de la Sociedad Europea de Hipertensión.

Hypertension in children and adolescents has been gaining ground in cardiovascular medicine, mainly due to the advances made in several areas of pathophysiological and clinical research. These guidelines arose from the consensus reached by specialists in the detection and control of hypertension in children and adolescents. Furthermore, these guidelines are a compendium of scientific data and the extensive clinical experience it contains represents the most complete information that doctors, nurses and families should take into account when making decisions. These guidelines, which stress the importance of hypertension in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, should act as a stimulus for governments to develop a global effort for the early detection and suitable treatment of high pressure in children and adolescents. J Hypertens 27:1719-1742 Q 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Manejo de la hipertensión arterial en niños y adolescentes: recomendaciones de la Sociedad Europea de Hipertensión / Management of high blood pressure in children and adolescents: Recommendations of the European Society of hypertension

La hipertensión en niños y adolescentes ha ido ganando terreno en la medicina cardiovascular, gracias a los avances producidos en distintas áreas de la investigación fisiopatológica y clínica. Estas guías nacen del consenso al que han llegado los especialistas en la detección y control de la hipertensión en niños y adolescentes. Por otra parte, dichas guías son un compendio de los datos científicos y la extensa experiencia clínica con la que se cuenta, y constituyen la información clínica más completa que los médicos, enfermeras y familiares deberían tener en cuenta a la hora de tomar decisiones. Estas guías, que hacen hincapié en la importancia de la hipertensión en niños y adolescentes, así como en el papel que desempeña en la actual epidemia de enfermedades cardiovasculares, deberían constituir un estímulo para que los gobiernos desarrollaran un esfuerzo global para una detección precoz y un tratamiento adecuado de la hipertensión arterial en niños y adolescentes. J Hypertens 27:1719-1742 Q 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins(AU)

Hypertension in children and adolescents has been gaining ground in cardiovascular medicine, mainly due to the advances made in several areas of pathophysiological and clinical research. These guidelines arose from the consensus reached by specialists in the detection and control of hypertension in children and adolescents. Furthermore, these guidelines are a compendium of scientific data and the extensive clinical experience it contains represents the most complete information that doctors, nurses and families should take into account when making decisions. These guidelines, which stress the importance of hypertension in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, should act as a stimulus for governments to develop a global effort for the early detection and suitable treatment of high pressure in children and adolescents. J Hypertens 27:1719-1742 Q 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins(AU)

European Society of Hypertension practice guidelines for home blood pressure monitoring.

Self-monitoring of blood pressure by patients at home (home blood pressure monitoring (HBPM)) is being increasingly used in many countries and is well accepted by hypertensive patients. Current hypertension guidelines have endorsed the use of HBPM in clinical practice as a useful adjunct to conventional office measurements. Recently, a detailed consensus document on HBPM was published by the European Society of Hypertension Working Group on Blood Pressure Monitoring. However, in daily practice, briefer documents summarizing the essential recommendations are needed. It is also accepted that the successful implementation of clinical guidelines in routine patient care is dependent on their acceptance by involvement of practising physicians. The present document, which provides concise and updated guidelines on the use of HBPM for practising physicians, was therefore prepared by including the comments and feedback of general practitioners.

[Drugs used in paediatric outpatients: do we have enough information available?]. / Medicamentos utilizados en pediatría extrahospitalaria: disponemos de información suficiente?

OBJECTIVE: To analyse the drugs taken in paediatric outpatients and the information available on these drugs. PATIENTS AND METHODS: A cross-sectional, observational, descriptive study was carried out. The study involved a sample of children under 14 years seen in the Emergency Room of the HGUV from June 2005 to August 2006. The medicines they received were quantified and classified, and the information on these drugs available in the Vademecum International Medicom and in the Summary of Product Characteristics, were analysed. RESULTS: Of the 462 children (mean age 5.2 (95 % CI 4.9-5.6)) included, 336 received 667 medicines (152 different medicines) that contained 864 drugs (161 different drugs). In 34.3 % of the cases it was for self-medication. Children under 4 years received more drugs than the older group (80.2 % in the younger group and 67.4 % in the older). Patients received from 1 to 7 medicines (mean 2.0). Children receiving 2 or 3 medicines were younger than those who received one. Five therapeutic groups of the Anatomical-Therapeutical-Chemical Classification (ATC) include the 93.1 % of the drugs administered (R: 26.5 %; M: 23.8 %; N: 22.8 %; J: 10.6 % and A: 10.0 %). In the information sources consulted there was no information available on paediatric use for 40 of the 152 medicines used. CONCLUSIONS: Almost 75 % of patients seen in the Emergency Room were already receiving drugs before they arrived at the hospital, in many cases as a result of self-medication. The information available on the paediatric use of drugs is deficient. Clinical research is required to study the effects of pharmacological treatment on children and to improve the information on their use.

Medicamentos utilizados en pediatría extrahospitalaria: ¿disponemos de información suficiente? / Drugs used in paediatric outpatients: Do we have enough information available?

Objetivo: Analizar los medicamentos que reciben los pacientes pediátricos en el ámbito extrahospitalario y la información disponible sobre los mismos. Pacientes y métodos: Estudio transversal, observacional y descriptivo realizado en una muestra de pacientes menores de 14 años atendidos en urgencias del Servicio de Pediatría del Consorcio Hospital General Universitario de Valencia entre junio 2005 y agosto 2006. Se cuantifican y clasifican los medicamentos utilizados antes de acudir a urgencias y se analiza la información sobre su uso que contiene el Vademécum Internacional Medicom y la ficha técnica. Resultados: Se recogió información sobre 462 niños con media de edad de 5,2 años (intervalo de confianza del 95 % [IC 95 %]: 4,9-5,6). De ellos, 336 reciben 667 medicamentos (152 distintos) que contienen 864 principios activos (161 diferentes). En el 34,3 % de los casos el uso es por automedicación. Los menores de 4 años reciben medicamentos en mayor proporción que los mayores (80,2 y 67,4 %, respectivamente). Los pacientes reciben entre 1 y 7 medicamentos (media 2,0). Los que toman 2 o 3 medicamentos son menores que los que toman uno. Cinco grupos terapéuticos de la Clasificación anatómico-terapéutico-química (ATC) incluyen el 93,1 % de los medicamentos (R [aparato respiratorio]: 26,5 %; M [aparato locomotor]: 23,8 %; N [sistema nervioso central]: 22,8 %; J [antiinfecciosos por vía general]: 10,6 % y A [aparato digestivo y metabolismo]: 10,0 %). Para 40 de los 152 medicamentos no hay información pediátrica en las fuentes consultadas. Conclusiones: Casi tres cuartas partes de los niños atendidos en urgencias toman medicamentos antes de acudir a este servicio, en muchos casos por automedicación. La información sobre uso pediátrico de medicamentos es incompleta y presenta incongruencias. Es necesario fomentar la investigación clínica sobre los efectos del tratamiento farmacológico en los niños para mejorar la información sobre su uso (AU)

Objective: To analyse the drugs taken in paediatric outpatients and the information available on these drugs. Patients and methods: A cross-sectional, observational, descriptive study was carried out. The study involved a sample of children under 14 years seen in the Emergency Room of the HGUV from June 2005 to August 2006. The medicines they received were quantified and classified, and the information on these drugs available in the Vademecum International Medicom and in the Summary of Product Characteristics, were analysed. Results: Of the 462 children (mean age 5.2 (95 % CI 4.9-5.6)) included, 336 received 667 medicines (152 different medicines) that contained 864 drugs (161 different drugs). In 34.3 % of the cases it was for self-medication. Children under 4 years received more drugs than the older group (80.2 % in the younger group and 67.4 % in the older). Patients received from 1 to 7 medicines (mean 2.0). Children receiving 2 or 3 medicines were younger than those who received one. Five therapeutic groups of the Anatomical-Therapeutical-Chemical Classification (ATC) include the 93.1 % of the drugs administered (R: 26.5 %; M: 23.8 %; N: 22.8 %; J: 10.6 % and A: 10.0 %). In the information sources consulted there was no information available on paediatric use for 40 of the 152 medicines used. Conclusions: Almost 75 % of patients seen in the Emergency Room were already receiving drugs before they arrived at the hospital, in many cases as a result of self-medication. The information available on the paediatric use of drugs is deficient. Clinical research is required to study the effects of pharmacological treatment on children and to improve the information on their use (AU)

Beneficios de la medida de la masa ventricular en adolescentes con hipertensión arterial / Benefits of the measurement of ventricular mass in adolescents with high blood pressure

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Monitorización ambulatoria de la presión arterial durante 24, 48, 72 horas... ¿cuál es el límite razonable? / Ambulatory monitoring of blood pressure during 24, 48, 72 hours Which is the reasonable limit?

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Obesity, body fat distribution, and ambulatory blood pressure in children and adolescents.

Obesity is a common disease with an ever-increasing prevalence and usually with late-onset consequences. If acquired during childhood, it tracks into adult life to some extent, and since the relationship between obesity and hypertension is well established in adults, obese children appear to be at particularly high risk of becoming hypertensive adults. In the authors' study, obese children seemed to have significantly higher casual and ambulatory blood pressure than nonobese children, except for nighttime diastolic blood pressure. The health effects of obesity may depend on the anatomic distribution of body fat, which in turn may be a better indicator of endocrinologic imbalance, environmental stress, or genetic factors than is fatness per se. Subjects with a higher waist-to-hip ratio or a larger waist, as an estimate of central obesity, tend to have higher blood pressure values even during childhood. Prevention of the onset of obesity in early life may be important to reducing the risk of coronary heart disease in later life.

Birth weight influences blood pressure values and variability in children and adolescents.

The objective of the present study was to assess the relationships between birth weight and the values and variability of ambulatory blood pressure. Six hundred thirty healthy children (369 girls) age 4 to 18 years (mean, 9.9 years) born at term after a normotensive pregnancy were included. The subjects were divided into 5 groups according to birth weight. For each subject, a 24-hour ambulatory blood pressure monitoring was performed according to the protocol designed. Average and variability (estimated as the standard deviation) of ambulatory blood pressure and heart rate were calculated separately for 24-hour, daytime, and nighttime periods. When values were adjusted for gender, current age, weight, and height, children with the lowest birth weights had the highest ambulatory blood pressure values and variability, whereas no differences in heart rate were observed. Multiple regression analysis showed that although current weight was the strongest predictor for 24-hour systolic blood pressure (P<0.001), there was also an independent and significant inverse relationship for birth weight (P<0.002) after controlling for gender, current age, and height. Likewise, birth weight was independently and inversely correlated with 24-hour systolic blood pressure variability (P<0.03). In conclusion, children who had lower birth weights tended to have not only the highest blood pressure values but also the highest blood pressure variability, independent of the increases in ambulatory blood pressure values. Knowing that high blood pressure variability is at least partially independent of blood pressure values, the importance of this variability on further blood pressure rises and/or on vascular damage later in life needs to be assessed in future studies.