Medical supervised duodenal-enteral feeding for the treatment of overweight and obesity: MESUDEFT / Nutrición duodenoenteral médicamente supervisada para el tratamiento del sobrepeso y la obesidad: MESUDEFT

Background: the development of specialised nutritional support techniques allows the maintenance of an adequate supply of nutrients in those patients in whom oral feeding is not possible or is insufficient in relation to their requirements, trying to improve the quality of life, especially in those with chronic diseases. Methods: single-center clinical study carried out in a clinical-nutritional center consisting of a medically supervised nasogastric-duodenal tube feeding treatment for overweight, obesity and increased body fat percentage in patients requiring it by means of duodeno-enteral feeding, expecting losses of more than 10 %. Results: twenty-nine patients completed the protocol (20.4 % male and 79.6 % female) with a mean age of 38 years (SD: 12.4); 87.2 kg (SD: 18.5) mean weight; 37.9 kg (SD: 4.8) mean iFat%; 32.4 (SD: 5.4) iMean body mass index (BMI); 100 cm (SD: 16.0) iMean waist; 113.6 cm (SD: 10.4) iMean hip; 33.8 cm (SD: 3.9) iMean upper arm circumference; 65.5 cm (SD: 7.5) iMean thigh circumference; 9.7 (SD: 4.8) iVisceral fat index; and 22.9 days (SD: 13.9) mean treatment. A mean of 22.9 (SD: 13.9) days of MESUDEFT influences weight loss, fat loss, visceral fat loss and decreased arm, hip and thigh circumferences (p < 0.05) (i: initial). Conclusions: MESUDEFT is shown to be an effective alternative as a sole treatment or as an adjunct prior to bariatric surgery for obesity or overweight treatment with a minimum of 10 % loss of BMI and fat mass at completion and 3-6 months follow-up.(AU)

Antecedentes: el desarrollo de técnicas especializadas de soporte nutricional permite mantener un aporte adecuado de nutrientes en aquellos pacientes en los que la alimentación oral no es posible o es insuficiente en relación a sus requerimientos, intentando mejorar la calidad de vida, especialmente de aquellos con enfermedades crónicas. Métodos: estudio clínico unicéntrico prospectivo realizado en un centro clínico-nutricional consistente en un tratamiento con alimentación por sonda nasogástrica-duodenal médicamente supervisado para el sobrepeso, la obesidad y el aumento del porcentaje de grasa corporal en pacientes que lo requieran mediante alimentación duodenoenteral, durante un mes aproximado, con previsión de pérdidas superiores al 10 % y con control posterior entre los tres y los seis meses siguientes. Resultados: veintinueve pacientes completaron el protocolo (20,4 % varones y 79,6 % mujeres) con una edad media de 38 años (DE: 12,4); 87,2 kg (DE: 18,5) iPeso medio; 37,9 kg (DE: 4,8) iGrasa% media; 32,4 (DE: 5,4) iIMC medio; 100 cm (DE: 16,0) iCintura media; 113,6 cm (DE: 10,4) iCadera media; 33,8 cm (DE: 3,9) iCircunferencia braquial media; 65,5 cm (DE: 7,5) circunferencia muslo media; 9,7 (DE: 4,8) iíndice de grasa visceral; y 22,9 días (DE: 13,9) de tratamiento medio. Una media de 22,9 (DE: 13,9) días de MESUDEFT influye en la pérdida de peso, la pérdida de grasa, la pérdida de grasa visceral y la disminución de las circunferencias del brazo, la cadera y el muslo (p < 0,05) (i: inicial). Conclusiones: MESUDEFT se muestra como una alternativa eficaz como tratamiento único o como coadyuvante previo a la cirugía bariátrica de la obesidad o tratamiento del sobrepeso con una pérdida mínima del 10 % del índice de masa corporal (IMC) y de la masa grasa al finalizar y con control durante los siguientes 3-6 meses.(AU)

Medical supervised duodenal-enteral feeding for the treatment of overweight and obesity: MESUDEFT.

BACKGROUND: the development of specialised nutritional support techniques allows the maintenance of an adequate supply of nutrients in those patients in whom oral feeding is not possible or is insufficient in relation to their requirements, trying to improve the quality of life, especially in those with chronic diseases. METHODS: single-center clinical study carried out in a clinical-nutritional center consisting of a medically supervised nasogastric-duodenal tube feeding treatment for overweight, obesity and increased body fat percentage in patients requiring it by means of duodeno-enteral feeding, expecting losses of more than 10 %. RESULTS: twenty-nine patients completed the protocol (20.4 % male and 79.6 % female) with a mean age of 38 years (SD: 12.4); 87.2 kg (SD: 18.5) mean weight; 37.9 kg (SD: 4.8) mean iFat%; 32.4 (SD: 5.4) iMean body mass index (BMI); 100 cm (SD: 16.0) iMean waist; 113.6 cm (SD: 10.4) iMean hip; 33.8 cm (SD: 3.9) iMean upper arm circumference; 65.5 cm (SD: 7.5) iMean thigh circumference; 9.7 (SD: 4.8) iVisceral fat index; and 22.9 days (SD: 13.9) mean treatment. A mean of 22.9 (SD: 13.9) days of MESUDEFT influences weight loss, fat loss, visceral fat loss and decreased arm, hip and thigh circumferences (p < 0.05) (i: initial). CONCLUSIONS: MESUDEFT is shown to be an effective alternative as a sole treatment or as an adjunct prior to bariatric surgery for obesity or overweight treatment with a minimum of 10 % loss of BMI and fat mass at completion and 3-6 months follow-up.

Macronutrients and micronutrients in Spanish adult vegans (Mediterranean population) / Macronutrientes y micronutrientes en adultos veganos españoles (población mediterránea)

OBJECTIVE: studies have been published in Europe comparing the mean macronutrient and micronutrient intake values of the general population with those of the vegan population, but none has been conducted in a country that mainly follows the Mediterranean diet. Therefore, the aim of this study was to carry out this comparison in Spain. METHODS: a cross-sectional study of a sample of Spanish vegans was designed in 2015. To compare the distribution of nutrients with those of the general population, we used data from the Spanish Agency for Food Safety and Nutrition, which was considered to be normally distributed as it was a large population with biological parameters. All participants were asked about their dietary intake for the previous day (24 hour reminder) and the nutrients were calculated using specialized software. The distributions were compared using the Kolmogorov-Smirnov test. RESULTS: the sample comprised 102 vegans, 67 of whom were women. The vegan population consumed more carbohydrates and fiber, less total fat (women only), fewer saturated fatty acids, and more polyunsaturated fatty acids. They had much lower cholesterol intake, lower calcium and iodine intake, higher iron and folic acid intake, and much lower intake of vitamins B12 and D. CONCLUSIONS: Spanish vegans had nutritional deficiencies compared to the general population and should therefore ensure their diet includes the necessary supplements

ANTECEDENTES: se han publicado en Europa estudios que comparan los valores medios de ingesta de macronutrientes y micronutrientes de la población general con los de la población vegana, pero ninguno se ha llevado a cabo en un país que sigue principalmente la dieta mediterránea. Por lo tanto, el objetivo de este estudio fue llevar a cabo esta comparación en España. MÉTODOS: se diseñó un estudio transversal de una muestra de veganos españoles en 2015. Para comparar la distribución de nutrientes con los de la población general, utilizamos datos de la Agencia Española de Seguridad Alimentaria y Nutrición, considerando dichos datos como una distribución normal de parámetros biológicos al constituir una gran muestra. A todos los participantes se les preguntó sobre su ingesta dietética en el día anterior y los nutrientes se calcularon utilizando un software especializado. Las distribuciones se compararon mediante la prueba de Kolmogorov-Smirnov. RESULTADOS: la muestra comprendió 102 veganos, 67 de los cuales eran mujeres. La población vegana consumió más carbohidratos y fibra, menos grasa total (solo mujeres), menos ácidos grasos saturados y más ácidos grasos poliinsaturados. Tenían una ingesta mucho más baja de colesterol, una ingesta más baja de calcio y yodo, una mayor ingesta de hierro y ácido fólico, y una ingesta mucho más baja de vitaminas B12 y D. CONCLUSIÓN: los veganos españoles tenían deficiencias nutricionales en comparación con la población general y, por lo tanto, deben asegurarse de que su dieta incluya los suplementos necesarios

Factors associated with moderate neonatal hyperthyrotropinemia.

BACKGROUND: Maternal iodine deficiency is related to high neonatal thyroid-stimulating hormone (TSH) values, with the threshold of 5 mIU/L recommended as an indicator of iodine nutrition status. The objective of this study was to analyse possible risk factors for increased TSH that could distort its validity as a marker of iodine status. The clinical relevance of this research question is that if the factors associated with iodine deficiency are known, iodine supplementation can be introduced in risk groups, both during pregnancy and in newborns. METHODS: A case-control study was carried out in a sample of 46,622 newborns in 2002-2015 in Spain. Of these, 45,326 had a neonatal TSH value ≥5 mIU/L. The main variable was having TSH ≥5 mIU/L and the secondary variables were: sex, gestational age, day of sample extraction and maternal origin. Associated factors were analysed through a logistic regression model, calculating the odds ratio (OR). RESULTS: The factors associated with this outcome were: male sex (OR = 1.34, 95% CI: 1.20-1.50, p<0.001), originating from an Asian/Oceanic country (OR = 0.80, 95% CI: 0.54-1.20, p = 0.536) or Europe (OR = 0.80, 95% CI: 0.66-0.96, p = 0.285) (including Spain, OR = 1) [p<0.001 for America (OR = 0.54, 95% CI: 0.44-0.68) and p = 0.025 for Africa (OR = 0.78, 95% CI: 0.62-0.97)] and fewer days from birth to sampling (OR = 0.80, 95% CI: 0.77-0.82, p<0.001). CONCLUSIONS: The risk of high neonatal TSH without congenital hypothyroidism is higher in males, decreases with a greater number of days from birth to extraction, and is dependent on maternal ethnicity but not on gestational age.

Factors Influencing the Success of Peripheral Venous Access in Neonates.

PURPOSE: In neonatal units, the use of peripheral venous catheters is a commonly used technique involving risks and local complications. Catheter duration and viability is limited and may involve multiple insertion attempts. Catheterization was considered successful when there were no local complications and the catheter was removed owing to completion of treatment. The aim of the study was to determine the optimal location and instruments to reduce the number of catheter insertion attempts and to increase time without complications. DESIGN AND METHODS: A cross-sectional descriptive study was undertaken to analyze all the catheters inserted in the neonatal intermediate care unit of Vinalopó University Hospital (Elche, Spain). Between 2013 and 2017 the following variables were collected: sex, age, gestational age, and venipuncture site, as well as catheter type, number of insertion attempts, duration and complications. RESULTS: A total of 929 catheters were analyzed with a mean duration of 46.5 ±â€¯33.9 h, and were removed upon completion of treatment (success 38.3%). The preferred site was the dorsal hand (48.2%) followed by the cubital fossa (20.1%). In both sites the success of the catheter and its duration was higher than the mean (42.4%; 43.9% and 49.4 ±â€¯35.7; 50.3 ±â€¯33.4 h respectively). The most frequent complications were extravasation (47.0%) and phlebitis (5.9%). Just one attempt was needed for 63.8% of cannulations of the dorsal hand, followed by 38.9% in the forearm. No significant differences were found in fixation type, sex, weight, gestational age or infusion type (continuous/intermittent). CONCLUSIONS: The success of the technique is low. The preferred insertion sites with fewer complications, longer duration and fewer attempts were the dorsal hand and cubital fossa. With fewer attempts required for cannulation, better results were achieved on the dorsal hand.

[Maternal and infant characteristics associated with obesity in infants under one year of age in northern Mexico]. / Características maternas e infantiles asociadas a obesidad en lactantes menores de un año de edad del norte de México.

INTRODUCTION: despite the fact that childhood obesity is a serious health problem, little is known about its related factors in early childhood. OBJECTIVE: to evaluate which maternal, cognitive and infant factors influence the infant's energy intake and if these influence their nutritional status before the year. METHODS: descriptive study of correlation. Two hundred and sixty-seven dyads (mother/child) participated. The questionnaires consisted of four instruments for the cognitive variables of the mother (maternal self-efficacy, attitude in the diet, perception of signs of hunger, satiety and weight of the child), energy intake through a 24-hour reminder and sociodemographic and anthropometric data of the mother and child, through which maternal body mass index (BMI) and Z-score of infant weight/height have been calculated. RESULTS: the model was significant for the intake of kcal/kg weight (F = 8.624, p < 0.001, R2 = 0.104), negatively correlating with the maternal perception of the weight of the child (B = -9.73, p = 0.002), hours of sleep (B = -2.19, p = 0.044) and age of the child (B = -2.26, p = 0.001). Also for the Z-score (weight/length) (F = 68.979, p < 0.001, R2 = 0.564) and explained positively with perception of the weight of the child (B = 1.133, p < 0.001) and age of the child (B = 0.054, p = 0.006) and negatively with hours of sleep of the mother (B = -0.07, p = 0.040) and caloric intake (B = -0.004, p = 0.027). CONCLUSION: mothers of nursing infants who underestimate their child's weight and sleep fewer hours provide more caloric intake and their children have a higher Z-score weight/length.

INTRODUCCIÓN: a pesar de que la obesidad infantil es un problema de salud serio, poco se sabe de los factores relacionados con esta en la primera infancia.Objetivo: evaluar qué factores maternos, cognitivos y del lactante influyen en la ingesta energética del lactante y si estos a la vez influyen en su estado nutricional antes del año. MÉTODOS: estudio descriptivo de correlación. Participaron 267 diadas (madre/hijo). Los cuestionarios consistieron en cuatro instrumentos para las variables cognitivas de la madre (autoeficacia materna, actitud en la alimentación, percepción sobre señales de hambre, saciedad y peso delhijo), aporte energético mediante recordatorio de 24 horas y datos sociodemográficos y antropométricos de la madre y del niño, mediante losque se han calculado el índice de masa corporal (IMC) materno y Z-score de peso/talla del lactante. RESULTADOS: el modelo fue significativo para la ingesta de kcal/kg peso (F = 8,624; p < 0,001; R2 = 0,104), correlacionando negativamente con la percepción materna del peso del hijo (B = -9,73; p = 0,002), las horas de sueño (B = -2,19; p = 0,044) y la edad del hijo (B = -2,26; p = 0,001). También para el Z-score (peso/longitud) (F = 68,979; p < 0,001; R2 = 0,564), y se explicó de manera positiva con percepción del peso del hijo (B = 1,133; p < 0,001) y edad del hijo (B = 0,054; p = 0,006) y negativamente con horas de sueño de la madre (B = -0,07; p = 0,040) e ingesta calórica (B = -0,004; p = 0,027). CONCLUSIÓN: las madres de hijos lactantes que subestiman el peso de su hijo y duermen menos horas proporcionan más ingesta calórica y sus niños presentan mayor Z-score del peso/longitud.

Características maternas e infantiles asociadas a obesidad en lactantes menores de un año de edad del norte de méxico / Maternal and infant characteristics associated with obesity in infants under one year of age in northern Mexico

Introducción: a pesar de que la obesidad infantil es un problema de salud serio, poco se sabe de los factores relacionados con esta en la primera infancia. Objetivo: evaluar qué factores maternos, cognitivos y del lactante influyen en la ingesta energética del lactante y si estos a la vez influyen en su estado nutricional antes del año. Métodos: estudio descriptivo de correlación. Participaron 267 diadas (madre/hijo). Los cuestionarios consistieron en cuatro instrumentos para las variables cognitivas de la madre (autoeficacia materna, actitud en la alimentación, percepción sobre señales de hambre, saciedad y peso delhijo), aporte energético mediante recordatorio de 24 horas y datos sociodemográficos y antropométricos de la madre y del niño, mediante los que se han calculado el índice de masa corporal (IMC) materno y Z-score de peso/talla del lactante. Resultados: el modelo fue significativo para la ingesta de kcal/kg peso (F = 8,624; p < 0,001; R2 = 0,104), correlacionando negativamente con la percepción materna del peso del hijo (B = -9,73; p = 0,002), las horas de sueño (B = -2,19; p = 0,044) y la edad del hijo (B = -2,26; p = 0,001). También para el Z-score (peso/longitud) (F = 68,979; p < 0,001; R2 = 0,564), y se explicó de manera positiva con percepción del peso del hijo (B = 1,133; p < 0,001) y edad del hijo (B = 0,054; p = 0,006) y negativamente con horas de sueño de la madre (B = -0,07; p = 0,040) e ingesta calórica (B = -0,004; p = 0,027).Conclusión: las madres de hijos lactantes que subestiman el peso de su hijo y duermen menos horas proporcionan más ingesta calórica y sus niños presentan mayor Z-score del peso/longitud

Introduction: despite the fact that childhood obesity is a serious health problem, little is known about its related factors in early childhood. Objective: to evaluate which maternal, cognitive and infant factors influence the infant’s energy intake and if these influence their nutritional status before the year. Methods: descriptive study of correlation. Two hundred and sixty-seven dyads (mother/child) participated. The questionnaires consisted of four instruments for the cognitive variables of the mother (maternal self-efficacy, attitude in the diet, perception of signs of hunger, satiety and weight of the child), energy intake through a 24-hour reminder and sociodemographic and anthropometric data of the mother and child, through which maternal body mass index (BMI) and Z-score of infant weight/height have been calculated. Results: the model was significant for the intake of kcal/kg weight (F = 8.624, p < 0.001, R2 = 0.104), negatively correlating with the maternal perception of the weight of the child (B = -9.73, p = 0.002), hours of sleep (B = -2.19, p = 0.044) and age of the child (B = -2.26, p = 0.001). Also for the Z-score (weight/length) (F = 68.979, p < 0.001, R2 = 0.564) and explained positively with perception of the weight of the child (B = 1.133, p < 0.001) and age of the child (B = 0.054, p = 0.006) and negatively with hours of sleep of the mother (B = -0.07, p = 0.040) and caloric intake (B = -0.004, p = 0.027). Conclusion: mothers of nursing infants who underestimate their child’s weight and sleep fewer hours provide more caloric intake and their children have a higher Z-score weight/length

A scoring system to detect fixed airflow limitation in smokers from simple easy-to-use parameters.

No validated screening method currently exists for Chronic Obstructive Pulmonary Disease (COPD) in smokers. Therefore, we constructed a predictive model with simple parameters that can be applied for COPD screening to detect fixed airflow limitation. This observational cross-sectional study included a random sample of 222 smokers with no previous diagnosis of COPD undertaken in a Spanish region in 2014-2016. The main variable was fixed airflow limitation by spirometry. The secondary variables (COPD factors) were: age, gender, smoking (pack-years and Fagerström test), body mass index, educational level, respiratory symptoms and exacerbations. A points system was developed to predict fixed airflow limitation based on secondary variables. The model was validated internally through bootstrapping, determining discrimination and calibration. The system was then integrated into a mobile application for Android. Fifty-seven patients (25.7%) presented fixed airflow limitation. The points system included as predictors: age, pack-years, Fagerström test and presence of respiratory symptoms. Internal validation of the system was very satisfactory, both in discrimination and calibration. In conclusion, a points system has been constructed to predict fixed airflow limitation in smokers with no previous COPD. This system can be integrated as a screening tool, though it should be externally validated in other geographical regions.

Physical activity values in two- to seven-year-old children measured by accelerometer over five consecutive 24-hour days.

INTRODUCTION: interpretation of accelerometer-derived physical activity in preschool children is confounded by differences in cut-off points. AIM: the purpose of this study was to analyze physical activity in 2-to-7-year-old children to establish reference values for daily activity. METHODS: observational study in children aged 2-7 years, without chronic diseases and whose parents provided informed consent. The main variable was physical activity, measured continuously over 120 hours (three workdays and two weekend days) by accelerometer. Secondary variables were weight status (body mass index [BMI] Z-score) and gender. The relationship between the main variable and secondary variables was determined through the t-test, ANOVA and the Pearson correlation coefficient. A multivariate model was used to obtain the standard deviation (SD) of all possible combinations of values, constructing percentiles of normality (x ± SD and x ± 2·SD). RESULTS: one hundred and thirty-six children (35% of municipality children) were included in the study (54.4% of them were girls). Their weight status distribution was: 25 underweight (18.4%), 54 normal weight (39.7%), 12 risk of overweight (8.8%), 22 overweight (16.2%) and 23 obese (16.8%). The median age was 5.7 years and the mean physical activity was 592 counts/minute. The boys undertook more physical activity (p = 0.031) and the underweight and normal-weight children undertook more physical activity than the overweight and obese children (p = 0.012). There were no significant differences according to age. The multivariate analysis showed significant differences (p < 0.001) according to gender and weight status. In boys, physical activity decreased as weight status increased. In contrast, the girls in the extreme BMI groups obtained higher levels of physical activity. CONCLUSION: overweight and obese preschool children had lower levels of physical activity than normal weight children. Physical activity levels were higher in boys.

Estimation of body fat among 2-to-7-year-old Spanish children by different skinfolds equations and waist-to-height ratio.

INTRODUCTION: It seems relevant to analyze the body composition in the early childhood. However, there is not an agreement in the protocol to assess body composition in this age range/group. OBJECTIVE: To determine the most useful equation to estimate the body fat percentage that preschool children contain and the utility of the waist-to-height ratio to determine abdominal obesity. METHODS: We measured (weight, height, waist circumference and skinfolds) in 285 children aged 2 to 7 years old. BMI Z-Score, waist-to-height ratio and body fat percentage were estimated by Brook and Lukaski, Siri, Goran, Slaughter, Deurenberg, Huang, Dezenberg and Hoffman equations. RESULTS: It was found 26% combined overweight and obesity, with similar distribution in both sexes. The body fat obtained with the Hoffman equation (15.6-31.9%) showed the highest correlation with children BMI Z-Score. Waist-to-height ratio also presented a good relationship with children weight status. There were not significant differences between gender and body fat percentage or waist-to-height ratio. CONCLUSIONS: Hoffman equation and waist-to-height ratio could be adequate to estimate body fat percentage and abdominal obesity respectively in Spanish preschool children from medium-low socioeconomic status.

Estimation of body fat among 2-to-7-year-old Spanish children by different skinfolds equations and waist-to-height ratio / Determinación de grasa corporal en niños españoles de 2 a 7 años mediante diferentes fórmulas de plicometría y el índice cintura-talla

Introduction: It seems relevant to analyze the body composition in the early childhood. However, there is not an agreement in the protocol to assess body composition in this age range/group. Objective: To determine the most useful equation to estimate the body fat percentage that preschool children contain and the utility of the waist-to-height ratio to determine abdominal obesity. Methods: We measured (weight, height, waist circumference and skinfolds) in 285 children aged 2 to 7 years old. BMI Z-Score, waist-to-height ratio and body fat percentage were estimated by Brook and Lukaski, Siri, Goran, Slaughter, Deurenberg, Huang, Dezenberg and Hoffman equations. Results: It was found 26% combined overweight and obesity, with similar distribution in both sexes. The body fat obtained with the Hoffman equation (15.6-31.9%) showed the highest correlation with children BMI Z-Score. Waist-to-height ratio also presented a good relationship with children weight status. There were not significant differences between gender and body fat percentage or waist-to-height ratio. Conclusions: Hoffman equation and waist-to-height ratio could be adequate to estimate body fat percentage and abdominal obesity respectively in Spanish preschool children from medium-low socioeconomic status (AU)

Introducción: parece relevante analizar la composición corporal en la primera infancia. Sin embargo, en este rango de edad no existe un protocolo consensuado para determinar la composición corporal. Objetivo: determinar la fórmula más útil para estimar el porcentaje de grasa corporal contenido en niños preescolares y la utilidad del índice cintura-talla para determinar la obesidad abdominal. Métodos: medimos (peso, talla, circunferencia abdominal y pliegues cutáneos) a 285 niños de 2 a 7 años. Se estimaron el Z Score de IMC, el índice cintura-talla y el porcentaje de grasa corporal mediante las fórmulas de Brook y Lukaski, Siri, Goran, Slaughter, Deurenberg, Huang, Dezenberg y Hoffman. Resultados: se halló un 26% de prevalencia combinada de sobrepeso y obesidad, con distribución similar entre sexos. El porcentaje de grasa corporal obtenido con la fórmula de Hoffman (15,6-31,9%) mostró la mayor correlación con el Z-Score del IMC. El índice cintura-talla también presentó una buena relación con el estado nutricional de los niños. No hubo diferencias significativas entre el sexo y el porcentaje de grasa corporal o el índice cintura-talla. Conclusiones: la fórmula de Hoffman y el índice cintura-talla podrían ser adecuados para estimar el porcentaje de grasa corporal y la obesidad abdominal respectivamente, en preescolares españoles de nivel socioeconómico medio-bajo (AU)

A simple equation to estimate body fat percentage in children with overweightness or obesity: a retrospective study.

BACKGROUND: Dual-energy X-ray absorptiometry (DXA) provides separate measurements of fat mass, fat-free mass and bone mass, and is a quick, accurate, and safe technique, yet one that is not readily available in routine clinical practice. Consequently, we aimed to develop statistical formulas to predict fat mass (%) and fat mass index (FMI) with simple parameters (age, sex, weight and height). METHODS: We conducted a retrospective observational cross-sectional study in 416 overweight or obese patients aged 4-18 years that involved assessing adiposity by DXA (fat mass percentage and FMI), body mass index (BMI), sex and age. We randomly divided the sample into two parts (construction and validation). In the construction sample, we developed formulas to predict fat mass and FMI using linear multiple regression models. The formulas were validated in the other sample, calculating the intraclass correlation coefficient via bootstrapping. RESULTS: The fat mass percentage formula had a coefficient of determination of 0.65. This value was 0.86 for FMI. In the validation, the constructed formulas had an intraclass correlation coefficient of 0.77 for fat mass percentage and 0.92 for FMI. CONCLUSIONS: Our predictive formulas accurately predicted fat mass and FMI with simple parameters (BMI, sex and age) in children with overweight and obesity. The proposed methodology could be applied in other fields. Further studies are needed to externally validate these formulas.

Mortality after out-of-hospital cardiac arrest in a Spanish Region.

AIMS: To determine out-of-hospital cardiac arrest mortality in the province of Alicante (Spain) and its associated factors. METHODS: Cross-sectional observational study of all patients who received cardiopulmonary resuscitation (CPR) by the Emergency Medical Services (EMS) (n = 422) in the province of Alicante in 2013. To determine associated factors, a binary logistic regression model was constructed. Primary outcome: death before arriving at the hospital. Predictive variables: gender, age, artificial respiration, prior functional status, asystole, cardiogenic aetiology, bystander CPR, time from the cardiac arrest to the arrival of the EMS and location of cardiac arrest. RESULTS: There were 337 deaths (79.9%; 95% CI: 76.0-83.7%). Factors independently associated (p<0.05) with death were: male gender (OR = 2.11; 95% CI: 1.20-3.72; p = 0.010), asystole (OR = 1.99, 95% CI: 1.17-3.39; p = 0.012), cardiac arrest at home (OR = 2.44; 95% CI: 1.42-4.18; p = 0.001) and an increased time between arrest and EMS arrival (OR = 1.05, 95% CI: 1.01-1.09, p = 0.009). Having a worse prior functional status had a tendency towards significance (OR = 0.56, 95% CI: 0.31-1.02, p = 0.059). CONCLUSIONS: Mortality was high. The associated factors were: male gender, asystole, worse prior functional status, longer time from the cardiac arrest to the arrival of the EMS and having the cardiac arrest at home. The clearly negative impact of experiencing a cardiac arrest at home necessitates modifying training policies in Spain. These policies should be focused on providing information about CPR in schools in order to decrease the mortality of these events.

Impact of prematurity and immigration on neonatal screening for sickle cell disease.

BACKGROUND: Others have described a relationship between hemoglobin A levels and gestational age, gender and ethnicity. However, studies are needed to determine normal cut-off points considering these factors. To address this issue we designed a study to determine the percentiles of normality of neonatal hemoglobin A levels taking these factors into account. METHODS: This cross-sectional study involved 16,025 samples for sickle cell disease screening in the province of Alicante, Spain, which has a high immigration rate. The primary variable was hemoglobin A, and the secondary variables were gender, gestational age (preterm and full term) and maternal origin (Spain, the rest of Europe, North Africa, Sub-Saharan Africa, Latin America and Asia). Percentiles of normality (1 and 99) were obtained by origin, gender and gestational age using quantile regression models and bootstrap samples. The association between these percentiles of normality and altered levels (≥1%) of hemoglobin E was analyzed. We obtained the percentiles of normality (1 and 99) for each maternal origin, gender and gestational age. RESULTS: Of a total of 88 possible E carriers, 65 had above-normal hemoglobin A levels (74%). The levels of normality for hemoglobin A varied greatly according to the maternal origin and gestational age. CONCLUSION: With the levels of normality that we established it is possible to discard samples with unrecorded blood transfusions. Our methodology could be applied to other diseases in the neonatal screening.

Multivariate Analysis of Thyrotropin in Preterm Newborns Based on Adequacy of Weight for Gestational Age.

BACKGROUND: Different and conflicting data have been published concerning thyrotropin (TSH) levels among small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) newborns. The hypothesis of this study was that SGA preterm infants have higher TSH levels than those who are not underweight do. METHODS: This cross-sectional study analyzed the TSH levels of all preterm newborns with a negative congenital hypothyroidism screening result (TSH <7.5 µIU/mL). Secondary variables were sex, birth weight (SGA, AGA), days of life at blood extraction, maternal origin, gestational age, and being a twin or not. Two multiple linear regression models were constructed comparing TSH levels in SGA and AGA or the z-score for birth weight and the remaining variables. RESULTS: A sample including 5819 preterm infants was obtained: 53.8% male, 23.3% twins, and 3.3% SGA. TSH concentrations were 2.16 ± 2.0 µIU/mL for the SGA infants and 1.80 ± 1.5 µIU/mL for the AGA infants (p = 0.012), with a negative correlation (p < 0.001) between TSH levels and the z-score for the weight of the newborn. The multivariate analysis comparing TSH levels between SGA and AGA gave the following: SGA (B = 0.46, p < 0.001), Latin American mother (B = -0.16, p = 0.029), days of life at blood extraction (B = -0.26, p < 0.001), and gestational age ≤28 weeks (B = -0.56, p < 0.001). Using the z-score for the weight, the associations were: maternal origin North Africa (B = 0.19, p = 0.042), days of life at blood extraction (B = -0.27, p < 0.001), gestational age ≤28 weeks (B = -0.55, p < 0.001), and z-score for weight (B = -0.12, p < 0.001). CONCLUSIONS: Our multivariate analysis suggests that TSH concentrations are higher in SGA infants than they are in AGA infants, and this should be taken into account when establishing a reference interval appropriate for this population. The clinical relevance remains unknown, but lines of research are opened that may allow a better understanding of the long-term morbidities in these newborns.

Fear of becoming pregnant among female healthcare students in Spain.

The inconsistent use of hormonal contraceptive methods can result, during the first year of use, in one in twelve women still having an undesired pregnancy. This may lead to women experiencing fear of becoming pregnant (FBP). We have only found one study examining the proportion of FBP among women who used hormonal contraceptives. To gather further scientific evidence we undertook an observational, cross-sectional study involving 472 women at a Spanish university in 2005-2009. The inclusion criteria were having had vaginal intercourse with a man in the previous three months and usual use for contraception of a male condom or hormonal contraceptives, or no method of contraception. The outcome was FBP. The secondary variables were contraceptive method used (oral contraceptives; condom; none), desire to increase the frequency of sexual relations, frequency of sexual intercourse with the partner, the sexual partner not always able to ejaculate, desire to increase the partner's time before orgasm, age and being in a stable relationship. A multivariate logistic regression model was used to determine the associated factors. Of the 472 women, 171 experienced FBP (36.2%). Factors significantly associated (p < 0.05) with this FBP were method of contraception (condom and none), desire to increase the partner's ability to delay orgasm and higher frequency of sexual intercourse with the partner. There was a high proportion of FBP, depending on the use of efficient contraceptive methods. A possible solution to this problem may reside in educational programmes. Qualitative studies would be useful to design these programmes.

Highest Plasma Phenylalanine Levels in (Very) Premature Infants on Intravenous Feeding; A Need for Concern.

OBJECTIVE: To analyse the association in newborns between blood levels of phenylalanine and feeding method and gestational age. STUDY DESIGN: This observational, cross-sectional study included a sample of 11,829 infants between 2008 and 2013 in a Spanish region. Data were recorded on phenylalanine values, feeding method [breast, formula, mixed (breast plus formula), or partial or fully intravenous feeding], gestational age in weeks (<32, 32-37, ≥37), gender and days since birth at the moment of blood collection. Outcomes were [phenylalanine] and [phenylalanine] ≥95th percentile. Associations were analysed using multivariate models [linear (means difference) and logistic regression (adjusted odds ratios)]. RESULTS: Higher phenylalanine values were associated with lower gestational age (p<0.001) and with intravenous feeding (p<0.001). CONCLUSION: The degree of prematurity and intravenous feeding influenced the plasma concentration of phenylalanine in the newborn. Caution should be taken in [phenylalanine] for newborns with intravenous feeding, monitoring them carefully. Very preterm infants given the recommended amount of amino acids should also be strictly monitored. These findings should be taken into consideration and call for adapting the amounts to the needs of the infant.

[EVALUATION OF GYM USERS' DIET WITH MUSCLE DYSMORPHIA (BIGOREXIA)]. / VALORACIÓN DE LA DIETA DE USUARIOS DE SALA DE MUSCULACIÓN CON DISMORFIA MUSCULAR (VIGOREXIA).

OBJECTIVE: it is an innovative study where has been analyzed the diet among gym users with Muscle Dysmorphia (MD) of gyms in the province of Alicante. METHODOLOGY: it have been analyzed 141 male gymnasts of several gyms of Alicante (urban area of southeastern Spanish) aged between 18-45 years old, who purpose increasing their muscle mass. Were considered BMI (kg/m2) and 24 hour diet. And it has been determined whether or not suffer MD trough Muscle Appearance Satisfaction Scale. RESULTS: the sample consisted of 141 men, of whom 45 are MD and 96 are not according to Muscle Appearance Satisfaction. Protein intake was calculated and was greater than 1.5 g/kg/day in patients without MD and greater than 2 g/kg/day in the MD group. Analyzing the other nutrients, results show that the proportion of carbohydrates and fats and their percentages by degree of instauration are within the recommendations except cholesterol which exceeds and the amount of dietary fiber that is slightly lower. In relation to micronutrients are within the recommendations in all cases except iodine which is slightly lower in MD. CONCLUSION: individuals with MD do a balanced energy and adequate carbohydrate and fat diet, however protein intake values exceed the limits proposed according to the scientific evidence for muscle mass development in strength sports.

Objetivo: se muestra un estudio novedoso en el cual se ha analizado la dieta entre usuarios de gimnasio de la provincia de Alicante que padecen dismorfia muscular (DM). Metodología: se analizaron 141 gimnastas varones de varias salas de musculación de Alicante (zona urbana del sureste español) de edad entre 18-45 años, que persiguen el aumento de su masa muscular. Se tuvieron en cuenta el IMC (kg/m2) y la dieta realizada durante 24 horas. Y se ha determinado si padecían o no DM, a través de la Escala de satisfacción muscular. Resultados: la muestra está constituida por 141 varones, de los cuales 45 padecen DM y 96 no, según la Escala de satisfacción muscular. Se calculó el consumo de proteínas, siendo superior a 1,5 g/kg/día en el grupo sin DM y superior a 2 g/kg/día en el grupo con DM. Al analizar los demás macronutrientes los resultados indican que la proporción de hidratos de carbono, grasas y sus porcentajes según grado de insaturación están dentro de las recomendaciones, excepto el colesterol, que las supera, y la cantidad de fibra, que es ligeramente inferior. En relación a los micronutrientes en todos los casos están dentro de las recomendaciones excepto en el caso del yodo, que en los DM es ligeramente inferior. Conclusión: los individuos con DM realizan una dieta normocalórica y adecuada en hidratos de carbono y lípidos; sin embargo, los valores de proteína ingerida exceden los límites propuestos según la evidencia científica para el desarrollo de masa muscular en los deportes de fuerza.

Valoración de la dieta de usuarios de sala de musculación con dismorfia muscular (vigorexia) / Evaluation of gym users' diet with muscle dysmorphia (bigorexia)

Objetivo: se muestra un estudio novedoso en el cual se ha analizado la dieta entre usuarios de gimnasio de la provincia de Alicante que padecen dismorfia muscular (DM). Metodología: se analizaron 141 gimnastas varones de varias salas de musculación de Alicante (zona urbana del sureste español) de edad entre 18-45 años, que persiguen el aumento de su masa muscular. Se tuvieron en cuenta el IMC (kg/m2 ) y la dieta realizada durante 24 horas. Y se ha determinado si padecían o no DM, a través de la Escala de satisfacción muscular. Resultados: la muestra está constituida por 141 varones, de los cuales 45 padecen DM y 96 no, según la Escala de satisfacción muscular. Se calculó el consumo de proteínas, siendo superior a 1,5 g/kg/día en el grupo sin DM y superior a 2 g/kg/día en el grupo con DM. Al analizar los demás macronutrientes los resultados indican que la proporción de hidratos de carbono, grasas y sus porcentajes según grado de insaturación están dentro de las recomendaciones, excepto el colesterol, que las supera, y la cantidad de fibra, que es ligeramente inferior. En relación a los micronutrientes en todos los casos están dentro de las recomendaciones excepto en el caso del yodo, que en los DM es ligeramente inferior. Conclusión: los individuos con DM realizan una dieta normocalórica y adecuada en hidratos de carbono y lípidos; sin embargo, los valores de proteína ingerida exceden los límites propuestos según la evidencia científica para el desarrollo de masa muscular en los deportes de fuerza (AU)

Objective: it is an innovative study where has been analyzed the diet among gym users with Muscle Dysmorphia (MD) of gyms in the province of Alicante. Methodology: it have been analyzed 141 male gymnasts of several gyms of Alicante (urban area of southeastern Spanish) aged between 18-45 years old, who purpose increasing their muscle mass. Were considered BMI (kg/m2 ) and 24 hour diet. And it has been determined whether or not suffer MD trough Muscle Appearance Satisfaction Scale. Results: the sample consisted of 141 men, of whom 45 are MD and 96 are not according to Muscle Appearance Satisfaction. Protein intake was calculated and was greater than 1.5 g/kg/day in patients without MD and greater than 2 g/kg/day in the MD group. Analyzing the other nutrients, results show that the proportion of carbohydrates and fats and their percentages by degree of instauration are within the recommendations except cholesterol which exceeds and the amount of dietary fiber that is slightly lower. In relation to micronutrients are within the recommendations in all cases except iodine which is slightly lower in MD. Conclusion: individuals with MD do a balanced energy and adequate carbohydrate and fat diet, however protein intake values exceed the limits proposed according to the scientific evidence for muscle mass development in strength sports (AU)

[Systolic pressure, abdominal obesity and body fat, metabolic syndrome predictors in Spanish preschoolers]. / PRESIÓN SISTÓLICA, OBESIDAD ABDOMINAL Y GRASA CORPORAL, PREDICTORES DEL SÍNDROME METABÓLICO EN PREESCOLARES ESPAÑOLES.

OBJECTIVE: The aim of this paper is to determine the presence of metabolic syndrome predictors in 2-to-7- year-old children according to nutrition state. METHOD: A descriptive study with quantitative analysis was conducted in 260 2-to-7-year-old children (135 girls and 125 boys), 66% of the total census. Anthropometric parameters and blood pressure were measured and BMI, body fat by Hoffman and waist-to-height ratio (ICT) were calculated. Subgroups according BMI Z-Score by age and gender (low weight, normal weight, overweight and obesity), body fat (normal and excess), ICT (normal and abdominal obesity) and systolic pressure (normotensive and hypertensive by age and gender) were performed. BMI Z-Score classification was primary endpoint used. RESULTS: Combined prevalence of overweight and obesity was 27%, with no difference by sex. Nutritional state was significantly associated with blood pressure, body fat and abdominal obesity as waist-to-height ratio. Higher percentage of obese children had high systolic blood pressure versus normal weight children (OR = 4.1; 95% CI 1.7-9.8; p <0.001). Higher hypertension risk was found in abdominal obesity group (OR = 84.4, 95% CI 17.8-194.0; p <0.001). ICT correlates with groups of systolic blood pressure (p <0.001). Distribution by ICT is consistent with the BMI Z-Score ones, increasing abdominal obesity with BMI (in 96.8% of obese match both criteria). CONCLUSION: A direct relation between overweight and obesity with hypertension, body fat and abdominal obesity in preschoolers is presented. It is showed the validity of accessible anthropometric (ICT and body fat percentage) to study metabolic syndrome risk factors.

Se plantea como objetivo determinar la presencia de predictores de síndrome metabólico en niños de 2 a 7 años en relación a su estado nutricional. Método: Estudio descriptivo con análisis cuantitativo en 260 niños de 2-7 años (135 niñas y 125 niños), 66% del total censados. Se midieron parámetros antropométricos y tensión arterial y se calcularon IMC, grasa corporal según Hoffman e índice cintura-talla (ICT). Se realizaron subgrupos con Z-Score del IMC según edad y sexo (bajo peso, normopeso, sobrepeso y obesidad), según grasa corporal (normal y con exceso), ICT (normal y obesidad abdominal) y tensión sistólica (normotensos e hipertensos según edad y sexo). Se utilizó como variable principal la clasificación según Z-Score del IMC. Resultados: La prevalencia combinada de sobrepeso y obesidad fue del 27%, sin diferencias por sexo. El estado nutricional relacionó significativamente con tensión arterial, grasa corporal e índice cintura-talla. Mayor porcentaje de obesos con tensión arterial sistólica alta que de normonutridos (OR=4.1; IC95% 1.7-9.8; p.