EVIDENT 3 Study: A randomized, controlled clinical trial to reduce inactivity and caloric intake in sedentary and overweight or obese people using a smartphone application: Study protocol.

INTRODUCTION: Mobile technology, when included within multicomponent interventions, could contribute to more effective weight loss. The objective of this project is to assess the impact of adding the use of the EVIDENT 3 application, designed to promote healthy living habits, to traditional modification strategies employed for weight loss. Other targeted behaviors (walking, caloric-intake, sitting time) and outcomes (quality of life, inflammatory markers, measurements of arterial aging) will also be evaluated. METHODS: Randomized, multicentre clinical trial with 2 parallel groups. The study will be conducted in the primary care setting and will include 700 subjects 20 to 65 years, with a body mass index (27.5-40 kg/m), who are clinically classified as sedentary. The primary outcome will be weight loss. Secondary outcomes will include change in walking (steps/d), sitting time (min/wk), caloric intake (kcal/d), quality of life, arterial aging (augmentation index), and pro-inflammatory marker levels. Outcomes will be measured at baseline, after 3 months, and after 1 year. Participants will be randomly assigned to either the intervention group (IG) or the control group (CG). Both groups will receive the traditional primary care lifestyle counseling prior to randomization. The subjects in the IG will be lent a smartphone and a smartband for a 3-month period, corresponding to the length of the intervention. The EVIDENT 3 application integrates the information collected by the smartband on physical activity and the self-reported information by participants on daily food intake. Using this information, the application generates recommendations and personalized goals for weight loss. DISCUSSION: There is a great diversity in the applications used obtaining different results on lifestyle improvement and weight loss. The populations studied are not homogeneous and generate different results. The results of this study will help our understanding of the efficacy of new technologies, combined with traditional counseling, towards reducing obesity and enabling healthier lifestyles. ETHICS AND DISSEMINATION: The study was approved by the Clinical Research Ethics Committee of the Health Area of Salamanca ("CREC of Health Area of Salamanca") on April 2016. A SPIRIT checklist is available for this protocol. The trial was registered in ClinicalTrials.gov provided by the US National Library of Medicine-number NCT03175614.

Trends in cardiometabolic parameters among Spanish children from 2006 to 2010: The Cuenca study.

OBJECTIVE: The aim of this study was to examine the trends in cardiometabolic risk factors among schoolchildren in Cuenca, Spain, from 2006 to 2010. METHODS: Data were taken from two cross-sectional surveys conducted in 2006 and 2010 among schoolchildren aged 8-12 years from 20 public schools in the province of Cuenca. The final sample consisted of 2148 participants with measured anthropometric variables, biochemical assessment, and blood pressure. RESULTS: We observed an increase in mean serum total cholesterol (8.5 mg/dL and 10.7 mg/dL), LDL-cholesterol (13.7 mg/dL and 17.3 md/dL), triglycerides (3.6 mg/dL and 2.6 md/dL), fasting insulin (1.2 µU/mL and 0.3 µU/mL) and HOMA-IR (0.2 and 0.02) and a decrease in mean serum HDL-cholesterol (4.4 mg/dL and 5.7 mg/dL), systolic blood pressure (3.8 mmHg and 5.4 mmHg) and diastolic blood pressure (0.8 mmHg and 2.0 mmHg) in both sexes. In girls, mean arterial pressure (3.2 mmHg) also decreased in this period. In addition, we found an increase in the prevalence of adverse total cholesterol concentration (≥200 mg/dL) (7.8% and 8.9%), HDL-cholesterol concentration (<40 mg/dL) (1.9% in boys and 3.5% in girls) and LDL cholesterol concentration (≥130mg/dL) (4.8% and 5.8%) in boys and girls, respectively. CONCLUSIONS: There has been a worsening of the lipid profile in schoolchildren from Cuenca, independent of weight status and age.

Effectiveness of multifactorial interventions in primary health care settings for primary prevention of cardiovascular disease: A systematic review of systematic reviews.

OBJECTIVE: To evaluate the effectiveness of multifactorial interventions carried out in the community setting to decrease cardiovascular risk in healthy patients. METHODS: Systematic review of the MEDLINE (via PubMed), Web of Science and Cochrane Library databases from January 1980 to January 2014. Identified for inclusion were systematic reviews of clinical trials that included multifactorial interventions carried out in primary care or community settings, targeting more than one cardiovascular risk factor, and implementing more than one type of intervention. The methodological quality of the included articles was evaluated using the AMSTAR tool. RESULTS: Eight systematic reviews were selected, including 219 studies. All of these reviews provided information about the effectiveness of multifactorial interventions in reducing mortality and morbidity due to cardiovascular diseases. Four reviews reported moderate effectiveness and four showed limited effectiveness. CONCLUSION: Multifactorial community interventions improve cardiovascular risk factors and have a small but potentially important effect on mortality. These interventions seem to be more effective in the at-risk population and when they are carried out at a high level of intensity.

Gender differences on effectiveness of a school-based physical activity intervention for reducing cardiometabolic risk: a cluster randomized trial.

BACKGROUND: Studies that have examined the impact of a physical activity intervention on cardiometabolic risk factors have yielded conflicting results. The objective of this study was to assess the impact of a standardized physical activity program on adiposity and cardiometabolic risk factors in schoolchildren. METHODS: Cluster randomized trial study of 712 schoolchildren, 8-10 years, from 20 public schools in the Province of Cuenca, Spain. The intervention (MOVI-2) consisted of play-based and non-competitive activities. MOVI-2 was conducted during two 90-minute sessions on weekdays and one 150-minute session on Saturday mornings every week between September 2010 and May 2011. We measured changes in adiposity (overweight/obesity prevalence, body mass index [BMI], triceps skinfold thickness [TST], body fat %, fat-free mass, waist circumference) and other cardiometabolic risk factors (LDL-cholesterol, triglycerides/HDL-cholesterol ratio, insulin, C-reactive protein and blood pressure). The analyses used mixed regression models to adjust for baseline covariates under cluster randomization. RESULTS: Among girls, we found a reduction of adiposity in intervention versus control schools, with a decrease in TST (-1.1 mm; 95% confidence interval [CI] -2.3 to -0.7), body fat % (-0.9%; 95% CI -1.3 to -0.4), waist circumference (-2.7 cm; 95% CI -4.5 to -0.9), and an increase in fat-free mass (0.3 kg; 95% CI 0.01 to 0.6). The intervention also led to lower serum LDL-cholesterol and insulin levels. Among boys, a reduction in waist circumference (-1.4 cm; 95% CI -2.6 to -0.1; P = 0.03), and an increase in fat-free mass (0.5 kg; 95% CI 0.2 to 0.9; P = 0.003) was associated with the intervention versus control schools. The prevalence of overweight/obesity or underweight, BMI, and other cardiometabolic risk factors was not modified by the intervention. No important adverse events were registered. CONCLUSIONS: An extracurricular intervention of non-competitive physical activity during an academic year, targeting all schoolchildren regardless of body weight, is a safe and effective measure to reduce adiposity in both genders and to improve cardiometabolic risk profile in girls. TRIAL REGISTRATION: Clinical trials NCT01277224.

Trends in excess of weight, underweight and adiposity among Spanish children from 2004 to 2010: the Cuenca Study.

OBJECTIVE: To examine the trends in BMI and adiposity among schoolchildren from Cuenca, Spain, during 2004-2010. DESIGN: Two methodologically comparable surveys were carried out in 2004 and 2010. SETTING: Primary schools in Cuenca, a province in the middle of Spain. SUBJECTS: All schoolchildren aged 8-11 years, belonging to 4th and 5th grades from twenty schools in the Province of Cuenca, were invited to participate in both cross-sectional studies. Weight, height and body fat percentage (BF%) from bioelectrical impedance were measured with standardized procedures. RESULTS: The study included 550 boys and 539 girls in 2004, and 569 boys and 531 girls in 2010. In 2010, 8.1 % of children were underweight, 25.9 % overweight and 9.5 % obese. From 2004 to 2010, the prevalence of overweight rose from 21.6 % to 28.0 % (P = 0.004) and BF % increased from 22.6 % to 24.0 % (P = 0.001) among boys. No change was observed in overweight and BF % in girls, or in underweight and obesity in either sex. In boys, most of the distribution of BMI and BF % shifted to the right; in contrast, among girls no substantial change was apparent in the distribution of BMI and BF %. CONCLUSIONS: From 2004 to 2010 the prevalence of overweight and adiposity has continued to increase among boys. However, the obesity epidemic may have levelled off in girls. Given that the prevalence of childhood excess weight is still very high, the current evidence-based efforts to halt the obesity epidemic in Spain should be strengthened.

Protocolo de un ensayo aleatorizado de clusters para evaluar la efectividad del programa MOVI-2 en la prevención del sobrepeso en escolares / Protocol of a randomized cluster trial to assess the effectiveness of the MOVI-2 program on overweight prevention in schoolchildren

Introducción y objetivos. Se ha demostrado que el programa MOVI de actividad física recreativa durante los días lectivos reduce la adiposidad y mejora el perfil lipídico en escolares. Sin embargo, puede que la mayor actividad física durante la semana se compensara con mayor sedentarismo en el fin de semana, de forma que MOVI no alcanzara toda su efectividad potencial. Por ello diseñamos el programa MOVI-2, que también incluye actividad física durante el fin de semana. Se comunican la justificación y los métodos de un ensayo sobre la efectividad de MOVI-2 en la prevención del sobrepeso y la reducción del riesgo cardiovascular en 1.200 escolares de cuarto y quinto curso de primaria en Cuenca. Métodos. Se asigna aleatoriamente a 10 colegios al programa MOVI-2 y 10 colegios al grupo de control. MOVI-2 consiste en actividad física recreativa en horario extraescolar, con dos sesiones de 90 min en días lectivos y una sesión de 150 min los sábados, durante cada semana de un curso académico. Se espera que el grupo control mantenga la actividad física habitual. Las variables principales, que se miden en cada niño al inicio y final de MOVI-2, son: peso y talla, perímetro de cintura, pliegue cutáneo tricipital, porcentaje de grasa corporal, presión arterial, perfil lipídico y resistencia a la insulina. Las variables secundarias son: actividad física realizada, condición física, calidad de vida y del sueño, rendimiento académico, disfrute con la actividad física y autoconcepto físico. Conclusiones. Este estudio informará de si MOVI-2 supera algunas limitaciones potenciales de las intervenciones de actividad física en escolares (número Clinicaltrials.gov, NCT01277224) (AU)

Introduction and objectives. The MOVI physical activity program has been shown to reduce adiposity and to improve serum lipid profiles in schoolchildren. However, MOVI may have not achieved its maximum potential effectiveness, as increased physical activity on weekdays may have been offset by more sedentary behavior at weekends. We therefore developed the MOVI-2 program, which includes physical activity at weekends as well. This paper reports the rationale and methods of a trial to assess the effectiveness of MOVI-2 in preventing overweight and reducing cardiovascular risk in 1200 4th- and 5th-grade primary schoolchildren in Cuenca, Spain. Methods. Ten schools were randomly assigned to MOVI-2 and 10 schools to the control group. MOVI-2 consisted of recreational physical activity in after-school time, including two 90-min sessions on weekdays and one 150-min session on Saturdays, during each week of one academic year. The control group was expected to follow their usual patterns of physical activity. The primary end points, which were assessed at the start and the end of the MOVI-2 program, were weight and height, waist circumference, skinfold thickness, percentage of body fat, blood pressure, lipid profile, and insulin resistance. Secondary end points were physical activity, fitness, health-related quality of life, sleep quality, academic performance, enjoyment with physical activity, and physical self-concept. Conclusions. This study will assess whether MOVI-2 overcomes some potential limitations of physical activity interventions in children (Clinicaltrials.gov number NCT01277224) (AU)

Protocol of a randomized cluster trial to assess the effectiveness of the MOVI-2 program on overweight prevention in schoolchildren.

INTRODUCTION AND OBJECTIVES: The MOVI physical activity program has been shown to reduce adiposity and to improve serum lipid profiles in schoolchildren. However, MOVI may have not achieved its maximum potential effectiveness, as increased physical activity on weekdays may have been offset by more sedentary behavior at weekends. We therefore developed the MOVI-2 program, which includes physical activity at weekends as well. This paper reports the rationale and methods of a trial to assess the effectiveness of MOVI-2 in preventing overweight and reducing cardiovascular risk in 1200 4th- and 5th-grade primary schoolchildren in Cuenca, Spain. METHODS: Ten schools were randomly assigned to MOVI-2 and 10 schools to the control group. MOVI-2 consisted of recreational physical activity in after-school time, including two 90-min sessions on weekdays and one 150-min session on Saturdays, during each week of one academic year. The control group was expected to follow their usual patterns of physical activity. The primary end points, which were assessed at the start and the end of the MOVI-2 program, were weight and height, waist circumference, skinfold thickness, body fat percentage, blood pressure, lipid profile, and insulin resistance. Secondary end points were physical activity, fitness, health-related quality of life, sleep quality, academic performance, enjoyment with physical activity, and physical self-concept. CONCLUSIONS: This study will assess whether MOVI-2 overcomes some potential limitations of physical activity interventions in children (Clinicaltrials.gov number NCT01277224).

Coste-efectividad de un programa de actividad física de tiempo libre paraprevenir el sobrepeso y la obesidad en niños de 9-10 años / Cost-effectiveness of an intervention to reduce overweight and obesity in 9-10-year-olds. The Cuenca study

Objetivos: Analizar el coste-efectividad de una intervención de actividad física de tiempo libre diseñada para reducir el sobrepeso, la obesidad y otros factores de riesgo cardiovascular en escolares. Métodos: Se realiza un análisis de coste-efectividad desde la perspectiva social e institucional de un ensayo de campo aleatorizado por cluster en 10 colegios de intervención (691 niños) y 10 de control (718 niño). Se calculan los costes netos como la diferencia entre los costes del programa y las posible salternativas. La efectividad se mide como la reducción en las medidas de salud frente al grupo de control. Resultados: El coste total de la intervención se estima en 125.469,75D , 269,83D por año y ni˜no. Losescolares del grupo de intervención mostraron un descenso del grosor del pliegue cutáneo tricipital(−1,25mm; intervalo de confianza del 95% [IC95%]: −1,82 a −0,67; p < 0,001) y del porcentaje de grasacorporal (−0,59%; IC95%: −1,03 a −0,67; p < 0,001) en los escolares con índice de masa corporal (IMC)entre los percentiles 25 y 75, y un descenso del grosor del pliegue cutáneo tricipital (−1,87mm; IC95%−3,43 a −0,32; p = 0,01) y del porcentaje de grasa corporal (−0,67%; IC95%: −1,32 a −0,01; p = 0,05) en los escolares con IMC > P75.Conclusiones: Realizar programas de actividad física como la intervención objeto de estudio es una forma coste-efectiva de prevenir la obesidad y de hacer un uso rentable de los fondos públicos (AU)

Objective: To assess the cost-effectiveness a school-based intervention designed to reduce overweight/obesity and other cardiovascular risk factors in children. Methods: Standard cost effectiveness analysis methods and two perspectives (societal and institutional)were used. A cluster-randomized controlled trial with 10 intervention schools (691 children) and 10control schools (718 children) was performed. Net costs were calculated by subtracting the usual after schoolcare cost from intervention costs. The effectiveness of the intervention was measured as the reduction in health outcomes compared with the control group.Results: The intervention costs totaled 125,469.75D , representing 269.83 D /year/child. The usual after schoolcare was estimated at 844,56 D /year/child. Intervention children showed a decrease in tricepsskinfold thickness (−1.25mm, 95% CI: −1.82 to −0.67; P < .001). Intervention children with body massindex (BMI) between the percentiles 25 and 75 showed a decrease in the percentage of body fat (−0.59%;95% CI: −1.03 to −0.67; P < .001), and those with a BMI > P75 showed a decrease in triceps skinfold thickness(−1.87mm; 95%CI: −3.43 to −0.32; P < .001), and percentage of body fat (−0.67%; 95%CI: −1.32 to−0.01; P < .05).Conclusions: This type of after-school program for recreational physical activity to prevent obesity are likely to be a cost-effective use of public funds and warrant careful consideration by policy makers and program planners (AU)

[Cost-effectiveness of an intervention to reduce overweight and obesity in 9-10-year-olds. The Cuenca study]. / Coste-efectividad de un programa de actividad física de tiempo libre para prevenir el sobrepeso y la obesidad en niños de 9-10 años.

OBJECTIVE: To assess the cost-effectiveness a school-based intervention designed to reduce overweight/obesity and other cardiovascular risk factors in children. METHODS: Standard cost effectiveness analysis methods and two perspectives (societal and institutional) were used. A cluster-randomized controlled trial with 10 intervention schools (691 children) and 10 control schools (718 children) was performed. Net costs were calculated by subtracting the usual after-school care cost from intervention costs. The effectiveness of the intervention was measured as the reduction in health outcomes compared with the control group. RESULTS: The intervention costs totaled 125,469.75€, representing 269.83 €/year/child. The usual after-school care was estimated at 844,56 €/year/child. Intervention children showed a decrease in triceps skinfold thickness (-1.25mm, 95% CI: -1.82 to -0.67; P<.001). Intervention children with body mass index (BMI) between the percentiles 25 and 75 showed a decrease in the percentage of body fat (-0.59%; 95% CI: -1.03 to -0.67; P<.001), and those with a BMI>P75 showed a decrease in triceps skinfold thickness (-1.87mm; 95%CI: -3.43 to -0.32; P<.001), and percentage of body fat (-0.67%; 95%CI: -1.32 to -0.01; P<.05). CONCLUSIONS: This type of after-school program for recreational physical activity to prevent obesity are likely to be a cost-effective use of public funds and warrant careful consideration by policy makers and program planners.

Impact of an after-school physical activity program on obesity in children.

OBJECTIVE: To assess the impact of a 2-year recreational physical activity program in 1044 fourth- and fifth-grade primary schoolchildren from the Province of Cuenca, Spain. STUDY DESIGN: Cluster-randomized controlled trial with 10 intervention and 10 control schools. The program consisted of 3 90-minute sessions of physical activity per week,during 28 weeks every year.Changes in endpoints between baseline (September 2004) and the end of follow-up (June 2006) were compared between the control and intervention group by using mixed regression models, with adjustment for the baseline endpoint value, age, and the school. RESULTS: Compared with control subjects, intervention girls reduced the frequency of overweight (odds ratio, 0.55; 95% CI, 0.39-0.78; P<.001). However, intervention was associated with an increase in the percentage of body fat in boys (0.97%; 95% CI, 0.14-1.81; P=.02). Girls in the intervention group had lower total cholesterol level (-6.86 mg/dL; 95% CI, -9.70--4.01; P<.001) and apolipoprotein B level (-3.61 mg/dL; 95% CI, -6.27--0.95; P=.008) than control subjects. Results were similar in boys. CONCLUSION: In 2 years, the physical activity program lowered the frequency of overweight in girls and reduced total cholesterol and apolipoprotein B in both girls and boys.

Trends in excess weight and thinness among Spanish schoolchildren in the period 1992-2004: the Cuenca study.

BACKGROUND: In developed countries, there is abundant information on the epidemic of childhood obesity, but only a few studies on trends in the dual burden of body weight (overweight and thinness). OBJECTIVE: To examine trends in overweight and thinness among 9-10-year-old Spanish children in the last decade. METHODS: Data were taken from cross-sectional studies on schoolchildren in Cuenca (Spain), conducted in 1992, 1996, 1998 and 2004 with similar methods. Weight and height were measured by trained personnel with standardized procedures. Overweight (including obesity) and thinness were defined according with the International Obesity Taskforce BMI cut-offs. RESULTS: The overall prevalence of overweight increased from 24.4% in 1992 to 30.9% in 2004 (P = 0.07), rising from 21.2% in 1992 to 32.0% in 2004 (P = 0.03) among boys and from 27.7% to 29.8% (P = 0.67) among girls. The overall prevalence of thinness was 2.7% in 1992 and 9.2% in 2004 (P < 0.001); in the same period, thinness prevalence rose from 1.9% to 9.0% (P = 0.10) among boys and from 3.7% to 9.5% (P < 0.01) among girls. CONCLUSIONS: The dual burden of body weight has increased among children in Cuenca in the last decade. Population-based policies addressing childhood obesity, which is the most frequent problem, should not increase the risk of thinness.

Entonces de la Investigación, ni hablamos / Then, about the research, we don´t speak

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[Prevalence of obesity and trends in cardiovascular risk factors among Spanish school children, 1992-2004: the Cuenca (Spain) study]. / Prevalencia de obesidad y tendencia de los factores de riesgo cardiovascular en escolares de 1992 a 2004: estudio de Cuenca.

BACKGROUND AND OBJECTIVE: The assess the prevalence of overweight and obesity in school children from the province of Cuenca in 2004, and to examine changes in the main cardiovascular risk factors in school children from the city of Cuenca from 1992 through 2004. SUBJECTS AND METHOD: Cross sectional survey of 1166 schoolchildren 9-10 years old from 22 public schools of the province of Cuenca. We also analyzed data from 3 earlier, methodologically similar, cross-sectional surveys of school children from the city of Cuenca carried out in 1992, 1996 and 1998. RESULTS: In 2004, among children aged 9-10 years from the province of Cuenca, 22.0% (95% confidence interval [CI], 19.53-24.37) were overweight and 8.8% (95% CI, 7.16-10.50) were obese. From 1992 through 2004, among children aged 9-10 years from the city of Cuenca, we registered a 12.2% absolute increase in the prevalence of overweight or obesity among males, which did no reach statistical significance (p > 0.05). Among women, changes in body mass index were of lower magnitude and with no statistical significance. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased (p < 0.05) in both sexes, with a greater decline in females. Among the latter, SBP decreased -9.22 mmHg (95% CI, -7.0 to -11.5) and DBP -5.9 mmHg (95% CI, -4.23 to -7.50). Non high density lipoproteins-cholesterol decreased among males (-18.1 mg/dl; 95% CI, -26.0 to -10.1 mg/dl) and among females (-23.7 mg/dl; 95% CI, -30.8 to -16.6 mg/dl). High density lipoproteins-cholesterol increased 6.3 mg/dl (95% CI, 2.6-10.0 mg/dl) in males and 5.1 mg/dl (95% CI, 1.9-8.2 mg/dl) in females. Triglycerides did not show substantial changes over the study period. CONCLUSIONS: Prevalence of overweight or obesity in schoolchildren of Cuenca is among the highest in Europe. From 1992 through 2004 in the city of Cuenca, frequency of overweight or obesity might have increased among males, while blood pressure and the lipid profile improved in both sexes.

Prevalencia de obesidad y tendencia de los factores de riesgo cardiovascular en escolares de 1992 a 2004: estudio de Cuenca / Prevalence of obesity and trends in cardiovascular risk factors among Spanish school children, 1992-2004: the Cuenca (Spain) study

Fundamento y objetivo: El propósito del presente estudio ha sido estimar la prevalencia de sobrepeso y obesidad en escolares de la provincia de Cuenca en el año 2004, así como examinar los cambios del índice de masa corporal (IMC), presión arterial sistólica (PAS) y diastólica (PAD) y lípidos plasmáticos en escolares de la ciudad de Cuenca desde 1992 hasta 2004. Sujetos y método: Se realizó un estudio transversal en 1.116 niños de 9-10 años de edad de 22 colegios públicos de la provincia de Cuenca en 2004. Además, se analizaron los resultados de 3 estudios transversales llevados a cabo con el mismo método en 1992, 1996 y 1998 en colegios de dicha ciudad. Resultados: En el año 2004, en escolares de 9-10 años de edad de la provincia de Cuenca, el 22,0% (intervalo de confianza [IC] del 95%, 19,5-24,4) tenía sobrepeso y el 8,8% (IC del 95%, 7,2-10,5), obesidad. En el período 1992-2004, en escolares de 9-10 años de edad de la ciudad de Cuenca, los niños registraron un aumento absoluto del 12,2% en la prevalencia de sobrepeso más obesidad, que no alcanzó la significación estadística (p > 0,05). En las niñas los cambios en el IMC fueron de menor magnitud y no significativos estadísticamente. Se observaron descensos (p < 0,05) en la presión arterial sistólica (PAS) y la presión arterial diastólica (PAD) en ambos sexos, que fueron mayores en las niñas. En ellas, el descenso de la PAS fue de ­9,2 mmHg (IC del 95%, de ­7,0 a ­11,5) y el de la PAD de ­5,9 mmHg (IC del 95%, de ­4,2 a ­7,5). También se observó la disminución del colesterol no unido a lipoproteínas de alta densidad, que en los niños fue de ­18,1 mg/dl (IC del 95%, de ­26,0 a ­10,1 mg/dl) y en las niñas de ­23,7 mg/dl (IC del 95%, de ­30,8 a ­16,6 mg/dl). El colesterol unido a lipoproteínas de alta densidad aumentó 6,3 mg/dl (IC del 95%, 2,6-10,0 mg/dl) en los niños y 5,1 mg/dl (IC del 95%, 1,9-8,2 mg/dl) en las niñas. Los triglicéridos no se modificaron sustancialmente. Conclusiones: La prevalencia de sobrepeso u obesidad en escolares de la provincia de Cuenca es de las más altas de Europa. En el período 1992-2004, en la ciudad de Cuenca, la frecuencia de sobrepeso u obesidad puede haber aumentado en los varones, mientras que la presión arterial y el perfil lipídico han mejorado en ambos sexos

Background and objective: The assess the prevalence of overweight and obesity in school children from the province of Cuenca in 2004, and to examine changes in the main cardiovascular risk factors in school children from the city of Cuenca from 1992 through 2004. Subjects and method: Cross sectional survey of 1166 schoolchildren 9-10 years old from 22 public schools of the province of Cuenca. We also analyzed data from 3 earlier, methodologically similar, cross-sectional surveys of school children from the city of Cuenca carried out in 1992, 1996 and 1998. Results: In 2004, among children aged 9-10 years from the province of Cuenca, 22.0% (95% confidence interval [CI], 19.53-24.37) were overweight and 8.8% (95% CI, 7.16-10.50) were obese. From 1992 through 2004, among children aged 9-10 years from the city of Cuenca, we registered a 12.2% absolute increase in the prevalence of overweight or obesity among males, which did no reach statistical significance (p > 0.05). Among women, changes in body mass index were of lower magnitude and with no statistical significance. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased (p < 0.05) in both sexes, with a greater decline in females. Among the latter, SBP decreased ­9.22 mmHg (95% CI, ­7.0 to ­11.5) and DBP ­5.9 mmHg (95% CI, ­4.23 to ­7.50). Non high density lipoproteins-cholesterol decreased among males (­18.1 mg/dl; 95% CI, ­26.0 to ­10.1 mg/dl) and among females (­23.7 mg/dl; 95% CI, ­30.8 to ­16.6 mg/dl). High density lipoproteins-cholesterol increased 6.3 mg/dl (95% CI, 2.6-10.0 mg/dl) in males and 5.1 mg/dl (95% CI, 1.9-8.2 mg/dl) in females. Triglycerides did not show substantial changes over the study period. Conclusions: Prevalence of overweight or obesity in schoolchildren of Cuenca is among the highest in Europe. From 1992 through 2004 in the city of Cuenca, frequency of overweight or obesity might have increased among males, while blood pressure and the lipid profile improved in both sexes

[Obesity prevalence and tracking of body mass index after a 6 years follow up study in children and adolescents: the Cuenca Study, Spain]. / Prevalencia de la obesidad y mantenimiento del estado ponderal tras un seguimiento de 6 años en niños y adolescentes: estudio de Cuenca.

BACKGROUND: The goals of this study were to estimate the prevalence of overweight and obesity in schoolchildren of Cuenca a Spanish city, and to track down both conditions over 6 years. METHOD: The follow-up study of cardiovascular risk factors began in 1992 with a cross-sectional survey of 307 children aged 9-12 years old who were recruited in three public schools. On a second survey in 1998, we examined schoolchildren of the 1992 cohort as well as 9-13 years-old schoolchildren from the same public schools. Besides socio-demographics variables, we determined weight, height and body mass index (BMI). Individuals were classified as having normal weight, overweight and obesity, according to criteria of the International Obesity Task Force. RESULTS: Prevalence of overweight was 26.6%, and that of obesity was 3.9%. Overweight and obesity were more frequent in women that in men (not statistically significant differences).Spearman's correlation coefficient in the cohort followed-up between 1992 and 1998 regarding BMI was 0.72. Intra-class correlation coefficient between BMI percentile in 1992 and 1998 was 0.78. Relative risk of overweight and obesity in 1998 for individuals who had overweight or obesity in 1992 was 2.9 (95% CI, 2.21-4.04). CONCLUSIONS: Prevalence of overweight and obesity in schoolchildren of Cuenca is among the highest reported so far. BMI increased from the pre-pubertal through the post-pubertal period.

Prevalencia de la obesidad y mantenimiento del estado ponderal tras un seguimiento de 6 años en niños y adolescentes: estudio de Cuenca / Obesity prevalence and tracking of body mass index after a 6 years follow up study in children and adolescents: the Cuenca Study, Spain

FUNDAMENTO: Estimar la prevalencia de sobrepeso y obesidad en escolares de Cuenca, y examinar el mantenimiento del estado ponderal a lo largo de 6 años. MÉTODO: Estudio de seguimiento de factores de riesgo cardiovascular, iniciado en 1992 con un estudio transversal en 307 escolares de 9 a 12 años de edad pertenecientes a tres colegios públicos de Cuenca. En 1998 se examinaron los escolares de 9 a 13 años de edad de los mismos colegios públicos y los alumnos de 14 a 17 años que ya participaron en el estudio de 1992.Además de variables de carácter sociodemográfico, se determinaron el peso, la talla y el índice de masa corporal (IMC), clasificando a los individuos por estado ponderal como normopeso sobrepeso y obesidad según los criterios del International Obesity Task Force. RESULTADOS: La prevalencia de sobrepeso fue del 26,6 por ciento, y la de la obesidad del 3,9 por ciento. La prevalencia, tanto de sobrepeso como de obesidad, fue mayor en mujeres que en varones, sin que las diferencias alcanzaran significación estadística. En la cohorte de seguimiento, el coeficiente de correlación de Spearman entre el IMC de 1992 y el de 1998 fue 0,72. El coeficiente de correlación intraclase entre el percentil del IMC en 1992 y en 1998 fue de 0,78. El riesgo relativo de los que presentaban sobrepeso u obesidad en 1992 de continuar en este estado ponderal en 1998 fue de 2,9 (intervalo de confianza del 95 por ciento, 2,21-4,04). CONCLUSIONES: La prevalencia de sobrepeso y obesidad en los escolares de Cuenca es de las más altas publicadas hasta ahora en Europa. El grado de mantenimiento del estado ponderal entre la edad prepuberal y la edad pospuberal es alto. (AU)

Agregación entre hermanos de factores de riesgo cardiovascular: estudio de Cuenca / Sib-sib correlations of cardiovascular risk factors: the Cuenca study (Spain)

Fundamento: Estimar la agregación entre hermanos de los factores de riesgo cardiovascular. Sujetos y método: Segundo estudio transversal incluido en un seguimiento de factores de riesgo cardiovascular en escolares. Se incluyeron 115 parejas de hermanos seleccionadas entre los escolares de la cohorte del estudio de Cuenca y sus hermanos en edad escolar. Se determinaron variables sociodemográficas, peso, talla, índice de masa corporal, presión arterial sistólica y diastólica, concentración plasmática en ayunas de colesterol total, cLDL, cHDL, triglicéridos, apolipoproteínas A-I y B100 y lipoproteína (a). Resultados: Los coeficientes de correlación parcial entre hermanos de las concentraciones plasmáticas de lípidos y lipoproteínas, ajustados por edad e índice de masa corporal, presentan valores positivos bastante elevados en general, con valores entre 0,27 para los triglicéridos y 0,48 para el cHDL, resultando estadísticamente significativos (p 0,05). Conclusiones: Se evidencia una notable asociación entre las concentraciones plasmáticas de lípidos entre hermanos, observándose diferencias según el sexo de las parejas, lo que lleva a pensar en una herencia genética ligada al sexo de estos valores lipídicos. También se aprecia una asociación, aunque más débil, de los valores del índice de masa corporal. Por último, la agregación entre hermanos de los valores de presión arterial en nuestro estudio se muestra bastante débil. (AU)