Network for blood pressure research in children and adolescents (COST Action CA 19115)

High blood pressure is a clearly established modifiable risk factor for cardiovascular and renal disease. Although most of its adverse effects develop in adulthood, it has become clear that high BP is a lifelong problem that can manifest early in life. While few would dispute the importance of taking effective steps to identify and manage this condition in middle-aged and elderly individuals, relatively little attention has been paid to the problem of high BP in children and adolescents. Therefore,the development of actions focused on early childhood, childhood and adolescence and the investigation of the underlying causes of this epidemic are of utmost importance. There is a pressing need for comprehensive pan-European action to increase the knowledge on the prevention, diagnosis and treatment of high blood pressure in children and adolescents, the current scarcity of which impedes the development of consensus across different research fields and hinders efforts to introduce changes in clinical practice. There are some aspects that demand urgent action: the definition of hypertension, the prevalence of high BP in Europe, accurate measurement for early identification, the assessment of hypertension-mediated organ damage and the development and implementation of prevention strategies. In order to provide answers to all of these unanswered questions and challenges, a multidisciplinary network was established, maintained and funded by the European Cooperation in Science and Technology(COST) Association. COST is a funding organization for the creation of research networks known as COST Actions. In this case, the network will promote coordinated and collaborative activities on personalized preventive measures for children and adolescents across Europe. © 2021 Published by Elsevier Espana'-

European Network for blood pressure research in children and adolescents

High blood pressure is a clearly established modifiable risk factor for cardiovascular and renal disease. Although most of its adverse effects develop in adulthood, it has become clear that high BP is a lifelong problem that can manifest early in life. While few would dispute the importance of taking effective steps to identify and manage this condition in middle-aged and elderly individuals, relatively little attention has been paid to the problem of high BP in children and adolescents. Therefore, the development of actions focused on early childhood, childhood and adolescence and the investigation of the underlying causes of this epidemic are of utmost importance. There is a pressing need for comprehensive pan-European action to increase the knowledge on the prevention, diagnosis and treatment of high blood pressure in children and adolescents, the current scarcity of which impedes the development of consensus across different research fields and hinders efforts to introduce changes in clinical practice. There are some aspects that demand urgent action: the definition of hypertension, the prevalence of high BP in Europe, accurate measurement for early identification, the assessment of hypertension-mediated organ damage and the development and implementation of prevention strategies. In order to provide answers to all of these unanswered questions and challenges, a multidisciplinary network was established, maintained and funded by the European Cooperation in Science and Technology (COST) Association. COST is a funding organization for the creation of research networks known as COST Actions. In this case, the network will promote coordinated and collaborative activities on personalized preventive measures for children and adolescents across Europe

Innovations In infant feeding : future challenges and opportunities in obesity and cardiometabolic disease

The field of nutrition in early life, as an e ective tool to prevent and treat chronic diseases, has attracted a large amount of interest over recent years. The vital roles of food products and nutrients on the body's molecular mechanisms have been demonstrated. The knowledge of the mechanisms and the possibility of controlling them via what we eat has opened up the field of precision nutrition, which aims to set dietary strategies in order to improve health with the greatest e ectiveness. However, this objective is achieved only if the genetic profile of individuals and their living conditions are also considered. The relevance of this topic is strengthened considering the importance of nutrition during childhood and the impact on the development of obesity. In fact, the prevalence of global childhood obesity has increased substantially from 1990 and has now reached epidemic proportions. The current narrative review presents recent research on precision nutrition and its role on the prevention and treatment of obesity during pediatric years, a novel and promising area of research

Obesity and Eating Disorders in Children and Adolescents : the Bidirectional Link

Obesity, eating disorders and unhealthy dieting practices among children and adolescents are alarming health concerns due to their high prevalence and adverse effects on physical and psychosocial health. We present the evidence that eating disorders and obesity can be managed or prevented using the same interventions in the pediatric age. In the presence of obesity in the pediatric age, disordered eating behaviors are highly prevalent, increasing the risk of developing eating disorders. The most frequently observed in subjects with obesity are bulimia nervosa and binge-eating disorders, both of which are characterized by abnormal eating or weight-control behaviors. Various are the mechanisms overlying the interaction including environmental and individual ones, and different are the approaches to reduce the consequences. Evidence-based treatments for obesity and eating disorders in childhood include as first line approaches weight loss with nutritional management and lifestyle modification via behavioral psychotherapy, as well as treatment of psychiatric comorbidities if those are not a consequence of the eating disorder. Drugs and bariatric surgery need to be used in extreme cases. Future research is necessary for early detection of risk factors for prevention, more precise elucidation of the mechanisms that underpin these problems and, finally, in the cases requiring therapeutic intervention, to provide tailored and timely treatment. Collective efforts between the fields are crucial for reducing the factors of health disparity and improving public health

Cardiovascular fitness in youth: association with obesity and metabolic abnormalities

[ES] Las terapias que se implantan actualmente para la obesidad se centran en los aspectos nutricionales y sobre la actividad física. Con el fin de hacer que la actividad física sea una terapia positiva en vez de un desencadenador de discapacidades, es relevante evaluar de forma precisa el entrenamiento cardiovascular. Objetivo: evaluar el entrenamiento cardiovascular midiendo el consumo máximo de oxígeno y evaluar su relación con los parámetros cardiometabólicos clásicos. Métodos: se aplicó el protocolo modificado de Balke a 126 individuos caucásicos (60 % de varones), con edades entre 9 y 16 años, que se sometieron a una evaluación de obesidad. El grupo de no obesos consistía de individuos sanos, de la población general, emparejados por edad y sexo y a los que se les invitó a participar. Resultados: se observaron diferencias significativas en el consumo máximo de oxígeno entre los indiviudos obesos y no obesos. Por contra, no existían diferencias significativas entre las categorías de obesidad. Además, en los sujetos obesos, el consumo máximo de oxígeno se correlacionó de forma inversa con los parámetros de riesgo cardiometabólico, particularmente con la insulina y el índice HOMA. Además, se han desarrollado dos ecuaciones predictivas del consumo máximo de oxígeno con una R2 de 0,74 y de 0,84, respectivamente. Conclusión: el consumo máximo de oxígeno es un pará- metro clínico relevante que debería incluirse en la evaluación clínica rutinaria de los sujetos obesos. Por lo tanto, es crucial hacer que las pruebas de esfuerzo sean más asequibles, que puedan alcanzarse empleando las ecuaciones predictivas.[EN] Therapies currently implemented for obesity are focused on nutritional aspects and on physical activity. In order to make physical activity a positive therapy instead of triggering disabilities it is relevant to accurately assess cardiovascular fitness. Objective: To assess the cardiovascular fitness by measuring the peak oxygen consumption and to asses their relationship with classical cardiometabolic parameters. Methods: A modified Balke protocol was applied to one hundred and twenty-six Caucasians (60% males), ranging between 9 and 16 years old, who underwent an assessment of obesity. The non-obese group consisted of healthy age and sex matched subjects who were invited to participate from the general population. Results: Significant differences in consumption of oxygen peak between non-obese and obese individuals were observed. In contrast, no significant differences existed between the categories of obesity. Furthermore in obese subjects consumption of oxygen peak was inversely correlated with parameters of cardiometabolic risk, particularly insulin and HOMA index. In addition, two predictive equations of consumption of oxygen peak, with an R-2 of 0.74 and 0.84, respectively, have been developed. Conclusion: The consumption of oxygen peak is a relevant clinical parameter that should be included in the routine clinical assessment of obese subjects. Therefore, it is crucial to make exercise tests more affordable which can be achieved by employing predictive equations.Guixeres Provinciale, J.; Redón Lurbe, P.; Saiz Rodríguez, FJ.; Alvarez, J.; Torró, MI.; Cantero, L.; Lurbe Ferrer, E. (2014). Cardiovascular fitness in youth: association with obesity and metabolic abnormalities. Nutrición Hospitalaria. 29(6):1290-1297. doi:10.3305/nh.2014.29.6.7383S1290129729

Prevalencia del trastorno por atracón en una muestra clínica de obesos

Introduction: Binge eating disorder is characterized 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, users of a specialized pediatric unit in the treatment of childhood obesity. Material and Methods: A sample had 70 children and adolescents aged 9 to 16, with a mean age of 12 years attending a pediatric ward in the General Hospital of Valencia. To carry out the evaluation the following instruments were used, 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-IVTR, and 14% showed subclinical forms of the diagnosis. Conclusions: The results are in line with previous studies that highlight the necessity of assessing these disorders in specialized units in the treatment of obesity

An electronic system (PDA) to record dietary and physical activity in obese adolescents; data about efficiency and feasibility

Introduction: Recently, the prevalence of childhood obesity is increasing significantly. Dietary and physical activity registers are frequently referred to as the “cornerstone" of behavioral weight control programs. Mobile devices such as Personal Digital Assistants (PDAs) are showing their usefulness to facilitate these self-registers. Objective: This study is aimed to analyze and compare the efficiency and feasibility of a PDA and Paper and Pencil (P&P) registers to record dietary and physical activity in a sample of Spanish adolescents with overweight. Methods: Sample was composed by 30 overweight participants aged 9-15 years seeking for obesity treatment. This is a counterbalance study, all participants completing both experimental conditions: PDA and P&P registers. Results: For dietary records, participants filled out more records using P&P than PDA when “total" number of self-registers was considered, but when “complete" records were taken into account, these differences disappeared, and when percentages of “complete" records were analyzed, PDA produced more accurate registers than P&P. For physical activity, PDA produced more records than P&P. PDA was the preferred system. According to participants, the PDA s strengths are the comfort, easiness to use and to transport. Conclusions: Results showed that P&P produced more incomplete dietary records than PDA. PDA is a reliable system that allows the clinician to be confident in the data recorded. Recently, several applications for mobile devices have been developed, but there are few studies supporting evidence of their efficacy and feasibility in assessment and treatment of childhood obesity. This study tries to provide some evidence in this field.INTRODUCCIÓN: En los últimos años, la prevalencia de la obesidad infantil se ha incrementado de forma significativa. Los registros de ingesta y actividad física son considerados la “piedra angular” de los programas comportamentales de control del peso. Los dispositivos móviles, como las Personal Digital Assistant (PDAs), están mostrando su utilidad en la realización de estos registros. OBJETIVO: El presente estudio tiene como objetivo analizar y comparar la eficiencia y viabilidad de un sistema PDA y un sistema de Lápiz y Papel (P&P) para el registro de ingesta y movimiento físico en una muestra de adolescentes españoles con sobrepeso. MÉTODO: La muestra estuvo compuesta por 30 niños de entre 9 y 15 años con sobrepeso que asisten a un tratamiento para obesidad infantil. Se trata de un estudio contrabalanceado, por lo que los participantes completaron ambas condiciones experimentales: PDA y P&P. RESULTADOS: Considerando los registros de ingesta, cuando se consideran los registros “totales” los participantes realizaron más registros utilizando el sistema P&P que el sistema PDA, pero cuando se consideran los registros “completos”, estas diferencias desaparecieron y al considerar el porcentaje de registros “completos”, el sistema en PDA produjo más registros que el sistema P&P. Respecto a los registros de actividad física, el sistema PDA produjo más registros que el sistema P&P. La PDA fue considerada el sistema preferido por los participantes. De acuerdo con las opiniones de éstos, las potencialidades de la PDA es su comodidad, su facilidad de uso y de transporte. CONCLUSIONES: Los resultados obtenidos indican que el sistema P&P produce mayor cantidad de registros de ingesta incompletos que el sistema en PDA. La PDA es un sistema fiable que permite al clínico confiar en los datos registrados por los niños respecto a la ingesta y a la actividad física. Recientemente, se han desarrollado diversas aplicaciones para llevar a cabo registros en dispositivos móviles, pero aún son escasos los estudios disponibles que avalan la eficacia y viabilidad de estos sistemas para la evaluación y el tratamiento de la obesidad infantil. Este estudio pretende proporcionar evidencia al respeto

Current and birth weights exert independent influences on nocturnal pressure-natriuresis relationships in normotensive children

The objective was to study the impact of birth weight on the relationship between ambulatory blood pressure and urinary sodium excretion in children and adolescents. The study included 134 healthy children (61 boys), all Caucasians, who were born at term after a normotensive pregnancy. For each subject, a 24-hour ambulatory blood pressure monitoring and a complete urine collection were simultaneously performed according to the protocols designed. Average ambulatory blood pressure (BP) and the urinary excretion rates for sodium, potassium, and creatinine were calculated separately for 24-hour, awake, and sleep periods defined by a mini-diary. The excretion rate of sodium during sleep time was positively correlated with ambulatory systolic BP; such a positive relationship was not found for waking hours. Consequently, the impact of birth weight on the relationship between blood pressure and the urinary sodium excretion rate was analyzed during sleeping hours. Stepwise multiple regression analysis shows that although current weight was the strongest predictor for the sodium excretion rate during sleep (P3.500 kg) of birth weight (P<.02). Differences in sodium excretion rates, adjusted for current weight, between the two extreme tertiles of birth weight became significant at the highest systolic BP (P<.04). The children who had the lowest birth weight tended to excrete less sodium during sleep. The results of the present study show a blunted pressure natriuresis curve in children and adolescents with the lowest birth weight. Whether this abnormal renal sodium handling may be present as an initial or as an intermediate mechanism leading to higher BP values must be assessed in additional studies.Lurbe Ferrer, Maria Desamparados, [email protected] ; Redon Mas, Josep, [email protected]

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.Lurbe Ferrer, Maria Desamparados, [email protected] ; Redon Mas, Josep, [email protected]