Association of Neck Circumference with Anthropometric Indicators and Body Composition Measured by DXA in Young Spanish Adults

Background: Due to a clinical and public health interest of neck circumference (NC), a better understanding of this simple anthropometric measurement, as a valid marker of body composition is necessary. Methods: A total of 119 young healthy adults participated in this study. NC was measured over the thyroid cartilage and perpendicular to the longitudinal axis of the neck. Body weight, height, waist circumference (WC), and hip circumference were measured. A Dual X-ray absorptiometry (DXA) scan was used to determine fat mass, lean mass, and visceral adipose tissue (VAT). Additionally, body mass index (BMI) and triponderal mass index (TMI), the waist to hip and waist to height ratios, and the fat mass and lean mass indexes (FMI and LMI, respectively) were calculated. Results: NC was positively associated in women (W) and men (M), with BMI (rW = 0.70 and rM = 0.84, respectively), TMI (rW = 0.63 and rM = 0.80, respectively), WC (rW = 0.75 and rM = 0.86, respectively), VAT (rW = 0.74 and rM = 0.82, respectively), Waist/hip (rW = 0.51 and rM = 0.67, respectively), Waist/height (rW = 0.68 and rM = 0.83, respectively) and FMI (rW = 0.61 and rM = 0.81, respectively). The association between NC and indicators of body composition was however weaker than that observed by BMI, TMI, WC and Waist/height in both women and men. It is of note that in women, NC was associated with FMI, VAT and LMI independently of BMI. In men, adding NC to anthropometric variables did not improve the prediction of body composition, while slight improvements were observed in women. Conclusions: Taken together, the present study provides no indication for NC as a useful proxy of body composition parameters in young adults, yet future studies should explore its usefulness as a measure to use in combination with BMI, especially in women.This study was supported by the Spanish Ministry of Economy and Competitiveness Grants (DEP2016-79512-R and PTA 12264-I), Fondo de Investigación Sanitaria del Instituto de Salud Carlos III (PI13/01393), and Retos de la Sociedad (DEP2016-79512-R), Fondos Estructurales de la Unión Europea (FEDER), by the Spanish Ministry of Education (FPU 13/04365), by the Fundación Iberoamericana de Nutrición (FINUT), by the Redes temáticas de investigación cooperativa RETIC (Red SAMID RD16/0022), by AstraZeneca HealthCare Foundation and by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Scientific Unit of Excellence on Exercise and Health (UCEES), Plan Propio de Investigación 2018: Programa Contratos-Puente and Programa Perfeccionamiento de Doctores, by the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades, the European Regional Development Funds (ref. SOMM17/6107/UGR), by the Fundación Alfonso Martín Escudero, and by the Fundación Carolina (C.2016-574961). This study is part of a Ph.D. Thesis conducted in the Biomedicine Doctoral Studies of the University of Granada, Spain

Associations of dietary energy density with body composition and cardiometabolic risk in children with overweight and obesity: role of energy density calculations, under-reporting energy intake and physical activity

This study examined (1) the association of dietary energy density from solid (EDS) and solid plus liquids (EDSL) with adiposity and cardiometabolic risk factors (CRF) in children with overweight and obesity, (2) the effect of under-reporting on the mentioned associations and (3) whether the association between ED and body composition and CRF is influenced by levels of physical activity. In a cross-sectional design, 208 overweight and obese children (8-12-year-old; 111 boys) completed two non-consecutive 24 h recalls. ED was calculated using two different approaches: EDS and EDSL. Under-reporters were determined with the Goldberg method. Body composition, anthropometry and fasting blood sample measurements were performed. Moderate to vigorous physical activity (MVPA) was registered with accelerometers (7-d-register). Linear regressions were performed to evaluate the association of ED with the previously mentioned variables. Neither EDS nor EDSL were associated with body composition or CRF. However, when under-reporters were excluded, EDS was positively associated with BMI (P=0 019), body fat percentage (P=0 005), abdominal fat (P=0 008) and fat mass index (P=0 018), while EDSL was positively associated with body fat percentage (P=0 008) and fat mass index (P=0 026). When stratifying the group according to physical activity recommendations, the aforementioned associations were only maintained for non-compliers. Cluster analysis showed that the low-ED and high-MVPA group presented the healthiest profile for all adiposity and CRF. These findings could partly explain inconsistencies in literature, as we found that different ED calculations entail distinct results. Physical activity levels and excluding under-reporters greatly influence the associations between ED and adiposity in children with overweight and obesity.The research leading to these results has received funding from la Caixa Foundation and Triptolemos Foundation, the Ministry of Health (FIS PI081297), the Research Network on Preventative Activities and Health Promotion (RD06/0018/ 0038), the Henning and Johan Throne-Holst Foundation (F. B. O.), the Spanish Ministry of Education, Culture and Sport (FPU14/03329 to M. M.), the Spanish Ministry of Economy and Competitiveness (DEP2013-47540 and DEP2016-78377-R; BES-2014-068829 to C. C.-S.), Fondo de Investigacion Sanitaria del Instituto de Salud Carlos III (PI13/01335), Fondos Estructurales de la Union Europea (FEDER), Una manera de hacer Europa, the Spanish Ministry of Science and Innovation (RYC-2011-09011 to F. B. O.), the University of Granada, Plan Propio de Investigacion 2016, Excellence Actions: Units of Excellence, Unit of Excellence on Exercise and Health (UCEES), Programa de Captacion de Talento - UGR Fellows (L. G.-M.), the SAMID III network, RETICS (PN I +D+ I 2017-2021). This study has been partially funded by the University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES), and by the Junta de Andalucia, Consejeria de Conocimiento, Investigacion y Universidades and European Regional Development Fund (ERDF), reference SOMM17/6107/UGR. ISCIII-Sub-Directorate General for Research Assessment and Promotion, the European Regional Development Fund (RD16/ 0022), the EXERNET Research Network on Exercise and Health in Special Populations (DEP2005-00046/ACTI), and the University of the Basque Country (GIU14/21). J. M.-G. is supported by the Spanish Ministry of Education, Culture and Sport (FPU14/06837). J. H. M. is supported by the Spanish Ministry of Education, Culture and Sport (FPU15/02645)

Rol de la actividad física, condición física y ejercicio sobre la conducta alimentaria en adultos

Appetite, eating behavior, and dietary intake are regulated by a complex neuropsychobiological system. Several physiological factors and both internal and external stimuli converge on food consumption and food preference, as well as the relationship with food. A dysregulation in this system can lead to physical health problems. It is of clinical interest to identify how the behavioral dimension of appetite control interacts with physical activity, fitness and exercise in adults. The aims of this Doctoral Thesis were: i) To examine the association between eating behavior traits and the time spent in physical activity of different intensities and sedentary behavior (study I); ii) To study the effect of a 6-month exercise intervention on eating behavior traits (study I); iii) To explore the association between eating behavior traits and physical fitness in young adults and (study II); iv) To validate the cultural adaptation of the Leeds Food Preference Questionnaire (LFPQ) in the Spanish population (study III). The results of section 1 show that binge eating, uncontrolled eating and emotional eating assessed by self-reported questionnaires are inversely related to sedentary behavior and directly associated with time spent in physical activity, objectively measured by triaxial accelerometry, in young healthy adults. However, these eating traits were not modified after a 6-month exercise training program of different intensities in this population (study I). Additionally, we found that poorer muscular strength is related to greater cognitive restraint, while greater cardiorespiratory fitness is associated with higher scores on binge eating and uncontrolled eating in young healthy adults (study II). On the other hand, in section 2, we have acquired a series of valid food images for use in future research on food reward in different contexts (study III). The results of this Doctoral Thesis contribute to the knowledge about the interaction of eating behavior in healthy young adults in the context of physical activity, fitness and exercise. In addition, it provides tools to improve an instrument for measuring food reward components in the Spanish population.El apetito, la conducta alimentaria y la ingesta dietética están regulados por un complejo sistema neuropsicobiólogico. Diversos factores fisiológicos y estímulos tanto internos como externos confluyen sobre el consumo, preferencia de alimentos, asi como con la relación con la comida. Un desregulación en este sistema puede llevar a problemas de salud física. Es de interés clínico identificar cómo la dimensión comportamental del control del apetito interacciona con la actividad fisica, condifición fisica y el ejercicio en adultos. Los objetivos de la presente Tesis Doctoral fueron: i) examinar la asociación entre rasgos de la conducta alimentaria y el tiempo dedicado a la actividad física de diferentes intensidades y al comportammiento sedentario (estudio I); ii) estudiar el efecto de una intervención de ejercicio de 6 meses sobre los rasgos de la conducta alimentaria (estudio I); iii) explorar la asociación entre los rasgos de la conducta alimentaria y la condición física en adultos jóvenes (estudio II) y, iv) validar la adaptación cultural del Cuestionario de Preferencia de Alimentos de Leeds (LFPQ) a la población española (estudio III). Los resultados de la sección 1 muestran que los atracones, la ingesta descontrolada y la ingesta emocional evaluados a través de cuestionarios autoreportados, están inversamente relacionados con el comportamiento sedentario y directamente asociados con el tiempo dedicado a la actividad física, medido objetivamente por acelerometría triaxial, en adultos jóvenes sanos. Sin embargo, estos rasgos alimentarios no se modificaron despues de un programa de entrenamiento físico de 6 meses de diferentes intensidades en esta población (estudio I). Además, encontramos que una menor fuerza muscular está relacionada con una mayor restricción cognitiva, mientras que una mayor condición cardiorespiratoria se asocia con puntuaciones más altas en atracones y alimentación descontrolada en adultos jóvenes sanos (estudio II). Por otro lado, en la sección 2, hemos adquirido una serie de imágenes alimentarias válidas para su uso en futuras investigaciones sobre la recompensa alimentaria en diferentes contextos (estudio III). Los resultados de esta Tesis Doctoral contribuyen al conocimiento sobre la interacción de la conducta alimentaria en adultos jóvenes sanos en el contexto de la actividad fisica, la condición física y el ejercicio. Además, proporciona herramientas para mejorar un instrumento de medición de los componentes de la recompensa alimentaria en la población española.Tesis Univ. Granada.Consejo Nacional de Ciencia y Tecnología de México (CONACYT) - 440575Spanish Ministry of Economy and Competitiveness (PTA 12264)Fondo de Investigación Sanitaria del Instituo de Salud Carlos III (PI13/01393).Retos de la Sociedad (DEP2016-79512-R), Fondos Estructurales de la Unión Europea (FEDER)Spanish Ministry of Education (FPU 13/04365, 14/04172, 15/04059)Fundación Iberoamericana de Nutrición (FINUT)Redes temáticas de investigación cooperative RETIC (Red SAMID RD16/0022)AstraZeneca Helathcare FoundationUniversity of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London