The effect of a multicomponent intervention on steatosis is partially mediated by the reduction of intermuscular abdominal adipose tissue in children with overweight or obesity: the EFIGRO Project

OBJECTIVE: In adults, there is evidence that improvement of metabolic-associated fatty liver disease (MAFLD) depends on the reduction of myosteatosis. In children, in whom the prevalence of MAFLD is alarming, this muscle-liver crosstalk has not been tested. Therefore, we aimed to explore whether the effects of a multicomponent intervention on hepatic fat is mediated by changes in intermuscular abdominal adipose tissue (IMAAT) in children with overweight/obesity. RESEARCH DESIGN AND METHODS: A total of 116 children with overweight/obesity were allocated to a 22-week family-based lifestyle and psychoeducational intervention (control group, n = 57) or the same intervention plus supervised exercise (exercise group, n = 59). Hepatic fat percentage and IMAAT were acquired by MRI at baseline and at the end of the intervention. RESULTS: Changes in IMAAT explained 20.7% of the improvements in hepatic steatosis (P < 0.05). Only children who meaningfully reduced their IMAAT (i.e., responders) had improved hepatic steatosis at the end of the intervention (within-group analysis: responders -20% [P = 0.005] vs. nonresponders -1.5% [P = 0.803]). Between-group analysis showed greater reductions in favor of IMAAT responders compared with nonresponders (18.3% vs. 0.6%, P = 0.018), regardless of overall abdominal fat loss. CONCLUSIONS: The reduction of IMAAT plays a relevant role in the improvement of hepatic steatosis after a multicomponent intervention in children with overweight/obesity. Indeed, only children who achieved a meaningful reduction in IMAAT at the end of the intervention had a reduced percentage of hepatic fat independent of abdominal fat loss. Our findings suggest that abdominal muscle fat infiltration could be a therapeutic target for the treatment of MAFLD in childhood.This project was funded by the Spanish Ministry of Health's Fondos de Investigación Sanitaria del Instituto de Salud Carlos III (PI13/01335), the Spanish Ministry of the Economy Industry and Competitiveness (DEP2016-78377-R), and by European Regional Development Funds (ERDF): Una Manera de Hacer Europa. Support was also provided by the Regional Government of Navarra's Department of Economic Development (0011-1365-2019-000152 & 0011-1365-2020-000243), co-funded by European Regional Development Funds (ERDF 2014-2020 for Navarra). CC-S is supported by the Spanish Ministry of Science and Innovation (FJC2018-037925-I). MM is supported by Junta de Andalucía and European Union (SNGJ Ref-8025). MO is supported by the Spanish Ministry of Economy and Competitiveness (BES-2017-080770). This study was supported by the University of Granada Plan Propio de Investigación 2021 -Excellence actions: Unit of Excellence on Exercise, Nutrition and Health (UCEENS)- and the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades, European Regional Development Funds (ref. SOMM17/6107/UGR)

Prevention of diabetes in overweight/obese children through a family based intervention program including supervised exercise (PREDIKID project): study protocol for a randomized controlled trial

Background: The global pandemic of obesity has led to an increased risk for prediabetes and type-2 diabetes (T2D). The aims of the current project are: (1) to evaluate the effect of a 22-week family based intervention program, including supervised exercise, on insulin resistance syndrome (IRS) risk in children with a high risk of developing T2D and (2) to identify the profile of microRNA in circulating exosomes and in peripheral blood mononuclear cells in children with a high risk of developing T2D and its response to a multidisciplinary intervention program including exercise. Methods: A total of 84 children, aged 8-12 years, with a high risk of T2D will be included and randomly assigned to control (N = 42) or intervention (N = 42) groups. The control group will receive a family based lifestyle education and psycho-educational program (2 days/month), while the intervention group will attend the same lifestyle education and psycho-educational program plus the exercise program (3 days/week, 90 min per session including warm-up, moderate to vigorous aerobic activities, and strength exercises). The following measurements will be evaluated at baseline prior to randomization and after the intervention: fasting insulin, glucose and hemoglobin A1c; body composition (dual-energy X-ray absorptiometry); ectopic fat (magnetic resonance imaging); microRNA expression in circulating exosomes and in peripheral blood mononuclear cells (MiSeq; Illumina); cardiorespiratory fitness (cardiopulmonary exercise testing); dietary habits and physical activity (accelerometry). Discussion: Prevention and identification of children with a high risk of developing T2D could help to improve their cardiovascular health and to reduce the comorbidities associated with obesity.The Spanish Ministry of Industry and Competitiveness (DEP2016-78377-R), by “Fondos Estructurales de la Unión Europea (FEDER), Una manera de hacer Europa.” and by the University of the Basque Country (GIU14/21). This work was also supported by grants from Spanish Ministry of Economy and Competitiveness (RYC-2010-05957; RYC- 2011-09011), Spanish Ministry of Education, Culture and Sports (FPU14/ 03329) and by the Education, Linguistic Policy and Culture Department of the Government of the Basque Country (PRE_2016_1_0057)

Fire Safety Strategies to Reduce Mortality in Dwellings Occupied by Elderly People: The Spanish Case

77% of fatal fires in Spain take place in residential buildings, and more than 60% of deaths are people over 65 years old. The collection of fire loss data in Spain is poorly regulated and it does not have homogeneity. This makes it extremely difficult to study the fire problem and the effectiveness of different safety strategies in general, and more specifically with relation to vulnerable groups, such as the elderly. As first step to assess the measures aimed to reduce mortality in residential buildings, a methodology for collecting fire data has been developed, based on information extracted from the media. Information on 289 fatal dwelling fires has been systematically analyzed in order to identify the prevention and protection strategies more effective to prevent fire deaths. Among the identified measures, they stand out the installation of fire detection and alarm systems in residential buildings, which is not required by law at the present time, and the installation of automatic extinguishing systems, such as household sprinklers. The use of safe heating systems, avoiding old and bad-maintained portable heaters, is a particularly useful prevention strategy for the elderly people

Lower temperature activation for kaolinite-based clay waste: evaluation of hydrated phases during the pozzolanic reaction

This paper reports on the effect of the temperature used to activate kaolinite-based paper industry waste on the hydration products obtained when the activated waste was mixed with a lime solution. After activation at temperatures ranging from 500 to 700 ºC, clay waste exhibited high pozzolanic activity. Analysis with instrumental techniques such as X-Ray diffraction, differential thermal analysis, infrared spectroscopy and scanning electron microscopy showed that higher temperatures favored the formation of calcium aluminate hydrates, hydrotalcite-like compounds and strätlingite, while at lower temperatures CSH gels constituted the majority hydrated phase. According to these findings, reaction kinetics differed substantially from the results obtained at temperatures of 700-800 ºC, particularly in terms of phase quantity and timing of appearanceCTM2006-12551-CO3Peer reviewe

Ganglioneuroblastoma secretor de péptido intestinal vasoactivo (VIP): a propósito de un caso

The case study involves a 22-month-old child with a 4-month course of chronic diarrhea, stagnant weight, bloated abdomen and hypokalemia. After a wide range of tests, he was diagnosed with a medium-risk right paravertebral ganglioneuroblastoma. Chemotherapy treatment was started, despite frequent hospital admissions because of moderate dehydration due to persistent diarrhea associated with hypokalemia and severe metabolic acidosis. A test for vasoactive intestinal peptide levels in serum was requested, which came out very high, confirming the suspected diagnosis of a ganglioneuroblastoma that was producing VIP. In the end, the patient had surgery, which involved the curative resection of the tumour and led to the resolution of the symptoms. The untreatable chronic diarrhea could be paraneoplastic syndrome from the ganglioneuroblastoma. In situations such as these, the measuring of VIP in serum could be crucial for diagnosis. Tumours that secrete VIP, or vipomas, are very rare in children, as they are most frequently tumours that form on the sympathetic nervous system (ganglioneuroma y ganglioneuroblastoma). They appear principally in children under 2 years old and normally have a favourable prognosis whenever they are removable. It is important to take this diagnostic possibility into account when assessing children with untreatable chronic diarrhea.Se presenta el caso de un niño de 22 meses con diarrea crónica de 4 meses de evolución, estancamiento ponderal, abdomen distendido e hipopotasemia. Tras la realización de pruebas complementarias se le diagnostica de ganglioneuroblastoma paravertebral derecho de riesgo intermedio. Se inicia tratamiento quimioterápico, a pesar del cual persisten los ingresos frecuentes por deshidrataciones moderadas debidas a diarreas persistentes asociadas a hipopotasemias y acidosis metabólicas severas. Se solicitan niveles de péptido intestinal vasoactivo (VIP) en suero, que aparecen muy elevados, lo que confirma el diagnóstico de ganglioneuroblastoma productor de VIP. Por último, se interviene quirúrgicamente al paciente, siendo la resección tumoral curativa y consiguiendo la resolución de los síntomas. La diarrea crónica intratable puede ser un síndrome paraneoplásico del ganglioneuroblastoma. En estas situaciones, las mediciones de VIP en suero pueden ser cruciales para el diagnóstico. Los tumores secretores de VIP o vipomas son muy raros en la infancia, y los tumores del sistema nervioso simpático (ganglioneuroma y ganglioneuroblastoma) son los más frecuentes. Se presentan principalmente en menores de 2 años y suelen tener un pronóstico favorable, siempre que sean resecables. Es importante valorar esta posibilidad diagnóstica en la evaluación de niños con diarrea crónica intratable

Effect of a Multicomponent Intervention on Hepatic Steatosis Is Partially Mediated by the Reduction of Intermuscular Abdominal Adipose Tissue in Children With Overweight or Obesity: The EFIGRO Project.

In adults, there is evidence that improvement of metabolic-associated fatty liver disease (MAFLD) depends on the reduction of myosteatosis. In children, in whom the prevalence of MAFLD is alarming, this muscle-liver crosstalk has not been tested. Therefore, we aimed to explore whether the effects of a multicomponent intervention on hepatic fat is mediated by changes in intermuscular abdominal adipose tissue (IMAAT) in children with overweight/obesity. A total of 116 children with overweight/obesity were allocated to a 22-week family-based lifestyle and psychoeducational intervention (control group, n = 57) or the same intervention plus supervised exercise (exercise group, n = 59). Hepatic fat percentage and IMAAT were acquired by MRI at baseline and at the end of the intervention. Changes in IMAAT explained 20.7% of the improvements in hepatic steatosis (P The reduction of IMAAT plays a relevant role in the improvement of hepatic steatosis after a multicomponent intervention in children with overweight/obesity. Indeed, only children who achieved a meaningful reduction in IMAAT at the end of the intervention had a reduced percentage of hepatic fat independent of abdominal fat loss. Our findings suggest that abdominal muscle fat infiltration could be a therapeutic target for the treatment of MAFLD in childhood