Transiciones de la obesidad infantil y factores de riesgo cardiometabólico

Incluye PDF de la presentación y vídeo del seminario.El Estudio ELOIN estima las prevalencias de sobrepeso y obesidad en la población infantil de los 4 hasta los 14 años de edad, los factores de riesgo y sus posibles efectos adversos en la salud infantil. En España la prevalencia de exceso de peso infantil (sobrepeso+obesidad) se sitúa en torno al 30-35%, con una prevalencia de obesidad entre el 10-15%.N

Tracking and risk of abdominal and general obesity in children between 4 and 9 years of age. The Longitudinal Childhood Obesity Study (ELOIN)

Background: Studies have shown that overweight and obesity conditions tend to be stable from childhood and adolescence to adulthood. Unfortunately, little is known about the evolution of abdominal obesity during childhood. The aim of this study was to evaluate the temporal variations and risk of general and abdominal obesity between 4, 6, and 9 years of age. Methods: Measurements of children in the ELOIN study taken at the three follow-ups of 4, 6, and 9 years of age were included (N = 1,902). Body mass index and waist circumference were recorded via physical examination. General obesity was determined according to the criteria of the World Health Organization (WHO) and abdominal obesity according to the cut-off points proposed by the International Diabetes Federation (IDF). Prevalence ratios (PRs) were estimated by sex and family affluence using generalized estimating equation models and relative risks (RRs) of obesity were obtained via Poisson regression. Results: The prevalence of general obesity was 5.1%, 9.1%, and 15.6% at 4, 6, and 9 years, respectively, yielding a PR of 3.05 (95%CI: 2.55–3.60) (9 years old relative to 4 years). The prevalence of abdominal obesity was 6.8%, 8.4%, 14.5% at 4, 6, and 9 years, respectively, and the PR was 2.14 (95%CI: 1.82–2.51) (9 years old relative to 4 years). An inverse correlation was observed between both general and abdominal obesity and socioeconomic status. Among participants with general or abdominal obesity at 4 years of age, 77.3% and 63.6% remained in their obesity classification at 9 years, respectively, and 3.4% and 3.5% presented general or abdominal obesity also at 6 and 9 years of age, respectively. The RRs of general and abdominal obesity at 9 years were 4.61 (95%CI: 2.76–7.72) and 4.14 (95%CI: 2.65–6.48) for children classified with obesity at 4 years of age, increased to 9.36 (95%CI: 7.72–11.35) and 9.56 (95%CI: 7.79–11.74) for children who had obesity at 6 years, and up to 10.27 (95%CI: 8.52–12.37) and 9.88 (95%CI: 8.07–12.11) for children with obesity at both 4 and 6 years, respectively. Conclusions: General and abdominal obesity begin at an early age and increase over time, showing an inverse correlation with socioeconomic status. In addition, general and abdominal obesity at 9 years are strongly associated with being classified with obesity at 4 and 6 years, so preventive interventions should be established at very early ages.The ELOIN study was funded by the General Directorate of Public Health of the Ministry of Health of the Community of Madrid. The authors have not received financial support for the research, authorship, or publication of this article. This project received a grant for the translation and publication of this paper from the Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP).S

Changes in general and abdominal obesity in children at 4, 6 and 9 years of age and their association with other cardiometabolic risk factors

Temporary changes in childhood obesity and their association with cardiometabolic risk factors have been receiving increased attention. The objective of this study was to evaluate changes in general (GO) and abdominal (AO) obesity in children from 4 to 9 years of age and their associations with cardiometabolic risk factors at 9 years of age. This study includes 1344 children from the Longitudinal Childhood Obesity Study (ELOIN). Physical examinations performed at 4, 6 and 9 years of age and a blood sample was only taken at 9 years of age. Changes in obesity from 4 to 9 years of age were estimated using Body Mass Index and waist circumference. Participants were classified into four groups according to GO and AO: (1) stable without obesity (no obesity at all three measurements); (2) remitting obesity at 9 years (obesity at 4 and/or 6 years but not at 9 years); (3) incident or recurrent obesity at 9 years (obesity only at 9 years, at 4 and 9 years or at 6 and 9 years); and (4) stable or persistent with obesity (obesity at 4, 6 and 9 years). Dyslipidemia and dysglycemia were defined by the presence of at least one altered parameter of the lipid or glycemic profile. Odds ratios (OR) were estimated using logistic regression. Compared with children without GO at all ages, those with persistent GO had an OR of 3.66 (95% CI: 2.06-6.51) for dyslipidemia, 10.61 (95% CI: 5.69-19.79) for dysglycemia and 8.35 (95% CI: 4.55-15.30) for high blood pressure. The associations were fairly similar in the case of AO, with ORs of 3.52 (95% CI: 1.96-6.34), 17.15 (95% CI: 9.09-32.34) and 8.22 (95% CI: 4.46-15.15), respectively, when comparing persistent versus stable without AO. Children with incident obesity at 9 years presented a moderate cardiometabolic risk that was nevertheless higher compared to those stable without obesity, whereas those with remitting obesity did not show any significant associations. Conclusion: Incident, and especially, persistent obesity, is associated with an increased cardiometabolic risk. The very early prevention of obesity, with a focus on nutrition, physical activity and sedentary behaviour, as well as tracking growth from birth to age 5, should be a priority to prevent the burden of cardiometabolic disease with consequences for adulthood.The ELOIN study was funded by the General Directorate of Public Health of the Ministry of Health of the Community of Madrid. The authors have not received financial support for the research, authorship or publication of this article. This project received a grant for the translation and publication of this paper from the Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP).S

Association between biomarkers of iron status and cardiometabolic risk in Spanish children aged 9-10 years. The ELOIN study

The relationship between iron metabolism and cardiometabolic risk factors has been scarcely studied in children, and the results are controversial. The objective of this study was to evaluate the association between iron parameters and lipid, glycemic and blood pressure alterations in the pediatric population. This was a cross-sectional study of 1954 children between 9 and 10 years of age in Madrid (Spain), participants in a longitudinal study of childhood obesity. Iron metabolism parameters, i.e., serum iron (Is), ferritin (Fs), transferrin (Tf) and transferrin saturation (STf) and lipid, glycemic and blood pressure profiles were evaluated. Odds ratios (ORs) were estimated using logistic regression models adjusted for sociodemographic characteristics, diet, physical activity, C-reactive protein and body mass index. Compared with the participants in the low Is and STf tertiles, those in the upper tertiles had a lower risk of low HDL-Chol (OR: 0.34; 95%CI: 0.17; 0.67) and OR: 0.44 (95%CI: 0.23; 0.84), respectively, and children in the upper Fs tertile had an OR of 2.07 (95%CI: 1.16; 3.68) for low HDL-Chol. Children in the highest Is and STf tertiles had a lower risk of prediabetes [OR: 0.63 (95%CI: 0.41; 0.97) and OR: 0.53 (95%CI: 0.34; 0.82)] and insulin resistance (IR) (OR: 0.37; 95%CI: 0.22; 0.64), and those in the upper Tf tertile had a higher risk of IR (OR: 1.90; 95%CI: 1.16; 3.12). An increased risk of hypertension was found only in children in the upper Fs tertile (OR: 1.46; 95%CI: 1.01; 2.13). Conclusions: Biomarkers of iron metabolism are associated with cardiometabolic alterations in the pediatric population, with a variable direction and magnitude depending on the indicators used. What is known: • Iron metabolism is related to important cardiometabolic alterations such as metabolic syndrome and its components. • Association between biomarkers of iron status and cardiometabolic risk have been less explored in children. What is new: • Biomarkers of iron metabolism are associated with cardiometabolic alterations in the pediatric population. • Iron parameters in the pediatric population could be of great help to detect and prevent cardiometabolic abnormalities early.The ELOIN study was funded by the General Directorate of Public Health of the Ministry of Health of the Community of Madrid. The authors have not received financial support for the research, authorship or publication of this article. This project received a grant for the translation and publication of this paper from the Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP).S

Accuracy of anthropometric measurements and weight status perceptions reported by parents of 4-year-old children

OBJECTIVE: To assess the validity of self-reported height and weight by parents of 4-year-old children and subjective weight perception. DESIGN: Descriptive cross-sectional study. SETTING: Paediatric population living in the Autonomous Community of Madrid. PARTICIPANTS: Children born in 2008-2009 examined at 47-59 months of age. Data were collected by paediatricians of the Madrid Primary Care Physicians Sentinel Network. Parents reported weight and height data. Prevalence of weight status categories was calculated using WHO and International Obesity Task Force (IOTF) reference criteria. Sensitivity, specificity and positive predictive value (PPV) were estimated. The appraisal of their child's weight perception and parental misperception were assessed. RESULTS: For 2914 children, reported height was underestimated by -1·38 cm, weight by -0·25 kg and BMI was overestimated by +0·41 kg/m2 on average. The prevalence of obesity estimated with reported data was 2·7 times higher than that calculated with measured data (16·2 v. 6·0 %) according to WHO classification, and 3·6 times higher with IOTF classification. Sensitivity to identify obesity was 70·5 %, specificity was 87·3 % and PPV was 26·2 % (WHO classification). Half of the parents of pre-schoolers with obesity failed to identify their child's weight status. Parental misperception among children classified as having overweight or obesity reached 93·0 and 58·8 %, respectively. CONCLUSIONS: Parents underestimated children's height and weight, leading to an overestimation of the prevalence of obesity. Small inaccuracies in reported measures have an important effect for the estimation of population prevalences. Parents' report of child weight status is unreliable. Parental awareness and acknowledgement of child weight status should be improved.S

Association between general and central adiposity and development of hypertension in early childhood

Objectives: To evaluate the association of general and abdominal obesity with high blood pressure in young children. Methods: A longitudinal study including 1796 participants from the Madrid region (Spain) with baseline at age 4 years and a follow-up 2 years later. Blood pressure, body mass index and waist circumference were measured during a physical examination. We evaluated the association between obesity at baseline and weight changes between the ages of 4 and 6 years and high blood pressure. Data were analysed using linear and logistic regressions adjusted for covariates. Results: Obese 4 year olds (general or abdominal obesity) experienced an average 4-5 mmHg increase in systolic blood pressure and a 2.5-3 mmHg increase in diastolic blood pressure by the age of 6 years. Compared to children maintaining a non-excess weight (based on body mass index) during follow-up incident and persistent cases of excess weight (overweight or obesity) had an odds ratio (OR) for high blood pressure of 2.49 (95% confidence interval (CI) 1.50-4.13) and OR 2.54 (95% CI 1.27-5.07), respectively. Regarding abdominal obesity we estimated OR 2.81 (95% CI 0.98-8.02) for incident cases and OR 3.42 (95% CI 1.38-8.49) for persistent cases. Similar estimates for the waist-height ratio were observed. Individuals who experienced remission to non-excess weight did not have an increased risk of high blood pressure. Conclusions: We observed an increased risk for high blood pressure among 4-year-olds who presented with persistent or incident cases of excess weight (body mass index) or abdominal obesity after 2 years of follow-up. Children with excess weight or obesity at baseline who remitted to non-excess weight did not exhibit an increased risk of high blood pressure.S

Validez y concordancia de la historia clínica electrónica de atención primaria (AP-Madrid) en la vigilancia epidemiológica de la diabetes mellitus. Estudio PREDIMERC

Objetivo: Estudiar la validez y la concordancia de los datos de diabetes en la historia clínica electrónica de atención primaria (AP-Madrid) comparándola con el estudio PREDIMERC. Métodos: En una muestra poblacional de 2268 individuos se calcularon la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y el índice kappa de los casos de diabetes registrados en la historia clínica AP-Madrid, comparándolos con el estudio PREDIMERC (como referencia). Se estimó la prevalencia de diabetes según cada fuente de información. Resultados: La sensibilidad para la diabetes registrada en AP-Madrid fue del 74%, la especificidad del 98,8%, el valor predictivo positivo del 87,9%, el valor predictivo negativo del 97,3% y el índice kappa de 0,78. La prevalencia de diabetes registrada fue del 6,7%, frente al 8,1% de PREDIMERC, siendo la diabetes conocida del 6,3%. Conclusiones: La AP-Madrid es un sistema de información válido para realizar estudios de vigilancia epidemiológica de diabetes en la Comunidad de Madrid

Demand for health services and drug prescriptions among overweight or obese preschool children.

To evaluate the association between excess weight and the demand of health services in preschool children compared with healthy weight. The data come from the Longitudinal Study of Childhood Obesity cohort (1884 4-year-old children, residing in the Madrid region, Spain) who provided information through telephone questionnaire, physical examination and electronic medical records. We defined overweight, general and abdominal obesity based on body mass index, waist circumference and waist-to-height ratio. Using mixed models of multivariable negative binomial regression we calculated the incidence rate ratio (IRR) regarding primary care (PC) doctor visits, drug prescriptions and hospital admissions by weight status at the end of the 2-year follow-up. Childhood general obesity was associated with a higher demand for PC services related to psychological problems (IRR=1.53; 95% CI 1.02 to 2.28) and childhood abdominal obesity, according to waist-to-height ratio, was related to more frequent problems of the musculoskeletal system (IRR=1.27; 95% CI 1.00 to 1.62). Drugs were prescribed more frequently to children falling under all three definitions of excess weight, compared with healthy weight children. No differences in the number of hospital admissions were observed. The demand of health services related to early childhood obesity was small. Nevertheless, obesity was associated with a slightly greater demand for drug prescriptions and for PC doctor visits related to psychological and musculoskeletal problems.S

Prevalencia, grado de control y tratamiento de la hipertensión arterial en la población de 30 a 74 años de la Comunidad de Madrid: Estudio PREDIMERC

Background: Hypertension (HT) is a major modifiable cardiovascular risk factors. The objective of this study is to estimate the adult population of the Community of Madrid (30-74 years) prevalence of hypertension, knowledge, degree of control and drug treatment. Methods: We studied a random sample population in 2007 among residents of Madrid Community of between 30 and 74 years, obtained by cluster sampling. An epidemiological questionnaire was applied through telephone interview. Physical examination was conducted by a team of trained nurses in the health center. . ; To assess control of hypertension by number of active ingredients Odds were calculated through logistic regression models. Results: The final sample included 1,085 men and 1,183 women with a mean age of 48.3 years. The prevalence of hypertension was 29.3% (35.1% men and 23.9% in women (p<0.01). Of the 665 hypertensives identified 68.6% knew their condition (62.4 76.65% in males and females, p<0.05), of which 54% were in drug treatment (45.4% in men and 64.5% in women, p<0.05). Of the 265 treated hypertensive patients, blood pressure was controlled in 33% of males and 49% of women, p<0.05. Patients treated with two or more active improves your control (aOR: 1, 89). Conclusions: Our data on prevalence, treatment and control are at the lower-intermediate between those reported in previous studies on Spanish and European populations. However, the HA is a public health problem in the CM. Many hypertensive patients are not detected. Of those detected, only 1 in 3 of men and 1 in 2 women are well controlled.Fundamentos: La hipertensión arterial (HTA) es uno de los principales factores de riesgo cardiovascular modificables. El objetivo del estudio es estimar en la población de 30 a 74 años de la Comunidad de Madrid (CM) la prevalencia de hipertensión arterial, el nivel de conocimiento y tratamiento farmacológico, y grado de control. Métodos: Estudio transversal de una muestra poblacional en 2007 entre los residentes en la Comunidad Madrid de entre 30 y 74 años, obtenida por muestreo aleatorio por conglomerados bietápico. Se aplicó un cuestionario epidemiológico por vía telefónica. En el centro de salud se realizó la exploración física por un equipo de enfermeras entrenadas. Para las variables cuantitativas se han calculado las medias e intervalos de confianza del 95% (IC del 95%) y para las cualitativas el porcentaje y el IC del 95% . Para evaluar el control de la HTA según número de principios activos se calcularon las Odds ratio mediante regresión logística. Resultados: La muestra definitiva incluyó a 1.085 hombres y 1.183 mujeres, con una edad media de 48,3 años. La prevalencia de hipertensión fue de 29,3% (IC95%:27,3-31,5) (35,1% en hombres y 23,9% en mujeres (p<0,01). De las 665 personas hipertensas detectadas el 68,6% conocía su condición (62,4% los varones y 76,65 las mujeres, p<0,05) de los cuales el 54% estaba en tratamiento farmacológico (45,4% los varones y 64,5% las mujeres, p<0,05). De las 265 personas hipertensas en tratamiento tenían controlada la tensión arterial el 33% de los varones frente al 49% de las mujeres (p<0,05). Las personas tratadas con dos o más principios activos mejoraron su control frente a las tratadas con monoterapia [ORa: 1,89; (IC95%:1,09-33,27)]. Conclusiones: Nuestras cifras de prevalencia, tratamiento y control ocupan un lugar intermedio-bajo entre las publicadas en estudios previos sobre poblaciones españolas y europeas. Sin embargo la HTA es un problema de salud pública en la CM. Un porcentaje importante de personas hipertensas no están diagnosticadas. De los hipertensos que conocen su diagnóstico y reciben tratamiento sólo 1 de cada 3 varones y una de cada 2 mujeres están bien controlados