Artículos de revista DCS - OZS Aldizkari artikuluak
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Publication Open Access Analysis of complications associated with peripherally inserted central venous catheters. Prospective observational study(Universidad de Santander (Colombia), 2024-11-07) Ferraz Torres, Marta; Díez-Revilla, Ana; Plaza-Unzue, Ruth; Corcuera Martínez, María Inés; Ciencias de la Salud; Osasun Zientziak; Ingeniería Eléctrica, Electrónica y de Comunicación; Ingeniaritza Elektrikoa, Elektronikoa eta Telekomunikazio IngeniaritzaLos equipos de acceso vascular suelen utilizar guías o algoritmos para determinar el dispositivo de acceso vascular más adecuado según el paciente y la sustancia que se va a administrar. Se supone que las guías permiten al personal identificar a la persona más calificada para insertar el catéter, pero pocos estudios recogen información sobre el desempeño de estas unidades. Objetivo: Este estudio busca identificar la evolución y la tasa de complicaciones de los catéteres centrales de inserción periférica (PICC) en pacientes que requieren acceso vascular. Materiales y Métodos: Estudio observacional prospectivo de tres años de duración. Las variables continuas con distribución normal se compararon mediante la prueba t de Student. Las variables distribuidas con distribución no paramétrica se analizaron con la prueba U de Mann-Whitney. Para las variables categóricas se utilizó la prueba chi cuadrado de dos colas o la prueba exacta de Fisher. Se realizó análisis de regresión para la variable dependiente ¿complicaciones¿. Resultados: El 61,99% (566) de los PICC fueron insertados en pacientes con tratamiento oncológico y una duración media de 136±127,51 días. Los PICC usados en pacientes hematológicos tuvieron una duración media de 144±141,3 días (p=0,438). Las complicaciones más frecuentes fueron la remoción accidental (3,50%, 32, OR 0,581), trombosis (3%, 27, OR 0,752) bacteriemia asociada al catéter venoso central (2,10%, 19, OR, 0,113). Discusión: Las complicaciones relacionadas con los PICC fueron poco frecuentes, siendo la principal la trombosis. Las remociones accidentales fueron frecuentes, una complicación que no ha sido suficientemente analizada en otros estudios. Conclusiones: La inserción y manejo de los PICC por un equipo de acceso vascular permite a las unidades lograr una baja tasa de complicaciones en pacientes oncohematológicos.Publication Open Access Association of intrinsic capacity with incidence and mortality of cardiovascular disease: prospective study in UK Biobank(Wiley, 2023) Ramírez Vélez, Robinson; Iriarte-Fernández, María; Santafé Rodrigo, Guzmán; Malanda Trigueros, Armando; Beard, John R.; García Hermoso, Antonio; Izquierdo Redín, Mikel; Ciencias de la Salud; Estadística, Informática y Matemáticas; Ingeniería Eléctrica, Electrónica y de Comunicación; Institute for Advanced Materials and Mathematics - INAMAT2; Osasun Zientziak; Estatistika, Informatika eta Matematika; Ingeniaritza Elektrikoa, Elektronikoaren eta Telekomunikazio Ingeniaritzaren; Universidad Pública de Navarra / Nafarroako Unibertsitate PublikoaBackground: The World Health Organization proposed the concept of intrinsic capacity (IC; the composite of all the physical and mental capacities of the individual) as central for healthy ageing. However, little research has investigated the interaction and joint associations of IC with cardiovascular disease (CVD) incidence and CVD mortality in middle- and older-aged adults. Methods: Using data from 443 130 UK Biobank participants, we analysed seven biomarkers capturing the level of functioning of five domains of IC to calculate a total IC score (ranging from 0 [better IC] to +4 points [poor IC]). Associations between IC score and incidence of six long-term CVD conditions (hypertension, stroke/transient ischaemic attack stroke, peripheral vascular disease, atrial fibrillation/flutter, coronary artery disease and heart failure), and grouped mortality from these conditions were estimated using Cox proportional models, with a 1-year landmark analysis to triangulate the findings. Results: Over 10.6 years of follow-up, CVD morbidity grouped (n = 384 380 participants for the final analytic sample) was associated with IC scores (0 to +4): mean hazard ratio (HR) [95% confidence interval, CI] 1.11 [1.08–1.14], 1.20 [1.16–1.24], 1.29 [1.23–1.36] and 1.56 [1.45–1.59] in men (C-index = 0.68), and 1.17 [1.13–1.20], 1.30 [1.26–1.36], 1.52 [1.45–1.59] and 1.78 [1.67–1.89] in women (C-index = 0.70). In regard to mortality, our results indicated that the higher IC score (+4 points) was associated with a significant increase in subsequent CVD mortality (mean HR [95% CI]: 2.10 [1.81–2.43] in men [C-index = 0.75] and 2.29 [1.85–2.84] in women [C-index = 0.78]). Results of all sensitivity analyses by full sample, sex and age categories were largely consistent independent of major confounding factors (P < 0.001). Conclusions: IC deficit score is a powerful predictor of functional trajectories and vulnerabilities of the individual in relation to CVD incidence and premature death. Monitoring an individual's IC score may provide an early-warning system to initiate preventive efforts.Publication Open Access Association of intrinsic capacity with respiratory disease mortality(Elsevier, 2023) Ramírez Vélez, Robinson; Iriarte-Fernández, María; Santafé Rodrigo, Guzmán; Malanda Trigueros, Armando; Beard, John R.; García Hermoso, Antonio; Izquierdo Redín, Mikel; Ciencias de la Salud; Estadística, Informática y Matemáticas; Ingeniería Eléctrica, Electrónica y de Comunicación; Institute for Advanced Materials and Mathematics - INAMAT2; Osasun Zientziak; Estatistika, Informatika eta Matematika; Ingeniaritza Elektrikoa, Elektronikoaren eta Telekomunikazio IngeniaritzarenThe World Health Organization (WHO) introduced a framework for healthy aging in 2015 that emphasizes functional ability instead of absence of disease. Healthy ageing is defined as “the process of building and maintaining the functional ability that enables well-being”. This framework considers an individual’s intrinsic capacity (IC), environment, and the interaction between them to determine functional ability. In this prospective cohort study, we investigated the link between mortality and various respiratory diseases in almost half a million adults who are part of the UK Biobank. We derived an IC score using measures from 4 of the 5 domains: two for psychological capacity, two for sensory capacity, two for vitality and one for locomotor capacity. The exposure variable in the study was the number of reported factors, which was summed and categorized into IC scores of zero, one, two, three, or at least four. The outcome was respiratory disease-related mortality, which was linked to national mortality records. The follow-up period started from participants’ inclusion in the UK Biobank study (2006–2010) and ended on December 31, 2021, or the participant’s death was censored. The average follow-up was 10.6 years (IQR 10.0; 11.3). During a median follow-up period of 10.6 years, 27,251 deaths were recorded. Out of these, 7.5% (2059) were primarily attributed to respiratory disease. The results showed that a higher IC score (+4 points) was associated with a significantly increased risk of respiratory disease mortality, with HRs of 3.34 [2.64 to 4.23] for men (C-index = 0.83) and 3.87 [2.86 to 5.23] for women (C-index = 0.84), independent of major confounding factors (P < 0.001). Our study provides evidence that lower levels of the WHO’s IC construct are associated with increased risk of mortality and various adverse health outcomes. The IC construct, which is easily and inexpensively measured, holds great promise for transforming geriatric care worldwide, including in regions without established geriatric medicine.Publication Open Access Astrocytic GLUT1 reduction paradoxically improves central and peripheral glucose homeostasis(American Association for the Advancement of Science, 2024-10-18) Ardanaz, Carlos G.; Cruz, Aida de la; Minhas, Paras S.; Hernández-Martín, Nira; Pozo, Miguel Ángel ; Valdecantos, M. Pilar; Martínez Valverde, Ángela; Villa-Valverde, Palmira; Elizalde-Horcada, Marcos; Puerta, Elena; Ramírez, María J.; Ortega, Jorge E.; Urbiola, Ainhoa; Ederra, Cristina; Ariz Galilea, Mikel; Ortiz de Solórzano, Carlos; Fernández Irigoyen, Joaquín; Santamaría Martínez, Enrique; Karsenty, Gerard; Brüning, Jens C. ; Solas, Maite; Ciencias de la Salud; Osasun Zientziak; Ingeniería Eléctrica, Electrónica y de Comunicación; Ingeniaritza Elektrikoa, Elektronikoa eta Telekomunikazio IngeniaritzaAstrocytes are considered an essential source of blood-borne glucose or its metabolites to neurons. Nonetheless, the necessity of the main astrocyte glucose transporter, i.e., GLUT1, for brain glucose metabolism has not been defined. Unexpectedly, we found that brain glucose metabolism was paradoxically augmented in mice with astrocytic GLUT1 reduction (GLUT1ΔGFAP mice). These mice also exhibited improved peripheral glucose metabolism especially in obesity, rendering them metabolically healthier. Mechanistically, we observed that GLUT1-deficient astrocytes exhibited increased insulin receptor–dependent ATP release, and that both astrocyte insulin signaling and brain purinergic signaling are essential for improved brain function and systemic glucose metabolism. Collectively, we demonstrate that astrocytic GLUT1 is central to the regulation of brain energetics, yet its depletion triggers a reprogramming of brain metabolism sufficient to sustain energy requirements, peripheral glucose homeostasis, and cognitive function.Publication Open Access Complications related to the securement device in peripheral intravenous catheters: a randomized study(Lippincott Williams and Wilkins, 2024) Ferraz Torres, Marta; Sancho Sena, Elena; Corcuera Martínez, María Inés; Martínez-García, Óscar; Suárez Mier, María Belén; Ciencias de la Salud; Osasun Zientziak; Ingeniería Eléctrica, Electrónica y de Comunicación; Ingeniaritza Elektrikoa, Elektronikoa eta Telekomunikazio IngeniaritzaStudies have not demonstrated the effectiveness of the different types of dressings in reducing the rate of complications. The purpose of this study was to determine which type of dressing is most beneficial in reducing the rate of complications. A total of 281 patients requiring a peripheral intravenous catheter were randomized to receive partially reinforced dressings or fully reinforced dressings (dressings with integral catheter securement). Patients were followed throughout their entire catheter course, and complications included infection, occlusion, phlebitis, accidental dislodgement, extravasation, and medical adhesive-related skin injury. Catheter outcome data were compared to determine whether statistically significant differences existed between the 2 groups. The groups had equivalent demographic characteristics and catheter indications. The average securement time with partially reinforced dressings was 2.72 days, and that for fully reinforced dressings was 2.64 days. However, catheters secured with fully reinforced dressings were associated with fewer total complications, such as infectious phlebitis (P = .043) and accidental dislodgement (P = .03). The fully reinforced securement device significantly reduced the rate of complications related to accidental dislodgement of the device and cases of infectious phlebitis. The use of fully reinforced dressings could reduce catheter-associated complications and improve the quality of patient care.Publication Open Access The contribution of the tendon electrode to M-wave characteristics in the biceps brachii, vastus lateralis and tibialis anterior(Wiley, 2023) Rodríguez Falces, Javier; Etxaleku, Saioa; Trajano, Gabriel S.; Setuain Chourraut, Igor; Ciencias de la Salud; Ingeniería Eléctrica, Electrónica y de Comunicación; Osasun Zientziak; Ingeniaritza Elektrikoa, Elektronikoaren eta Telekomunikazio IngeniaritzarenIn some compound muscle action potentials (M waves) recorded using the belly–tendon configuration, the tendon electrode makes a noticeable contribution to the M wave. However, this finding has only been demonstrated in some hand and foot muscles. Here, we assessed the contribution of the tendon potential to the amplitude of the vastus lateralis, biceps brachii and tibialis anterior M waves, and we also examined the role of this tendon potential in the shoulder-like feature appearing in most M waves. M waves were recorded separately at the belly and tendon locations of the vastus lateralis, biceps brachii and tibialis anterior from 38 participants by placing the reference electrode at a distant (contralateral) site. The amplitude of the M waves and the latency of their peaks and shoulders were measured. In the vastus lateralis, the tendon potential was markedly smaller in amplitude (∼75%) compared to the belly M wave (P = 0.001), whereas for the biceps brachii and tibialis anterior, the tendon and belly potentials had comparable amplitudes. In the vastus lateralis, the tendon potential showed a small positive peak coinciding in latency with the shoulder of the belly–tendon M wave, whilst in the biceps brachii and tibialis anterior, the tendon potential showed a clear negative peak which coincided in latency with the shoulder. The tendon potential makes a significant contribution to the belly–tendon M waves of the biceps brachii and tibialis anterior muscles, but little contribution to the vastus lateralis M waves. The shoulder observed in the belly–tendon M wave of the vastus lateralis is caused by the belly potential, the shoulder in the biceps brachii M wave is generated by the tendon potential, whereas the shoulder in the tibialis anterior M wave is caused by both the tendon and belly potentials.Publication Open Access Differences in specific abdominal fat depots between metabolically healthy and unhealthy children with overweight/obesity: the role of cardiorespiratory fitness(Wiley, 2023) Cadenas-Sánchez, Cristina; Medrano Echeverría, María; Villanueva Larre, Arantxa; Cabeza Laguna, Rafael; Idoate, Fernando; Osés Recalde, Maddi; Rodríguez Vigil, Beatriz; Álvarez de Eulate, Natalia; Alberdi Aldasoro, Nerea; Ortega, Francisco B.; Labayen Goñi, Idoia; Ciencias de la Salud; Ingeniería Eléctrica, Electrónica y de Comunicación; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Institute of Smart Cities - ISC; Osasun Zientziak; Ingeniaritza Elektrikoa, Elektronikoaren eta Telekomunikazio IngeniaritzarenObjectives: Fat depots localization has a critical role in the metabolic health status of adults. Nevertheless, whether that is also the case in children remains under- studied. Therefore, the aims of this study were: (i) to examine the differ-ences between metabolically healthy (MHO) and unhealthy (MUO) overweight/obesity phenotypes on specific abdominal fat depots, and (ii) to further explore whether cardiorespiratory fitness plays a major role in the differences between metabolic phenotypes among children with overweight/obesity. Methods: A total of 114 children with overweight/obesity (10.6 ±1.1 years, 62 girls) were included. Children were classified as MHO (n=68) or MUO. visceral (VAT), abdominal subcutaneous (ASAT), intermuscular abdominal (IMAAT), psoas, hepatic, pancreatic, and lumbar bone marrow adipose tissues were measured by magnetic resonance imaging. Cardiorespiratory fitness was assessed using the 20 m shuttle run test. Results: MHO children had lower VAT and ASAT contents and psoas fat fraction compared to MUO children (difference =12.4%– 25.8%, all p<0.035). MUO- unfit had more VAT and ASAT content than those MUO- fit and MHO- fit (difference =34.8%– 45.3%, all p<0.044). MUO- unfit shows also greater IMAAT fat fraction than those MUO- fit and MHO- fit peers (difference =16.4%– 13.9% respectively, all p≤0.001). In addition, MHO- unfit presented higher IMAAT fat fraction than MHO- fit (difference =13.4%, p<0.001). MUO- unfit presented higher psoas fat fraction than MHO- fit (difference =29.1%, p=0.008). Conclusions: VAT together with ASAT and psoas fat fraction, were lower in MHO than in MUO children. Further, we also observed that being fit, regardless of metabolic phenotype, has a protective role over the specific abdominal fat depots among children with overweight/obesity.Publication Open Access 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(American Diabetes Association, 2022) Cadenas-Sánchez, Cristina; Idoate, Fernando; Cabeza Laguna, Rafael; Villanueva Larre, Arantxa; Rodríguez Vigil, Beatriz; Medrano Echeverría, María; Osés Recalde, Maddi; Ortega, Francisco B.; Ruiz, Jonatan R.; Labayen Goñi, Idoia; Osasun Zientziak; Ingeniaritza Elektrikoa, Elektronikoaren eta Telekomunikazio Ingeniaritzaren; Institute of Smart Cities - ISC; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Ciencias de la Salud; Ingeniería Eléctrica, Electrónica y de Comunicación; Gobierno de Navarra / Nafarroako GobernuaOBJECTIVE: 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.Publication Open Access Effects of a family-based lifestyle intervention plus supervised exercise training on abdominal fat depots in children with overweight or obesity: a secondary analysis of a nonrandomized clinical trial(American Medical Association, 2022) Cadenas-Sánchez, Cristina; Cabeza Laguna, Rafael; Idoate, Fernando; Osés Recalde, Maddi; Medrano Echeverría, María; Villanueva Larre, Arantxa; Arenaza Etxeberría, Lide; Sanz Muñoz, Aritz; Ortega, Francisco B.; Ruiz, Jonatan R.; Labayen Goñi, Idoia; Ciencias de la Salud; Ingeniería Eléctrica, Electrónica y de Comunicación; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Institute of Smart Cities - ISC; Osasun Zientziak; Ingeniaritza Elektrikoa, Elektronikoaren eta Telekomunikazio IngeniaritzarenImportance Excess abdominal fat is a major determinant in the development of insulin resistance and other metabolic disorders. Increased visceral adipose tissue (VAT) seems to precede the development of insulin resistance and is therefore a prime target of childhood lifestyle interventions aimed at preventing diabetes. OBJECTIVES To examine the effect of added exercise to a family-based lifestyle intervention program designed to reduce VAT plus subcutaneous (ASAT), intermuscular (IMAAT), and pancreatic (PAT) adipose tissue in children with overweight or obesity and to explore the effect of changes in VAT on insulin resistance. DESIGN, SETTING, AND PARTICIPANTS This 2-group, parallel-design clinical trial was conducted in Vitoria-Gasteiz, Spain. A total of 116 children with overweight or obesity participated and were assigned to a 22-week family-based lifestyle program (control group [n = 57]) or the same program plus an exercise intervention (exercise group [n = 59]). Data were collected between September 1, 2014, and June 30, 2017, and imaging processing for fat depot assessments and data analysis were performed between May 1, 2019, and February 12, 2021. INTERVENTIONS The compared interventions consisted of a family-based lifestyle and psychoeducation program (two 90-minute sessions per month) and the same program plus supervised exercise (three 90-minute sessions per week). MAIN OUTCOMES AND MEASURES The primary outcome of this study was the change in VAT between baseline and 22 weeks as estimated by magnetic resonance imaging. The secondary outcomes were changes in ASAT, IMAAT, and PAT. The effect of changes in VAT area on insulin resistance was also recorded. RESULTS The 116 participants included in the analysis (62 girls [53.4%]) had a mean (SD) age of 10.6 (1.1) years, and 67 (57.8%) presented with obesity. Significantly greater reductions were recorded for the exercise group in terms of reduction in VAT (−18.1% vs −8.5% for the control group; P = .004), ASAT (−9.9% vs −3.0%; P = .001), and IMAAT (−6.0% vs −2.6%; P = .02) fat fractions compared with the control group. Changes in VAT explained 87.6% of the improvement seen in insulin resistance (β = −0.102 [95% CI, −0.230 to −0.002]). CONCLUSIONS AND RELEVANCE These findings suggest that the addition of exercise to a lifestyle intervention program substantially enhanced the positive effects on abdominal fat depots in children with overweight or obesity. In addition, the reduction in VAT seemed to largely mediate the improvement of insulin sensitivity. These results highlight the importance of including exercise as part of lifestyle therapies aimed at treating childhood obesity and preventing the development of type 2 diabetes.Publication Embargo Effects of early, late and self-selected time-restricted eating on visceral adipose tissue and cardiometabolic health in participants with overweight or obesity: a randomized controlled trial(Nature Research, 2025-01-07) Dote-Montero, Manuel; Clavero-Jimeno, Antonio; Merchán Ramírez, Elisa; Osés Recalde, Maddi; Echarte Medina, Jon; Camacho-Cardenosa, Alba; Concepción Álvarez, Mara de la Caridad; Amaro Gahete, Francisco J.; Alcántara Alcántara, Juan Manuel; López-Vázquez, Alejandro; Cupeiro, Rocío; Migueles, Jairo H.; De la O, Alejandro; García Pérez, Patricia Virginia; Contreras-Bolivar, Victoria ; Muñoz-Garach, Araceli; Zugasti Murillo, Ana; Petrina Jáuregui, María Estrella; Álvarez de Eulate, Natalia; Goñi Gironés, María Elena; Armendáriz Brugos, Cristina; González Cejudo, María Trinidad; Martín-Rodríguez, José L.; Idoate, Fernando; Cabeza Laguna, Rafael; Carneiro-Barrera, Almudena; Cabo, Rafael de; Muñoz Torres, Manuel; Labayen Goñi, Idoia; Ruiz, Jonatan R.; Ciencias de la Salud; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Ingeniería Eléctrica, Electrónica y de Comunicación; Ingeniaritza Elektrikoa, Elektronikoa eta Telekomunikazio Ingeniaritza; Agronomía, Biotecnología y Alimentación; Agronomia, Bioteknologia eta Elikadura; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa; Gobierno de Navarra / Nafarroako GobernuaThe optimal eating window for time-restricted eating (TRE) remains unclear, particularly its impact on visceral adipose tissue (VAT), which is associated with cardiometabolic morbidity and mortality. We investigated the effects of three TRE schedules (8 h windows in the early day, late day and participant-chosen times) combined with usual care (UC, based on education about the Mediterranean diet) versus UC alone over 12 weeks in adults with overweight or obesity. The primary outcome was VAT changes measured by magnetic resonance imaging. A total of 197 participants were randomized to UC (n = 49), early TRE (n = 49), late TRE (n = 52) or self-selected TRE (n = 47). No significant differences were found in VAT changes between early TRE (mean difference (MD): −4%; 95% confidence interval (CI), −12 to 4; P = 0.87), late TRE (MD: −6%; 95% CI, −13 to 2; P = 0.31) and self-selected TRE (MD: −3%; 95% CI, −11 to 5; P ≥ 0.99) compared with UC, nor among the TRE groups (all P ≥ 0.99). No serious adverse events occurred; five participants reported mild adverse events. Adherence was high (85–88%) across TRE groups. These findings suggest that adding TRE, irrespective of eating window timing, offers no additional benefit over a Mediterranean diet alone in reducing VAT. TRE appears to be a safe, well-tolerated and feasible dietary approach for adults with overweight or obesity. ClinicalTrials.gov registration: NCT05310721.Publication Open Access Effects of exercise on bone marrow adipose tissue in children with overweight/obesity: role of liver fat(Oxford University Press, 2024-08-07) Labayen Goñi, Idoia; Cadenas-Sánchez, Cristina; Idoate, Fernando; Gracia-Marco, Luis; Medrano Echeverría, María; Alfaro-Magallanes, Víctor Manuel; Alcántara Alcántara, Juan Manuel; Rodríguez Vigil, Beatriz; Osés Recalde, Maddi; Ortega, Francisco B.; Ruiz, Jonatan R.; Cabeza Laguna, Rafael; Ingeniería Eléctrica, Electrónica y de Comunicación; Ingeniaritza Elektrikoa, Elektronikoa eta Telekomunikazio Ingeniaritza; Agronomía, Biotecnología y Alimentación; Agronomia, Bioteknologia eta Elikadura; Ciencias de la Salud; Osasun Zientziak; Institute of Smart Cities - ISC; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Gobierno de Navarra / Nafarroako GobernuaContext: Exercise reduces adiposity, but its influence on bone marrow fat fraction (BMFF) is unknown; nor is it known whether a reduction in liver fat content mediates this reduction. Objectives: This work aimed to determine whether incorporating exercise into a lifestyle program reduces the lumbar spine (LS) BMFF and to investigate whether changes in liver fat mediate any such effect.Methods Ancillary analysis of a 2-arm, parallel, nonrandomized clinical trial was conducted at primary care centers in Vitoria-Gasteiz, Spain. A total of 116 children with overweight/obesity were assigned to a 22-week family-based lifestyle program (control group [n = 57]) or the same program plus an exercise intervention (exercise group [n = 59]). The compared interventions consisted of a family-based lifestyle program (two 90-minute sessions/month) and the same program plus supervised exercise (three 90-minute sessions/week). The primary outcome examined was the change in LS-BMFF between baseline and 22 weeks, as estimated by magnetic resonance imaging. The effect of changes in hepatic fat on LS-BMFF were also recorded.Results Mean weight loss difference between groups was 1.4 +/- 0.5 kg in favor of the exercise group. Only the children in the exercise group experienced a reduction in LS-BMFF (effect size [Cohen d] -0.42; CI, -0.86 to -0.01). Importantly, 40.9% of the reductions in LS-BMFF were mediated by changes in percentage hepatic fat (indirect effect: beta=-0.104; 95% CI, -0.213 to -0.019). The effect of changes in hepatic fat on LS-BMFF was independent of weight loss.Conclusion The addition of exercise to a family-based lifestyle program designed to reduce cardiometabolic risk improves bone health by reducing LS-BMFF in children with overweight or obesity. This beneficial effect on bone marrow appears to be mediated by reductions in liver fat.Publication Open Access Effects of time-restricted eating and resistance training on skeletal muscle tissue quantity, quality and function in postmenopausal women with overweight or obesity: a study protocol(Elsevier, 2024-12-30) Alfaro-Magallanes, Víctor Manuel; Medrano Echeverría, María; Echarte Medina, Jon; Osés Recalde, Maddi; Izquierdo Rodríguez, Claudia; Concepción Álvarez, Mara de la Caridad; Galbete Jiménez, Arkaitz; Idoate, Fernando; Zugasti Murillo, Ana; Petrina Jáuregui, María Estrella; Goñi Gironés, María Elena; Ribelles, María Jesús; Amasene, María; Arenaza Etxeberría, Lide; Tejada Garrido, Clara Isabel; Elejalde, E.; Azcárate Jiménez, Unai Xabier; Ruiz Sarrias, Oskitz; Sayar-Beristain, Onintza; García-Ramos, Amador; Martínez Labari, Cristina; Armendáriz Brugos, Cristina; Villanueva Larre, Arantxa; Ruiz Ruiz, Jonatan; Cabeza Laguna, Rafael; Labayen Goñi, Idoia; Ciencias de la Salud; Osasun Zientziak; Institute of Smart Cities - ISC; Ingeniería Eléctrica, Electrónica y de Comunicación; Ingeniaritza Elektrikoa, Elektronikoa eta Telekomunikazio Ingeniaritza; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute on Innovation and Sustainable Development in Food Chain - ISFOODBackground & aims: time-restricted eating (TRE) shows promise for weight loss and improving menopauserelated body composition and cardiometabolic health, but its effects on skeletal muscle tissue (SMT) in postmenopausal women are unknown. This study investigates the effects of three weight loss interventions over 12 weeks on SMT quantity, quality, function, and cardiometabolic health in postmenopausal women with overweight/obesity, with effects persistence evaluated at a 12-month follow-up. Methods and results: in this randomized controlled trial, 78 postmenopausal women (50–65 years; BMI 25–40 kg/m2; sedentary lifestyle; eating window ≥12 h/day; no severe metabolic impairments) will be recruited. Participants will be randomly assigned to one of three groups for 12 weeks: TRE, TRE + resistance training, or CR + resistance training. The TRE groups will reduce their eating window to 8 h and receive nutritional advice to adhere to a Mediterranean diet. The CR group will follow a personalized hypocaloric diet (− 500 kcal/day). Resistance training groups will perform supervised resistance training 3 times/week. Primary Outcome: Change in SMT quantity measured by MRI at baseline and after 12 weeks. Secondary Outcomes: intermuscular adipose tissue (IMAT), strength, power, body weight and composition, and cardiometabolic risk factors. Conclusion: this study will illustrate the effects of TRE and TRE combined with resistance exercise compared with the currently recommended obesity-lifestyle treatment on SMT quantity, quality, function, and cardiometabolic markers. The results will offer insights into dietary strategies to combat obesity and metabolic diseases without increasing sarcopenia risk in postmenopausal women, a sparsely studied and particularly affected population.Publication Open Access Formalize clinical processes into electronic health information systems: modelling a screening service for diabetic retinopathy(Elsevier, 2015-06-14) Eguzkitza Diego, Aitor; Trigo Vilaseca, Jesús Daniel; Martínez de Espronceda Cámara, Miguel; Serrano Arriezu, Luis Javier; Andonegui Navarro, José; Ciencias de la Salud; Osasun Zientziak; Ingeniería Eléctrica, Electrónica y de Comunicación; Ingeniaritza Elektrikoa, Elektronikoa eta Telekomunikazio Ingeniaritza; Institute of Smart Cities - ISC; Universidad Pública de Navarra / Nafarroako Unibertsitate PublikoaMost healthcare services use information and communication technologies to reduce and redistribute the workload associated with follow-up of chronic conditions. However, the lack of normalization of the information handled in and exchanged between such services hinders the scalability and extendibility. The use of medical standards for modelling and exchanging information, especially dual-model based approaches, can enhance the features of screening services. Hence, the approach of this paper is twofold. First, this article presents a generic methodology to model patient-centered clinical processes. Second, a proof of concept of the proposed methodology was conducted within the diabetic retinopathy (DR) screening service of the Health Service of Navarre (Spain) in compliance with a specific dual-model norm (openEHR). As a result, a set of elements required for deploying a model-driven DR screening service has been established, namely: clinical concepts, archetypes, termsets, templates, guideline definition rules, and user interface definitions. This model fosters reusability, because those elements are available to be downloaded and integrated in any healthcare service, and interoperability, since from then on such services can share information seamlessly.Publication Open Access Relevance of sex, age and gait kinematics when predicting fall-risk and mortality in older adults(Elsevier, 2020) Porta Cuéllar, Sonia; Martínez Ramírez, Alicia; Millor Muruzábal, Nora; Gómez Fernández, Marisol; Izquierdo Redín, Mikel; Ingeniería Eléctrica, Electrónica y de Comunicación; Estadística, Informática y Matemáticas; Ciencias de la Salud; Ingeniaritza Elektrikoa, Elektronikoaren eta Telekomunikazio Ingeniaritzaren; Estatistika, Informatika eta Matematika; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua, 87/10Approximately one-third of elderly people fall each year with severe consequences, including death. The aim of this study was to identify the most relevant features to be considered to maximize the accuracy of a logistic regression model designed for prediction of fall/mortality risk among older people. This study included 261 adults, aged over 65 years. Men and women were analyzed separately because sex stratification was revealed as being essential for our purposes of feature ranking and selection. Participants completed a 3-m walk test at their own gait velocity. An inertial sensor attached to their lumbar spine was used to record acceleration data in the three spatial directions. Signal processing techniques allowed the extraction of 21 features representative of gait kinematics, to be used as predictors to train and test the model. Age and gait speed data were also considered as predictors. A set of 23 features was considered. These features demonstrate to be more or less relevant depending on the sex of the cohort under analysis and the classification label (risk of falls and mortality). In each case, the minimum size subset of relevant features is provided to show the maximum accuracy prediction capability. Gait speed has been largely used as the single feature for the prediction fall risk among older adults. Nevertheless, prediction accuracy can be substantially improved, reaching 70% in some cases, if the task of training and testing the model takes into account some other features, namely, sex, age and gait kinematic parameters. Therefore we recommend considering sex, age and step regularity to predict fall-risk.Publication Open Access Time-restricted eating and supervised exercise for improving hepatic steatosis and cardiometabolic health in adults with obesity: protocol for the TEMPUS randomised controlled trial(BMJ Publishing Group, 2024) Camacho-Cardenosa, Alba; Clavero-Jimeno, Antonio; Martín-Olmedo, Juan J.; Amaro Gahete, Francisco J.; Cupeiro, Rocío; González Cejudo, María Trinidad; García Pérez, Patricia Virginia; Hernández-Martínez, Carlos; Sevilla-Lorente, Raquel; O, Alejandro de la; López-Vázquez, Alejandro; Molina-Fernández, Marcos; Carneiro-Barrera, Almudena; García, Federico; Rodríguez-Nogales, Alba; Gálvez Peralta, Julio Juan; Cabeza Laguna, Rafael; Martín-Rodríguez, José L.; Muñoz-Garach, Araceli; Muñoz Torres, Manuel; Labayen Goñi, Idoia; Ruiz, Jonatan R.; Ciencias de la Salud; Osasun Zientziak; Ingeniería Eléctrica, Electrónica y de Comunicación; Ingeniaritza Elektrikoa, Elektronikoaren eta Telekomunikazio Ingeniaritzaren; Institute on Innovation and Sustainable Development in Food Chain - ISFOODIntroduction. Metabolic dysfunction-associated steatotic liver disease is a major public health problem considering its high prevalence and its strong association with extrahepatic diseases. Implementing strategies based on an intermittent fasting approach and supervised exercise may mitigate the risks. This study aims to investigate the effects of a 12-week time-restricted eating (TRE) intervention combined with a supervised exercise intervention, compared with TRE or supervised exercise alone and with a usual-care control group, on hepatic fat (primary outcome) and cardiometabolic health (secondary outcomes) in adults with obesity. Methods and análisis. An anticipated 184 adults with obesity (50% women) will be recruited from Granada (south of Spain) for this parallel-group, randomised controlled trial (TEMPUS). Participants will be randomly designated to usual care, TRE alone, supervised exercise alone or TRE combined with supervised exercise, using a parallel design with a 1:1:1:1 allocation ratio. The TRE and TRE combined with supervised exercise groups will select an 8-hour eating window before the intervention and will maintain it over the intervention. The exercise alone and TRE combined with exercise groups will perform 24 sessions (2 sessions per week+walking intervention) of supervised exercise combining resistance and aerobic high-intensity interval training. All participants will receive nutritional counselling throughout the intervention. The primary outcome is change from baseline to 12 weeks in hepatic fat; secondary outcomes include measures of cardiometabolic health. Ethics and dissemination. This study was approved by Granada Provincial Research Ethics Committee (CEI Granada—0365-N-23). All participants will be asked to provide written informed consent. The findings will be disseminated in scientific journals and at international scientific conferences. Trial registration number NCT05897073.