Open Access
Evaluación de los requerimientos nutricionales en el paciente crítico
(2023) Osés Recalde, Maddi; Escalada Hernández, Paula; Facultad de Ciencias de la Salud; Osasun Zientzien Fakultatea
La evaluación de los requerimientos nutricionales en pacientes críticos es una tarea compleja para los profesionales de las unidades de cuidados intensivos. La desnutrición es una complicación común en estos pacientes, con una alta prevalencia en todos los hospitales. El aumento en la secreción de hormonas catabólicas sumada a los factores proinflamatorios aumentados, predisponen al paciente crítico a un alto riesgo de desnutrición. En este contexto, el aporte nutricional que reciben estos pacientes suele ser limitado y/o estar interrumpido por procedimientos clínicos específicos, agravando dicha condición. La desnutrición en el paciente crítico se ha asociado a un mayor riesgo de complicaciones y a una mayor mortalidad. La atención nutricional óptima de este tipo de pacientes requiere una determinación precisa y objetiva del gasto energético, para poder proporcionar un aporte nutricional acorde al mismo. El objetivo principal de este trabajo es identificar y valorar los métodos de evaluación de los requerimientos nutricionales en el paciente crítico. Esta revisión bibliográfica ha identificado las ecuaciones predictivas, el método de Fick y la calorimetría indirecta como los métodos más utilizados en la práctica clínica para calcular el gasto energético. Así, la literatura científica establece que determinación adecuada del gasto energético es imprescindible para realizar una pauta nutricional acorde al mismo. A su vez, a pesar de encontrar recomendaciones concretas del aporte de macronutrientes, es imprescindible individualizar la pauta nutricional de cada paciente a sus requerimientos. La correcta evaluación y monitorización de la alimentación es clave, y enfermería tiene la responsabilidad de realizarla correctamente. Se concluye que la calorimetría indirecta es la mejor metodología para determinar el gasto energético. La capacitación de las enfermeras en la valoración, control y monitorización de la ingesta ayudaría a mejorar los resultados en salud de los pacientes críticos.
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 Ingeniaritzaren
Importance 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.
Open Access
Twenty-year trend in the prevalence of increased cardiometabolic risk, measured by abdominal obesity, among Spanish children and adolescents across body mass index categories
(BCM, 2024-11-05) Schröder, Helmut; Juton, Charlotte; Goran, Michael I.; Wärnberg, Julia; Osés Recalde, Maddi; González Gross, Marcela; Gusi, Narcís; Aznar, Susana; Marín-Cascales, Elena; González Valeiro, Miguel A.; Herrera-Ramos, Estefanía; Terrados, Nicolás; Tur, Josep A.; Segú, Marta; Fitó, Montserrat; Ribas-Barba, Lourdes; Bautista-Castaño, Inmaculada; Peña-Quintana, Luis; Berruezo, Paula; Benavente-Marín, Juan C.; Labayen Goñi, Idoia; Zapico, Augusto G.; Sánchez-Gómez, Jesús; Jiménez-Zazo, Fabio; Alcaraz, Pedro E.; Sevilla-Sanchez, Marta; Pulgar, Susana; Bouzas, Cristina; Serra-Majem, Lluis; Gómez, Santiago F.; Ciencias de la Salud; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Background: identifying children and adolescents with cardiometabolic risk at an early stage is crucial for effective treatment and prevention. From a practical perspective, this could be accomplished by assessing the presence of abdominal obesity, which serves as a surrogate indicator of increased cardiometabolic risk and is easy to measure. However, the assessment of abdominal obesity via waist circumference has not yet become a standard procedure in pediatric healthcare. The present study aimed to analyze the secular trends in increased cardiometabolic risk, as indicated by waist circumference among Spanish children and adolescents. Methods: this study included 4861 children and adolescents aged 8 to 16 years from two nationwide representative cross-sectional surveys, the EnKid study and the PASOS study, conducted in 1998–2000 and 2019–2020, respectively. Anthropometric variables were measured in both surveys by trained personnel. Three different waist-to-height (WHtR) cutoffs were used to define abdominal obesity as criteria for cardiometabolic risk. BMI categories were defined according to the IOTF and WHO growth charts. Results: abdominal obesity [waist to height ratio (cm/cm) > 0.49] significantly increased from 40.7 to 56.1% and 93.8 to 97.2% in participants with overweight and obesity, respectively, between 1998–2000 and 2019–2020 (p < 0.05). Logistic regression analysis, adjusted for sex and age, revealed that the odds of being at increased cardiometabolic risk in 2019–2020 was 1.99 (95% CI 1.48–2.67) in participants with overweight in comparison with 1998–2000. The effect size was comparable among the three WHtR criteria for abdominal obesity or the BMI categories according to IOTF and WHO boundaries. Conclusions: the prevalence of Spanish children with increased cardiometabolic risk, identified by abdominal obesity, significantly increased among those with overweight during the last two decades. This finding underlines the need of including the measurement of waist circumference as a standard procedure in pediatric practice.
Open Access
Effects of exercise in addition to a family-based lifestyle intervention program on hepatic fat in children with overweight
(American Diabetes Association, 2020) Labayen Goñi, Idoia; Medrano Echeverría, María; Arenaza Etxeberría, Lide; Maiz, Edurne; Osés Recalde, Maddi; Martínez Vizcaíno, Vicente; Ruiz, Jonatan R.; Ortega, Francisco B.; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
OBJECTIVE Pediatric hepatic steatosis is highly prevalent and closely related to type 2 diabetes. This study aimed to determine whether the addition of supervised exercise to a family-based lifestyle and psycho-educational intervention results in greater reduction of percentage of hepatic fat (HF), adiposity, and cardiometabolic risk factors in children with overweight/obesity. RESEARCH DESIGN AND METHODS The study subjects of this nonrandomized, two-arm, parallel design clinical trial were 116 overweight/obese children (10.6 +/- 1.1 years of age, 53.4% girls) living in Vitoria-Gasteiz (Spain). For 22 weeks, they followed either a lifestyle and psycho-education program (control intervention [CInt], N = 57), consisting of two family-based education sessions/month, or the same plus supervised exercise (intensive intervention [II], N = 59) focused mainly on high-intensity aerobic workouts (3 sessions/week, 90 min/session). The primary outcome was the change in percentage of HF (as measured by MRI) between baseline and the end of the intervention period. Secondary outcomes included changes in BMI, fat mass index (FMI), abdominal fat (measured by DEXA), blood pressure, triglycerides, HDL, LDL, gamma-glutamyl transferase, glucose, and insulin concentrations. RESULTS A total of 102 children completed the trial (N = 53 and N = 49 in the CInt and II groups, respectively). Percentage of HF decreased only in the II group (-1.20 +/- 0.31% vs. 0.04 +/- 0.30%, II and CInt groups, respectively), regardless of baseline value and any change in adiposity (P < 0.01). BMI, FMI, abdominal fat (P <= 0.001), and insulin (P < 0.05) were reduced in both groups. CONCLUSIONS Multicomponent intervention programs that include exercise training may help to reduce adiposity, insulin resistance, and hepatic steatosis in overweight/obese children.
Open Access
Identification of sociodemographic, biochemical and epigenetic biomarkers of hepatic steatosis in children with overweight or obesity
(2022) Osés Recalde, Maddi; Labayen Goñi, Idoia; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
La obesidad infantil se ha convertido en unos de los problemas más graves en materia de salud pública del siglo XXI. En las últimas dos décadas, y de forma paralela a la epidemia de la obesidad infantil, diferentes comorbilidades asociadas como las enfermedades cardiovasculares, la diabetes mellitus de tipo 2 y la enfermedad metabólica asociada al hígado graso (en inglés MAFLD; metabolic associated fatty liver disease) han aumentado su prevalencia en la población infantil. La MAFLD se ha convertido en la comorbilidad más frecuente de la obesidad infantil, siendo hoy en día a nivel mundial la primera causa de enfermedad hepática crónica en población pediátrica. La MAFLD puede progresar a esteatohepatitis y cirrosis, complicando su pronóstico y la reversibilidad de la patología. Sin embargo, su evolución asintomática, junto con la dificultad de su diagnóstico por tratarse de métodos costosos y/o invasivos (biopsia hepática y/o resonancia magnética), impiden su identificación y diagnóstico precoz. La evolución y progresión de la MAFLD pediátrica es compleja, multifactorial y no está del todo esclarecida. Ciertos polimorfismos genéticos y modificaciones epigenéticas, así como factores sociodemográficos y de estilo de vida se han relacionado con el desarrollo de esta enfermedad. Así, la identificación de los factores de riesgo de desarrollo de MAFLD, así como el estudio de biomarcadores de la enfermedad es crucial para su prevención y tratamiento temprano. En este sentido, asociaciones médicas y científicas subrayan la necesidad de desarrollar métodos de cribado útiles para la detección de la MAFLD pediátrica. Por ello, los objetivos de la presente Tesis Doctoral Internacional son: i) desarrollar un protocolo mínimamente invasivo y con alta capacidad predictiva, para la identificación de esteatosis hepática en niños/as con sobrepeso u obesidad, ii) analizar el papel de los miRNAs como biomarcadores de la obesidad infantil y de sus comorbilidades mediante un análisis sistematizado de los estudios publicados que identifican perfiles de miRNAs en la obesidad pediátrica y/o en sus comorbilidades asociadas, y iii) identificar miRNAs potencialmente marcadores de MAFLD y/o resistencia a la insulina en niños/as preadolescentes y estudiar su asociación con factores de riesgo metabólico. Para dar respuesta a estos objetivos se llevaron a cabo cuatro estudios en el contexto de tres proyectos de investigación: EFIGRO, PREDIKID y MICROKID. Las conclusiones de esta Tesis Doctoral son: i) los factores sociodemográficos y de estilos de vida como la pertenencia a una etnia minoritaria, la prematuridad, un elevado índice cintura-talla, el consumo de bebidas azucaradas, el tiempo de visualización de pantallas, y la baja capacidad cardiorrespiratoria están consistentemente asociados con la presencia de esteatosis hepática en niños/as con sobrepeso u obesidad, ii) los métodos de cribado de MAFLD pediátrica disponibles muestran una limitada precisión y aplicabilidad, iii) el índice HEPAKID es la primera herramienta de cribado basada en datos antropométricos, sociodemográficos y de estilos de vida capaz de identificar a niños/as con sobrepeso u obesidad con elevado riesgo de padecer esteatosis hepática, iv) los niveles elevados de triglicéridos (TG), HOMA-IR, alanina aminotransferasa (ALT), aspartato aminotransferasa (AST), gamma-glutamil transferasa (GGT) y ferritina en plasma, así como la presencia de alelos de riesgo de las variantes genéticas PPARGrs13081389, PPARGrs1801282, HFErs1800562 y PNLPLA3rs4823173 se asocian consistentemente con la presencia de esteatosis hepática en niños/as con sobrepeso u obesidad. Sin embargo, su capacidad predictiva es baja por lo que no son suficientes para el cribado de la MAFLD, v) el protocolo de predicción HEPAKID muestra una alta sensibilidad, especificidad y capacidad discriminatoria, así como con una mínima inversión de tiempo y de recursos económicos, para identificar la MAFLD en niños/as con sobrepeso u obesidad y que deben ser derivados a unidades especializadas para la confirmación del diagnóstico, vi) los miRNAs circulantes son biomarcadores prometedores de enfermedades asociadas a la obesidad como la MAFLD y la diabetes mellitus tipo 2. Sin embargo, no ha sido posible identificar un perfil de miRNAs concreto asociado con las comorbilidades mencionadas en niños/as con obesidad en la literatura científica actual, vii) el miRNA circulante miR-660-5p parece ser un biomarcador predictivo de la presencia de MAFLD en niños/as preadolescentes, independientemente de su peso corporal y viii) los miRNAs circulantes miR-320a, miR 142-3p, miR-190a-5p, miR-374a-5p y los de la familia let-7 podrían servir como potenciales biomarcadores de la resistencia a la insulina en población pediátrica.
Open Access
Peripheral blood mononuclear cells-expressed miRNA profiles derived from children with metabolic-associated fatty liver disease and insulin resistance
(Wiley, 2022) Osés Recalde, Maddi; Medrano Echeverría, María; Margareto, Javier; Portillo, María P.; Aguilera, Concepción María; Altmäe, Signe; Labayen Goñi, Idoia; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Gobierno de Navarra / Nafarroako Gobernua
Background: miRNA have been proposed as potential biomarkers of metabolic diseases. Objectives: To identify potential miRNA biomarkers of early metabolic-associated fatty liver disease (MAFLD) and/or insulin resistance (IR) in preadolescent children. Methods: A total of 70 preadolescents, aged 8.5–12 years old participated in the study. Hepatic fat was assessed by magnetic resonance imaging. Fasting blood biochemical parameters were measured and HOMA-IR calculated. Peripheral blood mononuclear cells (PBMC)-derived miRNA profiles associated with MAFLD (≥5.5% hepatic fat) and IR (HOMA-IR ≥2.5) were identified using untargeted high-throughput miRNAs sequencing (RNA-seq). Results: A total of 2123 PBMC-derived miRNAs were identified in children with (21.4%) or without MAFLD. Among them, hsa-miR-143-3p, hsa-miR-142-5p and hsamiR-660-5p were up-regulated, and p-hsa-miR-247, hsa-let-7a-5p and hsa-miR6823-3p down-regulated. Importantly, children with MAFLD had consistently higher miR-660-5p expression levels than their peers without it (p < 0.01), regardless of weight status. A total of 2124 PBMC-derived miRNA were identified in children with IR (28.6%) versus children without IR, where thirteen of them were dysregulated (p < 0.05) in children with IR. In addition, children with IR showed higher levels of miR-374a-5p and miR-190a-5p (p < 0.01) and lower levels of miR-4284 and miR4791 (p < 005), than their peers without IR in both the whole sample and in those with overweight or obesity. Conclusions: Our study results suggest circulating miR-660-5p as a potential biomarker of the presence of MAFLD in preadolescent children while circulating miR320a, miR-142-3p, miR-190a-5p, miR-374a-5p and let-7 family miRNAs could serve as potential biomarkers of IR in children.
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 Gobernua
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.
Open Access
The effect of a family-based lifestyle education program on dietary habits, hepatic fat and adiposity markers in 8-12-year-old children with overweight/obesity
(MDPI, 2020) Arenaza Etxeberría, Lide; Medrano Echeverría, María; Osés Recalde, Maddi; Amasene, María; Díez, Ignacio; Rodríguez Vigil, Beatriz; Labayen Goñi, Idoia; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Healthy lifestyle education programs are recommended for obesity prevention and treatment. However, there is no previous information on the effects of these programs on the reduction of hepatic fat percentage. The aims were (i) to examine the effectiveness of a 22-week family-based lifestyle education program on dietary habits, and (ii) to explore the associations of changes in dietary intake with percent hepatic fat reduction and adiposity in children with overweight/obesity. A total of 81 children with overweight/obesity (aged 10.6 ± 1.1 years, 53.1% girls) and their parents attended a 22-week family based healthy lifestyle and psychoeducational program accompanied with (intensive group) or without (control) an exercise program. Hepatic fat (magnetic resonance imaging), adiposity (dual energy X-ray absorptiometry) and dietary habits (two non-consecutive 24 h-recalls) were assessed before and after the intervention. Energy (p < 0.01) fat (p < 0.01) and added sugar (p < 0.03) intake were significantly reduced in both groups at the end of the program, while, in addition, carbohydrates intake (p < 0.04) was reduced exclusively in the control group, and simple sugar (p < 0.05) and cholesterol (p < 0.03) intake was reduced in the exercise group. Fruit (p < 0.03) and low-fat/skimmed dairy consumption (p < 0.02), the adherence to the Mediterranean Diet Quality Index for children and teenagers (KIDMED, p < 0.01) and breakfast quality index (p < 0.03) were significantly higher in both control and intervention groups after the intervention. Moreover, participants in the exercise group increased the adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (p < 0.001), whereas the ratio of evening-morning energy intake was significantly lower exclusively in the control group after the program (p < 0.02). Changes in energy intake were significantly associated with changes in fat mass index (FMI) in the exercise group, whereas changes in sugar-sweetened beverages (SSB) consumption was associated with percent hepatic fat reduction (p < 0.05) in the control group. A 22-week family-based healthy lifestyle program seems to be effective on improving diet quality and health in children with overweight/obesity and these should focus on SSB avoidance and physical activity.
Open Access
Programa de prevención del sobrepeso y obesidad infantil en centros educativos de Navarra
(2017) Osés Recalde, Maddi; Aguinaga Ontoso, Inés; Facultad de Ciencias de la Salud; Osasun Zientzien Fakultatea
El objetivo general de este TFM es disminuir la prevalencia de sobrepeso y obesidad infantil en navarra. Todo ello para mejorar la salud en la población infantil y consecuentemente mejorar la salud en su edad adulta. Para ello se identifican los siguientes objetivos específicos: 1) Mejorar los hábitos alimentarios de los participantes del proyecto. 2) Aumentar la actividad física de los participantes. 3) Disminuir el sobrepeso y la obesidad de los participantes del programa. Para la consecución de los diferentes objetivos se intervendrá con sesiones de nutrición, actividad física y psicología.
Open Access
Circulating miRNAs as biomarkers of obesity and obesity-associated comorbidities in children and adolescents: a systematic review
(MDPI, 2019) Osés Recalde, Maddi; Margareto, Javier; Portillo, María P.; Aguilera, Concepción María; Labayen Goñi, Idoia; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Early detection of obesity and its associated comorbidities in children needs priority for the development of effective therapeutic intervention. Circulating miRNAs (microRNAs) have been proposed as biomarkers for obesity and its comorbidities; therefore, we conducted a systematic review to summarize results of studies that have quantified the profile of miRNAs in children and adolescents with obesity and/or associated disorders. Nine studies aiming to examine differences in miRNA expression levels between children with normal weight and obesity or between obese children with or without cardiometabolic diseases were included in this review. We identified four miRNAs overexpressed in obesity (miR-222, miR-142–3, miR-140-5p, and miR-143) and two miRNAs (miR-122 and miR-34a) overexpressed in children with obesity and nonalcoholic fatty liver disease (NAFLD) and/or insulin resistance. In conclusion, circulating miRNAs are promising diagnostic biomarkers of obesity-associated diseases such as NAFLD and type 2 diabetes already in childhood. However, more studies in children, using massive search technology and with larger sample sizes, are required to draw any firm conclusions.