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
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
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-Sánchez, 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
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, Jonatan R.; 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 - ISFOOD
Background & 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.