Open Access
Cardiorespiratory fitness, muscular strength, and obesity in adolescence and later chronic disability due to cardiovascular disease: a cohort study of 1 million men
(Oxford University Press, 2020) Henriksson, Hanna; Henriksson, Pontus; Tynelius, Per; Ekstedt, Mattias; Berglind, Daniel; Labayen Goñi, Idoia; Ruiz, Jonatan R.; Lavie, Carl J.; Ortega, Francisco B.; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Aims: Cardiorespiratory fitness, muscular strength, and obesity in adulthood are risk factors for cardiovascular disease (CVD). However, little is known regarding the associations of these risk factors, already in adolescence, with later disability due to chronic CVD. Hence, we investigated associations of cardiorespiratory fitness, muscular strength, and body mass index (BMI) in adolescence with later chronic disability due to specific causes of CVD disability (i.e. cerebrovascular disease, ischaemic heart disease and heart failure). Methods and results: This population-based cohort study included 1 078 685 male adolescents (16-19 years) from the Swedish military conscription register from 1972 to 1994. Cardiorespiratory fitness (bicycle ergometer test), muscular strength (knee extension strength), and BMI were measured during the conscription examination. Information about disability pension due to CVD was retrieved from the Social Insurance Agency during a mean follow-up of 28.4 years. Cardiorespiratory fitness was strongly and inversely associated with later risk of chronic CVD disability for all investigated causes. The association was particularly strong for ischaemic heart diseases (hazard ratio 0.11, 95% confidence interval 0.05-0.29 for highest vs. lowest fitness-quintiles). Furthermore, overweight/obesity were associated with CVD disability for all investigated causes. Conversely, associations of muscular strength with CVD disability were generally weak. Conclusions: This study provides evidence for associations between low levels of cardiorespiratory fitness and obesity with later risk of chronic disability due to CVD. Preventive actions may begin at young ages and include promotion of cardiorespiratory fitness and healthy body weight.
Open Access
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 Gobernua
The 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.
Open Access
Combined body mass index and waist-to-height ratio and its association with lifestyle and health factors among Spanish children: the PASOS study
(MDPI, 2022) Bibiloni, María del Mar; Gallardo Alfaro, Laura; Gómez, Santiago F.; Wärnberg, Julia; Osés Recalde, Maddi; González Gross, Marcela; Gusi, Narcís; Aznar, Susana; Marín-Cascales, Elena; González Valeiro, Miguel A.; Serra-Majem, Lluis; Terrados, Nicolás; Segú, Marta; Lassale, Camille; Homs, Clara; Benavente-Marín, Juan C.; Labayen Goñi, Idoia; Zapico, Augusto G.; Sánchez-Gómez, Jesús; Jiménez-Zazo, Fabio; Alcaraz, Pedro E.; Sevilla-Sánchez, Marta; Herrera-Ramos, Estefanía; Pulgar, Susana; Sistac-Sorigué, Clara; Schröder, Helmut; Bouzas, Cristina; Tur, Josep A.; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Ciencias de la Salud
Background and Aims: The World Health Organization recommended simultaneous measurement of body mass index (BMI) and waist circumference (WC) and suggested joint use to predict disease risks. The aim of this study was to assess the prevalence of BMI and waist-to-height ratio (WHtR) categories among Spanish children and adolescents, as well as their associations with several lifestyle factors. Methods: Cross-sectional analysis of 8–16-year-old children and adolescents (n = 3772) were included in the PASOS nationwide representative study. Children/adolescents and their mothers/female caregivers answered a questionnaire on lifestyle and health factors. Child/adolescent anthropometrics were measured. Four combined BMI-WHtR disease risk categories were built. Results: A third of participants showed combined BMI-WHtR categories with high disease risk (12.3% ‘increased risk’, 9.7% ‘high risk’, 14.3% ‘very high risk’). Participants in the ‘very high risk’ group were less likely to be females (odds ratio 0.63; 95% CI: 0.52–0.76) and adolescents (0.60; 95% CI: 0.49–0.72), to practice ≥60 min/day of moderate-vigorous physical activity (MVPA) (0.73; 95% CI: 0.57–0.93), and to watch <120 min/day of total screen time on weekdays (0.61; 95% CI: 0.49–0.76). Mothers of participants in the ‘very high risk’ group were less likely to have a high educational level, be in the overweight or normal range, have never smoked or were former smokers, and watch <120 min/day of total screen time on weekends. Participants in the ‘increased’ and ‘high risk’ categories had mothers with normal weight and ≥60 min/day of MVPA. Participants in the ’high risk’ group did not achieve ≥60 min/day of MVPA and showed lower adherence to the mediterranean diet. Conclusions: Adherence to a healthy lifestyle in children and adolescents, but also in their mothers/female caregivers during offspring’s childhood and adolescence, is associated with low BMI-WHtR disease risk.
Open Access
Congruent validity of resting energy expenditure predictive equations in young adults
(MDPI, 2019) Amaro Gahete, Francisco J.; Sánchez Delgado, Guillermo; Alcántara Alcántara, Juan Manuel; Martínez Téllez, Borja; Muñoz-Hernández, Victoria; Merchán Ramírez, Elisa; Löf, Marie; Labayen Goñi, Idoia; Ruiz, Jonatan R.; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Having valid and reliable resting energy expenditure (REE) estimations is crucial to establish reachable goals for dietary and exercise interventions. However, most of the REE predictive equations were developed some time ago and, as the body composition of the current population has changed, it is highly relevant to assess the validity of REE predictive equations in contemporary young adults. In addition, little is known about the role of sex and weight status on the validity of these predictive equations. Therefore, this study aimed to investigate the role of sex and weight status in congruent validity of REE predictive equations in young adults. A total of 132 young healthy adults (67.4% women, 18⁻26 years old) participated in the study. We measured REE by indirect calorimetry strictly following the standard procedures, and we compared it to 45 predictive equations. The most accurate equations were the following: (i) the Schofield and the "Food and Agriculture Organization of the United Nations/World Health Organization/United Nations" (FAO/WHO/UNU) equations in normal weight men; (ii) the Mifflin and FAO/WHO/UNU equations in normal weight women; (iii) the Livingston and Korth equations in overweight men; (iv) the Johnstone and Frankenfield equations in overweight women; (v) the Owen and Bernstein equations in obese men; and (vi) the Owen equation in obese women. In conclusion, the results of this study show that the best equation to estimate REE depends on sex and weight status in young healthy adults.
Open Access
Reproducibility of the energy metabolism response to an oral glucose tolerance test: influence of a postcalorimetric correction procedure
(Springer, 2022) Alcántara Alcántara, Juan Manuel; Sánchez Delgado, Guillermo; Jurado Fasoli, Lucas; Galgani, José E.; Labayen Goñi, Idoia; Ruiz, Jonatan R.; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Purpose Metabolic fexibility (MetF), which is a surrogate of metabolic health, can be assessed by the change in the respiratory exchange ratio (RER) in response to an oral glucose tolerance test (OGTT). We aimed to determine the day-to-day reproducibility of the energy expenditure (EE) and RER response to an OGTT, and whether a simulation-based postcalorimetric correction of metabolic cart readouts improves day-to-day reproducibility. Methods The EE was assessed (12 young adults, 6 women, 27±2 years old) using an Omnical metabolic cart (Maastricht Instruments, Maastricht, The Netherlands) after an overnight fast (12 h) and after a 75-g oral glucose dose on 2 separate days (48 h). On both days, we assessed EE in 7 periods (one 30-min baseline and six 15-min postprandial). The ICcE was performed immediately after each recording period, and capillary glucose concentration (using a digital glucometer) was determined. Results We observed a high day-to-day reproducibility for the assessed RER (coefcients of variation [CV]<4%) and EE (CVs<9%) in the 7 diferent periods. In contrast, the RER and EE areas under the curve showed a low day-to-day reproducibility (CV=22% and 56%, respectively). Contrary to our expectations, the postcalorimetric correction procedure did not infuence the day-to-day reproducibility of the energy metabolism response, possibly because the Omnical’s accuracy was~100%. Conclusion Our study demonstrates that the energy metabolism response to an OGTT is poorly reproducible (CVs>20%) even using a very accurate metabolic cart. Furthermore, the postcalorimetric correction procedure did not infuence the day-to-day reproducibility. Trial registration NCT04320433; March 25, 2020.
Open Access
Determinants of adherence to the mediterranean diet in Spanish children and adolescents: the PASOS Study
(MDPI, 2022) Bibiloni, María del Mar; Gallardo Alfaro, Laura; Gómez, Santiago F.; Wärnberg, Julia; Osés Recalde, Maddi; González Gross, Marcela; Gusi, Narcís; Aznar, Susana; Marín-Cascales, Elena; González Valeiro, Miguel A.; Serra-Majem, Lluis; Terrados, Nicolás; Segú, Marta; Lassale, Camille; Homs, Clara; Benavente-Marín, Juan C.; Labayen Goñi, Idoia; Zapico, Augusto G.; Sánchez-Gómez, Jesús; Jiménez-Zazo, Fabio; Alcaraz, Pedro E.; Sevilla-Sánchez, Marta; Herrera-Ramos, Estefanía; Pulgar, Susana; Sistac-Sorigué, Clara; Schröder, Helmut; Bouzas, Cristina; Tur, Josep A.; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Ciencias de la Salud
A progressive shift away from traditional healthy dietary patterns, such as the Mediterranean diet (MedDiet), has been observed in recent decades. The aim of this study was to assess determinants of optimal adherence to the MedDiet in Spanish children and adolescents. A cross-sectional analysis was included in the PASOS nationwide representative study in Spain. Participants were 3607 children and adolescents; 8–16 years old. Primary and secondary outcome measures of weight and height were measured. Adherence to the MedDiet, physical activity, and sedentary behavior in children and adolescents, as well as parental physical activity and dietary habits, were assessed. Optimal adherence to the MedDiet was observed in 45.5% of primary school students and 34.8% of secondary school students (OR: 0.65; 95%CI: 0.56–0.75). Optimal adherence to the MedDiet was higher in children/adolescents meeting daily recommended moderate and vigorous physical activity (OR: 2.39, 95%CI: 1.97–2.89) and in those meeting daily recommended screen time on week-days (OR: 2.05, 95%CI: 1.77–2.38) and weekends (OR: 1.76, 95%CI: 1.48–2.10). Participants with optimal adherence to the MedDiet were more likely to have mothers with a high-level education and high-tercile of SDQS, mothers who never smoked or were former smokers, and mothers who met the recommended physical activity and screen time. It can be concluded that a low prevalence of optimal adherence to the MedDiet was found among current Spanish children and adolescents. Optimal adherence to the MedDiet was associated with reaching the recommendations on physical activity and screen time, with the highest maternal educational level, and healthier maternal life-styles.
Open Access
Effects of combined aerobic and resistance training on the inflammatory profile of children with overweight/obesity: a randomized clinical trial
(Wiley, 2024-07-31) Gil Cosano, José J.; Plaza Florido, Abel; Gracia-Marco, Luis; Migueles, Jairo H.; Cadenas-Sánchez, Cristina; Olvera-Rojas, Marcos; Ubago Guisado, Esther; Labayen Goñi, Idoia; Lucía, Alejandro; Ortega, Francisco B.; Ciencias de la Salud; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Background: we assessed the effects of a 20-week combined (aerobic and resistance) exercise training programme on the inflammatory profile of prepubertal children with overweight or obesity. Methods: totally 109 participants (10.1±1.1 years, 41% girls) were randomly allocated to an exercise or control group. Adiponectin, C-reactive protein, epidermal growth factor, insulin-like growth factor-1, interleukin (IL)-1β, IL-6, leptin, tumour necrosis factor-α and vascular endothelial growth factor A (VEGFA) were analysed in plasma. Total white blood cell (WBC) count and immune subpopulations (eosinophils, basophils, neutrophils, lymphocytes and monocytes) were also determined. Results: no intervention effect was found for any of the analysed biomarkers (all p≥0.05). We observed a significant sex by intervention interaction for IL-1β (p= 0.03). When stratifying the sample by sex, the exercise programme induced a significant effect on IL-1β levels (mean Z-score difference, 0.66 [95% confidence interval 0.32-1.01]) in girls, but not in boys. A lower number of girls in the exercise group showed a meaningful reduction in IL-1β (i.e., ≥0.2 standard deviations) than in the control group (15% vs. 85%, p=0.01). Conclusions: this exercise programme failed to improve the inflammatory profile in prepubertal children with overweight/obesity. Future studies should explore the effect of longer exercise interventions and in combination with diet.
Open Access
Development of a prediction protocol for the screening of metabolic associated fatty liver disease in children with overweight or obesity
(Wiley, 2022) Osés Recalde, Maddi; Cadenas-Sánchez, Cristina; Medrano Echeverría, María; Galbete Jiménez, Arkaitz; Miranda Ferrúa, Emiliano; Ruiz, Jonatan R.; Sánchez-Valverde, Félix; Ortega, Francisco B.; Cabeza Laguna, Rafael; Villanueva Larre, Arantxa; Idoate, Fernando; Labayen Goñi, Idoia; Osasun Zientziak; Institute of Smart Cities - ISC; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Ciencias de la Salud; Gobierno de Navarra / Nafarroako Gobernua
Background: the early detection and management of children with metabolic associ-ated fatty liver disease (MAFLD) is challenging. Objective: to develop a non-invasive and accurate prediction protocol for the identi-fication of MAFLD among children with overweight/obesity candidates to confirma-tory diagnosis. Methods: a total of 115 children aged 8–12 years with overweight/obesity, rec-ruited at a primary care, were enrolled in this cross-sectional study. The external vali-dation was performed using a cohort of children with overweight/obesity (N=46)aged 8.5–14.0 years. MAFLD (≥5.5% hepatic fat) was diagnosed by magnetic reso-nance imaging (MRI). Fasting blood biochemical parameters were measured, and25 candidates’ single nucleotide polymorphisms (SNPs) were determined. Variablespotentially associated with the presence of MAFLD were included in a multivariatelogistic regression. Results: children with MAFLD (36%) showed higher plasma triglycerides (TG),insulin, homeostasis model assessment ofinsulin resistance (HOMA-IR), alanineaminotransferase (ALT), aspartate transaminase (AST), glutamyl-transferase (GGT)and ferritin (p< 0.05). The distribution of the risk-alleles of PPARGrs13081389, PPARGrs1801282, HFErs1800562 and PNLPLA3rs4823173 was significantly different between children with and without MAFLD (p<0.05). Threebiochemical- and/or SNPs-based predictive models were developed, showingstrong discriminatory capacity (AUC-ROC: 0.708–0.888) but limited diagnosticperformance (sensitivity 67%–82% and specificity 63%–69%). A prediction proto-col with elevated sensitivity (72%) and specificity (84%) based on two consecutive steps was developed. The external validation showed similar results: sensitivity of 70% and specificity of 85%. Conclusions: the HEPAKID prediction protocol is an accurate, easy to implant, minimally invasive and low economic cost tool useful for the early identification and management of paediatric MAFLD in primary care.
Open Access
Association between CNTF polymorphisms and adiposity markers in European adolescents
(Mosby/Elsevier, 2020) Pascual Gamarra, José Miguel; Salazar-Tortosa, Diego; Labayen Goñi, Idoia; Rupérez, Azahara I.; Censi, Laura; Béghin, Laurent; Michels, Nathalie; González Gross, Marcela; Manios, Yannis; Lambrinou, Christina-Paulina; Moreno, Luis A.; Meirhaeghe, Aline; Castillo, Manuel J.; Ruiz, Jonatan R.; Ciencias de la Salud; Osasun Zientziak
Objective: To examine the association between polymorphisms of the ciliary neurotrophic factor gene (CNTF) and total and central adiposity markers in adolescents. Study design: This cross-sectional study involved 1057 European adolescents aged 12-18 years enrolled in the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study. Five polymorphisms of CNTF were genotyped, and the weight, height, waist and hip circumference, and triceps and subscapular skinfold thickness of the subjects were measured and recorded. Results: The T allele of rs2509914, the C allele of rs2515363, and the G allele of rs2515362 were significantly associated (after Bonferroni correction) with higher values for several adiposity markers under different inheritance models. The CNTF CCGGA haplotype (rs2509914, rs17489568, rs2515363 rs1800169, and rs2515362) was also significantly associated with lower body mass index, waist circumference, waist/height ratio, and waist/hip ratio values compared with the TCCGG haplotype under several inheritance models. Conclusions: Three polymorphisms—rs2509914, rs2515363, and rs2515362—and the CCGGA haplotype of CNTF were significantly associated with adiposity in European adolescents. These results suggest the potential role of CTNF in the development of obesity-related phenotypes.
Open Access
Multicomponent physical exercise in older adults after hospitalization: a randomized controlled trial comparing short-vs. long-term group-based interventions
(MDPI, 2020) Echeverría, Iñaki; Amasene, María; Urquiza, Miriam; Labayen Goñi, Idoia; Anaut, Pilar; Rodríguez Larrad, Ana; Irazusta, Jon; Besga, Ariadna; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Multicomponent physical exercise is effective in curbing the effect of hospitalization in older adults. However, it is not well established which characteristics of the exercise interventions would optimize intervention sustainability and efficacy. This study compared the effects of two group-based multicomponent exercise interventions of different lengths in older adults after hospitalization. Fifty-five participants were randomly assigned to a short-term group-based branch (SGB, n = 27) or to a long-term group-based branch (LGB, n = 28). The SGB participated in a six-week multicomponent group-based exercise-training program followed by 18 weeks of home-based exercise. The LGB completed 12 weeks of each phase. Physical function, physical activity, quality of life, anthropometrics, and nutritional status were assessed at baseline, after 12 weeks, and after 24 weeks of intervention. Both groups improved physical function and nutritional status and increased physical activity after 12 weeks of intervention (paired student’s t-test, p < 0.01), and maintained the positive effects during the following 12 weeks. No group-by-time interaction was observed in any of the studied variables using mixed-model ANOVA. Based on these findings, we determined that 6 weeks of a group-based exercise intervention caused similar functional and nutritional benefits to a longer group-based intervention of 12 weeks when both are continued at home until 24 weeks.