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
Understanding the association of intrapancreatic fat deposition with adiposity and components of metabolic syndrome in children and adolescents: a systematic review and meta-analysis
(Elsevier, 2025-05-06) Izquierdo Rodríguez, Claudia; Cadenas-Sánchez, Cristina; Santos Martín, José Luis; Ruiz, Jonatan R.; Medrano Echeverría, María; Martínez Vizcaíno, Vicente; Goran, Michael I.; Labayen Goñi, Idoia; Ciencias de la Salud; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background: Intrapancreatic fat deposition is associated with increased cardiovascular risk in adults, but the association is less clear in children. Our goal in this work was therefore to conduct a systematic review and meta-analysis of the associations between intrapancreatic fat deposition with adiposity and components of metabolic syndrome in children and adolescents. Methods: Systematic searches were conducted in MEDLINE, Web of Science, and Scopus from database inception to January 11, 2025 (registration number: CRD42022374159). Random-effects meta-analysis was performed to obtain pooled correlations estimates of the association of intrapancreatic fat deposition with various adiposity related outcomes (i.e., overall/central adiposity and specific fat depots; primary outcome) and cardiometabolic risk factors (i.e., glycaemic traits, insulin resistance/sensitivity, insulin secretion surrogates, plasma lipids, and blood pressure; secondary outcomes). Risk of bias and the quality of evidence were evaluated. Findings: We identified a total of 252 studies, of which 15 unique studies (N = 1261 participants, mean age ranged 10.6–17.7 years, 44.4% females) were eligible for meta-analysis. Magnetic resonance imaging-measured intrapancreatic fat deposition showed a small to medium positive significant association with adiposity (n = 53 studies, r = 0.24 [95% CI:0.19; 0.29], I2 = 61.5%), impaired glycaemic traits and insulin sensitivity (n = 11 studies, r = 0.15 [95% CI:0.03; 0.26], I2 = 58.9%), and HDL levels (n = 7 studies, pooled r = 0.11 [95% CI: 0.01; 0.20], I2 = 0%), and increased blood pressure (n = 6 studies, pooled r = 0.15 [95% CI: 0.05; 0.25], I2 = 0%). Interpretation: Intrapancreatic fat deposition may increase the risk of cardiometabolic disturbances in children. Therefore, it requires more attention in clinical research as an early indicator of ectopic fat deposition, insulin resistance and metabolic syndrome. Longitudinal studies are necessary to understand the temporal dynamics of these associations and to determine the long-term impact of intrapancreatic fat deposition on the risk of developing type 2 diabetes and cardiovascular diseases.
Open Access
Differences in brain volume between metabolically healthy and unhealthy overweight and obese children: the role of fitness
(MDPI, 2020) Cadenas-Sánchez, Cristina; Esteban Cornejo, Irene; Migueles, Jairo H.; Labayen Goñi, Idoia; Verdejo Román, Juan; Mora González, José; Henriksson, Pontus; Maldonado, José; Gómez Vida, José; Hillman, Charles H.; Erickson, Kirk I.; Kramer, Arthur F.; Catena, Andrés; Ortega, Francisco B.; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
The aim of this study was to examine whether metabolically healthy overweight/obese children have greater global and regional gray matter volumes than their metabolically unhealthy peers. We further examined the association between gray matter volume and academic achievement, along with the role of cardiorespiratory fitness in these associations. A total of 97 overweight/obese children (10.0 +/- 1.2 years) participated. We classified children as metabolically healthy/unhealthy based on metabolic syndrome cut-offs. Global and regional brain volumes were assessed by magnetic resonance imaging. Academic achievement was assessed using the Woodcock-Munoz standardized test. Cardiorespiratory fitness was assessed by the 20 m shuttle run test. Metabolically healthy overweight/obese (MHO) children had greater regional gray matter volume compared to those who were metabolically unhealthy (MUO) (all p <= 0.001). A similar trend was observed for global gray matter volume (p = 0.06). Global gray matter volume was positively related to academic achievement (beta = 0.237, p = 0.036). However, all the associations were attenuated or disappeared after adjusting for cardiorespiratory fitness (p > 0.05). The findings of the present study support that metabolically healthy overweight/obese children have greater gray matter volume compared to those that are metabolically unhealthy, which is in turn related to better academic achievement. However, cardiorespiratory fitness seems to explain, at least partially, these findings.
Open Access
European fitness landscape for children and adolescents: updated reference values, fitness maps and country rankings based on nearly 8 million test results from 34 countries gathered by the FitBack network
(BMJ Publishing Group, 2023) Ortega, Francisco B.; Leskošek, Bojan; Blagus, Rok; Gil Cosano, José J.; Mäestu, Jarek; Tomkinson, Grant R.; Ruiz, Jonatan R.; Mäestu, Evelin; Starc, Gregor; Milanovic, Ivana; Tammelin, Tuija H.; Soric, Maroje; Scheuer, Claude; Carraro, Attilio; Kaj, Mónika; Csányi, Tamás; Sardinha, Luis B.; Lenoir, Matthieu; Emeljanovas, Arunas; Mieziene, Brigita; Sidossis, Labros S.; Pihu, Maret; Lovecchio, Nicola; Konstabel, Kenn; Tambalis, Konstantinos D.; Stefan, Lovro; Drenowatz, Clemens; Rubín, Lukáš; Gontarev, Seryozha; Castro Piñero, José; Vanhelst, Jérémy; O'Keeffe, Brendan; Veiga, Óscar L.; Gisladottir, Thordis; Sandercock, Gavin; Misigoj-Durakovic, Marjeta; Niessner, Claudia; Riso, Eva-María; Popovic, Stevo; Kuu, Saima; Chinapaw, Mai; Clavel, Iván; Labayen Goñi, Idoia; Dobosz, Janusz; Colella, Dario; Kriemler, Susi; Salaj, Sanja; Noriega, María José; Bös, Klaus; Sánchez López, Mairena; Lakka, Timo A.; Tabacchi, Garden; Novak, Dario; Ahrens, W.; Wedderkopp, Niels; Jurak, Gregor; Ciencias de la Salud; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Objectives (1) To develop reference values for health-related fitness in European children and adolescents aged 6-18 years that are the foundation for the web-based, open-access and multilanguage fitness platform (FitBack); (2) to provide comparisons across European countries. Methods This study builds on a previous large fitness reference study in European youth by (1) widening the age demographic, (2) identifying the most recent and representative country-level data and (3) including national data from existing fitness surveillance and monitoring systems. We used the Assessing Levels of PHysical Activity and fitness at population level (ALPHA) test battery as it comprises tests with the highest test-retest reliability, criterion/construct validity and health-related predictive validity: the 20 m shuttle run (cardiorespiratory fitness); handgrip strength and standing long jump (muscular strength); and body height, body mass, body mass index and waist circumference (anthropometry). Percentile values were obtained using the generalised additive models for location, scale and shape method. Results A total of 7 966 693 test results from 34 countries (106 datasets) were used to develop sex-specific and age-specific percentile values. In addition, country-level rankings based on mean percentiles are provided for each fitness test, as well as an overall fitness ranking. Finally, an interactive fitness platform, including individual and group reporting and European fitness maps, is provided and freely available online (www.fitbackeurope.eu). Conclusion This study discusses the major implications of fitness assessment in youth from health, educational and sport perspectives, and how the FitBack reference values and interactive web-based platform contribute to it. Fitness testing can be conducted in school and/or sport settings, and the interpreted results be integrated in the healthcare systems across Europe.
Open Access
Trends in adherence to the mediterranean diet in spanish children and adolescents across two decades
(MDPI, 2023) Herrera-Ramos, Estefanía; Tomaino, Laura; Sánchez Villegas, María Almudena; Ribas-Barba, Lourdes; Gómez, Santiago F.; Wärnberg, Julia; Osés Recalde, Maddi; González Gross, Marcela; Gusi, Narcís; Aznar, Susana; Marín-Cascales, Elena; González Valeiro, Miguel A.; Terrados, Nicolás; Tur, Josep A.; Segú, Marta; Fitó, Montserrat; Homs, Clara; 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; Sistac-Sorigué, Clara; Schröder, Helmut; Serra-Majem, Lluis; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Unhealthy dietary habits determined during childhood may represent a risk factor to many of the chronic non-communicable diseases (NCDs) in adulthood. Mediterranean Diet (MD) adherence in children and adolescents (8–16 years) living in Spain was investigated using the KIDMED questionnaire in a comparative analysis of two cross-sectional nationwide representative studies: enKid (1998–2000, n = 1001) and PASOS (2019–2020, n = 3540). Taking into account the educational level of pupils, as well as the characteristics of the place of living, a significant association was found between a KIDMED score ≥ 8 (optimal MD adherence) and primary education as well as residency in an area of <50,000 inhabitants, while living in the southern regions was associated with non-optimal MD adherence (p < 0.001). Participants of the 2019–2020 study showed an increase in the consumption of dairy products (31.1% increase), pasta/rice (15.4% increase), olive oil (16.9% increase), and nuts (9.7% increase), as well as a decreased sweets and candies intake (12.6% reduction). In contrast, a significantly lower MD adherence was found when comparing the 2019–2020 (mean ± SE: 6.9 ± 0.04) and the 1998–2000 study (7.37 ± 0.08); p < 0.001), due to less consumption of fish (20.3% reduction), pulse (19.4% reduction), and fruits (14.9% reduction), and an increased intake of commercial goods/pastries or fast-food intake (both 19.4% increase). The lowest adherence was recorded for adolescents also in the most recent study, where 10.9% of them presented a KIDMED score ≤ 3. This study shows that eating habits are deteriorating among Spanish children and adolescents. Such findings point out the urgency of undertaking strong measures to promote the consumption of healthy, sustainable, and non-ultra-processed food, such as those available in an MD, not only at a scientific and academic level, but also at a governmental one.
Open Access
The role of sex in the relationship between fasting adipokines levels, maximal fat oxidation during exercise, and insulin resistance in young adults with excess adiposity
(Elsevier, 2023) Chávez-Guevara, Isaac A.; Amaro Gahete, Francisco J.; Osuna Prieto, Francisco J.; Labayen Goñi, Idoia; Aguilera, Concepción María; Ruiz, Jonatan R.; Ciencias de la Salud; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Aim: Previous evidence suggest that a sexual dimorphism in exercise fat oxidation and adipokines levels may explain a lower risk of cardio-metabolic disorders in women. Therefore, we investigated the role of sex in the relationship between adipokines levels, maximal fat oxidation (MFO) during exercise and insulin resistance. Methods: Fifty young adults with excess adiposity (31 women; body fat: 38.7 ± 5.3%) were included in this study. The fasting levels of leptin, adiponectin, glucose and insulin were determined from blood samples and the homeostatic model assessment of insulin resistance index (HOMA-IR) subsequently calculated. Body fat percentage and visceral adipose tissue (VAT) were assessed through dual-energy X-ray absorptiometry whereas MFO was estimated during an incremental-load exercise test after an overnight fasting through indirect calorimetry. Results: Men had lower levels of body fat (d = 1.80), adiponectin (d = 1.35), leptin (d = 0.43) and MFO (d = 1.25) than women. Conversely, men showed higher VAT (d = 0.85) and fasting glucose levels (d = 0.89). No sex differences were observed in HOMA-IR (d = 0.34). Adipokines levels were not associated with MFO in both sexes (r < 0.30), whereas adiponectin levels were inversely related with HOMA-IR in both men (r = −0.58) and women (r = −0.50). Leptin concentration was associated to HOMA-IR only in men (r = 0.41), while no statistically significant relationships were observed between MFO and HOMA-IR in both sexes (r < 0.44). Conclusion: Insulin resistance was similar between sexes regardless of superior levels of adipokines and MFO during exercise in women. Therefore, adiponectin and leptin may regulate glucose homeostasis without altering whole body fat oxidation rate during exercise.
Open Access
Effects of an exercise program on cardiometabolic and mental health in children with overweight or obesity: a secondary analysis of a randomized clinical trial
(American Medical Association, 2023) Migueles, Jairo H.; Cadenas-Sánchez, Cristina; Lubans, David R.; Henriksson, Pontus; Torres-López, Lucía V.; Rodríguez Ayllon, María; Plaza Florido, Abel; Gil Cosano, José J.; Henriksson, Hanna; Escolano Margarit, María Victoria; Gómez Vida, José; Maldonado, José; Löf, Marie; Ruiz, Jonatan R.; Labayen Goñi, Idoia; Ortega, Francisco B.; Ciencias de la Salud; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Importance: Childhood obesity is a risk factor associated with type 2 diabetes, cardiovascular disease, and mental disorders later in life. Investigation of the parallel effects of a defined exercise program on cardiometabolic and mental health in children with overweight or obesity may provide new insights on the potential benefits of exercise on overall health. Objective: To investigate the effects of a 20-week exercise program on cardiometabolic and mental health in children with overweight or obesity. Design, Setting, and Participants: This secondary analysis of a parallel-group randomized clinical trial was conducted in Granada, Spain, from November 1, 2014, to June 30, 2016. Data analyses were performed between February 1, 2020, and July 14, 2022. Children with overweight or obesity aged 8 to 11 years were eligible, and the study was performed in an out-of-school context. Intervention: The exercise program included 3 to 5 sessions/wk (90 min/session) of aerobic plus resistance training for 20 weeks. The wait-list control group continued with their usual routines. Main Outcomes and Measures: Cardiometabolic outcomes as specified in the trial protocol included body composition (fat mass, fat-free mass, and visceral adipose tissue), physical fitness (cardiorespiratory, speed-agility, and muscular), and traditional risk factors (waist circumference, blood lipid levels, glucose levels, insulin levels, and blood pressure). Cardiometabolic risk score (z score) was calculated based on age and sex reference values for levels of triglycerides, inverted high-density lipoprotein cholesterol, and glucose, the mean of systolic and diastolic blood pressure, and waist circumference. An additional cardiometabolic risk score also included cardiorespiratory fitness. Mental health outcomes included an array of psychological well-being and ill-being indicators. Results: The 92 participants included in the per-protocol analyses (36 girls [39%] and 56 boys [61%]) had a mean (SD) age of 10.0 (1.1) years. The exercise program reduced the cardiometabolic risk score by approximately 0.38 (95% CI, -0.74 to -0.02) SDs; decreased low-density lipoprotein cholesterol level by -7.00 (95% CI, -14.27 to 0.37) mg/dL (to convert to mmol/L, multiply by 0.0259), body mass index (calculated as weight in kilograms divided by height in meters squared) by -0.59 (95% CI, -1.06 to -0.12), fat mass index by -0.67 (95% CI, -1.01 to -0.33), and visceral adipose tissue by -31.44 (95% CI, -58.99 to -3.90) g; and improved cardiorespiratory fitness by 2.75 (95% CI, 0.22-5.28) laps in the exercise group compared with the control group. No effects were observed on mental health outcomes. Conclusions and Relevance: In this secondary analysis of a randomized clinical trial, an aerobic plus resistance exercise program improved cardiometabolic health in children with overweight or obesity but had no effect on mental health. Trial Registration: ClinicalTrials.gov Identifier: NCT02295072.
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
Associations between the adherence to the Mediterranean diet and cardiorespiratory fitness with total and central obesity in preschool children: the PREFIT project
(Springer, 2018) Labayen Goñi, Idoia; Arenaza Etxeberría, Lide; Medrano Echeverría, María; García, Natalia; Cadenas-Sánchez, Cristina; Ortega, Francisco B.; Ciencias de la Salud; Osasun Zientziak
Purpose: Early recognition of risk factors associated with overweight/obesity is animportant step towards preventing long-term health consequences. The aim of the current study was to examine the associations of the adherence to the Mediterranean dietary pattern (MDP) and cardiorespiratory fitness (CRF) with adiposity in preschool children from thenorth of Spain. Methods: The adherence to the MDP (KIDMED), CRF (20-m shuttle run test), total (BMI) and central (waist circumference) adiposity and socio-demographic factors were assessed in 619 children (48.6% girls) who were on average 4.7 years old. Results: Higher MDP index (P < 0.05) and CRF levels (P < 0.01) were significantly related to lower waist circumference. CRF was inversely associated with BMI (P <= 0.001), yet no significant association was observed between MDP and BMI. Children not having high CRF levels and high MDP (i.e., non-upper sex-specific tertile of CRF or MDP, respectively) had the highest waist circumference. Conclusions: Our findings support that higher adherence to the MDP and higher CRF are associated with lower waist circumference in preschool children, pointing them as relevant modifiable factors to be targeted by educational strategies aiming to prevent central obesity and later obesity-related comorbidities.