Editorial
New elements in childhood obesity
Nuevos elementos en la obesidad infantil
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array:1 [ 0 => array:4 [ "autoresLista" => "Empar Lurbe, Pau Redon" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Empar" "apellidos" => "Lurbe" "email" => array:1 [ 0 => "empar.lurbe@uv.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pau" "apellidos" => "Redon" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Pediatría, Consorcio Hospital General Universitario, Universidad de Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevos elementos en la obesidad infantil" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Obesity in children and adolescents is of particular relevance because it is very common, potentially extends into later life, and is associated to comorbidities such as arterial hypertension, hyperinsulinemia, dyslipidaemia, impaired physical condition, sleep disturbances, social limitations, and decreased quality of life.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> If obesity perpetuates into adulthood, the risk of cardiometabolic disease increases, reducing life expectancy.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> Childhood obesity is a great challenge for both society and the healthcare systems. According to data from the Aladino study conducted in 2010 and 2011 among children between 6 and 9 years of age and based on the World Health Organization (WHO) growth curves, the prevalence of overweight was 26.2% and that of obesity 18.3%.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> A later study using the same methodology and published in 2015 reported a slightly lower prevalence of overweight (23.2%), while obesity showed virtually no change (18.1%).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> Knowing not only the extent of the problem but also the factors that favour excess weight is a priority concern, since it constitutes a starting point for defining possible interventions aimed at fighting obesity. The approach to the problem of obesity requires better understanding of the critical periods for its development, in order to adopt preventive measures and establish the best management approach.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although several studies have been carried out to identify the critical periods in the development of obesity, the pattern of weight gain during childhood implying sustained obesity is not clear, since the studies show great variability in terms of subject age, duration of follow-up and sample size. Relevant data have been obtained from a recent longitudinal study based on the general population and including 51,505 children, with observation starting at birth and up until 18 years of age.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> The study showed that overweight and obesity manifest early in life, and 75% of the children who were obese at three years of age remained obese in adolescence. Among the adolescents who were overweight or obese, the greatest acceleration in body mass index (BMI) occurred between 2 and 6 years of age. Even after this period of rapid weight gain, the BMI continued to increase, though at a lower rate. Of note is the fact that children born to obese mothers had a particularly high risk of suffering obesity, though the critical periods in the development of obesity were no different from those in children whose mothers were not obese. The patterns of change in BMI early in life, more than the absolute BMI value, may act as a predictor for identifying children at risk of developing adiposity in later stages.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The constant increase in obesity in developed countries shows that the classical dietary and nutritional, pharmacological and behavioural management approaches applied for decades have failed, and have been particularly ineffective in preventing obesity, as well as in maintaining lost weight. The management of overweight and obesity requires a multidisciplinary approach and is based on three key objectives: reorganization of eating habits, increased physical activity, and motivation of the child and family environment to achieve the necessary lifestyle changes, establishing acceptable goals that can be maintained over time. Drug treatment<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> or bariatric surgery<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> is still an exceptional indication in paediatric patients. The existing systematic reviews and meta-analyses on the different therapeutic options agree that it is presently not possible to establish specific recommendations in this respect, or to ascertain the long-term outcomes of such interventions. No proven treatments are yet available, and management individualization is required.</p><p id="par0020" class="elsevierStylePara elsevierViewall">If treatment proves necessary, combined strategies involving diet, exercise and behavioural changes are the most effective option, particularly if the parents are implicated in the treatment. Such an individualized approach should include the assessment of cardiometabolic risk factors and the personalization of indicated treatment, especially as regards physical exercise.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> A parameter that may offer relevant information for the correct individualized planning of physical exercise is the cardiorespiratory capacity (CRC) of the child, as assessed by peak or maximum oxygen consumption (VO<span class="elsevierStyleInf">2</span> peak) in the context of an exercise test. This is a particularly relevant parameter that constitutes a comprehensive measure of the functionality of the musculoskeletal, cardiocirculatory and metabolic components involved in physical activity and exercise.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">8,9</span></a> In this context, an adequate CRC implies a good coordinated physiological response of all of the aforementioned components and addresses a series of physical characteristics such as muscle strength and resistance, aerobic capacity, joint mobility, speed of movement, agility, coordination and balance.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Despite the limited number of studies, an association has been observed in children and adolescents between CRC and cardiometabolic alterations and an increased risk of cardiovascular disease. It has been shown that CRC, estimated on the basis of oxygen consumption (VO<span class="elsevierStyleInf">2</span> peak) during an exercise test, is inversely correlated to baseline insulin and HOMA index, and provides an assessment of the degree of autonomic activation of the nervous system.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> These results agree with those of other studies conducted in young women,<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">10,11</span></a> suggesting a relevant role of CRC as a potential predictor of future cardiometabolic alterations.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Along with the association studies, the <span class="elsevierStyleItalic">Amsterdam Growth and Health Longitudinal Study</span> found CRC during adolescence (between 13 and 16 years of age) to be related to the cardiovascular risk profile at 32 years of age. A higher CRC grade was inversely associated to skin fold thickness, abdominal circumference and total cholesterol concentration.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A better understanding of the factors and critical periods in the development of obesity, together with an individualized approach to management, are basic elements for containing the childhood obesity epidemic and its short- and long-term consequences. The early identification of risk in the first years of life should result in monitoring of the increase in BMI. Once overweight or obesity has started, accurate risk assessment may allow an adequate approach to the problem, thereby increasing the success rates.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lurbe E, Redon P. Nuevos elementos en la obesidad infantil. Endocrinol Diabetes Nutr. 2019;66:137–139.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood adiposity, adult adiposity, and cardiovascular risk factors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Juonala" 1 => "C.G. Magnussen" 2 => "G.S. Berenson" 3 => "A. 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Kemper" 2 => "W. van Mechelen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2002-28455" "Revista" => array:6 [ "tituloSerie" => "Int J Sports Med" "fecha" => "2002" "volumen" => "23" "paginaInicial" => "S8" "paginaFinal" => "S14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12012256" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25300180/0000006600000003/v1_201904190633/S2530018019300459/v1_201904190633/en/main.assets" "Apartado" => array:4 [ "identificador" => "64497" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25300180/0000006600000003/v1_201904190633/S2530018019300459/v1_201904190633/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018019300459?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 0 | 6 |
| 2024 October | 8 | 2 | 10 |
| 2024 September | 13 | 3 | 16 |
| 2024 August | 9 | 3 | 12 |
| 2024 July | 10 | 3 | 13 |
| 2024 June | 12 | 2 | 14 |
| 2024 May | 8 | 7 | 15 |
| 2024 April | 18 | 2 | 20 |
| 2024 March | 8 | 3 | 11 |
| 2024 February | 16 | 3 | 19 |
| 2024 January | 5 | 2 | 7 |
| 2023 December | 6 | 2 | 8 |
| 2023 November | 12 | 6 | 18 |
| 2023 October | 8 | 2 | 10 |
| 2023 September | 6 | 4 | 10 |
| 2023 August | 8 | 3 | 11 |
| 2023 July | 8 | 1 | 9 |
| 2023 June | 8 | 1 | 9 |
| 2023 May | 5 | 3 | 8 |
| 2023 April | 7 | 0 | 7 |
| 2023 March | 9 | 0 | 9 |
| 2023 February | 8 | 1 | 9 |
| 2023 January | 10 | 8 | 18 |
| 2022 December | 9 | 1 | 10 |
| 2022 November | 12 | 5 | 17 |
| 2022 October | 8 | 5 | 13 |
| 2022 September | 14 | 5 | 19 |
| 2022 August | 12 | 7 | 19 |
| 2022 July | 10 | 5 | 15 |
| 2022 June | 9 | 6 | 15 |
| 2022 May | 9 | 8 | 17 |
| 2022 April | 11 | 4 | 15 |
| 2022 March | 11 | 5 | 16 |
| 2022 February | 5 | 6 | 11 |
| 2022 January | 11 | 4 | 15 |
| 2021 December | 11 | 7 | 18 |
| 2021 November | 7 | 9 | 16 |
| 2021 October | 9 | 8 | 17 |
| 2021 September | 11 | 8 | 19 |
| 2021 August | 13 | 6 | 19 |
| 2021 July | 6 | 6 | 12 |
| 2021 June | 15 | 9 | 24 |
| 2021 May | 12 | 7 | 19 |
| 2021 April | 20 | 15 | 35 |
| 2021 March | 21 | 8 | 29 |
| 2021 February | 11 | 8 | 19 |
| 2021 January | 9 | 13 | 22 |
| 2020 December | 11 | 9 | 20 |
| 2020 November | 14 | 4 | 18 |
| 2020 October | 5 | 4 | 9 |
| 2020 September | 12 | 11 | 23 |
| 2020 August | 18 | 16 | 34 |
| 2020 July | 6 | 8 | 14 |
| 2020 June | 5 | 3 | 8 |
| 2020 May | 5 | 9 | 14 |
| 2020 April | 10 | 3 | 13 |
| 2020 March | 5 | 2 | 7 |
| 2020 February | 3 | 2 | 5 |
| 2020 January | 2 | 7 | 9 |
| 2019 December | 5 | 7 | 12 |
| 2019 November | 3 | 5 | 8 |
| 2019 October | 8 | 7 | 15 |
| 2019 September | 2 | 3 | 5 |
| 2019 August | 1 | 0 | 1 |
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