During the last decades several observational studies have been published linking disruption of the endogenous circadian clock to metabolic dysfunction, associated to obesity or type 2 diabetes. Studies in infants and children are scarce.

In this review, some basic concepts on the mechanisms of the internal clock will be reviewed, when related to nutrition. The consequences of this disynchrony will be also commented.

Two recent studies have linked the risk of having a higher body mass index in childhood in those infants who have more frequent meals during nightime. No current studies have been performed in other ages, except for those skipping breakfast (increased risk of excess of weight).

Although there are no clear evidences te make robust recommendations, common sense suggests that adapting meal times (and composition) to energy needs along the day may help to adquire a healthy lifestyle and to prevent cardiometabolic diseases in adulthood.

Obesity and metabolic syndrome are two of the major child health problems in Western society. During the last years, it has been also noticed a decline in sleeping hours among children. Since 1992, many epidemiological studies, both cross-sectional and longitudinal, have shown that chronic sleep deprivation in children relates to an increasing risk of developing overweight-obesity and/or metabolic syndrome (hypertension, increasing resistance to insulin and dyslipidemia). Although precise proccess that make obesity leads to a reduction of sleeping hours are currently unknown, a number of proccess that seem to be somehow involved have been identified. Among others, we may mention the alterations in the hypothalamic-pituitary (several neuropeptides such as leptin and ghrelin), an increasing appetite with special foods high avidity energy, a greater sense of fatigue with consequent reduction in physical activity, and changes in sleep-wake cycle (melatonin rhythm disturbances). This work contains a review of current evidence on the relationship between sleep and obesity within the pediatric population. It is now accepted that children who sleep less hours are more likely to develop overweight and metabolic syndrome, but it has not been possible to demonstrate a clear causality yet. It is necessary to promote adequate sleep among children, not only due to the many beneficial effects already known (cognitive, immunological, behavioral, metabolic and even decrease mortality), but also given its potential ability to prevent obesity and metabolic syndrome.

We review the evolution of the concept of metabolic syndrome in adults and in children and adolescents. It provides data that should be suspected diagnosis in primary care. It is updated knowledge about the interconnection between metabolic syndrome, insulin resistance and inflammatory state, with emphasis on possible dietary factors.

I. Vitoria Miñana. Unidad de Nutrición y Metabolopatías. Hospital «La Fe». Bulevar Sur, s/n. 46026 Valencia.
Correo electrónico: vitoria_isi@gva.es

Introduction and aim: We have perceived an increased frequency and earlier onset of child overweight and obesity. Our objetive is to prove this hypothesis by identifying the age of higher risk of child obesity onset and by studying its association to gender and birth weight.

Material and methods: Birth weight was expressed as z-score and yearly Body Mass Index (BMI) from the first year to the age of eight were collected from all clinical records of 660 children of three Primary Health Centers of Tenerife. Data were classified into three cohorts by their birth year (1989, 1997 and 2000). BMI progression plots were done by gender and cohort. BMI evolution by gender, so intra as among cohorts, has been tested using a multivariate generalized linear model for iterated measurements. ANOVA test was used to estimate at which age the cohorts show a different BMI. The independent predictive power of birth year, birth weight z-score and gender on BMI at the age of eight was evaluated using multiple linear regression models, whereas the influence of these variables on the risk of obesity at eight years old was evaluated using binary multivariable logistic regression models.

Results: Birth year, birth weight z-score and gender show predictive power on BMI at eight years of age, being the former which implies as significant risk of obesity at that age. Obesity onset is more frequent at the age of four years.

Conclusions: a) obesity onset occur at earlier age in our children; b) obesity begins at four years of age in average and is more frequent in boys, and c) a higher birth weight is associated with an increased BMI, at least until the age of eight.

The family can exert a strong influence on children's diet and eating behaviors, which, in turn, may have an impact on their weight status. Since the dawn of time, the dining table has been the nexus of family interaction. The simple act of sharing meals solidifies the family identity and family ties by modeling a wide range of learned behavioural patterns. One of the groups most affected in this respect are adolescents.

Researchers have shown that family meals are associated with improved dietary intake. A higher frequency of family meals is associated with a greater intake of fruits, vegetables, grains and calcium-rich products, and negatively associated with consumption of fried foods and soft drinks. Family meals have also been shown to contribute to the development of regular eating habits and positive psychosocial functioning and to improvements in language and literacy. In addition, family meals have been associated with reduced risk-taking behaviours such as smoking and alcohol and drug use, as well as better school performance.

Because of the multiple benefits of eating meals together as a family, promoting the family meal is a powerful public health measure for improving dietary quality, reducing the incidence of weight problems and improving educational and social outcomes.

Body mass index (BMI) values vary during childhood and adolescence depending on age and gender. The BMI is the para¬meter most frequently used for the screening of excess body fat because it is easy to determine and it tends to correlate well with body fat. International Obesity Task Force (IOTF) BMI cutoff points for the definition of excess weight and obesity have recently been proposed for each age and sex, corresponding to adult BMI values of 25 and 30 at the age of 18 years. In addition to excess body fat, the BMI has been correlated with various components of metabolic syndrome: dyslipidemia, hypertension, insulin resistance/hyperinsulinemia and impaired glucose tolerance/type 2 diabetes. The BMI is not a reliable predictor of the percent fat mass at the individual level, but is a good index of adiposity. Nevertheless, despite its acceptable sensitivity and specificity, the BMI may classify as obese or overweight individuals who do not really have excess adiposity.

Objectives: To evaluate the effectiveness of a program to promote proper eating habits and physical activity to reduce obesity and overweight in a pediatric quota.

Materials and methods: Design: quasi before and after. Setting: Primary Care. Subjects: 611 children between 2 and 13 years old, overweight or obesity in a pediatric quota between 2005 and 2007. Interventions: Promoting physical activity and food healthy habits. Variables: age, sex, family history of first degree of obesity, body mass index (BMI), analytical (lipid profile, TSH, blood, iron metabolism). Statistical Analysis: descriptive parameters of central tendency and distribution of frequencies. Student's test and chi-square test.

Results: The prevalence of overweight or obesity was 12,11% (49 and 25 cases diagnosed of obesity and overweight respectively). 73,6% of the obese children had a family history of first degree of overweight or obesity (p <0,01). At the end of two years the BMI of 43,47% of children decreased or stabilized (1,94 Kg/m2; 95% CI 1,17-2,70); the 4,0% of children diagnosed of overweight initially, were normoweight; the 52,3% of children diagnosed of obesity initially, were overweight (p<0,001).

Conclusions: The performance of primary care pediatrician promoting physical activity and healthy eating, weight and height continuous measurements, reduces levels of overweight or obesity in children. It is necessary to identify and to tackle early the children of obese parents.

J.J. Fernández de Velasco Galán. Paraíso de Santa Eufemia, 12. 41940 Tomares (Sevilla).
Correo electrónico: mantd@telefonica.net

Obesity is one of the main public health problems due to its fast prevalence increase and co-morbidities with several diseases, as the metabolic syndrome, diabetes and cardiovascular diseases. Social changes associated to high intake of energy-dense food and low physical activities have created an obesogenic environment worldwide. In this context, the identification of new factors involved in the regulation of the energy balance has mainly the aim of developing more efficient intervention strategies.

The intestinal microbiota is considered a new factor involved in the body weight regulation and in diseases associated with obesity through its influence in the metabolic and immunologic functions of the host. The intestinal microbiota and some probiotics also regulate the subject's immunological functions, protecting from infections and chronic inflammation processes. Instead, disorders in the intestinal ecosystem (dysbiosis) and endotoxemia might be inflammatory factors responsible for developing insulin resistance and body weight gain. Based on the relations between the intestinal microbiota, the metabolism and immunity, the use of dietary strategies to modulate the microbiota, based on probiotics and prebiotics, is likely to contribute to the control of the metabolic disorders more efficiently.

Introduction: Unsuitable dietary habits and sedentary life are perhaps the main causes of the alarming increase in childhood obesity, and they are closely linked to eating disorders. The school is an ideal place to foster healthier lifestyles.

Materials and methods: This is a community-based, interventional, longitudinal, prospective study for the purpose of measuring the improvement in eating habits and physical activity after a year of health education in two schools during the school year 2003-2004. Five hundred one school children ranging in age from 3 to 16 years took part in the project. Surveys were designed and were completed before and after the program. The intervention was designed for children, parents and teachers.

Results: We must highlight the low intake of legumes, fruits, vegetables and fish. Of the children who took part in the project, 5.1% attended class without having had breakfast. The improvements achieved after the program were: at breakfast, a decrease in the intake of industrial bakery and pastry products (p

Conclusions: After a year of health education in the school, we find little improvement regarding eating habits. It is necessary to promote physical activity at an early age and reduce the time spent in front of the TV, video games and computers. The school is the best place to develop these programs, but getting parents involved in this task is difficult.

Children's diet in our country seems to be deficient in fruits and vegetables and rich in hyper caloric food. The purpose of this study is to access intake frequency of food groups in school children of our environment and the influence gender and ethnicity pose over it as well. We have evaluated the socioeconomic and demographic characteristics, lifestyles and the intake frequency of food groups in a population of 383 2nd, 3rd and 4th grade children from elementary school. Boys consume more daily servings of food rich in carbohydrates (4.38 ± 1.6 vs. 3.97 ± 1.4; p= 0.03) and more dairy products (3.23 ± 1.1 vs. 2.83 ± 1.0; p= 0.002) than girls, and, on the other hand, girls eat more candy than boys (2.81 ± 3.9 vs. 2.01 ± 2.3 servings per week; p= 0.03). A high percentage of children did not meet regular recommended food percentages, both by deficiency: fruits and vegetables (78.1%), dairy products (43.4%) and carbohydrates (42.8%); and by excess: protein food (8.1%), pastries (21.2%), candy (18.9%), and sodas/snacks (8.7%). Children belonging to a certain ethnic group consume significantly less dairy products, protein products and fruits/vegetables; and, at the same time, more pastries, candy and sodas/snacks than children that do not belong to a specific ethnic group. Two significant associations (p <0.01) have been found in the analysis of the relationship between different food groups: 1) fruits and vegetables intake was associated with a higher consumption of carbohydrates and fish, and with a lower consumption of sodas/snacks and time watching TV; and 2) pastry intake was associated with a higher consumption of sodas/snacks and sweets.

The estudy concludes that gender and ethnicity are factors that influence the school children´s diet and they shall be considered as risk factors for malnutrition.

It has been considered in occasions that breakfast is the most important meal of the day, although paradoxically it is the most missed meal. There is a growing scientific interest in the role of breakfast in weight control, and in factors such as appetite control, dietary quality and the reduction of risk of chronic diseases. The regular consumption of breakfast has been linked with improvement in academic performance and better social abilities'. Breakfast consumption is also considered an important determinant of a healthful lifestyle and this association may have a positive influence in the prevention of childhood obesity. We will review the scientific data on this topic and will propose some suggestions directed to improve the practice of eating breakfast among our youngsters.

Endogenous Cushing's syndrome is rare endocrine disorders in pediatric age whose most common cause are the pituitary tumors producers of adrenocorticotropin (ACTH) (Cushing's syndrome, CS). This disease must be suspected in any children with unjustified weight gain associated with a decrease in the speed of growth. The first therapeutic option in the CS is the transsphenoidal adenomectomy, followed by radiotherapy if CS persists. After the treatment pituitary disorders can be associated which will need a substitutive therapy, growth hormone deficit can cause an inadequate catch-up growth in children. We report the case of a nearly 11 years-old girl with unjustified weight gain, growth stagnation, signs of virilization and proximal myopathy. Through hormonal determinations was confirmed an ACTH-dependent hypercortisolism was confirmed. The cranial MRI showed a pituitary micro adenoma that was removed through transsphenoidal adenomectomy with clinical and analytic remission. Before surgery, ketoconazole was used in order to control hypercortisolism. There were no signs of relapse four years later.

Non-alcoholic fatty liver disease (NAFLD) is the main cause of chronic liver disease in children and adolescents in some countries, as the United States of America. This fact may be due to a two-fold rise increase in rates of obesity in the last twenty years. The possible progress to steatohepatitis, cirrhosis, hepatocellular carcinoma and heart failure makes the natural history of a seemingly innocent process not to be so at all. However, the NAFLD is not only found in obese patients. We report a case of NAFLD in a 14 year old child with a body mass index of 21.5. This case will be useful to review diverse aspects of this entity.