Impact of body mass index on long-term clinical outcomes after second-generation drug eluting stent implantation: Insights from the international global RESOLUTE program

BACKGROUND An increased body mass index (BMI) is associated with a high risk of cardiovascular disease and reduction in life expectancy. However, several studies reported improved clinical outcomes in obese patients treated for cardiovascular diseases. The aim of the present study is to investigate the impact of BMI on long-term clinical outcomes after implantation of zotarolimus eluting stents. METHODS Individual patient data were pooled from the RESOLUTE Clinical Program comprising five trials worldwide. The study population was sorted according to BMI tertiles and clinical outcomes were evaluated at 2-year follow-up. RESULTS Data from a total of 5,127 patients receiving the R-ZES were included in the present study. BMI tertiles were as follow: I tertile (≤ 25.95 kg/m(2) -Low or normal weight) 1,727 patients; II tertile (>25.95 ≤ 29.74 kg/m(2) -overweight) 1,695 patients, and III tertile (>29.74 kg/m(2) -obese) 1,705 patients. At 2-years follow-up no difference was found for patients with high BMI (III tertile) compared with patients with normal or low BMI (I tertile) in terms of target lesion failure (I-III tertile, HR [95% CI] = 0.89 [0.69, 1.14], P = 0.341; major adverse cardiac events (I-III tertile, HR [95% CI] = 0.90 [0.72, 1.14], P = 0.389; cardiac death (I-III tertile, HR [95% CI] = 1.20 [0.73, 1.99], P = 0.476); myocardial infarction (I-III tertile, HR [95% CI] = 0.86 [0.55, 1.35], P = 0.509; clinically-driven target lesion revascularization (I-III tertile, HR [95% CI] = 0.75 [0.53, 1.08], P = 0.123; definite or probable stent thrombosis (I-III tertile, HR [95% CI] = 0.98 [0.49, 1.99], P = 0.964. CONCLUSIONS In the present study, the patients' body mass index was found to have no impact on long-term clinical outcomes after coronary artery interventions.

Social exclusion and shame in obesity

Weight bias often results in the social exclusion of individuals with obesity. The direct, short-term psychological effects of social exclusion in obesity have not been investigated yet. This study experimentally tests whether social exclusion elicits stronger negative emotions in individuals with obesity compared to normal-weight controls. Specifically, we test whether social exclusion has a specific impact on shame. In total, N = 299 individuals (n = 130 with body mass index [BMI] ≤ 30 and n = 169 with BMI N 30) were randomly assigned to a social exclusion condition or a control condition that was implemented with an online Cyberball paradigm. Before and after, they filled out questionnaires assessing state emotionality. Social exclusion increased negative emotionality in both groups compared to the control condition (p b 0.001) according to a multivariate ANOVA. However, the interaction of group and social exclusion was also significant (p = 0.035) and arose from a significant, specific increase of shame in the group with obesity during social exclusion (p b 0.001, Cohen's d = 0.7). When faced with social exclusion, individuals with obesity do not respond with more intensive negative emotions in general compared to controls, but with a specific increase in shame. As social exclusion is frequent in individuals with obesity, psychological interventions focussing shame-related emotional distress could be crucial.

A cross-sectional analysis of physical activity and obesity in inner city Houston Texas Mexican American youth

Obesity prevalence among children and adolescents is rising. It is one of the most attributable causes of hospitalization and death. Overweight and obese children are more likely to suffer from associated conditions such as hypertension, dyslipidemia, chronic inflammation, increased blood clotting tendency, endothelial dysfunction, hyperinsulinemia, and asthma. These children and adolescents are also more likely to be overweight and obese in adulthood. Interestingly, rates of obesity and overweight are not evenly distributed across racial and ethnic groups. Mexican American youth have higher rates of obesity and are at higher risk of becoming obese than non-Hispanic black and non-Hispanic white children. ^ Methods. This cross-sectional study describes the association between rates of obesity and physical activity in a sample of 1313 inner-city Mexican American children and adolescents (5-19 years of age) in Houston, Texas. This study is important because it will contribute to our understanding of childhood and adolescent obesity in this at-risk population. ^ Data from the Mexican American Feasibility Cohort using the Mano a Mano questionnaire are used to describe this population's status of obesity and physical activity. An initial sample taken from 5000 households in inner city Houston Texas was used as the baseline for this prospective cohort. The questionnaire was given in person to the participants to complete (or to parents for younger children) at a home visit by two specially trained bilingual interviewers. Analysis comprised prevalence estimates of obesity represented as percentile rank (<85%= normal weight, >85%= at risk, >95%= obese) by age and gender. The association between light, moderate, strenuous activity, and obesity was also examined using linear regression. ^ Results. Overall, 46% of this Mexican American Feasibility cohort is overweight or obese. The prevalence for children in the 6-11 age range (53.2%) was significantly greater than that reported from NHANES, 1999–2002 data (39.4%). Although the percentage of overweight and obese among the 12-19 year olds was greater than that reported in NHANES (38.5% versus 38.6%) this difference was not statistically significant. ^ A significant association between BMI and sit time and moderate physical activity (both p < 0.05) found in this sample. For males, this association was significant for moderate physical activity (p < 0.01). For the females, this association was significant for BMI and sit time (p < 0.05). These results need to be interpreted in the light of design and measurement limitations. ^ Conclusion. This study supports observations that the inner city Houston Texas Mexican American child and adolescent population is more overweight and obese than nationally reported figures, and that there are positive relationships between BMI, activity levels, and sit time in this population. This study supports the need for public health initiatives within the Houston Hispanic community. ^

A meta-analysis: Obesity and colorectal cancer screening

Of cancer death, colorectal cancer death ranks second in the United States. Obesity is an important risk factor for colorectal cancer (1). Early detection of colorectal cancer when it is localized can effectively reduce mortality of colorectal cancer and increase survival time of patients if they are treated. Also, previous studies showed that obese women were more likely to delay breast cancer screening and cervical cancer screening than normal weight women (2-5). However, results from prior studies demonstrating the relationship between obesity and colorectal cancer screening are not consistent. This research was done to conduct a meta-analysis of previous cross-sectional studies selected from the Medline database and to evaluate the association between obesity and colorectal cancer screening. While the odds ratio was not statistically different from one, the results from this meta-analysis under the random effects model showed that obese people are slightly less likely to have colorectal cancer screening compared to normal weight individuals (OR,0.93;95% CI 0.75-1.15). This meta-analysis was particularly sensitive to one individual study (6) and the effect of obesity on colorectal cancer screening was statistically significant (OR, 0.87; 95% CI, 0.81-0.92) after removing Heo's study. Further systematic studies focused on whether the effect of obesity on colorectal cancer screening is limited to women only are suggested. ^

Contraceptive use in women by body mass index categories

The prevalence of obesity has increased sharply in the United States since the mid 1970's. Obese women who become pregnant are at increased risk of pregnancy complications for both mother and fetus. This study assessed whether women in higher body mass index (BMI) categories engage in the preventive behaviors of contraception more frequently than normal weight women. It also evaluated the type of contraception used by both obese and normal weight women. The study used cross-sectional data from 7 states participating in the Family Planning Module of the 2006 Behavioral Risk Factor Surveillance System (BRFSS). The Behavioral Risk Factor Surveillance System survey is an annual random digit dialed telephone survey of the non-institutionalized civilian population aged 18 years and older. The Family Planning Module was administered by Arizona, Kentucky, Minnesota, Missouri, Montana, Oregon, and Wisconsin. Of the 4,757 women who participated in the Family Planning Module, 2,244 (53.2%) were normal weight, 1,202 (25.6%) were overweight, and 1,072 (21.2%) were obese. The majority of these women 4,115 (86.2%) reported using some type of contraception to prevent pregnancy. Six hundred forty two women (13.8%) stated they did not use any type of contraception to prevent pregnancy. Within body mass index categories, 14% of normal weight women, 13% of overweight women, and 13.4% of obese women did not use any type of contraception. Neither the bivariate analysis nor the logistic regressions found body mass index categories to be statistically associated with contraceptive use. The relationship between body mass index categories and contraceptive method was found to be statistically significant. The predictive probability graph found that women at all levels of BMI have a lower probability of using barrier contraception methods as compared to procedural and hormonal methods. Hormonal contraception methods have the highest probability of use for women with a BMI of 15 to 25. In contrast, the probability of using procedural contraception methods is relatively flat and less than hormonal methods for BMI between 15 and 25. However, the probability of using procedural contraception increases dramatically with a BMI greater than 25. At a BMI greater than 42, women have a greater than 50% probability of using procedural contraception. Although a relationship between body mass index and contraception use was not found, contraception method was found to be associated with body mass index. The reasons why normal weight women prefer hormonal contraception while overweight/obese women are more likely to use procedural methods needs to be explored. By understanding the relationship between obesity and contraception, we can hopefully decrease unintended pregnancies and overall improve pregnancy related health outcomes. To determine if relationships between contraception use/type and body mass index exist, further research needs to be conducted on a national level. ^

The prevalence, health risks, and consequences of asthma among adult residents in Texas

Based on asthma prevalence data collected from the 2000 BRFSS survey, approximately 14.7 million U.S. adults had current asthma, accounting for 7.2% of the total U.S. population. In Texas alone, state data extrapolated from the 1999-2003 Texas BRFSS suggested that approximately 1 million Texas adults were reporting current asthma and approximately 11% of the adult population has been diagnosed with the illness during their lifetime. From a public health perspective, the disease is manageable. Comprehensive state-specific asthma surveillance data are necessary to identify disparities in asthma prevalence and asthma-control characteristics among subpopulations and to develop targeted public health interventions. The purpose of this study was to determine the relative importance of various risk factors of asthma and to examine the impact of asthma on health-related quality of life among adult residents of Texas. ^ The study employed a cross-sectional study of respondents in Texas. The study extracted all the variables related to asthma along with their associated demographic, socioeconomic, and quality of life variables from the 2007 BRFSS data for 17,248 adult residents of Texas aged 18 and older. Chi-square test and logistic regression using SPSS were used in various data analyses on weighted data, adjusting for the complex sample design of the BRFSS data. All chi-square analyses were carried out using SPSS's CSTABULATE command. In addition, logistic regression models were fitted using SPSS's CSLOGISTIC command. ^ Risks factors significantly associated with reporting current asthma included BMI, race/ethnicity, gender, and income. Holding all other variables constant, obese adults were almost twice as likely to report current asthma as those adults who were normal weight (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.25 to 2.53). Other non-Hispanic adults were significantly more likely to report current asthma than non-Hispanic Whites (OR, 2.43; 95% CI, 1.38 to 4.25), while Hispanics were significantly less likely to report current asthma than non-Hispanic Whites (OR, 0.38; 95% CI, 0.25 to 0.60), after controlling for all other variables. After adjusting for all other variables, adult females were almost twice as likely to report current asthma as males (OR, 1.97; 95% CI, 1.49 to 2.60). Adults with household income of less than $15,000 were almost twice as likely to report current asthma as those persons with an annual household income of $50,000 or more (OR, 1.98; 95% CI, 1.33 to 2.94). In regards to the association between asthma and health-related quality of life, after adjusting for age, race/ethnicity, gender, tobacco use, body mass index (BMI), exercise, education, and income, adults with current asthma compared to those without asthma were more likely to report having more than 15 days of unhealthy physical health (OR, 1.84; 95% CI, 1.29 to 2.60). ^ Overall, the findings of this study provide insight and valuable information into the populations in Texas most adversely affected by asthma and health-related consequences of the disease condition. Further research could build on the findings of this study by replicating this study as closely as possible in other asthma settings, and look at the relationship for hospitalization rates, asthma severity, and mortality.^

A formative evaluation of the American Diabetes Association's Choosing Health and Sensible Exercise childhood obesity intervention

Background. The increasing prevalence of overweight among youth in the United States, and the parallel rise in related medical comorbidities has led to a growing need for efficient weight-management interventions. Purpose. The aim of this study was to evaluate the effects of the Choosing Health and Sensible Exercise (C.H.A.S.E.) childhood obesity prevention program on Body Mass Index (BMI), physical activity and dietary behaviors. Methods. This study utilized de-identified data collected during the fall 2006 session of the C.H.A.S.E. program. A total of 65 students at Woodview Elementary School and Deepwater Elementary School participated in this intervention. The C.H.A.S.E. program is a 10-week obesity prevention program that focuses on nutrition and physical activity education. Collection of height and weight data, and a health behavior survey was conducted during the first and last week of the intervention. Paired t-tests were used to determine statistically significant differences between pre- and post-intervention measurements. One-way analysis of variance was used to adjust for potential confounders, such as gender, age, BMI category ("normal weight", "at risk overweight", or "overweight"), and self-reported weight loss goals. Data were analyzed using STATA, v. 9.2. Results. A significant decrease in mean BMI (p< 0.05) was found after the 10-week intervention. While the results were statistically significant for the group as a whole, changes in BMI were not significant when stratified by age, sex, or ethnicity. The mean overall scores for the behavior survey did not change significantly pre- and post-intervention; however, significant differences were found in the dietary intention scale, indicating that students were more likely to intend to make healthier food choices (p<0.05). No statistically significant decreases in BMI were found when stratified for baseline BMI-for-age percentiles or baseline weight loss efforts (p>0.05). Conclusion. The results of this evaluation provide information that will be useful in planning and implementing an effective childhood obesity intervention in the future. Changes in the self-reported dietary intentions and BMI show that the C.H.A.S.E. program is capable of modifying food choice selection and decreasing BMI. Results from the behavior questionnaire indicate that students in the intervention program were making changes in a positive direction. Future implementation of the C.H.A.S.E. program, as well as other childhood obesity interventions, may want to consider incorporating additional strategies to increase knowledge and other behavioral constructs associated with decreased BMI. In addition, obesity prevention programs may want to increase parental involvement and increase the dose or intensity of the intervention. ^

The relationship between body image and physical activity in African American women

High rates of overweight and obesity in African American women have been attributed, in part, to poor health habits, such as physical inactivity, and cultural influences on body image perceptions. The purpose of this study was to determine the relationship among body mass index (BMI=kg/m2), body image perception (perceived and desired) and physical activity, both self-reported and objectively measured. Anthropometric measures of BMI and Pulvers' culturally relevant body image, physical activity and demographic data were collected from 249 African American women in Houston. Women ( M = 44.8 yrs, SD = 9.5) were educated (53% college graduates) and were overweight (M = 35.0 kg/m2, SD = 9.2). Less than half of women perceived their weight correctly regardless of their actual weight (p < 0.001). Nearly three-fourths (73.9%) of women who were normal weight desired to be obese, and only 39.4% of women desired to be normal weight, regardless of actual or perceived weight. Women in all weight classes (normal, overweight and obese) varied in objective measures of physical activity (F(2,112) = 4.424, p = .014). Regression analyses showed objectively measured physical activity was significantly associated with BMI ( Beta = -2.45, p < .01) and self-reported walking was significantly associated with perceived BMI (Beta = -.156, p = .017). Results suggest African American women who are smaller want to be larger and African American women who are larger want to be smaller, revealing dichotomous distortion in body images. Low rates of physical activity may be a factor. Research is needed to increase physical activity levels in African American women, leading to improved satisfaction with normal weight as desirable for health and beauty. Supported by NCI (NIH) 1R01CA109403. ^

THE USE OF ARM CIRCUMFERENCE FOR SIMPLIFIED SCREENING FOR MALNUTRITION BY MINIMALLY TRAINED HEALTH WORKERS

Because of its simplicity and low cost, arm circumference (AC) is being used increasingly in screening for protein energy malnutrition among pre-school children in many parts of the developing world, especially where minimally trained health workers are employed. The objectives of this study were as follows: (1) To determine the relationship of the AC measure with weight for age and weight for height in the detection of malnutrition among pre-school children in a Guatemalan Indian village. (2) To determine the performance of minimally trained promoters under field conditions in measuring AC, weight and height. (3) To describe the practical aspects of taking AC measures versus weight, age and height.^ The study was conducted in San Pablo La Laguna, one of four villages situated on the shores of Lake Atitlan, Guatemala, in which a program of simplified medical care was implemented by the Institute for Nutrition for Central America and Panama (INCAP). Weight, height, AC and age data were collected for 144 chronically malnourished children. The measurements obtained by the trained investigator under the controlled conditions of the health post were correlated against one another and AC was found to have a correlation with weight for age of 0.7127 and with weight for height of 0.7911, both well within the 0.65 to 0.80 range reported in the literature. False positive and false negative analysis showed that AC was more sensitive when compared with weight for height than with weight for age. This was fortunate since, especially in areas with widespread chronic malnutrition, weight for height detects those acute cases in immediate danger of complicating illness or death. Moreover, most of the cases identified as malnourished by AC, but not by weight for height (false positives), were either young or very stunted which made their selection by AC better than weight for height. The large number of cases detected by weight for age, but not by AC (false negative rate--40%) were, however, mostly beyond the critical age period and had normal weight for heights.^ The performance of AC, weight for height and weight for age under field conditions in the hands of minimally trained health workers was also analyzed by correlating these measurements against the same criterion measurements taken under ideally controlled conditions of the health post. AC had the highest correlation with itself indicating that it deteriorated the least in the move to the field. Moreover, there was a high correlation between AC in the field and criterion weight for height (0.7509); this correlation was almost as high as that for field weight for height versus the same measure in the health post (0.7588). The implication is that field errors are so great for the compounded weight for height variable that, in the field, AC is about as good a predictor of the ideal weight for height measure.^ Minimally trained health workers made more errors than the investigator as exemplified by their lower intra-observer correlation coefficients. They consistently measured larger than the investigator for all measures. Also there was a great deal of variability between these minimally trained workers indicating that careful training and followup is necessary for the success of the AC measure.^ AC has many practical advantages compared to the other anthropometric tools. It does not require age data, which are often unreliable in these settings, and does not require sophisticated subtraction and two dimensional table-handling skills that weight for age and weight for height require. The measure is also more easily applied with less disturbance to the child and the community. The AC tape is cheap and not easily damaged or jarred out of calibration while being transported in rugged settings, as is often the case with weight scales. Moreover, it can be kept in a health worker's pocket at all times for continual use in a widespread range of settings. ^

Influence of family meals on obesity and dietary behaviors among adolescents in India

The study objectives were to (i) Describe the frequency and priority of family meals, (ii) Compare the family mealtime environment by gender and SES, (iii) Examine the association between family meals and weight status among adolescents living in New Delhi, India, (iv) Examine the association between family meals and eating patterns (healthy/unhealthy) among adolescent boys and girls living in New Delhi, India. Survey and anthropometric data were collected from 8th and 10th grade students (n=1818) from four Government (public) schools and four private schools who participated in the HRIDAY study. Chi-square tests were used to evaluate if the distributions of outcomes and exposure varied by gender and SES groups. Logistic regression models were used to obtain the association of weight status (underweight / normal weight Vs overweight / obese) with frequency of family meals as the main exposure. Overall the prevalence of obesity was more among the mid- high SES group and in boys. Over half of the participants had 7 or more family meals in the past week. There was no statistically significant association seen between family meals and weight status. Majority of the participants believed that eating healthy food and maintaining a healthy weight was important and eating at least one family meal was important. Majority of the participants who ate more than 3 or more family meals eat healthy food and also ate fast food. Intervention strategies should focus on the high risk group. Private schools are appropriate settings for interventions. Eating with families should be encouraged and future research should examine family meal patterns.^

Bullied status and physical activity in Texas youths

Data from the 2009–2011 School Physical Activity and Nutrition (SPAN) project were analyzed to examine the association between bullied status at school during the past six months and engaging in five or more days of physical activity during the past seven days in a population of 8th and 11th grade Texas youths after stratifying by gender. As a secondary aim, this study also examined the association between weight status and the prevalence of bullied status at school. The final sample size for this study, after excluding missing data, consisted of 6,246 8th and 11th grade youths (girls, n= 3,237; boys, n=3,009) representing a total of 518,838 youths from 8th and 11th grade. Results from the multiple logistic regression adjusting for weight status, grade, and ethnicity, indicate that girls with a bullied status of at least two or three times per month had significantly lower odds of engaging in five or more days of physical activity during the past seven days than girls who were never bullied at school (ORadj=0.62; 95% CI, 0.40, 0.96). Conversely, girls who reported a bullied status of at least once per week were significantly more likely to engage in five or more days of physical activity during the past seven days compared to girls who were never bullied at school (ORadj=3.44; 95% CI, 1.56, 7.63). No significant associations between bullied status and engaging in five or more days of physical activity during the past seven days were found for boys. Bullied status differed significantly across weight status for 8th grade girls (χ2(6)=63.7, p<.05) and 11th grade boys (χ2(6) =94.93, p<.05), with overweight and obese youths reporting a higher prevalence of being bullied once or twice, at least two or three times per month, and at least once per week than their normal weight peers. Our finding that girls with bullied status of at least once per week were more likely to engage in five or more days of physical activity than girls who were never bullied warrants future qualitative research to identify potential explanations for such results. Future research on relational and weight-based bullying is also needed and may help explain the inconsistent findings between bullied status and engaging in physical activity in girls.^

Effects of overweight and obesity on economic outcomes among U.S. adults with kidney disease

Background. Kidney disease is a growing public health phenomenon in the U.S. and in the world. Downstream interventions, dialysis and renal transplants covered by Medicare's renal disease entitlement policy in those who are 65 years and over have been expensive treatments that have been not foolproof. The shortage of kidney donors in the U.S. has grown in the last two decades. Therefore study of upstream events in kidney disease development and progression is justified to prevent the rising prevalence of kidney disease. Previous studies have documented the biological route by which obesity can progress and accelerate kidney disease, but health services literature on quantifying the effects of overweight and obesity on economic outcomes in the context of renal disease were lacking. Objectives . The specific aims of this study were (1) to determine the likelihood of overweight and obesity in renal disease and in three specific adult renal disease sub-populations, hypertensive, diabetic and both hypertensive and diabetic (2) to determine the incremental health service use and spending in overweight and obese renal disease populations and (3) to determine who financed the cost of healthcare for renal disease in overweight and obese adult populations less than 65 years of age. Methods. This study was a retrospective cross-sectional study of renal disease cases pooled for years 2002 to 2009 from the Medical Expenditure Panel Survey. The likelihood of overweight and obesity was estimated using chi-square test. Negative binomial regression and generalized gamma model with log link were used to estimate healthcare utilization and healthcare expenditures for six health event categories. Payments by self/family, public and private insurance were described for overweight and obese kidney disease sub-populations. Results. The likelihood of overweight and obesity was 0.29 and 0.46 among renal disease and obesity was common in hypertensive and diabetic renal disease population. Among obese renal disease population, negative binomial regression estimates of healthcare utilization per person per year as compared to normal weight renal disease persons were significant for office-based provider visits and agency home health visits respectively (p=0.001; p=0.005). Among overweight kidney disease population health service use was significant for inpatient hospital discharges (p=0.027). Over years 2002 to 2009, overweight and obese renal disease sub-populations had 53% and 63% higher inpatient facility and doctor expenditures as compared to normal weight renal disease population and these result were statistically significant (p=0.007; p=0.026). Overweigh renal disease population had significant total expenses per person per year for office-based and outpatient associated care. Overweight and obese renal disease persons paid less from out-of-pocket overall compared to normal weight renal disease population. Medicare and Medicaid had the highest mean annual payments for obese renal disease persons, while mean annual payments per year were highest for private insurance among normal weight renal disease population. Conclusion. Overweight and obesity were common in those with acute and chronic kidney disease and resulted in higher healthcare spending and increased utilization of office-based providers, hospital inpatient department and agency home healthcare. Healthcare for overweight and obese renal disease persons younger than 65 years of age was financed more by private and public insurance and less by out of pocket payments. With the increasing epidemic of obesity in the U.S. and the aging of the baby boomer population, the findings of the present study have implications for public health and for greater dissemination of healthcare resources to prevent, manage and delay the onset of overweight and obesity that can progress and accelerate the course of the kidney disease.^

Effect of endurance, speed and strength training on skin temperature measured by infrared thermography = Efecto del entrenamiento de resistencia, velocidad y fuerza en la temperatura de la piel a través de la termografía infrarroja

La termografía infrarroja (TI) es una técnica no invasiva y de bajo coste que permite, con el simple acto de tomar una fotografía, el registro sin contacto de la energía que irradia el cuerpo humano (Akimov & Son’kin, 2011, Merla et al., 2005, Ng et al., 2009, Costello et al., 2012, Hildebrandt et al., 2010). Esta técnica comenzó a utilizarse en el ámbito médico en los años 60, pero debido a los malos resultados como herramienta diagnóstica y la falta de protocolos estandarizados (Head & Elliot, 2002), ésta se dejó de utilizar en detrimento de otras técnicas más precisas a nivel diagnóstico. No obstante, las mejoras tecnológicas de la TI en los últimos años han hecho posible un resurgimiento de la misma (Jiang et al., 2005, Vainer et al., 2005, Cheng et al., 2009, Spalding et al., 2011, Skala et al., 2012), abriendo el camino a nuevas aplicaciones no sólo centradas en el uso diagnóstico. Entre las nuevas aplicaciones, destacamos las que se desarrollan en el ámbito de la actividad física y el deporte, donde recientemente se ha demostrado que los nuevos avances con imágenes de alta resolución pueden proporcionar información muy interesante sobre el complejo sistema de termorregulación humana (Hildebrandt et al., 2010). Entre las nuevas aplicaciones destacan: la cuantificación de la asimilación de la carga de trabajo físico (Čoh & Širok, 2007), la valoración de la condición física (Chudecka et al., 2010, 2012, Akimov et al., 2009, 2011, Merla et al., 2010), la prevención y seguimiento de lesiones (Hildebrandt et al., 2010, 2012, Badža et al., 2012, Gómez Carmona, 2012) e incluso la detección de agujetas (Al-Nakhli et al., 2012). Bajo estas circunstancias, se acusa cada vez más la necesidad de ampliar el conocimiento sobre los factores que influyen en la aplicación de la TI en los seres humanos, así como la descripción de la respuesta de la temperatura de la piel (TP) en condiciones normales, y bajo la influencia de los diferentes tipos de ejercicio. Por consiguiente, este estudio presenta en una primera parte una revisión bibliográfica sobre los factores que afectan al uso de la TI en los seres humanos y una propuesta de clasificación de los mismos. Hemos analizado la fiabilidad del software Termotracker, así como su reproducibilidad de la temperatura de la piel en sujetos jóvenes, sanos y con normopeso. Finalmente, se analizó la respuesta térmica de la piel antes de un entrenamiento de resistencia, velocidad y fuerza, inmediatamente después y durante un período de recuperación de 8 horas. En cuanto a la revisión bibliográfica, hemos propuesto una clasificación para organizar los factores en tres grupos principales: los factores ambientales, individuales y técnicos. El análisis y descripción de estas influencias deben representar la base de nuevas investigaciones con el fin de utilizar la TI en las mejores condiciones. En cuanto a la reproducibilidad, los resultados mostraron valores excelentes para imágenes consecutivas, aunque la reproducibilidad de la TP disminuyó ligeramente con imágenes separadas por 24 horas, sobre todo en las zonas con valores más fríos (es decir, zonas distales y articulaciones). Las asimetrías térmicas (que normalmente se utilizan para seguir la evolución de zonas sobrecargadas o lesionadas) también mostraron excelentes resultados pero, en este caso, con mejores valores para las articulaciones y el zonas centrales (es decir, rodillas, tobillos, dorsales y pectorales) que las Zonas de Interés (ZDI) con valores medios más calientes (como los muslos e isquiotibiales). Los resultados de fiabilidad del software Termotracker fueron excelentes en todas las condiciones y parámetros. En el caso del estudio sobre los efectos de los entrenamientos de la velocidad resistencia y fuerza en la TP, los resultados muestran respuestas específicas según el tipo de entrenamiento, zona de interés, el momento de la evaluación y la función de las zonas analizadas. Los resultados mostraron que la mayoría de las ZDI musculares se mantuvieron significativamente más calientes 8 horas después del entrenamiento, lo que indica que el efecto del ejercicio sobre la TP perdura por lo menos 8 horas en la mayoría de zonas analizadas. La TI podría ser útil para cuantificar la asimilación y recuperación física después de una carga física de trabajo. Estos resultados podrían ser muy útiles para entender mejor el complejo sistema de termorregulación humano, y por lo tanto, para utilizar la TI de una manera más objetiva, precisa y profesional con visos a mejorar las nuevas aplicaciones termográficas en el sector de la actividad física y el deporte Infrared Thermography (IRT) is a safe, non-invasive and low-cost technique that allows the rapid and non-contact recording of the irradiated energy released from the body (Akimov & Son’kin, 2011; Merla et al., 2005; Ng et al., 2009; Costello et al., 2012; Hildebrandt et al., 2010). It has been used since the early 1960’s, but due to poor results as diagnostic tool and a lack of methodological standards and quality assurance (Head et al., 2002), it was rejected from the medical field. Nevertheless, the technological improvements of IRT in the last years have made possible a resurgence of this technique (Jiang et al., 2005; Vainer et al., 2005; Cheng et al., 2009; Spalding et al., 2011; Skala et al., 2012), paving the way to new applications not only focused on the diagnose usages. Among the new applications, we highlighted those in physical activity and sport fields, where it has been recently proven that a high resolution thermal images can provide us with interesting information about the complex thermoregulation system of the body (Hildebrandt et al., 2010), information than can be used as: training workload quantification (Čoh & Širok, 2007), fitness and performance conditions (Chudecka et al., 2010, 2012; Akimov et al., 2009, 2011; Merla et al., 2010; Arfaoui et al., 2012), prevention and monitoring of injuries (Hildebrandt et al., 2010, 2012; Badža et al., 2012, Gómez Carmona, 2012) and even detection of Delayed Onset Muscle Soreness – DOMS- (Al-Nakhli et al., 2012). Under this context, there is a relevant necessity to broaden the knowledge about factors influencing the application of IRT on humans, and to better explore and describe the thermal response of Skin Temperature (Tsk) in normal conditions, and under the influence of different types of exercise. Consequently, this study presents a literature review about factors affecting the application of IRT on human beings and a classification proposal about them. We analysed the reliability of the software Termotracker®, and also its reproducibility of Tsk on young, healthy and normal weight subjects. Finally, we examined the Tsk thermal response before an endurance, speed and strength training, immediately after and during an 8-hour recovery period. Concerning the literature review, we proposed a classification to organise the factors into three main groups: environmental, individual and technical factors. Thus, better exploring and describing these influence factors should represent the basis of further investigations in order to use IRT in the best and optimal conditions to improve its accuracy and results. Regarding the reproducibility results, the outcomes showed excellent values for consecutive images, but the reproducibility of Tsk slightly decreased with time, above all in the colder Regions of Interest (ROI) (i.e. distal and joint areas). The side-to-side differences (ΔT) (normally used to follow the evolution of some injured or overloaded ROI) also showed highly accurate results, but in this case with better values for joints and central ROI (i.e. Knee, Ankles, Dorsal and Pectoral) than the hottest muscle ROI (as Thigh or Hamstrings). The reliability results of the IRT software Termotracker® were excellent in all conditions and parameters. In the part of the study about the effects on Tsk of aerobic, speed and strength training, the results of Tsk demonstrated specific responses depending on the type of training, ROI, moment of the assessment and the function of the considered ROI. The results showed that most of muscular ROI maintained warmer significant Tsk 8 hours after the training, indicating that the effect of exercise on Tsk last at least 8 hours in most of ROI, as well as IRT could help to quantify the recovery status of the athlete as workload assimilation indicator. Those results could be very useful to better understand the complex skin thermoregulation behaviour, and therefore, to use IRT in a more objective, accurate and professional way to improve the new IRT applications for the physical activity and sport sector.

La coordinación motriz en la Adolescencia y su relación con el IMC, hábitos de práctica y motivación en E.F: Estudio transversal y longitudinal

En las últimas décadas, ha aumentado el interés de la investigación sobre el desarrollo de la coordinación motriz en la adolescencia por ser una etapa sensible, crítica y crucial para la adquisición de hábitos y conductas saludables de vida. Estos estudios han mostrado que la adquisición de unos niveles óptimos de coordinación y competencia motriz van a ser determinantes para el bienestar del adolescente y van a estar relacionados e influidos por otras dimensiones del desarrollo de la persona. Recientes investigaciones han sacado a la luz datos alarmantes sobre el aumento de problemas de coordinación motriz en la población infantil y adolescente (Cantell, Smyth y Ahonen, 1994; Gómez, 2004; Ruiz, Graupera, Gutiérrez y Miyahara, 2003; Sudgen y Chambers, 2005) donde abrocharse los botones de una camisa o correr de forma armónica puede ser todo un mundo lleno de dificultades y consecuencias sobre otras dimensiones del desarrollo (Ramón-Otero y Ruiz, 2015). Estos problemas han sido tratados por investigadores como una “dificultad oculta” (Gómez, Ruiz y Mata, 2006), cuya manifestación está presente en las actividades de la vida cotidiana, en contextos deportivos, en juegos y/o en la clase de Educación Física (Ruiz, 2004). La preocupación por estas dificultades se ha extendido a nivel internacional, creando todo un campo de investigación que estudia el diagnóstico de éstos problemas, conocido bajo las siglas DCD (Developmental Coordination Disorder). El presente estudio se centra en la etapa adolescente, periodo de transición entre la etapa infantil y adulta, caracterizada por numerosos cambios biológicos, cognitivos y socioemocionales (Santrock, 2005), que van a determinar la adaptación con el entorno (Gallahue, Ozmun y Goodway, 2011; Gómez, Ruiz, y Mata, 2006). El propósito principal del estudio es analizar el desarrollo de la coordinación motriz en la etapa adolescente investigando las diferencias de género y de edad en relación con variables psicosociales, los hábitos de práctica y las variables antropométricas. El diseño de la investigación se estructura en dos estudios. El primero de ellos, de carácter transversal, analizó una muestra representativa de 1.966 adolescentes de 1º a 4º de la ESO. El segundo, de naturaleza longitudinal, utilizó un grupo de 89 adolescentes del estudio transversal los cuales fueron estudiados durante 4 años, desde los 12 a los 15 años. Los mismos instrumentos fueron utilizados en ambos estudios: el Test Sportcomp para la evaluación de la coordinación motriz, el test AMPET4 para valorar la motivación de logro para el aprendizaje en Educación Física, el inventario HBSC para conocer los hábitos saludables sobre la práctica de actividad física y, por ultimo, se utilizó un estadiómetro para obtener el peso y la altura y así calcular el índice de masa corporal (IMC). La toma de datos del Estudio Transversal se realizó en 2 cursos académicos (2011/12 - 2012/13), en la cual se requirieron 3 sesiones coincidiendo con la clase de Educación Física. En la primera sesión, se evaluó la coordinación motriz. En la segunda se aplicaron los cuestionarios (AMPET4 y HBSC) y, en la última sesión se midió el peso y la altura en un espacio reservado al estadiómetro. El análisis de datos fue descriptivo y diferencial de cada una de las variables estudiadas: motoras, psicosociales, de hábitos de práctica de actividad física y antropométricas. Asimismo, se llevaron a cabo pruebas de análisis univariante y multivariante, calculando el valor-p y las pruebas de efecto. Respecto al Estudio Longitudinal, la toma de datos se llevó cabo durante 4 años desde el 2011 al 2014. La evaluación de la coordinación motriz se realizó en cada uno de los 4 años. Sin embargo, los 2 cuestionarios y las medidas antropométricas fueron evaluadas en el primer y cuarto año. Los análisis de datos fueron descriptivos y comparativos entre las variables analizadas. En el caso de la coordinación motriz, se realizaron las pruebas de medidas repetidas y, en el caso de las demás variables analizadas, se realizaron Prueba T para muestras relacionadas. Los resultados globales mostraron que el índice motor en el Estudio Transversal fue progresivo en el conjunto de chicos. Sin embargo, en las chicas, el rendimiento se estabiliza a partir de los 13 años. En el caso del Estudio Longitudinal, este índice se estabiliza en los 3 primeros años y a la edad de los 14, es cuando comienzan a acusarse las diferencias de género. En el caso de los hombres el rendimiento mejora y, por el contrario, en las mujeres empeora. En el Estudio Transversal, el análisis de varianza mostraron diferencias en función de la edad [F(7, 1958) = 220.70, p < .001; η2 = .101], del género [F(7, 1958) = 29.76, p < .001; η2 = .044], así como en la interacción entre ambos [F(7, 1958)= 11.90, p < .001; η2 = .018]. Únicamente aparecieron diferencias significativas con la edad en todos los grupos de hombres, excepto entre 14 y 15 años. En el Longitudinal, los contrastes multivariados mostraron que no hubo diferencias sgnificativas en el tiempo [F(3,85) = .05, p = .987, η2= .002] mostrando un nivel de coordinación estable a lo largo de los años, aunque existieron diferencias entre chicos y chicas [F(3,85) = 4.64 p = .005] con un tamaño de efecto destacable (η2 = .141). En cuanto a la motivación de logro para prender en Educación Física, en ambos estudios, los chicos fueron los que obtuvieron puntuaciones más elevadas en todas las dimensiones positivas del test (compromiso de aprendizaje, competencia autopercibida y comparada). Sin embargo, en la dimensión negativa del test, la referida a la ansiedad y al agobio ante el fracaso, fueron las chicas las que puntuaron más alto. En el Estudio Transversal, los resultados mostraron diferencias significativas en todas las dimensiones del AMPET4 en función del nivel de coordinación motriz: compromiso con el aprendizaje [F(2, 1644) = 8.66, p < .001; η2 = .010], competencia autopercibida [F(2, 1644) = 50.94, p < .001; η2 = .048], competencia comparada [F(2, 1644) = 41.56, p < .001, η2 = .020] y ansiedad [F(2, 1644) = 16.67, p < .001, η2 = .058]. En este sentido, los grupos de mejor nivel de coordinación motriz, fueron los que mayor puntuación obtuvieron en las dimensiones positivas y los que menor, en la negativa. En el Estudio Longitudinal, también se encontraron diferencias entre el primer y cuarto año de estudio en todas las dimensiones, excepto en competencia motriz autopercibida. Estas diferencias se tradujeron en una disminución en las 3 variables significativas del primer al cuarto año. Respecto al inventario HBSC, en el Estudio Longitudinal, la prueba T mostró únicamente la existencia de diferencias significativas entre el primer y cuarto año en 2 de los 11 ítems: percepción de la forma física (p = .006) y percepción de la salud (p = .047), los cuales disminuyeron en el intervalo de tiempo del estudio. En el Transversal, las diferencias se observaron en función del género (p < .001) y de la edad (p < .001). Asimismo, se mostraron diferencias significativas en todos los ítems respecto al nivel de coordinación motriz, excepto en 2 de ellos: frecuencia tiempo libre con los amigos fuera del colegio (p = .580) y facilidad para hacer amigos en el centro escolar (p = .098). Por último, en las variables antropométricas, los resultados del Estudio Transversal y Longitudinal coinciden tanto en la estatura como en el peso, apuntando, que en ambos estudios, se produce un aumento progresivo tanto en chicos como en chicas a medida que se avanza en edad. Concretamente en el Transversal, estas diferencias en la edad se encuentran en todos los grupos en ambos géneros, excepto en el conjunto de chicas entre los 14 y los 15 años. Asimismo, ambos estudios coincidieron en que tanto las ganancias en cm y kg, como las puntuaciones medias, fueron mayores en los chicos que en las chicas. Respecto al IMC, los 2 estudios coincidieron en que la evolución es paralela, y tal y como apuntan los resultados del Transversal, no se encontraron diferencias ni en la edad (p = 792) ni en el género (p = 284). No obstante, el Longitudinal apuntó únicamente diferencias significativas entre el primer y cuarto año en el conjunto de los hombres [t(41) = -4.01, p < .001]. Finalmente, y en relación con los niveles de coordinación motriz, hubo diferencias significativas en relación con el IMC (p = .012), mostrando como el grupo de peso normal coincide con puntuaciones óptimas de coordinación motriz. A modo de conclusiones, el presente estudio revela cómo la adquisición de un nivel de coordinación óptimo va a ser fundamental para el desarrollo psicosocial, para el desarrollo de hábitos saludables de práctica y para mantener un IMC dentro de la normalidad para el género y la edad. De esta manera, el desarrollo de la coordinación motriz será un aspecto fundamental para lograr un estado de bienestar físico y mental, y unos hábitos favorables para la práctica de actividad física. ABSTRACT In the past couple of decades, adolescence stage in motor coordination gained significant interest in research especially due to its sensitive and critical importance to achieving a healthy life style. These studies observed how to acquire optimum levels of coordination and motor competence, which proved crucial to the quality of the adolescent stage in addition to being influenced by other dimensions of development for each individual. Recent research shed light to an alarming set of data, which showed increased motor coordination problems in children and adolescents (Cantell, Smyth & Ahonen, 1994; Gómez, 2004; Ruiz, Graupera, Gutierrez & Miyahara, 2003; Sugden & Chambers, 2005). For instance, even to the extent that buttoning a shirt or running in a harmonic form can lead to a whole set of consequences and difficulties on the development stage. Researchers have addressed such problems in various studies such as “dificultad oculta” (Gomez, Ruiz & Mata, 2006), which literally translates as “hidden trouble”. The studies are evidently present in the activities of daily life, sporting contexts, games and/or Physical Education (Ruiz, 2004). Concern about these difficulties spread internationally, creating a whole framework research studying the diagnosis of these problems, known under the acronym DCD (Developmental Coordination Disorder). The study focuses on the adolescent stage, transition period between childhood and adulthood characterized by numerous biological, cognitive and socio-emotional changes (Santrock, 2005), which interestingly determines an individual´s adaptation to the environment (Gallahue, Ozmun & Goodway, 2011; Gomez, Ruiz & Mata, 2006). The main purpose of the study is to analyse the development of motor coordination in the adolescent stage investigating gender differences and age in relation to psychological variables, physical activity habits and anthropometric variables. The research design is structured in two studies. The first (transversal nature), analyses a representative sample of 1,966 adolescents from 1st to 4th of Secondary Education School. The second (longitudinal nature) used a group of 89 teenagers from cross-sectional study, which were studied for four years, from 12 to 15 years. The same instruments were used in both studies, namely; “Sportcomp Test” used to evaluate of motor coordination; “AMPET4 Test” which assesses the motivational achievement of learning Physical Education; “HBSC Inventory” to find out the healthy habits gained from physical activities; And finally a “stadiometer” was used to obtain the weight and height and thus calculate the body mass index (BMI). The data collection of the cross-sectional Study was conducted in two academic years (2011/12 - 2012/13), in which 3 sessions coinciding with the Physical Education level are required. In the first session, motor coordination was evaluated; questionnaires were applied in the second session (AMPET4 and HBSC); and in the last session the weight and height were measured in a reserved space for the “stadiometer”. Notably, data analysis was descriptive and differential in each of the variable studies: motor, psychological, practical and anthropometric habits of physical activity. Thus the tests were conducted in a univariate and multivariate analysis, calculating the p-value and effect tests. Regarding the Longitudinal Study, data collection was carried out during four years from 2011 to 2014 inclusively. The assessment of motor coordination was performed on each of the four years, however, the 2 questionnaires and anthropometric measures were evaluated in the first and fourth year. Data analyses were also descriptive and comparative among the variables that were put to the test. In the case of motor coordination tests, they were done on repeated measures, whilst, in the case of other variables analysed, they were accomplished through T Tests under comparable samples. The overall results showed that the engine Motor Index in Study 1 was progressive in all male gender studies, however in the females the performance remained constant after reaching 13 years of age. For the Longitudinal Study, this index is stabilized in the first 3 years and at the age of 14 is when the gender differences take place. In the case of males, the performance improves, however, in females worsens. The cross-sectional Study, analysis of variance showed differences in terms of age [F(7, 1958) = 220.70, p < .001; η2 = .101], gender [F(7, 1958) = 29.76, p <.001; η2 = .044], as well as their interaction [F(7, 1958) = 11.90, p <.001; η2 = .018]. They only show significant differences in respect to age in the male set sample, in all groups except between 14 and 15 years old. In the Longitudinal, the multivariate contrasts showed no significant differences in time [F(3,85) = 0.05, p = 0.987, η2 = 0.002] showing a stable level of coordination over the years, but if there were differences between both genders [F(3,85) = 4.64, p = .005] it took place with a noteworthy effect size (η2 = .141). In regards, to the Motivational Achievement for learning Physical Education, in both studies the male sample administered obtained higher scores on all the positive dimensions of the test (commitment to learning, self-assessed competence, and comparable competence). However, on the negative assessment side, namely, anxiety and fear of failure, the female sample scored higher than the male one. In Study 1, the multivariate analysis showed significant differences between the psychosocial dimensions and levels of motor coordination with moderate to significant effect [Lambada de Wilks = .931, F(8, 3282) = 14.99; p = <0.001; η2 = .035]. By the same token, the groups with the best level of motor coordination were the highest scoring ones in the positive dimensions, whilst the lower performing ones, performed better in the negative dimension. In the longitudinal study, there is also differences were also found between the first and fourth years of study in all dimensions, except in self-perceived motor competition. These differences resulted in a significant decrease in the 3 variables from first to fourth year. Regarding, the “HBSC Inventory”, the T test in the longitudinal study showed uniquely the existence of significant differences between the first and fourth year in 2 of the 11 items: perception of physical fitness (p = .006) and perceived health (p = 047), which diminished in the interval time of the study. In the Cross-sectional study, the se differences were also observed in gender (p < .001) and age (p < .001). Similarly, they showed significant differences in all items in respect to the motor coordination level, except in 2 of them; frequency of free time with friends outside of school (p = .580) and the ease to make friends at the educational centre (p = 098). And last but not least, the anthropometric variables, both the results of the Transversal and Longitudinal Study matched both height and weight, pointing out that in both studies a gradual increase in both genders, as they grow older. Notably in the Cross-sectional, these differences in age are found in all groups in both genders, except for the set of girls between 14 and 15 years. Thus both studies concluded that both gains in cm and kg and the mean scores were higher amongst males compared to females. Regarding BMI, the 2 studies concluded that the evolution is parallel, and as pointed cross-sectional study there isn’t differences found in age (p = 792) or in gender (p = 284). However, the Longitudinal study uniquely shows significant difference between the first and fourth year for male set sample [t (41) = -4.01, p < .001]. Finally, in relation to levels of motor coordination, there were significant differences in relation to BMI (p = .012), showing how the “normal weight group” matches the optimal scores of motor coordination. In conclusion, this study reveals how the acquisition of an optimal level of coordination is vital for psychological development, to develop and practice healthy habits, and to maintain a BMI within the normal range for age and gender. Therefore, the development of motor coordination is fundamental to achieving a state of physical and mental wellbeing, and preferable habits to pursuing physical activity.

Lipoprotein lipase controls fatty acid entry into adipose tissue, but fat mass is preserved by endogenous synthesis in mice deficient in adipose tissue lipoprotein lipase

Lipoprotein lipase (LPL) is the rate-limiting enzyme for the import of triglyceride-derived fatty acids by muscle, for utilization, and adipose tissue (AT), for storage. Relative ratios of LPL expression in these two tissues have therefore been suggested to determine body mass composition as well as play a role in the initiation and/or development of obesity. To test this, LPL knockout mice were mated to transgenics expressing LPL under the control of a muscle-specific promoter (MCK) to generate induced mutants with either relative (L2-MCK) or absolute AT LPL deficiency (L0-MCK). L0-MCK mice had normal weight gain and body mass composition. However, AT chemical composition indicated that LPL deficiency was compensated for by large increases in endogenous AT fatty acid synthesis. Histological analysis confirmed that such up-regulation of de novo fatty acid synthesis in L0-MCK mice could produce normal amounts of AT as early as 20 h after birth. To assess the role of AT LPL during times of profound weight gain, L0-MCK and L2-MCK genotypes were compared on the obese ob/ob background. ob/ob mice rendered deficient in AT LPL (L0-MCK-ob/ob) also demonstrated increased endogenous fatty acid synthesis but had diminished weight and fat mass. These findings reveal marked alterations in AT metabolism that occur during LPL deficiency and provide strong evidence for a role of AT LPL in one type of genetic obesity.