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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Why should obesity prevention start in early life&#63; There are four main reasons&#58; prevalence&#44; clinical burden &#40;comorbidities already in pediatric age&#41;&#44; tracking and poor therapeutic results once it has been established&#46; In this human and preventive context the fundamental reason is that 30&#37; of all obese adults begun to be so before adolescence&#46; When we consider that 2500 million individuals &#40;older than 18 years&#41; suffer from overweight and obesity&#44; this percentage has a very practical preventive sense&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In addition and in a global context among children and adolescents 10&#37; are overweight and 3&#37; obese&#46; Furthermore since 1980 up to the present decade the prevalence of pediatric obesity has tripled in many parts of the world even in low- and middle-income countries &#40;LMIC&#41;&#46; Lastly&#44; obesity treatment implies a long&#44; bitter&#44; costly and frequent path to overweight and seldom to normal weight&#46; A particular phenomenon related to the four pointed out reasons is the varied scientific response toward obesity prevention and treatment&#44; to which the &#40;e-&#41; extended panorama of shamanistic or magical cures should be added&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In order to obtain reliable information&#44; the evidence methods applied to systematic reviews&#44; randomized controlled trials and observational studies can assess the degree of evidence and subsequent recommendation&#46; These research studies are qualified through a rating system going from the wide one of the Center for Evidence-Based Medicine&#44; Oxford to GRADE&#44; or the simpler SORT&#46; Another general preventive aspect is the homogenization of anthropometric measurements assessment&#46; Body mass index &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41; and waist circumference <span class="elsevierStyleItalic">Z</span>-scores are probably the most appropriate in clinical grounds&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Present ways for prevention&#58; To gain efficacy&#44; prevention has been divided into three levels for application&#58; Primary prevention &#40;before disease&#41;&#44; Secondary prevention &#40;latent disease&#41; and Tertiary prevention &#40;for disease consequences&#41;&#46; The normal flow goes from global and&#47;or national organizations to community organizations&#44; at which stage there is a diversion addressed to environment and at individual level&#58; family&#47;child&#44; individual clinicians&#44; nurses&#44; health workers&#8230;This sequence should run smoothly but in fact it has some obstacles between levels&#46; However&#44; the preventive reduction is more drastic when considering the individual level which is in fact the other interface of prevention concept&#46; To support this not very optimistic evolution I have revised 56 plans for obesity prevention issued from 2010 up to the present day&#58; Perhaps it could be said that the main preventive lines are all similar and not varying greatly from those of 50 years ago&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The classical questions raised by the population Health Promotion&#58; What&#44; Who and How can be applied to pediatric obesity prevention but with a pragmatic profile&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">To the first one WHAT kind of prevention&#44; the response would be general and individual&#46; The General approach is a competency of health authorities&#44; i&#46;e&#46; the recent WHO Commission on Ending Child Obesity&#44; FAO HLPE Nutrition and Food System for malnutrition in its three forms&#44; EU EATWELL project&#44; the EU Commission on Public health designed a general program for obesity prevention&#46; In this there are three stepping stones&#58; Primary care &#40;health professionals&#44; barriers&#44; and efficacy&#41;&#44; Community and School Programs &#40;education&#44; diets&#44; physical activity&#41; and Administrative Programs &#40;play and sport grounds&#44; food energy regulations&#44; etc&#46;&#41; clearly implying the state support&#46; Unfortunately results are still to come&#46; Due to obesity spreading&#44; a series of national or community programs have been issued to which the local scientific societies or expert groups should be added&#46; A new study Cochrane Review on the prevention of obesity in children showed an improvement on the studies quality despite that from 93 reviews only 37 &#40;279&#44;946 children&#41; could be included in the meta-analysis&#46; It was concluded that programs were effective to reduce adiposity&#44; all individual interventions were not equally successful and the heterogeneity was largely unexplained &#40;the impossible assessment of energetic balance&#63;&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The next point is to WHOM prevention should be addressed&#46; This has changed due to the earliest prevention concept&#46; According to this&#44; obesity prevention should start even preconceptionally&#44; diminishing gestational excessive weight gain&#44; gestational diabetes and large for gestational age &#40;&#62;4&#46;0<span class="elsevierStyleHsp" style=""></span>kg&#41; newborns &#40;epigenetic changes&#41;&#46; These are linked to adult obesity and comorbidities&#46; After birth&#44; prevention should focus on the weight gain in the first 3&#8211;6 months and to achieve breastfeeding longer than six months&#46; Therefore the classical recommendation to start prevention between 4 and 6 years of age must be revised in the lights of the &#8216;early rebound&#8217; of BMI &#40;BMI-Zs 1&#8211;1&#46;9 SD&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">HOW prevention can be done at individual level&#46; This stage represents the crucial point where the policymakers and targets meet&#44; i&#46;e&#46; primary care health professionals and child&#47;families&#46; The preliminary and perhaps most important action is the education of the pediatrician or primary health care professional on healthy habits&#44; obesity risks and early recognition of overweight&#44; and providing them with basic tools to transmit them to the family and the child&#46; The concise directions given by WHO could be sufficient&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> The first principle of thermodynamic balance according to which if the energy intake exceeds the expenditure&#44; the difference will be stored as body fat should be given&#46; The &#8216;how&#8217; prevention is carried out&#44; is a large chapter beyond the present scope and can be seen elsewhere for children<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> and adults&#46; The individual preventive points are not complicated nor require complementary exams or specialists &#40;psychiatrics&#41; cooperation&#44; but they require time &#40;not less than 30&#8242;&#47;visit&#41; and a fixed follow up schedule&#44; unfortunately not many primary care points&#47;settings have these possibilities&#46; Although prevention activities at small-scale only produce small-scale results until the moment of general prevention it is functioning globally &#40;as in many infectious diseases&#41;&#44; this action if well designed&#44; is the only one to cope with the spreading problem&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As a final reflection it could be said if there are good preventive programs why has obesity been increasing until now and probably will continue up to 2030 or even to the more realistic date of 2060&#46; On the positive side there have been important clinical advances but ambitious projects such as energy food content laws in vending machines or restaurants &#40;US Affordable Care Act&#41;&#44; agriculture changes and food chains &#40;EU&#41;&#44; will need more time to show their efficacy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">On the dark side&#44; apart from minor slips &#40;Fat letters&#59; more than 50 food pyramids&#41; the following facts can be included&#58; It is difficult to apply the evidence criteria for assessing prevention effectivity&#44; this is not a health characteristic and it also occurs in another fields&#44; i&#46;e&#46; in conflicts prevention&#46; There are too many plans&#47;guidelines not all with the desirable quality and wide covering&#46; The flow from global directions to individual preventive level is slow moving even in high-income countries &#40;HIC&#41; with integrative approaches&#46; The continuous evaluation of the applied procedures is far from generalized&#46; Important actions such as labeling &#40;Flabel in EU&#41;&#44; fast food advertising&#44; taxes for sugary drinks&#44; school-lunch programs and so many others&#44; still have an unknown impact on obesity reduction&#46; In HIC the specific budget for prevention is considerably lower than that of acute care&#46; In LMIC nothing is done apart from punctual and tiny actions consequently in a few decades obesity will be a problem there added to the treatment lag of these regions&#46;</p></span>"
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Editorial
The little and large of pediatric obesity prevention
Lo pequeño y lo grande en la prevención de la obesidad infantil
Manuel Moya
Universidad Miguel Hernández, Campus de San Juan de Alicante, Alicante, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Why should obesity prevention start in early life&#63; There are four main reasons&#58; prevalence&#44; clinical burden &#40;comorbidities already in pediatric age&#41;&#44; tracking and poor therapeutic results once it has been established&#46; In this human and preventive context the fundamental reason is that 30&#37; of all obese adults begun to be so before adolescence&#46; When we consider that 2500 million individuals &#40;older than 18 years&#41; suffer from overweight and obesity&#44; this percentage has a very practical preventive sense&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In addition and in a global context among children and adolescents 10&#37; are overweight and 3&#37; obese&#46; Furthermore since 1980 up to the present decade the prevalence of pediatric obesity has tripled in many parts of the world even in low- and middle-income countries &#40;LMIC&#41;&#46; Lastly&#44; obesity treatment implies a long&#44; bitter&#44; costly and frequent path to overweight and seldom to normal weight&#46; A particular phenomenon related to the four pointed out reasons is the varied scientific response toward obesity prevention and treatment&#44; to which the &#40;e-&#41; extended panorama of shamanistic or magical cures should be added&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In order to obtain reliable information&#44; the evidence methods applied to systematic reviews&#44; randomized controlled trials and observational studies can assess the degree of evidence and subsequent recommendation&#46; These research studies are qualified through a rating system going from the wide one of the Center for Evidence-Based Medicine&#44; Oxford to GRADE&#44; or the simpler SORT&#46; Another general preventive aspect is the homogenization of anthropometric measurements assessment&#46; Body mass index &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41; and waist circumference <span class="elsevierStyleItalic">Z</span>-scores are probably the most appropriate in clinical grounds&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Present ways for prevention&#58; To gain efficacy&#44; prevention has been divided into three levels for application&#58; Primary prevention &#40;before disease&#41;&#44; Secondary prevention &#40;latent disease&#41; and Tertiary prevention &#40;for disease consequences&#41;&#46; The normal flow goes from global and&#47;or national organizations to community organizations&#44; at which stage there is a diversion addressed to environment and at individual level&#58; family&#47;child&#44; individual clinicians&#44; nurses&#44; health workers&#8230;This sequence should run smoothly but in fact it has some obstacles between levels&#46; However&#44; the preventive reduction is more drastic when considering the individual level which is in fact the other interface of prevention concept&#46; To support this not very optimistic evolution I have revised 56 plans for obesity prevention issued from 2010 up to the present day&#58; Perhaps it could be said that the main preventive lines are all similar and not varying greatly from those of 50 years ago&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The classical questions raised by the population Health Promotion&#58; What&#44; Who and How can be applied to pediatric obesity prevention but with a pragmatic profile&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">To the first one WHAT kind of prevention&#44; the response would be general and individual&#46; The General approach is a competency of health authorities&#44; i&#46;e&#46; the recent WHO Commission on Ending Child Obesity&#44; FAO HLPE Nutrition and Food System for malnutrition in its three forms&#44; EU EATWELL project&#44; the EU Commission on Public health designed a general program for obesity prevention&#46; In this there are three stepping stones&#58; Primary care &#40;health professionals&#44; barriers&#44; and efficacy&#41;&#44; Community and School Programs &#40;education&#44; diets&#44; physical activity&#41; and Administrative Programs &#40;play and sport grounds&#44; food energy regulations&#44; etc&#46;&#41; clearly implying the state support&#46; Unfortunately results are still to come&#46; Due to obesity spreading&#44; a series of national or community programs have been issued to which the local scientific societies or expert groups should be added&#46; A new study Cochrane Review on the prevention of obesity in children showed an improvement on the studies quality despite that from 93 reviews only 37 &#40;279&#44;946 children&#41; could be included in the meta-analysis&#46; It was concluded that programs were effective to reduce adiposity&#44; all individual interventions were not equally successful and the heterogeneity was largely unexplained &#40;the impossible assessment of energetic balance&#63;&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The next point is to WHOM prevention should be addressed&#46; This has changed due to the earliest prevention concept&#46; According to this&#44; obesity prevention should start even preconceptionally&#44; diminishing gestational excessive weight gain&#44; gestational diabetes and large for gestational age &#40;&#62;4&#46;0<span class="elsevierStyleHsp" style=""></span>kg&#41; newborns &#40;epigenetic changes&#41;&#46; These are linked to adult obesity and comorbidities&#46; After birth&#44; prevention should focus on the weight gain in the first 3&#8211;6 months and to achieve breastfeeding longer than six months&#46; Therefore the classical recommendation to start prevention between 4 and 6 years of age must be revised in the lights of the &#8216;early rebound&#8217; of BMI &#40;BMI-Zs 1&#8211;1&#46;9 SD&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">HOW prevention can be done at individual level&#46; This stage represents the crucial point where the policymakers and targets meet&#44; i&#46;e&#46; primary care health professionals and child&#47;families&#46; The preliminary and perhaps most important action is the education of the pediatrician or primary health care professional on healthy habits&#44; obesity risks and early recognition of overweight&#44; and providing them with basic tools to transmit them to the family and the child&#46; The concise directions given by WHO could be sufficient&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> The first principle of thermodynamic balance according to which if the energy intake exceeds the expenditure&#44; the difference will be stored as body fat should be given&#46; The &#8216;how&#8217; prevention is carried out&#44; is a large chapter beyond the present scope and can be seen elsewhere for children<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> and adults&#46; The individual preventive points are not complicated nor require complementary exams or specialists &#40;psychiatrics&#41; cooperation&#44; but they require time &#40;not less than 30&#8242;&#47;visit&#41; and a fixed follow up schedule&#44; unfortunately not many primary care points&#47;settings have these possibilities&#46; Although prevention activities at small-scale only produce small-scale results until the moment of general prevention it is functioning globally &#40;as in many infectious diseases&#41;&#44; this action if well designed&#44; is the only one to cope with the spreading problem&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As a final reflection it could be said if there are good preventive programs why has obesity been increasing until now and probably will continue up to 2030 or even to the more realistic date of 2060&#46; On the positive side there have been important clinical advances but ambitious projects such as energy food content laws in vending machines or restaurants &#40;US Affordable Care Act&#41;&#44; agriculture changes and food chains &#40;EU&#41;&#44; will need more time to show their efficacy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">On the dark side&#44; apart from minor slips &#40;Fat letters&#59; more than 50 food pyramids&#41; the following facts can be included&#58; It is difficult to apply the evidence criteria for assessing prevention effectivity&#44; this is not a health characteristic and it also occurs in another fields&#44; i&#46;e&#46; in conflicts prevention&#46; There are too many plans&#47;guidelines not all with the desirable quality and wide covering&#46; The flow from global directions to individual preventive level is slow moving even in high-income countries &#40;HIC&#41; with integrative approaches&#46; The continuous evaluation of the applied procedures is far from generalized&#46; Important actions such as labeling &#40;Flabel in EU&#41;&#44; fast food advertising&#44; taxes for sugary drinks&#44; school-lunch programs and so many others&#44; still have an unknown impact on obesity reduction&#46; In HIC the specific budget for prevention is considerably lower than that of acute care&#46; In LMIC nothing is done apart from punctual and tiny actions consequently in a few decades obesity will be a problem there added to the treatment lag of these regions&#46;</p></span>"
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Article information
ISSN: 23412879
Original language: English
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2022 May 72 44 116
2022 April 68 28 96
2022 March 49 50 99
2022 February 28 26 54
2022 January 57 54 111
2021 December 39 40 79
2021 November 42 49 91
2021 October 84 81 165
2021 September 42 41 83
2021 August 18 45 63
2021 July 22 39 61
2021 June 30 36 66
2021 May 32 44 76
2021 April 71 52 123
2021 March 45 38 83
2021 February 23 13 36
2021 January 49 27 76
2020 December 38 17 55
2020 November 27 23 50
2020 October 24 14 38
2020 September 25 27 52
2020 August 76 13 89
2020 July 69 16 85
2020 June 17 12 29
2020 May 27 17 44
2020 April 24 17 41
2020 March 38 21 59
2020 February 47 20 67
2020 January 29 16 45
2019 December 25 11 36
2019 November 20 13 33
2019 October 16 14 30
2019 September 20 10 30
2019 August 33 34 67
2019 July 28 33 61
2019 June 37 24 61
2019 May 34 12 46
2019 April 32 17 49
2019 March 33 16 49
2019 February 35 18 53
2019 January 38 26 64
2018 December 36 24 60
2018 November 61 23 84
2018 October 64 14 78
2018 September 25 19 44
2018 August 3 0 3
2018 July 4 0 4
2018 June 4 0 4
2018 May 5 0 5
2018 April 28 0 28
2018 March 34 0 34
2018 February 12 0 12
2018 January 26 0 26
2017 December 18 0 18
2017 October 0 8 8
2017 September 0 14 14
2017 August 0 7 7
2017 July 0 9 9
2017 June 0 18 18
2017 May 0 27 27
2017 April 0 118 118
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Idiomas
Anales de Pediatría (English Edition)