López-Jiménez, Francisco

SummaryBackgroundThe ideal means of identifying obesity in children and adolescents has not been determined although body mass index (BMI) is the most widely used screening tool.ObjectiveWe performed a systematic review and meta‐analysis of studies assessing the diagnostic performance of BMI to detect adiposity in children up to 18 years.MethodsData sources were EMBASE, MEDLINE, Cochrane, Database of Systematic Reviews Cochrane CENTRAL, Web of Science and SCOPUS up to March 2013. Studies providing measures of diagnostic performance of BMI and using body composition technique for body fat percentage measurement were included.ResultsThirty‐seven eligible studies that evaluated 53 521 patients, with mean age ranging from 4 to 18 years were included in the meta‐analysis. Commonly used BMI cut‐offs for obesity showed pooled sensitivity to detect high adiposity of 0.73 (confidence interval [CI] 0.67–0.79), specificity of 0.93 (CI 0.88–0.96) and diagnostic odds ratio of 36.93 (CI 20.75–65.71). Males had lower sensitivity. Moderate heterogeneity was observed (I2 = 48%) explained in meta‐regression by differences across studies in race, BMI cut‐off, BMI reference criteria (Center for Disease Control vs. International Obesity Task Force) and reference standard method assessing adiposity.ConclusionBMI has high specificity but low sensitivity to detect excess adiposity and fails to identify over a quarter of children with excess body fat percentage.

AbstractHigh stress is a prevalent problem in the worksite. To reduce stress, improve productivity, reduce absenteeism, and lower healthcare costs, many companies offer exercise classes or stress management programmes. Although physical activity is an important component of stress management, few worksites have integrated physical activity into their comprehensive stress reduction programmes. The purpose of this single‐arm pilot project was to examine the potential effectiveness of an integrated exercise (studio cycling) and cognitive–behavioural stress management programme. Eighty‐four adults, 75% female, mostly aged 40+ years, participated in an integrated 12‐week cycling studio and cognitive–behavioural stress management programme. Participants experienced a significant and clinically meaningful reduction on the Perceived Stress Scale (p < 0.01), rating of current stress level and confidence to manage stress at the programme's end and at a 1‐month follow‐up. Participants also reported having significantly improved overall health, improved nutritional habits, higher physical activity level, greater confidence in their ability to follow a healthy diet, higher spiritual well‐being, improved sleep, receiving more support for maintaining healthy living and improved quality of life at the completion of the 12‐week programme and 1‐month follow‐up. These findings provide further support for an integrated exercise and stress management programme. Copyright © 2013 John Wiley & Sons, Ltd.

Background— Cardiac rehabilitation (CR) is recommended for all patients after coronary artery bypass surgery, yet little is known about the long-term mortality effects of CR in this population. Methods and Results— We performed a community-based analysis on residents of Olmsted County, Minnesota, who underwent coronary artery bypass surgery between 1996 and 2007. We assessed the association between subsequent outpatient CR attendance and long-term survival. Propensity analysis was performed. Cox proportional hazards regression was then used to assess the association between CR attendance and all-cause mortality adjusted for the propensity to attend CR. We identified 846 eligible patients (age 66±11 years, 76% men, and 96% non-Hispanic whites) who survived at least 6 months after surgery, of whom 582 (69%) attended CR. During a mean (±SD) follow-up of 9.0±3.7 years, the 10-year all-cause Kaplan-Meier mortality rate was 28% (193 deaths). Adjusted for the propensity to attend CR, participation in CR was associated with a 10-year relative risk reduction in all-cause mortality of 46% (hazard ratio, 0.54; 95% confidence interval, 0.40–0.74; P <0.001) and a 10-year absolute risk reduction of 12.7% (number needed to treat=8). There was no evidence of a differential effect of CR on mortality with respect to age (≥65 versus <65 years), sex, diabetes, or prior myocardial infarction. Conclusions— CR attendance is associated with a significant reduction in 10-year all-cause mortality after coronary artery bypass surgery. Our results strongly support national standards that recommend CR for this patient group.

Objectives To determine the prevalence range for sarcopenic obesity and its relationship with sex, age, and ethnicity. Design Cross‐sectional analysis of a population‐based sample. Setting Noninstitutionalized persons in the U nited S tates participating in the N ational H ealth and N utrition E xamination S urveys 1999–2004. Participants Subsample of 4,984 subjects aged 60 and older with dual‐energy X‐ray absorptiometry body composition data. Measurements Eight definitions of sarcopenic obesity identified from six studies found using a systematic literature review ( B aumgartner, B ouchard, D avison, Z oico, L evine, K im‐1,2,3) were applied to the sample. Results were stratified according to sex, age, and ethnicity. Results Prevalence of sarcopenic obesity ranged from 4.4% to 84.0% in men and from 3.6% to 94.0% in women. Prevalence was higher in men using definitions from Baumgartner (17.9% vs 13.3%, P < .001), Levine (14.2% vs 6.6%, P < .001), and Kim‐1 (30.0% vs 9.3%, P < .001); lower for men using the Davison (4.4% vs 11.1%, P < .001) and Kim‐2 (83.7% vs 94.0%) definitions; and the same for men and women using the Bouchard (45.3% vs 44.3%, P = .32) and Kim‐3 (75.6% vs 77.0%, P = .51) definitions. For all but one definition, sarcopenic obesity increased with each decade and was lower in non‐ H ispanic blacks than whites. Conclusion Prevalence of sarcopenic obesity in older adults varies up to 26‐fold depending on current research definitions. Such a high degree of variability suggests the need to establish consensus criteria that can be reliably applied across clinical and research settings.

Background— Obstructive sleep apnea is highly prevalent in patients with cardiovascular disease and has detrimental effects on systolic and diastolic function of the ventricles. In this research, the changes in strain (S) and strain rate (SR) during the performance of the Mueller maneuver (MM) in an effort to better understand how negative intrathoracic pressures affect ventricular mechanics. Methods and Results— The MM was performed to maintain a target intrathoracic pressure of −40 mm Hg. Echocardiography was used to measure various parameters of cardiac structure and function. Myocardial deformation measurements were performed using tissue speckle tracking. Twenty-four healthy subjects (9 women; mean age, 30�6 years) were studied. Global left ventricular longitudinal S in systole and SR in early filling were significantly decreased during the MM (S: baseline, −17.0�1.6%; MM, −14.5�2.2%; P <0.0001, SR: baseline, 1.09�0.20 s −1 ; MM, 0.92�0.21 s −1 ; P =0.01). Global right ventricular longitudinal S was also significantly decreased during the MM (baseline, −22.0�3.1%; MM, −17.2�2.5%; P <0.0001), as was global right ventricular longitudinal systolic SR (baseline, −1.34�0.35 s −1 ; MM, −1.02�0.21 s −1 ; P =0.0006). Conclusions— Left ventricular and right ventricular longitudinal deformation are significantly reduced during the MM. These results suggest that negative intrathoracic pressure during apnea may contribute to changes in myocardial mechanics. These results could help explain the observed changes in left ventricular and right ventricular mechanics in patients with obstructive sleep apnea.