UNITAT DE RECERCA EN PEDIATRIA, NUTRICIÓ I DESENVOLUPAMENT HUMÀ

Universitat Rovira i Virgili (URV), Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari de Tarragona Joan XXIII (HUJ23), Hospital Universitari Sant Joan de Reus (HUSJ)

Director: Joaquín Escribano Subías
Adreça mail de contacte del grup de Recerca: pediatria@iispv.cat
Telèfon de contacte: 977759364 / 977759365

Actualització fitxa tècnica del grup: juliol 2017

MEMBRES DEL GRUP INVESTIGADOR

Joaquín Escribano Subías, Director (URV, IISPV, HUSJ)
a/e: joaquin.escribano@urv.cat

Ricardo Closa Monasterolo, Co-Director (URV, IISPV, HUJ23)
a/e: ricardo.closa@urv.cat

Natàlia Ferré Pallàs, Professora Agregada (URV, IISPV)
a/e: natalia.ferre@urv.cat

Verónica Luque Moreno, Coordinadora Unitat d’Investigació (URV, IISPV, HUJ23)
a/e: veronica.luque@urv.cat

Gemma Castillejo de Villasante, Investigador clínic col·laborador (HUSJ)
a/e: gemmacastillejo@gmail.com

Albert Feliu Rovira, Investigador clínic col·laborador (HUSJ)
a/e: albert.feliu.rovira@gmail.com

Ester Parada Ricart, Investigador clínic col·laborador (HUJ23)
a/e: esterparada@yahoo.es

Rosa Collell Hernández, Investigador clínic col·laborador (HUSJ)
a/e: rcollel@grupsagessa.com

Raquel Monné Gelonch, Investigador clínic col·laborador (HUJ23)
a/e: raquel.monne@urv.cat

Juan Carretero Bellon , Investigador clínic col·laborador (HUJ23)
a/e: jcarret@telefonica.net

Adolf Gómez Papi, Investigador clínic col·laborador (HUJ23)
a/e: gomezpapi@yahoo.es

Marta Zaragoza Jordana, Investigadora Postdoctoral (IISPV)
a/e: marta.zaragoza@urv.cat

Mariona Gispert Llauradó, Investigadora Postdoctoral (IISPV)
a/e: mariona.gispert@urv.cat

Mª del Carme Rubio Torrents, Investigadora Postdoctoral (IISPV)
a/e: carme.rubio@urv.cat

Desirée Gutiérrez Marin, Estudiant de doctorat (URV)
a/e: desiree.gutierrez@urv.cat

Mireia Alcázar López, Estudiant de doctorat (URV)
a/e: mireia.alcazar@iispv.cat

Judit Muñoz Hernando, Estudiant de doctorat (URV)
a/e: judit.munoz@iispv.cat

Mercè Núñez Roig, Estudiant de doctorat (URV)
a/e: merce.nunez@iispv.cat

ACTIVITATS I CAPACITATS DEL GRUP DE RECERCA

La Unitat de Recerca en Pediatria, Nutrició i Desenvolupament Humà (URPNDH) de la Universitat Rovira i Virgili és un Grup de Recerca Consolidat que engloba l’activitat investigadora en pediatria que es duu a terme als dos Hospitals Universitaris de la zona (Hospital Universitari de Tarragona Joan XXIII i Hospital Universitari Sant Joan de Reus).

Les seves principals línies d’investigació s’emmarquen dins l’estudi de problemes de salut relacionats amb la nutrició, com la obesitat o la malaltia celíaca, i també sobre l’efecte de l’alimentació del lactant en la seva salut i desenvolupament posterior mitjançant la programació metabòlica.

La URPNDH te també per objectiu desenvolupar, des d’un enfocament de Medicina Basada en l’Evidència, revisions crítiques i sistemàtiques de la literatura d’aspectes relacionats amb les seves línies d’investigació.

Tot i que la unitat de recerca té una llarga història prèvia, amb els responsables que la dirigeixen actualment, investiga en nutrició infantil des del 2002, motiu pel qual es considera un grup jove. En aquests anys, el grup ha rebut suport de la comissió europea, del govern espanyol i la indústria.

LÍNIES DE RECERCA

Línia: NUTRICIÓ I METABOLISME INFANTIL
Programació metabòlica precoç
Obesitat infantil: estudi de factors de risc cardiovascular, síndrome metabòlic i estratègies d’intervenció
Nutrició aplicada
Investigador principal: Dr. Ricardo Closa i Dr. Joaquín Escribano

Línia: GASTROENTEROLOGÍA I NUTRICIÓ
Malaltia celíaca
Investigador principal: Dra. Gemma Castillejo

Línia: FUNCIÓ PULMONAR I INFECCIONS A L’EDAT PEDIÀTRICA
Investigador principal: Responsable: Dr. Ricardo Closa i Dr. Joaquín Escribano

Línia: MEDICINA BASADA EN L’EVIDÈNCIA
Revisions sistemàtiques de la literatura
Guies de pràctica clínica
Investigador principal: Dr. Joaquín Escribano

Línia: ESTUDI DE LA COMPOSICIÓ CORPORAL EN PEDIATRIA
Investigador principal: Dra. Verónica Luque

MILLORS PUBLICACIONS DEL GRUP (2015-2017)

Closa-Monasterolo R, Zaragoza-Jordana M, Ferré N, Luque V, Grote V, Koletzko B, Verduci E, Vecchi F, Escribano J; Childhood Obesity Project Group.
Adequate calcium intake during long periods improves bone mineral density in healthy children. Data from the Childhood Obesity Project.
Clin Nutr. 2017 Mar 16. pii: S0261-5614(17)30102-4. doi: 10.1016/j.clnu.2017.03.011. [Epub ahead of print]
PMID: 28351509

BACKGROUND: Bone mineralization can be influenced by genetic factors, hormonal status, nutrition, physical activity and body composition. The association of higher calcium (Ca) intake or Ca supplementation with better bone mineral density (BMD) remains controversial. Furthermore, it has been speculated that maintaining long-term adequate Ca intake rather than having a brief supplementation period is more effective. The aim of the study was to prospectively analyse the influence of adequate Ca intake on BMD at 7 years of age in European children.
METHODS: Data from the Childhood Obesity Project were analysed in a prospective longitudinal cohort trial. Dietary intake was recorded using 3-day food records at 4, 5 and 6 years of age. The probability of adequate intake (PA) of Ca was calculated following the American Institute of Medicine guidelines for individual assessments, with FAO, WHO and United Nations University joint expert consultation dietary recommendations. Children were categorised as having high Ca PA (PA >95%) or not (PA <95%). At 7 years, whole body (WB) and lumbar spine (LS) BMD were measured in the Spanish subsample by dual-energy x-ray absorptiometry. Internal BMD z-scores were calculated; BMD below -1 z-score were considered to indicate osteopenia, and BMD z-scores below -2, "low bone mineral density for age". RESULTS: BMD was measured in 179 children. Ca intake at 6 years was positively correlated with LS BMD at 7 years (R = 0.205, p = 0.030). A Ca increase of 100 mg/day explained 19.4% (p = 0.011) of the LS BMD z-score variation, modifying it by 0.089 (0.021, 0.157) units. Children with Ca PA >95% at 5 and 6 or from 4 to 6 years of age showed higher BMD z-scores at the LS and WB levels than children with Ca PA <95% (p < 0.001 and p < 0.05 for LS and WB BMD, respectively). Ca PA >95% maintained over 2 years explained 26.3% of the LS BMD z-score variation (p < 0.001), increasing it by 0.669 (0.202, 1.137). PA >95% maintained over 3 years explained 24.9% of the LS BMD z-score variation, increasing it by 0.773 (0.282, 1.264). The effects of Ca adequacy on WB BMD were similar. Children with PA >95% over 2 years had an Odds ratio of 13.84 and 12 for osteopenia at the LS and WB levels, respectively (p = 0.001).
CONCLUSIONS: Long periods of adequate Ca intake in childhood increase BMD and reduce osteopenia risk. The Childhood Obesity Project clinical trial (CHOP) was registered at clinicaltrials.gov as NCT00338689.

Zaragoza-Jordana M, Closa-Monasterolo R, Luque V, Ferré N, Grote V, Koletzko B, Pawellek I, Verduci E, ReDionigi A, Socha J, Stolarczyk A, Poncelet P, Rousseaux D, Escribano J; Childhood Obesity Project Group.
Micronutrient intake adequacy in children from birth to 8 years. Data from the Childhood Obesity Project.
Clin Nutr. 2017 Feb 9. pii: S0261-5614(17)30053-5. doi: 10.1016/j.clnu.2017.02.003. [Epub ahead of print]
PMID: 28238467

BACKGROUND: In European countries, suboptimal intake has been reported for several micronutrients (as calcium, iron, zinc, vitamin B12, D and folate) in both adulthood and childhood. No studies to date have prospectively compiled nutrient intake from healthy children in different European countries using the same methodology.
AIM: To describe the adequacy of micronutrient intake during the first eight years of life in children from 5 European countries.
METHODS: Prospective observational trial analyzing data from the EU Childhood Obesity Project. Infants were enrolled within the first two months of life and were followed regularly to age 8 years. Dietary intake was collected periodically with 3-day food records. Nutrient intake adequacy was estimated for calcium, phosphorus, iron, zinc, magnesium, iodine, folate and vitamins B12, A and D, following the American Institute of Medicine (IOM) guidelines at group (prevalence of adequacy >80%) and individual (high probability of adequate intake >80% of the children) level; the assessment was based on the Estimated Average Requirements of nutrients of the FAO, WHO and United Nations University (FAO/WHO/UNU) or the IOM if FAO/WHO/UNU data were not available.
RESULTS: Intake data were available for a decreasing number of children, from 904 at 3 months to 396 at 8 years. Iron, iodine, folate and vitamin D were inadequately consumed when assessing adequacy at group level; at individual-level less than 80% of the children showed high probability of adequate intake for iron, iodine, folate and zinc at all ages, and calcium from 12 months onwards.
CONCLUSIONS: Accurate dietary intake and adequacy assessment methodology in this prospective cohort of European children found iron, calcium, vitamin D, folate, iodine and zinc to be inadequately consumed in childhood, as described previously by epidemiologic studies. Further studies are needed to elucidate health consequences of these deficiencies. CHOP trial was registered at clinicaltrials.gov as

Gispert-Llaurado M, Perez-Garcia M, Escribano J, Closa-Monasterolo R, Luque V, Grote V, Weber M, Torres-Espínola FJ, Czech-Kowalska J, Verduci E, Martin F, Piqueras MJ, Koletzko B, Decsi T, Campoy C, Emmett PM; EU Childhood Obesity Trial (CHOP) Study Group.; NUHEAL Study Group.
Fish consumption in mid-childhood and its relationship to neuropsychological outcomes measured in 7-9 year old children using a NUTRIMENTHE neuropsychological battery.
Clin Nutr. 2016;35(6):1301-1307.
PMID: 26968967
BACKGROUND: Long-chain polyunsaturated fatty acids (LCPUFA), particularly n-3 LCPUFA, play a central role in neuronal growth and the development of the human brain. Fish is the main dietary source of n-3 LCPUFA. To assess the relation between fish consumption, estimated dietary n-3 LCPUFA intake and cognition and behaviour in childhood in a multi-centre European sample.
METHODS: Children from 2 European studies, CHOP and NUHEAL, were assessed at 8 and 7.5 years of age, respectively. Different outcomes of neuropsychological development (assessed with the standardized NUTRIMENTHE Neuropsychological Battery (NNB) consisting of 15 subtests) were related with outcomes from a food-frequency questionnaire (FFQ) focussing on the consumption of fish.
RESULTS: A total of 584 children completed the FFQ and the neuropsychological tests. We found no associations with calculated DHA or EPA intakes for any of the neuropsychological domains. Children who consumed 2 fish meals per week including one of fatty fish, showed no substantive differences in the cognitive domains from the children who did not. However negative associations with fatty fish consumption were found for social problems (p = 0.019), attention problems (p = 0.012), rule-breaking problems (p = 0.019) and aggressive behaviour problems (p = 0.032). No association was observed with internalizing problems. Higher levels of externalizing problems (p = 0.018) and total problems (p = 0.018) were associated with eating less fatty fish.
CONCLUSIONS: Children who consumed 2 fish meals per week including one of fatty fish were less likely to show emotional and behavioural problems than those who did not.

Collell R, Closa-Monasterolo R, Ferré N, Luque V, Koletzko B, Grote V, Janas R, Verduci E, Escribano J.
Higher protein intake increases cardiac function parameters in healthy children: metabolic programming by infant nutrition-secondary analysis from a clinical trial.
Pediatr Res. 2016;79(6):880-8.
PMID: 26882370

BACKGROUND: Protein intake may modulate cardiac structure and function in pathological conditions, but there is a lack of knowledge on potential effects in healthy infants.
METHODS: Secondary analysis of an ongoing randomized clinical trial comparing two groups of infants receiving a higher (HP) or lower (LP) protein content formula in the first year of life, and compared with an observational group of breastfed (BF) infants. Growth and dietary intake were assessed periodically from birth to 2 y. Insulin-like growth factor 1 (IGF-1) axis parameters were analyzed at 6 mo in a blood sample. At 2 y, cardiac mass and function were assessed by echocardiography.
RESULTS: HP infants (n = 50) showed a higher BMI z-score at 2 y compared with LP (n = 47) or BF (n = 44). Cardiac function parameters were increased in the HP group compared with the LP and were directly related to the protein intake during the first 6 mo of life. Moreover, there was an increase in free IGF-1 in the HP group at 6 mo.
CONCLUSION: A moderate increase in protein supply during the first year of life is associated with higher cardiac function parameters at 2 y. IGF-1 axis modifications may, at least in part, underlie these effects.

Vriezinga SL, Auricchio R, Bravi E, Castillejo G, Chmielewska A, Crespo Escobar P, Kolaček S, Koletzko S, Korponay-Szabo IR, Mummert E, Polanco I, Putter H, Ribes-Koninckx C, Shamir R, Szajewska H, Werkstetter K, Greco L, Gyimesi J, Hartman C, Hogen Esch C, Hopman E,Ivarsson A, Koltai T, Koning F, Martinez-Ojinaga E, te Marvelde C, Pavic A, Romanos J, Stoopman E, Villanacci V,Wijmenga C, Troncone R, Mearin ML.
Randomized feeding intervention in infants at high risk for celiac disease.
N Engl J Med. 2014; 371(14), 1304–15.
PMID: 25271603

BACKGROUND: A window of opportunity has been suggested for reducing the risk of celiac disease by introducing gluten to infants at 4 to 6 months of age.
METHODS: We performed a multicenter, randomized, double-blind, placebo-controlled dietary-intervention study involving 944 children who were positive for HLA-DQ2 or HLA-DQ8 and had at least one first-degree relative with celiac disease. From 16 to 24 weeks of age, 475 participants received 100 mg of immunologically active gluten daily, and 469 received placebo. Anti-transglutaminase type 2 and antigliadin antibodies were periodically measured. The primary outcome was the frequency of biopsy-confirmed celiac disease at 3 years of age.
RESULTS: Celiac disease was confirmed by means of biopsies in 77 children. To avoid underestimation of the frequency of celiac disease, 3 additional children who received a diagnosis of celiac disease according to the 2012 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria (without having undergone biopsies) were included in the analyses (80 children; median age, 2.8 years; 59% were girls). The cumulative incidence of celiac disease among patients 3 years of age was 5.2% (95% confidence interval [CI], 3.6 to 6.8), with similar rates in the gluten group and the placebo group (5.9% [95% CI, 3.7 to 8.1] and 4.5% [95% CI, 2.5 to 6.5], respectively; hazard ratio in the gluten group, 1.23; 95% CI, 0.79 to 1.91). Rates of elevated levels of anti-transglutaminase type 2 and antigliadin antibodies were also similar in the two study groups (7.0% [95% CI, 4.7 to 9.4] in the gluten group and 5.7% [95% CI, 3.5 to 7.9] in the placebo group; hazard ratio, 1.14; 95% CI, 0.76 to 1.73). Breast-feeding, regardless of whether it was exclusive or whether it was ongoing during gluten introduction, did not significantly influence the development of celiac disease or the effect of the intervention.
CONCLUSIONS: As compared with placebo, the introduction of small quantities of gluten at 16 to 24 weeks of age did not reduce the risk of celiac disease by 3 years of age in this group of high-risk children. (Funded by the European Commission and others; PreventCD Current Controlled Trials number, ISRCTN74582487.).

INSTITUCIONS QUE RECONEIXEN AL GRUP DE RECERCA

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