Suchergebnisse

Meseret Derbew Molla,1 Haileab Fekadu Wolde,2 Asmamaw Atnafu3,4 1Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 3Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 4Dabat Research Centre Health and Demographic Surveillance System, Institute of Public Health College of Medicine and Health Science, University of Gondar, Gondar, EthiopiaCorrespondence: Meseret Derbew MollaDepartment of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, EthiopiaTel +251 918331617Email messidrm19@gmail.comPurpose: Obesity is becoming one of the most common public health problems worldwide. In particular, central obesity which indicates abnormal fat accumulation in the abdominal regions is highly associated with the risk of getting cardiometabolic diseases and their progression to end stage diseases or death. However, in developing countries, including Ethiopia less attention has been given to analyze the magnitude and associated factors of it. Therefore, we aimed to determine the prevalence of central obesity and its associated factors among adults in urban areas of Northwest Ethiopia.Methods: A cross-sectional study was conducted among 773 adults who lived in urban areas of Northwest Ethiopia from April 1 to May 30, 2019. Central obesity was assessed using both waist to hip ratio and waist circumference of the participants. Data were analyzed using STATA 14.0. The factors associated with central obesity were identified by binary logistic regression analyses using 95% confidence interval and the degree of association of the factors was measured using adjusted odds ratio (AOR). P-value < 0.05 was used to declare statistical significance.Results: The prevalence of central obesity with waist circumference and waist to hip ratio definition criteria was 37.6% and 35.7%, respectively. According to body mass index, about 26.26% and 10.29% of the study participants were overweight and obese, respectively. A one-year increase in age (AOR=1.05; 95%CI: 1.03– 1.07), being female (AOR=9.62; 95%CI: 4.84– 19.12) and eating of liquid oils (AOR=2.58; 95%CI: 1.71− 3.90) were found to have statistically significant variables with central obesity.Conclusion: The prevalence of central obesity was relatively high in comparison with similar studies. Thus, governmental and nongovernmental organizations that work in the health system as well as health professionals should focus on the preventive measure of central obesity to control its associated disorders at an early stage.Keywords: central obesity, magnitude, associated factor, Northwest Ethiopia

Objetivo: probar una metodología de valoración nutricional en la detección de factores predisponentes de enfermedades cardiovasculares.Métodos: se aplicó una evaluación nutricional que incluía indicadores antropométricos y la medición cuantitativa y cualitativa del consumo alimentario. La muestra estuvo conformada por 50 voluntarios entre 18 y 75 años de la consulta de Endocrinología del Hospital Militar "Dr. Carlos Arvelo".Resultados: De acuerdo a indicadores antropométricos, 66% presentó un IMC >25, 80% se ubicó por encima de los valores de referencia para circunferencia de cintura, 78% presentó obesidad abdominal por coeficiente cintura / cadera y 60% reportó un porcentaje de grasa corporal superior a los valores de normalidad. En la evaluación de consumo alimentario se encontró: dieta hipocalórica (76%), hiperproteica (52%), hipergrasa con predominio de grasa de origen animal (44%), hipoglucídica (80%) y baja en fibra dietética (68%) de acuerdo a valores de referencia del INN. Los resultados obtenidos permitieron la identificación de factores de riesgo cardiovascular, tanto antropométricos como dietéticos.Conclusión: del análisis conjunto, se concluye que la valoración del estado nutricional a través de indicadores antropométricos y dietéticos puede ser una herramienta útil en la detección de factores de riesgo para enfermedad cardiovascular. Es imperativo la medición y evaluación de los indicadores propuestos en una muestra mayor de sujetos con el fin de comprobar la consistencia en los resultados obtenidos.Objective: To validate a nutritional assessment methodology to detect cardiovascular disease predisposing factors.Methods: It was applied a nutritional assessment, including the anthropometric indicators, and quantitative and qualitative measurement of food consumption. 50 volunteers, among 18 and 75 years, patient of the Endocrinology department database of the Hospital Militar "Dr. Carlos Arvelo" were evaluated.Results: According to anthropometric indicators, 66% of the patients show a BMI>25; 80% of them was above the reference values for waist circumference; 78% have a abdominal obesity for waist-hip ratio, and 60% with a body fat percentage higher to those normal values. When evaluating the food consumption, it was found: low-calorie diet (76%), high protein (52%), and high fat with a predominance of animal fat consumption (44%), hipoglucidic (80%) and low in dietary fiber (68%), all of these data is in according to reference values for the INN. These results are allowing the identification of cardiovascular risk factors, anthropometrical and diet.Conclusion: It can be concluded that the nutritional status through anthropometric and dietary indicators can be a useful tool in identifying risk factors for cardiovascular disease. It is imperative that the measurement and evaluation of the indicators should be performed in a larger sample of subjects in order to verify the consistency of the results.

Objectives: To assess the association between being overweight or obese with low back pain (LBP) and clinically defined low back disorders across the life course. Design: A longitudinal and cross-sectional study. Setting: A nationwide health survey supplemented with data from records of prior compulsory military service. Participants: Premilitary health records (baseline) were searched for men aged 30–50 years (n=1385) who participated in a national health examination survey (follow-up). Methods and outcome measures: Height and weight were measured at baseline and follow-up, and waist circumference at follow-up. Weight at the ages of 20, 30, 40 and 50 years were ascertained, when applicable. Repeated measures of weight were used to calculate age-standardised mean body mass index (BMI) across the life course. The symptom-based outcome measures at follow-up included prevalence of non-specific and radiating LBP during the previous 30 days. The clinically defined outcome measures included chronic low back syndrome and sciatica. Results: Baseline BMI (20 years) predicted radiating LBP in adulthood, with the prevalence ratio (PR) being 1.26 (95% CI 1.08 to 1.46) for one SD (3.0 kg/m2) increase in BMI. Life course BMI was associated with radiating LBP (PR=1.23; 95% CI 1.03 to 1.48 per 1 unit increment in Z score, corresponding to 2.9 kg/m2). The development of obesity during follow-up increased the risk of radiating LBP (PR=1.91, 95% CI 1.03 to 3.53). Both general and abdominal obesity (defined as waist-to-height ratio) were associated with radiating LBP (OR=1.64, 95% CI 1.02 to 2.65 and 1.44, 95% CI 1.02 to 2.04). No associations were seen for non-specific LBP. Conclusions: Our findings imply that being overweight or obese in early adulthood as well as during the life course increases the risk of radiating but not non-specific LBP among men. Taking into account the current global obesity epidemic, emphasis should be placed on preventive measures starting at youth and, also, measures for preventing further weight gain during the life course should be implemented.

Background: Exercise training improves performance and biochemical parameters on average, but wide interindividual variability exists, with individuals classified as responders (R) or non-responders (NRs), especially between populations with higher or lower levels of insulin resistance. This study assessed the effects of high-intensity interval training (HIIT) and the prevalence of NRs in adult women with higher and lower levels of insulin resistance. Methods: Forty adult women were assigned to a HIIT program, and after training were analyzed in two groups; a group with higher insulin resistance (H-IR, 40 ± 6 years; BMI: 29.5 ± 3.7 kg/m2; n = 20) and a group with lower insulin resistance (L-IR, 35 ± 9 years; 27.8 ± 2.8 kg/m2; n = 20). Anthropometric, cardiovascular, metabolic, and performance variables were measured at baseline and after 10 weeks of training. Results: There were significant training-induced changes [delta percent (Δ%)] in fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) scores in the H-IR group (−8.8, −26.5, −32.1%, p < 0.0001), whereas no significant changes were observed in the L-IR. Both groups showed significant pre-post changes in other anthropometric variables [waist circumference (−5.2, p < 0.010, and −3.8%, p = 0.046) and tricipital (−13.3, p < 0.010, and −13.6%, p < 0.0001), supra-iliac (−19.4, p < 0.0001, and −13.6%, p < 0.0001), and abdominal (−18.2, p < 0.0001, and −15.6%, p < 0.010) skinfold measurements]. Systolic blood pressure decreased significantly only in the L-IR group (−3.2%, p < 0.010). Both groups showed significant increases in 1RMLE (+12.9, p < 0.010, and +14.7%, p = 0.045). There were significant differences in the prevalence of NRs between the H-IR and L-IR groups for fasting glucose (25 vs. 95%, p < 0.0001) and fasting insulin (p = 0.025) but not for HOMA-IR (25 vs. 45%, p = 0.185). Conclusion: Independent of the "magnitude" of the cardiometabolic disease (i.e., higher vs. lower insulin resistance), no differences were observed in the NRs prevalence with regard to improved HOMA-IR or to anthropometric, cardiovascular, and muscle performance co-variables after 10 weeks of HIIT in sedentary adult women. This research demonstrates the protective effect of HIIT against cardiometabolic disease progression in a sedentary population. ; This work was supported by the health promotion program of the Public Health Service of Los Ríos Government (SSVV). MI was funded by research grants from the Spanish Net on Aging and frailty (RETICEF) (ISCIII, FEDER) and Centro de Investigación Biomédica en Red (CIBER) en Fragilidad y Envejecimiento Saludable (CIBERFES; CB16/10/00315) del Instituto de Salud Carlos III (FEDER).

Obesity is a public health issue with growing prevalence worldwide, which leads to morbi-mortality and has given rise to its recognition as an independent nosological entity. Colombia reports a prevalence of obese adults of 51.2% in 2010. Several elements influence the epidemiology of overweight and obesity including genetic, ethnic, metabolic, environmental, political, and social aspects, amongst many others. The association of obesity with multiple pathologies is more evident as time goes by, not only because it increases the risk of cardiovascular disease, but because it also causes pulmonary, gastrointestinal, and osteoarticular disorders. To date, body mass index is the parameter used to determine and classify overweight and obesity. Alternative measurements, such as waist circumference, have been proposed as independent predictors of morbility. Considering the high prevalence of obesity and the poor precision of the classification methods to estimate cardiovascular risk, it is an important clinical decision to identify the patient who is candidate for treatment. The therapeutic approach in obese patients should focus on correcting the modifiable risk factors, and is fundamentally based on making changes in life style, which may be complemented with medication and surgery in certain patients. However, only multidisciplinary prevention will effectively avert obesity from becoming pandemic. ; La obesidad es un problema de salud pública, con prevalencia creciente en todo el mundo, que acarrea una importante morbimortalidad, lo cual ha llevado a su reconocimiento como entidad nosológica independiente. Colombia no escapa a esta situación y reporta una prevalencia de adultos obesos del 51.2% en 2010. Varios elementos influyen en el comportamiento epidemiológico del sobrepeso y la obesidad: aspectos genéticos, étnicos, metabólicos, ambientales, políticos y rasgos socioculturales, entre otros. La asociación de la obesidad con múltiples patologías es cada vez más evidente, no sólo porque aumenta de forma considerable el riesgo cardiovascular, sino, también, porque causa afecciones pulmonares, gastrointestinales y osteoarticulares. A la fecha, el índice de masa corporal es el parámetro que permiten la definición y clasificación del sobrepeso y la obesidad. Medidas alternas, como la circunferencia abdominal, se han planteado como predictores de morbilidad independientes. Teniendo en cuenta la alta prevalencia de la obesidad y la imprecisión de los métodos clasificatorios para estimar el riesgo cardiovascular e identificar el paciente candidato a tratamiento, es una decisión clínica importante. El enfoque terapéutico del paciente con obesidad debe dirigirse a la intervención de los factores de riesgo modificables y está basado fundamentalmente en los cambios en el estilo de vida, complementado con la farmacoterapia en algunos pacientes, sin desconocer la opción quirúrgica en pacientes que cumplan ciertos criterios. Sin embargo, sólo será la prevención multidimensional lo que combatirá la conversión de la obesidad en una verdadera pandemia. ; A obesidade é um problema de saúde pública, com prevalência crescente em todo mundo, que arca uma importante morbimortalidade, o qual levou a seu reconhecimento como entidade nosológica independente. A Colômbia não escapa a esta situação e reporta uma prevalência de adultos obesos de 51.2% em 2010. Vários elementos influem no comportamento epidemiológico do sobrepeso e a obesidade: aspectos genéticos, étnicos, metabólicos, ambientais, políticos e rasgos socioculturais, entre outros. A associação da obesidade com múltiplas patologias é cada vez mais evidente, não só porque aumenta de forma considerável o risco cardiovascular, senão, também, porque causa afecções pulmonares, gastrointestinais e osteoarticulares. À data, o índice de massa corporal é o parâmetro que permitem a definição e classificação do sobrepeso e a obesidade. Medidas alternas, como a circunferência abdominal, propuseram-se como preditores de morbilidade independentes. Tendo em conta a alta prevalência da obesidade e a imprecisão dos métodos classificatórios para estimar o risco cardiovascular e identificar o paciente candidato a tratamento, é uma decisão clínica importante. O enfoque terapêutico do paciente com obesidade deve dirigir-se à intervenção dos fatores de risco modificáveis e está baseado fundamentalmente nas mudanças no estilo de vida, complementado com a fármaco-terapia em alguns pacientes, sem desconhecer a opção cirúrgica em pacientes que cumpram certos critérios. No entanto, só será a prevenção multidimensional o que combaterá a conversão da obesidade numa verdadeira pandemia.

Introduction: Metabolic syndrome (MetS) characterized by the clustering of glucose intolerance, central obesity, abnormal lipid profiles, and hypertension has been increasing rapidly worldwide and is a major public health problem. Numerous studies have shown that calcium consumption can contribute to a decreased risk of developing MetS by affecting one or several of its components. However, epidemiologic evidence relating calcium intake and metabolic syndrome is limited. This study aimed to evaluate the association between habitual calcium intake and MetS incidence, as well as its components, in a population-based cohort of Korean adults aged ≥40 years old. Method: Data from the Korean Multi-Rural Communities Cohort Study (MRCohort) which is a part of the Korean Genome Epidemiology Study (KoGES), were used. There were total 5,509 subjects (men 2,204, women 3,305) who did not have MetS at enrollment. Calcium intake was calculated using a food frequency questionnaire (FFQ) composed of 106 items. MetS was defined using the updated National Cholesterol Education Program Adult Treatment Panel III criteria after modified according to the International Diabetes Federation and Korean Diabetes Association criteria. The association between calcium intake and Mets risk was investigated by a modified Poisson regression model, using a robust error estimator. Results: For 18,880 person-years of follow-up, 876 participants developed de novo MetS (312 subjects in male, 564 subjects in female). When total calcium intake was divided by quintile, it was not statistically significant for males, but the higher the total calcium intake, the less the diagnosis of new MetS (Q1:Q3:Q5 = 1:0.56 (0.40–0.78):0.85 (0.61–1.17, adjusted incidence rate ratio (IRR) (95% CI), p for trend 0.922), In females, a higher amount of intake of animal calcium (Q1:Q3:Q5 = 1:0.58 (0.45–0.75):0.71 (0.55–0.92), IRR (95% CI), p for trend 0.0091), vegetable calcium (Q1:Q3:Q5 = 1:0.73 (0.57–0.93):0.48 (0.73–0.81), IRR (95% CI), p for trend 0.0304) and total calcium (Q1:Q3:Q5 = 1:0.69 (0.54–0.88):0.74 (0.57–0.96), IRR (95% CI), p for trend 0.0434) was associated with lower incidence of new MetS. In addition, There was a mainly inverse relationship between calcium intake and abdominal obesity (Q1:Q3:Q5 = 1:0.57 (0.40–0.81):0.50 (0.35–0.72), IRR (95% CI), p for trend 0.0006) of components of Mets in male and blood glucose level (Q1:Q3:Q5 = 1:0.68 (0.55–0.85):0.75 (0.607–0.93), IRR (95% CI), p for trend 0.0336) of components of Mets in female. Conclusion: Our findings suggest that increased calcium intake was associated with decreased MetS incidence, especially decreased waist circumference in males and decreased blood glucose level in females in a population-based cohort of Korean adults aged ≥40 years old. Acknowledgement/Funding: Korea Centers for Disease Control and Prevention and the National Research Foundation of Korea grant funded by the Korea government ; open

Antecedentes: el cuidado de la salud, de forma autónoma e independiente, ha sido una preocupación permanente a lo largo de la historia y una de las metas más importantes para las personas. El movimiento constituye el fundamento básico de la vida pero, por múltiples razones, el ser humano contemporáneo puede llevar una vida exenta de actividad física regular, produciéndose uno de los problemas más relevantes de salud en la actualidad, determinando la aparición de sobrepeso, obesidad y múltiples patologías crónicas asociadas como enfermedades cardiovasculares, osteoporosis, cáncer y diabetes, entre otras. La composición corporal se relaciona con la salud y es utilizada habitualmente para la investigación de la obesidad, el crecimiento corporal y la actividad física fundamentalmente. El ejercicio físico se asocia positivamente con la salud, una mayor longevidad y esperanza de vida. Cuando se desarrolla con regularidad, es un componente esencial de un estilo de vida saludable, generando beneficios tanto a nivel fisiológico, como psicológico y social, incidiendo, por tanto, de manera positiva en los individuos que la practican. El entrenamiento físico programado y asistido por un experto es uno de los procesos que los individuos pueden elegir para mejorar su condición física, de una forma sistemática, motivada y exenta de riesgos. Objetivos: la tesis doctoral que se presenta tiene como objetivo principal la evaluación del impacto del entrenamiento combinado de fuerza-resistencia en la mejora de la composición corporal en personas adultas sedentarias, que será la base de nuestra hipótesis primaria. Como objetivos específicos se destaca la identificación del perfil antropométrico de los usuarios de los centros deportivos estudiados y el análisis del efecto de la intervención anteriormente mencionada sobre la reducción de la grasa corporal total, la grasa visceral, así como el aumento de la masa muscular y su efecto diferenciado en los diferentes grupos de edad y complexión. Este estudio, tiene el propósito de contribuir a mejorar la salud de las personas y, de forma más concreta, a aquellas que optan por la actividad física programada. Se pretende obtener información que nos permita incrementar la calidad de este tipo de prescripción de ejercicio para la salud, aumentar la seguridad de los usuarios, incrementar las competencias de los prescriptores, motivar a la población hacia la práctica del ejercicio de forma continuada y, en definitiva, contribuir desde nuestra área de responsabilidad al aumento de la calidad de vida de la población. Metodología: se ha realizado un estudio bifásico. En primer lugar se realizó un estudio descriptivo transversal del perfil antropométrico de los usuarios de los diferentes centros en los que se realizó este trabajo a través de una muestra de 250 individuos. Posteriormente se procedió a la realización de un estudio cuasi-experimental prospectivo pretest-postest que evaluó el efecto de un programa de combinado de fuerza resistencia sobre la composición corporal de un grupo experimental de 54 participantes. Los estudios se llevaron a cabo durante los años 2011 y 2012 en tres centros deportivos de la Comunidad de Madrid (España). En este trabajo se han seguido las recomendaciones de la guía CONSORT para los estudios experimentales controlados aleatorizados. Se ha considerado como variable independiente el programa combinado de fuerza y resistencia que se le aplicó al grupo experimental, que consistió en un programa combinado de fuerza y resistencia con una frecuencia de 2 sesiones por semana (con al menos 48 h de descanso entre sesiones) y una duración de 16 semanas. La duración aproximada de la sesión fue de 80 minutos. Como variables dependientes se consideraron el peso, los pliegues de grasa subcutánea, las circunferencias corporales, el índice de masa corporal [IMC], el porcentaje de tejido graso, el porcentaje de masa muscular y la distribución del tejido muscular. También se valoraron como variables moderadoras la edad, el sexo, la talla, el tipo de complexión, la frecuencia cardíaca basal y los diámetros óseos. Las técnicas utilizadas en la recogida de datos fueron un cuestionario inicial de datos socio demográficos y antropométricos, un cuestionario de datos antropométricos post-test, el cuestionario Par-Q (ACSM, 2011) y el software Fitcomp, en el que se incluyeron los datos antropométricos para la obtención de un perfil de cada participante. Para el análisis de datos se comenzó describiendo las variables sociodemográficas y antropométricas de la muestra objeto de estudio. Los análisis uni-variados se efectuaron teniendo en cuenta las características propias de las escalas de medida de dichas variables. Posteriormente se continuó con el análisis descriptivo del grupo experimental. Se procedió a realizar el contraste de hipótesis por medio de la prueba T-Student de comparación de medias para muestras relacionadas, contrastes multivariados intra/inter sujetos, Anova de Medidas Repetidas así como la prueba de contrastes Post-Hoc de Scheffe. Para identificar diferencias de promedio entre variables, se aplicaron las pruebas no paramétricas de Kruskal Wallis y U de Mann-Withney. Respecto a las consideraciones éticas se han aplicado todos los principios establecidos por la declaración de Helsinki de la Asociación Médica Mundial [AMM] sobre "Principios Éticos para las Investigaciones en Seres Humanos" de 2008, así como la legislación actual sobre protección de datos. Resultados: se observa que en la muestra de 250 personas hay 96 personas con sobrepeso, lo que equivale a un 38.4%, y 29 personas con obesidad, un 11.6. Estos datos son muy representativos de la sociedad actual, ya que, según la Organización Mundial de la Salud, en el Mundo un 39% de las personas sufren de sobrepeso y un 13% de ellas obesidad (OMS, 2015). En el grupo experimental se obtiene que hay 54 participantes (21.6% del total) con pre-obesidad abdominal y 34 participantes (13.60% del total) con obesidad abdominal, lo que representa un 35.20% de personas con un alto riesgo de padecer problemas crónicos de salud en el futuro. En este grupo hay una clara mejoría de la composición corporal tras la intervención con el programa combinado de fuerza y resistencia en todos los parámetros medidos. Respecto al peso, existen diferencias significativas entre el pre-test y el post-test (t = 4.88, p = 0.001), siendo menor en el post-test en un promedio de 2.14 Kg. También hay una reducción considerable en los pliegues de grasa y prácticamente en todas las circunferencias corporales. El porcentaje total de grasa también se redujo de manera significativa entre el pre-test y el post-test (t = 7.56, p = 0.001), siendo menor en el post-test en un promedio de 3.33 %. Además se observó un incremento importante en el porcentaje de masa muscular el pre-test y el post-test en un promedio de 2.15% (t = -5.45, p = 0.001). Conclusiones: en términos globales, se puede afirmar que el entrenamiento combinado de fuerza-resistencia es altamente efectivo la mejora de la composición corporal, ya que contribuye significativamente a la reducción de la grasa corporal total y la grasa visceral. Además, tiene un efecto muy positivo en el aumento de la masa muscular, especialmente en el miembro superior. ; Background: Health care has been a permanent concern throughout history and one of the most important desires of society. Movement is the basic foundation of life, nonetheless, for a variety of reasons, contemporary human being develops a life free of regular physical activity, constituting one of the most important health problems today, determining the appearance of overweight, obesity and multiple chronic diseases associated. Sedentariness is directly related to cardiovascular diseases, osteoporosis, cancer and diabetes, among others, unlike physical activity that is related to positive aspects on health, greater longevity and life expectancy. Regular physical activity is an essential component of a healthy lifestyle, generating physiological, psychological and social benefits, affecting positively to individuals who practice it. Body composition has an important relationship with health and is commonly used for research in obesity, body growth, physical activity and health, among others. Programmed and expert-assisted physical training is one of the processes that individuals may choose to improve their physical condition, in a systematic, motivated and risk-free trend. Objectives: The main objective of the present dissertation is the evaluation of the effectiveness of a combined endurance-strength training program on the improvement of body composition in sedentary adults, which will be the basis of our primary hypothesis. Specific objectives include the identification of the anthropometric profile of the users of sports centers and the analysis of the effect of the intervention, mentioned in the main objective, on the reduction of total body fat, visceral fat as well as the increase of muscle mass and the effect that this program has on the different age groups and complexion. This study aims to contribute to improving the health of people, more specifically, those who opt for scheduled physical activity. It has been possible through obtaining information that allows to increase quality of exercise prescription, safety of users, and competencies of prescribers, motivating users towards the practice of exercise on a daily basis and, in, all in all, to contribute from our area of responsibility to increase the quality of life of population. Methodology: a biphasic study was carried out. In the first place, a cross-sectional descriptive study of the anthropometric profile of the users of the different centers in which the study was carried out was developed, which consisted of a sample of 250 individuals. Subsequently, a prospective, quasi-experimental, pre-test/pos-test study was conducted to evaluate the effectiveness of a combined strength-resistance program on the body composition over an experimental group of 54 participants. The studies were realized during years 2011 and 2012 in three sports centers of Madrid (Spain). This project follows the recommendations of the CONSORT guide for the randomized controlled experimental studies. The combined endurance and strength program applied to the experimental experimental group was considered as an independent variable. That intervention had a frequency of 2 sessions per week (with at least 48h rest between sessions) during 16 weeks. The approximate duration of the session was 80 minutes. Weight, subcutaneous fat folds, body circumference, body mass index [BMI], percentage of fat tissue, percentage of muscle mass and distribution of muscle tissue were considered as dependent variables. Moderating variables were also taken into account: age, sex, height, type of complexion, basal heart rate and bone diameters. The techniques used in the data collection were an initial questionnaire of sociodemographic and anthropometric data used in the first phase, a questionnaire of anthropometric data post-test, Par-Q questionnaire (ACSM, 2011) and Fitcomp software, in which the anthropometric data were included to obtain a profile of each user. For the analysis of data, a descriptive analysis of sociodemographic and anthropometric variables of the sample under study was started. The uni-varied analysis was carried out taking into account the characteristics of the scales of measurement of these variables. Likewise, the descriptive analysis of the experimental group was continued. To test the hypothesis, the T-Student test of comparison of means for related samples, multivariate contrasts intra/inter subjects, Anova of Repeated Measurements as well as the test of Scheffe´s Post-Hoc were accomplished. In order to identify differences in mean between variables, non-parametric Kruskal Wallis and Mann-Withney U tests were applied. Regarding ethical considerations, all the principles established by the Helsinki Declaration of the World Medical Association (WMA) on "Ethical Principles for Research in Human Beings" of 2008 as well as the current legislation on data protection have been applied. Results: in the sample of 250 people there are 96 overweight people, which is equivalent to 38.4%, and 29 people with obesity, 11.6. According to World Health Organization, 39% of people in the world are overweight and 13% of them are obese (OMS, 2015). In the experimental group, there were 54 participants (21.6% of the total) with abdominal pre-obesity and 34 participants (13.60% of the total) with abdominal obesity, representing 35.20% of people with a high risk of chronic health problems in the future. In the experimental group, there is a clear improvement of the body composition after the intervention with the combined program of strength and resistance in all measured parameters. Regarding weight, there were significant differences between the pre-test and the post-test (t = 4.88, p = 0.001), being lower in the posttest at an average of 2.14 kg. There is also a considerable reduction in fat folds and practically all body circumferences. The total fat percentage also decreased significantly between the pre-test and the post-test (t = 7.56, p = 0.001), being lower in the post-test by an average of 3.33%. In addition, a significant increase in muscle mass percentage between the pre-test and the post-test was observed in an average of 2.15% (t = -5.45, p = 0.001). Conclusions: Overall, combined endurance-strength training is highly effective in controlling body composition, as it contributes significantly to the reduction of total body fat and visceral fat. In addition, this intervention has a very positive effect on muscle mass increase, especially in the upper body.

Directly caused by long-term imbalance in energy intake and energy expenditure, obesity and overweight are conditions of excess body fat bringing with them a range of adverse health effects. What is less well understood is their intimate connection with the action of the hormone insulin in the body, a hormone which promotes the use of ingested glucose as a primary fuel source and blocks the metabolism of stored fat. In a large number of people, genetic pre-disposition and/ or the presence of overweight leads to insulin resistance, where higher levels of the hormone are required for the same blood glucose regulating effect - a state that is highly conducive to weight gain. Indigenous populations, among them Indigenous Australian people, have a greater incidence of insulin resistance, and exposed to some elements typical of Western lifestyle, are at greater risk of developing overweight and obesity. Generally, overweight and obesity are defined in relation to the body mass index, or BMI. The BMI is a weight-for-height ratio with categories based on increasing health risk. Its universal suitability, particularly as regards muscular individuals and different ethnic groups, is contested. Generally, Aboriginal people will have a higher proportion of body fat, and Torres Strait Islander people a lower proportion of body fat than will a non-Indigenous person for a given BMI. Nevertheless, the available national data on obesity and overweight among the Indigenous population (most recently from the 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS)) are based on the BMI as calculated from selfreported height and weight measurements (as opposed to waist circumference, where abdominal fat has a strong correlation with insulin resistance and cardiovascular and diabetic risk). The 2004-05 NATSIHS found that overweight and obesity were substantial and increasing problems for Indigenous people. The greatest disparities were observed in levels of obesity, where 29% of Indigenous people were classified as obese compared with 17% of non-Indigenous people, and in the comparison between Indigenous and nonIndigenous females. Overall, Indigenous people were 1.2 times more likely than non-Indigenous people to be overweight or obese. For Torres Strait Islanders, the difference was even greater. The socioeconomic gradient of obesity, where higher levels of obesity are observed among groups of lower socioeconomic status, plays a distinctive role in this problem for Indigenous people. A wide range of environmental factors contribute to the higher prevalence of overweight and obesity among Indigenous people, of which the indirect contributors are perhaps the most important. In the main, immense changes to the dietary and physical activity patterns of Indigenous people have taken place since European settlement. The Indigenous diet has changed from one that was typically low energydensity and nutrient-rich to one that is typically energy-dense and nutrient-poor, high in refined carbohydrate, saturated fat and salt. Closely linked has been a substantial reduction in physical activity. Widespread poor dental health has a negative impact on nutritional health and high alcohol consumption contributes to excess energy intake and the diversion of income away from the purchase of healthy foods and other related household items. Across all countries of the Organisation for Economic Co-operation and Development (OECD), the highest proportion of low birthweight babies are born to Indigenous mothers, babies which are likely programmed from the very beginning of life for insulin resistance, a propensity to obesity and eventual chronic disease. Dispossession and social exclusion, which have affected the lifestyle choices of Indigenous people since almost the earliest point of contact with European settlers, cannot be seen as anything other than centrally important contributors due to their role in preserving the socioeconomic disadvantage so strongly correlated with the high presence of this condition. Obesity and overweight are significant risk factors for a long list of adverse health conditions, among them some of the principal causes of Indigenous morbidity and mortality- cardiovascular disease, type 2 diabetes and chronic renal disease. High and rising rates of obesity and its consequent conditions are particularly burdensome in the light of the continuing and parallel existence of problems of malnutrition and infectious disease in many Indigenous communities. It is difficult, and likely of little use, to single out obesity and overweight in Indigenous people for targeted and narrow policy response due firstly to its uniquely cross-sectoral, multi-factoral nature and secondly to the holistic conception of health of many Indigenous people. The government has committed to ambitious targets in Indigenous health, has sharply increased Indigenous health spending and is concentrating resources on early intervention and prevention in the areas of maternal and child health and early childhood development (a significant juncture for the promotion of healthy weight). The Council of Australian Governments (COAG) process, the School Nutrition Program and adapted income management appear to hold particular promise for progress in Indigenous health as it relates to overweight and obesity. Pivotal areas of encounter include the push for an evidence base in Indigenous policy, the division of resources between the Northern Territory and the other states and territories, funding to meet commitments and need across the spectrum of Indigenous Affairs into the future, and the interface between Aboriginal Community Controlled Health Services and external expertise.