Global Proportion of Disordered Eating in Children and Adolescents: A Systematic Review and Meta-analysis.

Importance: The 5-item Sick, Control, One, Fat, Food (SCOFF) questionnaire is the most widely used screening measure for eating disorders. However, no previous systematic review and meta-analysis determined the proportion of disordered eating among children and adolescents. Objective: To establish the proportion among children and adolescents of disordered eating as assessed with the SCOFF tool. Data Sources: Four databases were systematically searched (PubMed, Scopus, Web of Science, and the Cochrane Library) with date limits from January 1999 to November 2022. Study Selection: Studies were required to meet the following criteria: (1) participants: studies of community samples of children and adolescents aged 6 to 18 years and (2) outcome: disordered eating assessed by the SCOFF questionnaire. The exclusion criteria included (1) studies conducted with young people who had a diagnosis of physical or mental disorders; (2) studies that were published before 1999 because the SCOFF questionnaire was designed in that year; (3) studies in which data were collected during COVID-19 because they could introduce selection bias; (4) studies based on data from the same surveys/studies to avoid duplication; and (5) systematic reviews and/or meta-analyses and qualitative and case studies. Data Extraction and Synthesis: A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures: Proportion of disordered eating among children and adolescents assessed with the SCOFF tool. Results: Thirty-two studies, including 63 181 participants, from 16 countries were included in this systematic review and meta-analysis. The overall proportion of children and adolescents with disordered eating was 22.36% (95% CI, 18.84%-26.09%; P < .001; n = 63 181) (I2 = 98.58%). Girls were significantly more likely to report disordered eating (30.03%; 95% CI, 25.61%-34.65%; n = 27 548) than boys (16.98%; 95% CI, 13.46%-20.81%; n = 26 170) (P < .001). Disordered eating became more elevated with increasing age (B, 0.03; 95% CI, 0-0.06; P = .049) and body mass index (B, 0.03; 95% CI, 0.01-0.05; P < .001). Conclusions and Relevance: In this systematic review and meta-analysis, the available evidence from 32 studies comprising large samples from 16 countries showed that 22% of children and adolescents showed disordered eating according to the SCOFF tool. Proportion of disordered eating was further elevated among girls, as well as with increasing age and body mass index. These high figures are concerning from a public health perspective and highlight the need to implement strategies for preventing eating disorders.

Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and non-linear dose-response meta-analysis of data from 1 853 610 adults.

OBJECTIVE: To quantify the association between physical activity and risk of SARS-CoV-2 infection, COVID-19-associated hospitalisation, severe illness and death due to COVID-19 in adults. DESIGN: A systematic review and meta-analysis. DATA SOURCES: Three databases were systematically searched through March 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Peer-reviewed articles reporting the association between regular physical activity and at least one COVID-19 outcome in adults were included. Risk estimates (ORs, relative risk (RR) ratios or HRs) were extracted and pooled using a random-effects inverse-variance model. RESULTS: Sixteen studies were included (n=1 853 610). Overall, those who engaged in regular physical activity had a lower risk of infection (RR=0.89; 95% CI 0.84 to 0.95; I2=0%), hospitalisation (RR=0.64; 95% CI 0.54 to 0.76; I2=48.01%), severe COVID-19 illness (RR=0.66; 95% CI 0.58 to 0.77; I2=50.93%) and COVID-19-related death (RR=0.57; 95% CI 0.46 to 0.71; I2=26.63%) as compared with their inactive peers. The results indicated a non-linear dose-response relationship between physical activity presented in metabolic equivalent of task (MET)-min per week and severe COVID-19 illness and death (p for non-linearity <0.001) with a flattening of the dose-response curve at around 500 MET-min per week. CONCLUSIONS: Regular physical activity seems to be related to a lower likelihood of adverse COVID-19 outcomes. Our findings highlight the protective effects of engaging in sufficient physical activity as a public health strategy, with potential benefits to reduce the risk of severe COVID-19. Given the heterogeneity and risk of publication bias, further studies with standardised methodology and outcome reporting are now needed. PROSPERO REGISTRATION NUMBER: CRD42022313629.

Relationship between parents' and children's objectively assessed movement behaviours prior to and during the COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic could have provoked undesirable harmful effects on movement behaviours among children. OBJECTIVE: To compare levels of physical activity (PA), sedentary behaviour (SB), and sleep time in children prior to and during the COVID-19 pandemic (after the lockdown) and to determine the association between changes in moderate-to-vigorous PA (MVPA), total PA (TPA), SB, and sleep time between mothers and fathers with their children. METHODS: A total of 110 children (aged 4-7 years) and their parents (63 mothers and 52 fathers) wore GENEActiv accelerometers for 6 days (4 weekdays and 2 weekend days) prior to the pandemic and 1 year into the pandemic to assess SB, MVPA, TPA, and sleep time. RESULTS: Children performed more MVPA on weekdays (p = 0.002), had higher SB (p = 0.001), and slept fewer hours during the pandemic than before (p < 0.001). Likewise, children performed more weekend day MVPA and TPA (p < 0.001) during the pandemic, and slept less than prior to the pandemic (p = 0.002). On weekdays, an increase in mother's MVPA and TPA (categorized as tertiles) was associated with higher increased on MVPA (p = 0.030) and TPA in their children (p = 0.023), respectively. On weekends, an increase in mother's MVPA was also associated with higher increases in MVPA (p = 0.011) in their children. CONCLUSION: During the pandemic, children got more MVPA, more SB, and slept fewer hours than before. Changes in PA seem to be associated with mother's behaviours, especially during weekdays.

Is adherence to 24-Hour Movement Guidelines associated with a higher academic achievement among adolescent males and females?

OBJECTIVES: This study aims to examine the independent and combined associations of 24-Hour Movement Guidelines for physical activity, screen time, and sleep duration with academic achievement in adolescent males and females. DESIGN: Cross-sectional study. METHODS: 1290 Spanish adolescents (565 females), aged 11 to 16 years (13.06 ±â€¯0.84), participated in this study. Self-reported physical activity, screen time, and sleep duration questionnaires were assessed. Academic achievement was calculated as an average score of the adolescents'' grades in first language (Spanish), first foreign language (English), and mathematics subjects. A multiple linear regression model was used to examine the association between meeting 24-Hour Movement Guidelines and academic achievement. Covariates included age, sex, socioeconomic status, body mass index, and cardiorespiratory fitness. RESULTS: Not meeting any of the three 24-Hour Movement Guidelines was associated with lower academic achievement in the whole sample (p < 0.001). Meeting physical activity and sleep duration guidelines, both independently and together, was associated with higher academic achievement in the whole sample (p < 0.001). Meeting at least two recommendations was associated with higher academic achievement in males (p < 0.01). However, trend analysis revealed that participants who met two or three recommendations had higher academic achievement compared to those who met one or none of these recommendations (p < 0.05). All these results were similar for males and females. CONCLUSIONS: Our findings suggest the importance of promoting more than one 24-Hour Movement Guidelines, mainly physical activity and sleep duration, which seems to contribute positively to increased academic performance in adolescents.

Dietary Patterns, Adherence to the Food-Based Dietary Guidelines, and Ultra-Processed Consumption During the COVID-19 Lockdown in a Sample of Spanish Young Population.

Purpose: The aim of this study was to explore the dietary patterns, adherence to Food-Based Dietary Guidelines, and the ultra-processed consumption during the COVID-19 lockdown among a Spanish young population aged 3-17 years. Methods: Parents/legal guardians of preschoolers, children, and adolescents aged 3-17 years were enrolled through social networks. The eating habits were assessed by a Food Propensity Questionnaire applied in the ENALIA (Encuesta Nacional de Alimentación en la población Infantil y Adolescente) Spanish survey, which aims to collect food intake information and other data about eating habits on children and adolescents (0-18 years old). Participants were dichotomized following the Food-Based Dietary Guidelines for the Spanish young population offered by the Spanish Society of Community Nutrition. The ultra-processed food score was determined following the principles established in the NOVA classification. Results: Data from 604 children and adolescents were included. An association between age group and the recommendations of snacks (p = 0.002), fruits (p = 0.010), and diaries (p < 0.001) was found. Adolescents showed a lower mean compliance with these guidelines than children (p = 0.004) and preschoolers (p < 0.001). Similarly, children reported lower Food-Based Dietary Guidelines than preschoolers (p = 0.015). Regarding ultra-processed consumption, it was also observed a higher intake in adolescents than in children (p = 0.037), as well as in preschoolers (p < 0.001). Conclusions: The associations that were found highlight the low proportion of the young population (especially adolescents) meeting the Food-Based Dietary Guidelines and the high consumption of ultra-processed foods during COVID-19 lockdown.

Physical Activity, Sedentary Behavior, Sleep and Self-Regulation in Spanish Preschoolers during the COVID-19 Lockdown.

BACKGROUND: A better understanding of the effects of the lockdown on lifestyle behaviors may help to guide the public health response to COVID-19 at a national level and to update the global strategy to respond COVID-19 pandemic. The aim of the study was to examine the effects of the COVID-19 lockdown on device-measured physical activity (PA), sedentary time, sleep and self-regulation; and to determine whether PA and sleep are related to self-regulation problems during the lockdown. METHODS: PA, sedentary time and sleep were assessed using accelerometry in the week in which the Spanish national state of alarm was declared (n = 21). Parents reported preschooler's self-regulation difficulties (internalizing and externalizing) before (n = 268) and during the lockdown (n = 157) by a validated questionnaire. RESULTS: Preschoolers showed a decrease in total PA (mean difference [MD] = -43.3 min per day, 95% CI -68.1 to -18.5), sleep efficiency (MD = -2.09%, 95% CI -4.12 to -0.05), an increase in sedentary time (MD = 50.2 min per day, 95% CI 17.1 to 83.3) internalizing (MD = 0.17, 95% CI 0.06 to 0.28) and externalizing (MD = 0.33, 95% CI 0.23 to 0.44) problems. Preschoolers who met the World Health Organization recommendations for PA had lower internalizing scores than non-active peers (MD = -1.28, 95% CI -2.53 to -0.03). CONCLUSIONS: Our findings highlight the importance of meeting PA recommendations to reduce psychosocial difficulties during a lockdown situation.