[Evolution of the diet and physical activity of university students after the COVID-19 pandemic]. / Evolución de la dieta y la actividad física de los estudiantes universitarios tras la pandemia de COVID-19.

Introduction: Objective: to assess the evolution of adherence to Mediterranean diet and level of physical activity of university students of Health Sciences in Castilla-La Mancha during the COVID-19 lockdown and one year afterwards. Methods: a cross-sectional observational study using questionnaires on adherence to the Mediterranean diet and level of physical activity. A total of 893 students enrolled in Health Sciences degrees at the University of Castilla la Mancha participated, 575 in the first survey (during the lockdown) and 318 in the second (one year later). By sex, 672 women and 221 men (in the first survey 77.7 % were women and 22.3 % men while in the second survey these were 70.8 % and 29.2 %, respectively). Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Adherence Screener (MEDAS) questionnaire and the modified Prevention with Mediterranean Diet (PREDIMED) questionnaire. The level of physical activity was assessed with the Rapid Assessment of Physical Activity Scale (RAPA). Results: one year after the COVID-19 confinement, consumption of olive oil has almost tripled. Daily fruit consumption has also doubled. Similarly, the consumption of wine and alcoholic beverages has doubled. Conversely, there was a reduction in the consumption of butter and margarine, as well as of carbonated drinks and sweetened beverages. Likewise, the percentage of university students with high adherence to the Mediterranean diet increased significantly (from 26 % to 34.3 %). Regarding physical activity level, there was a significant increase in the percentage of university students who engaged in light, moderate and even intense physical activity on an irregular basis. This increase was not found in the case of muscular strength and flexibility training activities. Conclusion: the results of the study indicate that, although the levels of adherence to the Mediterranean diet and physical activity have improved after the COVID-19 confinement, adherence to Mediterranean diet and physical activity level among the university population analyzed is still low. It is necessary to implement strategies for the achievement or maintenance of a healthy lifestyle in this population.

Introducción: Objetivo: valorar la evolución de la adherencia a la dieta mediterránea y el nivel de actividad física de los estudiantes universitarios de Ciencias de la Salud de Castilla-La Mancha durante la pandemia de COVID-19 y un año después de la misma. Método: estudio observacional transversal mediante cuestionarios sobre la adherencia a la dieta mediterránea y el nivel de actividad física. Participaron 893 alumnos matriculados en grados de Ciencias de la Salud de la Universidad de Castilla-La Mancha, 575 en la primera encuesta (durante la pandemia) y 318 en la segunda (un año después). Por sexos, 672 mujeres y 221 hombres (en la primera encuesta, el 77,7 % eran mujeres y el 22,3 % hombres, mientras que en la segunda lo eran el 70,8 % y 29,2 %, respectivamente). La adherencia a la dieta mediterránea se valoró con el cuestionario Mediterranean Diet Adherence Screener (MEDAS) y el cuestionario de Prevención con Dieta Mediterránea (PREDIMED), modificado. El nivel de actividad física se valoró con el cuestionario Rapid Assessment of Physical Activity Scale (RAPA). Resultados: tras un año desde el confinamiento por la COVID-19, el consumo de aceite de oliva casi se ha triplicado. Se ha duplicado también el consumo de frutas diario. De igual modo, se ha duplicado el consumo de vino y bebidas alcohólicas. Por el contrario, se encontró una reducción del consumo de mantequilla y margarina, al igual que de bebidas carbonatadas y azucaradas. Asimismo, aumentó significativamente el porcentaje de estudiantes universitarios con adherencia alta a la dieta mediterránea (del 26 % al 34,3 %). En cuanto al nivel de actividad física, ha aumentado significativamente el porcentaje de estudiantes universitarios que realizan actividad fisica ligera, moderada e incluso intensa de forma irregular. Este aumento no se ha encontrado en el caso de las actividades de fuerza muscular y flexibilidad. Conclusión: los resultados del estudio nos indican que, aunque los niveles de adherencia a la dieta mediterránea y de actividad física han mejorado tras el confinamiento por la COVID-19, la adherencia a la dieta mediterránea y el nivel de actividad física de la población universitaria analizada siguen siendo bajos. Es necesario aplicar estrategias para la consecución o mantenimiento de un estilo de vida saludable en dicha población.

Association of the Practice of Physical Activity and Dietary Pattern with Psychological Distress before and during COVID-19 in Brazilian Adults.

To verify the association between the practice of physical activity and dietary patterns and psychological distress before and during the lockdown due to COVID-19, a cross-sectional study was performed with 2000 Brazilians (mean [M] = 35.78 years; standard deviation [SD] = 11.20; 59.6% women) recruited through convenience sampling via digital media. Participants completed an electronic questionnaire containing sociodemographic and clinical information, nutritional patterns, physical activity, and psychological distress. Data were analyzed using descriptive statistics and multinomial regression. Before the COVID-19 lockdown, the chance of women presenting very high stress, in relation to men, was six times higher (OR = 6.32; 95% CI 4.20-9.51), a behavior that remained similar during the lockdown (OR = 6.63; 95% CI 4.40-10.00). Before the lockdown, insufficient physical activity doubled the chance of having very high stress in relation to those who engaged in physical activities six to seven times a week (OR = 2.11; 95% CI 1.10-4.02). However, during the lockdown, this probability was higher, from twice to 10 times the chance (OR = 10.19; 95% CI 4.85-21.41). Not exercising alone (OR = 2.18; 95% CI 1.52-3.11) and a decreasing physical activity frequency (OR = 2.28; 95% CI 1.40-3.71) were also associated with very high stress during the lockdown. Additionally, the consumption of smaller amounts of food showed an inverse association with very high stress (OR = 0.28; 95% CI 0.18-0.43). The maintenance of physical activity and an adequate eating frequency are measures that should be considered to cope with higher levels of anxiety and depression.

Inequalities in the association between adherence to the Mediterranean diet and physical fitness in the young population during the COVID-19 lockdown.

Introduction: Objective: this study analyzed the association between adherence to the Mediterranean diet and proxy-reported physical fitness among Spanish and Brazilian youths during the COVID-19 lockdown according to several inequality indicators. Methods: we conducted a cross-sectional study with parents and guardians of children and adolescents from Spain and Brazil. The evaluation process was through the use of online questionnaires. Adherence to the Mediterranean diet was assessed using the Mediterranean Diet Quality Index in Children and Adolescents. Proxy-reported physical fitness was determined using the International Fitness Scale. Inequality indicators (gender, nationality, socioeconomic status, and parents/guardians' education level) were evaluated with a survey completed by the participants' parents/guardians. Binary logistic regression models estimated the association between adherence to the Mediterranean diet and proxy-reported physical fitness, with stratification according to inequality variables. A total sample of 1,099 Spanish and Brazilian individuals (47.6% girls, aged 3 to 17 years) were included in the analysis. Results: compared to the "improvement needed to Mediterranean diet" category, the "optimal Mediterranean diet" group was significantly associated with "very good" physical fitness in boys (OR = 1.5; 95 % CI: 1.0-2.1) and in participants with parents/legal guardians' education level without university studies (OR = 1.5; 95 % CI: 1.0-2.4). Conclusions: gender and parents/guardians' education level plays a significant role in the association between the "optimal Mediterranean Diet" and "very good" physical fitness level in Spanish and Brazilian children and adolescents. Future prospective studies are needed to investigate the role of inequality indicators in this relationship.

Introducción: Objetivo: este estudio analizó la asociación entre la adherencia a la dieta mediterránea y la aptitud física autoinformada entre jóvenes españoles y brasileños durante el confinamiento de COVID-19 según varios indicadores de desigualdad. Métodos: se realizó un estudio transversal con padres y tutores de niños y adolescentes de España y Brasil. El proceso de evaluación fue a través del uso de cuestionarios online. La adherencia a la dieta mediterránea se evaluó mediante el Índice de Calidad de la Dieta Mediterránea en Niños y Adolescentes. La aptitud física declarada por los padres se determinó mediante la Escala Internacional de Aptitud Física. Los indicadores de desigualdad (género, nacionalidad, estatus socioeconómico y nivel educativo de los padres/tutores) se evaluaron con una encuesta completada por los padres/tutores de los participantes. Los modelos de regresión logística binaria estimaron la asociación entre la adherencia a la dieta mediterránea y la aptitud física informada por los progenitores, estratificando según las variables de desigualdad. Se incluyó en el análisis una muestra total de 1099 individuos españoles y brasileños (47,6 % niñas, de 3 a 17 años). Resultados: en comparación con la categoría de "necesidad de mejorar la dieta mediterránea", la de "dieta mediterránea óptima" se asoció significativamente con una aptitud física "muy buena" en los chicos (OR = 1,5; IC del 95 %: 1,0-2,1) y en los participantes con nivel educativo de los padres/tutores sin estudios universitarios (OR = 1,5; IC del 95 %: 1,0-2,4). Conclusiones: el género y el nivel educativo de los padres/tutores legales desempeñan un papel significativo en la asociación entre la "dieta mediterránea óptima" y el nivel de condición física "muy bueno" en niños y adolescentes españoles y brasileños. Se necesitan futuros estudios prospectivos para investigar el papel de los indicadores de desigualdad en esta relación.

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.

Adherence to the Mediterranean Diet and Health-Related Quality of Life during the COVID-19 Lockdown: A Cross-Sectional Study including Preschoolers, Children, and Adolescents from Brazil and Spain.

Scientific literature has suggested positive associations between the Mediterranean diet (MD) and the health-related quality of life (HRQoL) in young populations. However, to our knowledge, this relationship is unexplored during a situation of social isolation (i.e., lockdown). The objective of the current study is to examine the relationship between the MD and HRQoL during the COVID-19 lockdown among preschoolers, children, and adolescents from Brazil and Spain. This cross-sectional study includes a sample of 1099 three- to seventeen-year-old participants (47.6% girls) who were recruited via social networks. The HRQoL was assessed with the EQ-5D-Y. The Quality Index for Children and Teenagers (KIDMED) questionnaire was applied to evaluate the relationship between the MD and HRQoL. The highest prevalence of reported problems was found for worried, sad, or unhappy participants (39.8%). Furthermore, the lowest proportion of HRQoL problems was observed for "mobility" (2.5%). The proportion of high adherence to the MD was 44.3%. Participants with greater MD adherence reported higher HRQoL mean scores when compared with those who did not adhere to the MD (83.7 ± 0.6 vs. 85.6 ± 0.7, respectively; p < 0.05). Adherence to the MD and especially daily fruit intake were related to higher HRQoL during the COVID-19 lockdown among Brazilian and Spanish young people aged three to seventeen years.

Global Matrix 4.0 Physical Activity Report Card Grades for Children and Adolescents: Results and Analyses From 57 Countries.

BACKGROUND: The Global Matrix 4.0 on physical activity (PA) for children and adolescents was developed to achieve a comprehensive understanding of the global variation in children's and adolescents' (5-17 y) PA, related measures, and key sources of influence. The objectives of this article were (1) to summarize the findings from the Global Matrix 4.0 Report Cards, (2) to compare indicators across countries, and (3) to explore trends related to the Human Development Index and geo-cultural regions. METHODS: A total of 57 Report Card teams followed a harmonized process to grade the 10 common PA indicators. An online survey was conducted to collect Report Card Leaders' top 3 priorities for each PA indicator and their opinions on how the COVID-19 pandemic impacted child and adolescent PA indicators in their country. RESULTS: Overall Physical Activity was the indicator with the lowest global average grade (D), while School and Community and Environment were the indicators with the highest global average grade (C+). An overview of the global situation in terms of surveillance and prevalence is provided for all 10 common PA indicators, followed by priorities and examples to support the development of strategies and policies internationally. CONCLUSIONS: The Global Matrix 4.0 represents the largest compilation of children's and adolescents' PA indicators to date. While variation in data sources informing the grades across countries was observed, this initiative highlighted low PA levels in children and adolescents globally. Measures to contain the COVID-19 pandemic, local/international conflicts, climate change, and economic change threaten to worsen this situation.

Meeting 24 h Movement Guidelines and Health-Related Quality of Life in Youths during the COVID-19 Lockdown

Limitations in the use of public spaces have impacted the frequency and duration of movement behaviours (physical activity, sedentary behaviour, sleep) and outdoor activities of children and adolescents. Whether pandemic-induced changes in movement behaviours are related to the health-related quality of life (HRQoL) of children and adolescents is unknown. The aim of the current study was to examine the association between meeting 24 h movement guidelines and HRQoL during the COVID-19 lockdown among children and adolescents. Data from 1099 3–17-year-old children and adolescents from Spain and Brazil were analysed. An online questionnaire was used to collect parent-reported information concerning physical activity, screen time, and sleep duration. For the assessment of HRQoL, the EQ-5D-Y proxy version was used. The highest prevalence of reported problems was related to the 'worries/sadness/unhappiness' factor, where 36.3% of participants declared to have at least 'some problems'. Participants meeting the 24 h guidelines had a higher HRQoL score compared with those who did not (91.9 ±2.5 vs. 84.3 ±0.5, respectively;p < 0.05). The current study shows that children and adolescents that met 24 h movement guidelines presented a higher HRQoL during the COVID-19 lockdown, providing support for the promotion of healthy movement behaviours-especially during a pandemic.

Anxiety-Induced Sleep Disturbance and Associated Lifestyle Behaviors According to Sex in Argentine Adolescents.

Purpose: The aim of the current study was twofold: first, to determine the prevalence of anxiety-induced sleep disturbances among Argentine adolescents according to sex, and second, to identify the association between these sleep disturbances and lifestyle behaviors in this population. Methods: This is a cross-sectional study with data from the Global School-based Student Health Survey (GSHS) in Argentina (2018). A total of 32,393 adolescents (aged 12-17 years; 53.4% girls) were included in the final analysis. Anxiety-induced sleep disturbances were assessed with the question "During the past 12 months, how often have you been so worried about something that you could not sleep at night?" Results: The prevalence of anxiety-induced sleep disturbances was higher in girls (17.4%) than in boys (7.9%) (p < 0.001). In boys, results indicated that those who used marijuana (cannabis) (odds ratio [OR] = 1.46, 95% confidence interval [CI] 1.08-1.98), used amphetamine or methamphetamine (OR = 2.19, 95% CI 1.28-3.77), walked or biked to or from school (OR = 1.53, 95% CI 1.19-1.96), and spent 3 h or more in sedentary behaviors (OR = 1.35, 95% CI 1.05-1.74) were more likely to report anxiety-induced sleep disturbances. In girls, those who ate from a fast-food restaurant (OR = 1.24, 95% CI 1.05-1.47), consumed alcoholic beverages (OR = 1.45, 95% CI 1.19-1.75), smoked cigarettes (OR = 2.09, 95%CI 1.05-4.14), consumed any tobacco product (OR = 1.47, 95% CI 1.19-1.82), used amphetamine or methamphetamine (OR = 2.08, 95% CI 1.33-3.26), and those who spent 3 h or more in sedentary behaviors (OR = 1.32, 95% CI 1.11-1.57) were more likely to report frequent anxiety-induced sleep disturbances. Conclusion: In conclusion, considerable sex differences were observed with respect to the prevalence of anxiety-related sleep disturbances and associated lifestyle aspects.

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.

Sleep-related problems and eating habits during COVID-19 lockdown in a southern Brazilian youth sample.

The pandemic has affected children's behaviors and this fact has an effect on their healthy habits, such as sleep and diet. The aim of the current study was to determinate the prevalence of sleep-related problems and its relationship with eating habits in children from the south of Brazil during the pandemic. Parents/legal guardians of 3-17 years old participants responded to a online survey distributed using the snowball sampling strategy in Brazil. The survey was conducted in April, 2020. Participants were asked for their sleep duration and sleep-related problems, as well as for their eating habits. Logistic regressions were performed to analyze the relationship between sleep-related problems and eating habits. 495 participants were included in the analysis. 48.8% of participants reported sleep-related problems with 12.3% not meeting the sleep guidelines. Moreover, participants reported eating fruits or vegetables and sweets over four and three per week, respectively. Different associations were found between varibles of sleep and eating habits. Those participants with healthy eating habits showed a lower prevalence of sleep-related problems.

Changes in Healthy Behaviors and Meeting 24-h Movement Guidelines in Spanish and Brazilian Preschoolers, Children and Adolescents during the COVID-19 Lockdown.

BACKGROUND: The aim of this study was to assess changes in physical activity, screen time and sleep duration of preschoolers, children and adolescents and the prevalence of meeting the 24-h movement guidelines during the lockdown caused by COVID-19 in a sample from Spain and Brazil. METHODS: A total of 1099 preschoolers, children and adolescents (aged 3-17 years) from Spain (12.1 ± 4.6 years) and Brazil (10.7 ± 4.3 years) were included. An online survey was created and distributed in each country using a snowball sampling strategy. This online survey was completed by parents (mother/father/responsible guardian). RESULTS: The proportion of the sample who met the PA and ST recommendations decreased during the COVID-19 lockdown in both Spanish and Brazilian samples (p < 0.001), while sleep duration increased (p < 0.001). The proportion of the sample meeting the overall 24-h movement guidelines was very low before the lockdown (Spain 3.0%; Brazil 11.7%) and even worse during the lockdown (Spain 0.3%; Brazil 7.5%). CONCLUSIONS: The prevalence of preschoolers, children and adolescents in both the Spain and Brazil samples meeting the 24-h movement guidelines during COVID-19 restrictions was as low as previous studies in other countries. Efforts to protect and support healthy behaviors of young people during a period of pandemic restrictions need to be a priority.