Beat the Clock: Assessment of Night Eating Syndrome and Circadian Rhythm in a Sample of Greek Adults.

The night eating syndrome (NES) is characterized by excessive food intake during the evening and night hours, with 25% of the daily intake being consumed post-dinner, paired with ep-isodes of nocturnal food intake, at a frequency of more than twice weekly. The NES has been associated with a misaligned circadian rhythm related to a delay in overall food intake, increased energy and fat consumption. The present cross-sectional study aimed to assess NES in a Greek population and evaluate possible links between NES and chronotype. NES was assessed using the Night Eating Questionnaire (NEQ), and circadian rhythm, sleep and mood were evaluated with the Sleep, Circadian Rhythms, and Mood (SCRAM) questionnaire. A total of 533 adults participated in the study. A relatively high prevalence of NES was revealed, with more than 8.1% (NEQ ≥ 30) of the participants reporting experiencing NES symptoms, depending on the NEQ threshold used. Most participants had the intermediate chronotype. NEQ score was positively associated with the morning chronotype, and SCRAM was negatively related to "Good Sleep". Each point increment in the depression score was associated with 6% higher odds of NES. The early identification of NES gains importance in clinical practice, in a collective effort aiming to reduce NES symptomatology and its detrimental health effects.

The Challenges of Vaccine Trial Participation among Underserved and Hard-to-Reach Communities: An Internal Expert Consultation of the VACCELERATE Consortium.

Underserved and hard-to-reach population groups are under-represented in vaccine trials. Thus, we aimed to identify the challenges of vaccine trial participation of these groups in member countries of the VACCELERATE network. Seventeen National Coordinators (NC), each representing their respective country (15 European countries, Israel, and Turkey), completed an online survey. From 15 eligible groups, those that were more frequently declared underserved/hard-to-reach in vaccine research were ethnic minorities (76.5%), persons experiencing homelessness (70.6%), illegal workers and refugees (64.7%, each). When prioritization for education on vaccine trials was considered, ethnic groups, migrants, and immigrants (5/17, 29.4%) were the groups most frequently identified by the NC as top targets. The most prominent barriers in vaccine trial participation affecting all groups were low levels of health literacy, reluctance to participate in trials due to engagement level, and low levels of trust in vaccines/vaccinations. This study highlighted population groups considered underserved/hard-to-reach in countries contained within the European region, and the respective barriers these groups face when participating in clinical studies. Our findings aid with the design of tailored interventions (within-and across-countries of the European region) and with the development of strategies to overcome major barriers in phase 2 and phase 3 vaccine trial participation.

Fact-based nutrition for infants and lactating mothers-The NUTRISHIELD study.

Background: Human milk (HM) is the ideal source of nutrients for infants. Its composition is highly variable according to the infant's needs. When not enough own mother's milk (OMM) is available, the administration of pasteurized donor human milk (DHM) is considered a suitable alternative for preterm infants. This study protocol describes the NUTRISHIELD clinical study. The main objective of this study is to compare the % weight gain/month in preterm and term infants exclusively receiving either OMM or DHM. Other secondary aims comprise the evaluation of the influence of diet, lifestyle habits, psychological stress, and pasteurization on the milk composition, and how it modulates infant's growth, health, and development. Methods and design: NUTRISHIELD is a prospective mother-infant birth cohort in the Spanish-Mediterranean area including three groups: preterm infants <32 weeks of gestation (i) exclusively receiving (i.e., >80% of total intake) OMM, and (ii) exclusively receiving DHM, and (iii) term infants exclusively receiving OMM, as well as their mothers. Biological samples and nutritional, clinical, and anthropometric characteristics are collected at six time points covering the period from birth and until six months of infant's age. The genotype, metabolome, and microbiota as well as the HM composition are characterized. Portable sensor prototypes for the analysis of HM and urine are benchmarked. Additionally, maternal psychosocial status is measured at the beginning of the study and at month six. Mother-infant postpartum bonding and parental stress are also examined. At six months, infant neurodevelopment scales are applied. Mother's concerns and attitudes to breastfeeding are registered through a specific questionnaire. Discussion: NUTRISHIELD provides an in-depth longitudinal study of the mother-infant-microbiota triad combining multiple biological matrices, newly developed analytical methods, and ad-hoc designed sensor prototypes with a wide range of clinical outcome measures. Data obtained from this study will be used to train a machine-learning algorithm for providing dietary advice to lactating mothers and will be implemented in a user-friendly platform based on a combination of user-provided information and biomarker analysis. A better understanding of the factors affecting milk's composition, together with the health implications for infants plays an important role in developing improved strategies of nutraceutical management in infant care. Clinical trial registration: https://register.clinicaltrials.gov, identifier: NCT05646940.

Joint Microbiota Activity and Dietary Assessment through Urinary Biomarkers by LC-MS/MS.

Accurate dietary assessment in nutritional research is a huge challenge, but essential. Due to the subjective nature of self-reporting methods, the development of analytical methods for food intake and microbiota biomarkers determination is needed. This work presents an ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS) method for the quantification and semi quantification of 20 and 201 food intake biomarkers (BFIs), respectively, as well as 7 microbiota biomarkers applied to 208 urine samples from lactating mothers (M) (N = 59). Dietary intake was assessed through a 24 h dietary recall (R24h). BFI analysis identified three distinct clusters among samples: samples from clusters 1 and 3 presented higher concentrations of most biomarkers than those from cluster 2, with dairy products and milk biomarkers being more concentrated in cluster 1, and seeds, garlic and onion in cluster 3. Significant correlations were observed between three BFIs (fruits, meat, and fish) and R24h data (r > 0.2, p-values < 0.01, Spearman correlation). Microbiota activity biomarkers were simultaneously evaluated and the subgroup patterns detected were compared to clusters from dietary assessment. These results evidence the feasibility, usefulness, and complementary nature of the determination of BFIs, R24h, and microbiota activity biomarkers in observational nutrition cohort studies.

Food Allergies and Quality of Life among School-Aged Children and Adolescents: A Systematic Review.

Recently, besides the focus on the medical diagnosis and therapeutic interventions for food allergy (FA), the psychosocial aspects of this frequent condition have also been investigated. The current systematic review aimed to explore and synthesize the scientific evidence published from January 2015 to April 2022 on Health-Related Quality of Life (HRQoL) among children and adolescents with FAs. Twenty-eight research studies were included in the review, which was conducted on three databases (PubMed, Scopus and Cochrane Library). In most studies, the scores indicate an average level of HRQoL for children and adolescents with FAs, with girls and older children being more negatively affected than boys and younger ones, respectively. Few studies compared HRQoL between children with FA and healthy children, with 3 of them showing worse HRQoL for children with FAs. Immunotherapy has been found to improve the QoL of children with FAs. Anaphylaxis history, number of FAs, additional allergies, number and severity of symptoms were identified as the main factors with a negative impact on QoL. More comparative studies on the HRQoL of children and adolescents with FAs and healthy populations or children with other chronic diseases are required in order to improve QoL of children with FAs.

Adherence to the Mediterranean lifestyle pattern is associated with favorable weight loss outcomes: the MedWeight study.

Individual lifestyle targets have been associated with weight loss outcomes, yet few studies have examined associations of one's total lifestyle with weight loss maintenance. We aimed to examine the relationship between lifestyle patterns and weight loss outcomes in weight loss maintainers and regainers. We hypothesized that higher adherence to a broader healthy lifestyle favors maintenance (over regain). This is a cross-sectional analysis of 470 adults (62% women) with a history of overweight/obesity and significant weight loss 12 months before study entry. Participants were classified as maintainers (current weight ≤90% maximum weight) or regainers. They were asked to fill in a series of questionnaires on demographics and lifestyle habits (dietary intake and eating behaviors through two 24-hour recalls, physical activity, and sleep). A total Mediterranean Lifestyle Index (total-MLI, range 0-13) was generated by summing up ratings in the lifestyle domain quartiles (diet quality, physical activity, and sleep habits) and dietary behaviors (seasonal food and vegetable intake, intake of traditional foods, responsibility for food preparation, conviviality). Maintainers scored higher in the total-MLI than regainers (6.93 ± 2.31 vs 5.78 ± 2.49, P < .001). Adherence to the total-MLI was associated with 28% higher odds for weight loss maintenance (per unit increment) in linear analyses. Being in the highest total-MLI quartile was associated with 5.27 (95% CI, 2.77-10.02) odds for maintenance. Higher adherence to a comprehensive Mediterranean lifestyle pattern was associated with higher odds for weight loss maintenance. Our findings suggest that even modest shifts toward a healthier living may contribute to favorable weight loss outcomes.

Objective and Subjective Appetite Assessment in Patients with Gynecological Cancer: A Pre- and Post-Operative Pilot Study.

Although appetite and its disorders have been implicated in disease progression and outcomes, ghrelin concentrations, an objective appetite measure, are rarely assessed in patients with gynecological malignancies. The present study aimed to assess changes in post-operative versus pre-operative appetite levels in patients with gynecological cancers scheduled for tumor removal surgery (N = 53). Acylated ghrelin concentrations were assessed as an objective appetite proxy, whereas the Council of Nutrition appetite questionnaire (CNAQ) was employed as a subjective appetite measure. Ghrelin concentrations were increased post-operatively (median: 12.1 pg/mL, IQR: 0.67 to 23.5, p-value = 0.001) but the perceived appetite of patients (CNAQ) remained unchanged (median: -1, IQR: -3 to 1). Tumor removal surgery decreased all anthropometric indices (body weight, body mass index, waist and hips circumferences, triceps skinfolds, body fat, fat mass and fat mass index, p-value ≤ 0.001 for all) and doubled the risk of malnutrition among patients. No difference was recorded in the change in participants' objective and subjective appetite when they were classified according to the tumor type. No correlation was observed between ghrelin concentrations and CNAQ score pre-operatively (Spearman's rho correlation coefficient = -0.181, p-value = 0.298) or post-operatively (Spearman's rho correlation coefficient = 0.071, p-value = 0.684). The observed post-operative rise in ghrelin concentrations is associated with body weight loss and consists of a possible defense mechanism of the human body, aiming to prolong survival.

Intentional weight loss and mortality in middle-aged and older adults: A narrative review.

The literature on the association between intentional weight loss and mortality rates has yielded controversial results, especially when it comes to older groups. The aim of the present narrative review was the critical evaluation of studies exploring the association between intentional weight loss and mortality in middle-aged and older adults (i.e., those aged 50 years or more). The majority of the longitudinal studies identified concluded that losing weight intentionally is not associated with mortality in middle-aged and older adults. However, when it comes to younger adults at the recruitment point, the studies have yielded more mixed results. In any case, more well-designed longitudinal studies and randomized clinical trials are needed in the area, with long follow-up periods and taking into account the underlying disease states.

The effectiveness of technology-based interventions for weight loss maintenance: A systematic review of randomized controlled trials with meta-analysis.

OBJECTIVE: To systematically review and meta-analyze randomized controlled trials on the effects of technology-based interventions for maintenance of lost weight. METHODS: A systematic literature search was performed to identify randomized controlled trials with at least one intervention arm delivered through the internet or mobile application, published in English until September 2021. Weight change at the end of the weight loss maintenance phase was considered the primary outcome. RESULTS: Twelve manuscripts with 2941 adults were included in the review; 10 studies were meta-analyzed. Included interventions had a duration of 3-30 months and were tested compared with minimum interventions (no contact with the study staff or intervention with only a limited number of features) or in-person groups. Technology-based interventions resulted in similar weight regain when compared with minimum interventions (ES = -0.07 kg; 95% CI = [-0.57, 0.42]; p = 0.770). However, when compared with in-person interventions, technology-based interventions were found to lead in significantly higher weight regain (ES = 1.36 kg; 95% CI = [0.29, 2.43]; p = 0.010). CONCLUSION: Web- and app-based interventions for weight loss maintenance produced similar results with minimum interventions and resulted in greater weight regain compared with in-person interventions. Appropriate interventions for weight loss maintenance provide benefits against weight regain, only when provided in-person.

Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis.

BACKGROUND: Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. OBJECTIVE: The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. METHODS: A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. RESULTS: In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference -0.61, 95% CI -1.10 to -0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference -0.36, 95% CI -0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. CONCLUSIONS: The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations.

Examining the associations between a posteriori dietary patterns and obesity indexes: Systematic review of observational studies.

BACKGROUND: Few reports on the association of population-derived dietary patterns with excess body weight, using the approach of a systematic review currently exist. AIM: The aim of the present systematic review was to identify dietary patterns associated with body mass index (BMI), body weight (BW)/BMI change, weight status and weight loss maintenance status. METHODS: Using MEDLINE (via PubMed) and EBSCO Host databases, we systematically reviewed studies from 1980 to 2020, which included men and women, aged ≥18 years. Primary outcome was BMI or the longitudinal change of individuals' BW or BMI, or weight status (normal weight/overweight/obesity) or weight loss maintenance status. We included observational studies, with or without a prospective design. Studies which met the inclusion criteria were evaluated based on the Newcastle-Ottawa Scale; only a posteriori dietary patterns were evaluated. RESULTS: Twenty-six studies were eligible for inclusion in the current analysis. The results indicate a relationship between adherence to a lacto-vegetarian dietary pattern, characterized by high intake of fruits, vegetables, whole grains, unprocessed cereals, dairy and low intake of high-fat foods and sweets, and longitudinal change of individuals' BW or BMI, or the risk of overweight/obesity. CONCLUSIONS: Promotion of this healthy dietary pattern, as an alternative to focusing on specific nutrients or foods, may be a promising approach to be included in future long-term weight maintenance interventions.

Standards of Nutritional Care for Patients with Cystic Fibrosis: A Methodological Primer and AGREE II Analysis of Guidelines.

Although many Clinical Practice Guidelines (CPGs) have been published for the care of patients with Cystic Fibrosis (CF), including a variety of nutrition recommendations, the quality of these CPGs has never been evaluated. The aim of this study was to compare, review, and critically appraise CPGs for the nutritional management of CF, throughout the lifespan. We searched PubMed, Guidelines International Network (GIN), ECRI Institute, and Guidelines Central for CPGs, with information on the nutritional management of CF. Retrieved CPGs were appraised by three independent reviewers, using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument and checklist. A total of 22 CPGs (seven solely nutrition oriented), by 14 different publishers, were retrieved. The Thoracic Society of Australia and New Zealand CPGs scored the highest overall quality (94.4%), while the Paediatric Gastroenterology Society/Dietitians Association of Australia CPGs had the lowest score (27.8%). Great variation in AGREE II domain-specific scores was observed in all CPGs, suggesting the existence of different strengths and weaknesses. Despite the availability of several CPGs, many appear outdated, lacking rigor, transparency, applicability, and efficiency, while incorporating bias. Considering that CPGs adherence is associated with better outcomes and the need for improving life expectancy in patients with CF, the development of CPGs of better quality is deemed necessary.

Motives for weight loss and weight loss maintenance: results from the MedWeight study.

BACKGROUND: The relationship of weight loss motives with long-term outcomes is equivocal. We aimed to examine differences in weight loss motives of maintainers and regainers, as well as explore associations between motives and successful maintenance. METHODS: The study sample includes 607 adults, with a history of overweight/obesity and self-reported ≥10% voluntary weight loss, 12 months before study entry. Participants were classified as maintainers (weighing ≤90% maximum weight) or regainers. Volunteers identified possible motives for weight loss and maintenance (maintainers only), from a specific list. RESULTS: Both maintainers and regainers were predominantly motivated by physical appearance (38.6% versus 39.9%, P > 0.05) and self-esteem (26.8% versus 32.0%, P > 0.05) for weight loss. Compared to regainers, more maintainers reported weight reduction driven by social purposes (16.6% versus 9.4%, P = 0.022) and less were prompted by friends/family to lose weight (21.1% versus 31.7%, P = 0.005). In maintainers, shifts in motives from weight loss to maintenance phase were found, including an increased prevalence of health motives (6.4% versus 9.6%, P < 0.001) and decreased physical appearance motives (38.6% versus 30.3%, P < 0.001). Reporting physical appearance as main maintenance motive was inversely associated with maintained weight loss, after adjusting for age, sex and years of education (B = -3.49 [1.07], P = 0.001); maintainers reporting physical appearance as the main motive maintained 3.5% less weight loss compared to those who did not (P = 0.001). CONCLUSIONS: The present study has highlighted motivational influences associated with weight loss outcomes. Future studies should explore the ability of people with overweight/obesity to act upon motives for long-term weight management, as well as the impact of shifting through motives on the magnitude of maintenance.

The validity of technology-based dietary assessment methods in childhood and adolescence: a systematic review.

Technology-based dietary assessment has promising benefits on improving accuracy and reducing cost of dietary data collection. The validity of technology-based tools in children/adolescents was examined. A systematic literature search was performed to identify studies published till September 2019. In total, 26 studies with 29 validation-related estimations were selected; 13 web-based 24-hdietary recalls (image assisted; n = 12, drop-down food list; n = 13), 4 mobile applications and 3 web-based dietary records (image based; n = 2 and image assisted; n = 1, drop-down food list; n = 3) and 6 web-based food frequency questionnaires (FFQs) (image assisted; n = 3). Fourteen studies were addressed to adolescents, ten studies to children (principally 9-11 years old) and two studies to mixed study samples. Validation was mostly performed through 24-h dietary recalls and dietary records while in some cases objective methods were used. Image-assisted 24-h dietary recalls presented good level of agreement with paper-based methods, yet principally in adolescents. Mobile-application dietary records with image-based facilities and drop-down food lists were found to accurately record dietary intake even when compared with objective methods. FFQs, mainly examined in adolescents, had good level of agreement with the "gold standard" dietary records method. The validity of technology-based methods could be supported yet various technical/methodological issues need better clarification.

Feeding the preterm infant: an overview of the evidence.

Feeding from own mother's milk is not always an option for preterm infants, and choosing between alternative means of feeding should be made in light of their effect on infants' health. In this work, we aimed to present evidence regarding feeding pre-term infants with human milk, either own mother's or donor milk (DM), and the potential effects on growth and other health related outcomes. Exclusive breastfeeding (BF) remains the optimal option, whereas feeding with DM as a sole diet or supplemental to maternal milk confers immunological advantages and fewer rates of necrotising enterocolitis against preterm formula feeding, yet the latter results in greater growth velocity. Literature gaps in the use of DM, practical suggestions for choosing suitable feeding means (i.e. continuous support of BF, adequate education regarding feeding preterm infants, including DM), and future perspectives on the potential effects of dietary manipulations of the maternal diet, are also discussed.

Triage for Malnutrition Risk among Pediatric and Adolescent Outpatients with Cystic Fibrosis, Using a Disease-Specific Tool.

Malnutrition prevails in considerable proportions of children with Cystic Fibrosis (CF), and is often associated with adverse outcomes. For this, routine screening for malnutrition is pivotal. In the present cross-sectional study, we aimed to assess the risk for malnutrition in pediatric outpatients with CF. A total of 76 outpatients (44 girls, 11.9 ± 3.9 years old, 39.5% adolescents) were recruited and anthropometric, clinical, dietary and respiratory measures were collected. All outpatients were screened for malnutrition risk with a validated disease-specific instrument. Most children exhibited a low risk for malnutrition (78.9%), whereas none of the participants were characterized as having a high malnutrition risk. In the total sample, malnutrition risk was positively associated with age (r = 0.369, p = 0.001), and inversely related to the body mass index (r = -0.684, p < 0.001), height z-score (r = -0.264, p = 0.021), and forced expiratory volume (FEV1%, r = -0.616, p < 0.001). Those classified as having a low malnutrition risk were younger (p = 0.004), heavier (p < 0.001) and taller (p = 0.009) than their counterparts with a moderate risk. On the other hand, patients in the moderate risk group were more likely pubertal (p = 0.034), with a reduced mid-upper arm fat area (p = 0.011), and worse pulmonary function (p < 0.001). Interestingly, none of the children attaining ideal body weight were classified as having a moderate malnutrition. risk, whereas 37.5% of the patients allocated at the moderate risk group exhibited physiological lung function. In this cohort of outpatients with CF that were predominantly well-nourished and attained physiological lung function, malnutrition risk was identified only in small proportions of the sample. Our data support that patients that are older, pubertal, or have diminished fat mass are at greater risk for malnutrition.

Adherence to Dietary Recommendations, Nutrient Intake Adequacy and Diet Quality among Pediatric Cystic Fibrosis Patients: Results from the GreeCF Study.

Nutrition is an important component of cystic fibrosis (CF) therapy, with a high-fat diet being the cornerstone of treatment. However, adherence to the dietary recommendations for CF appears suboptimal and burdensome for most children and adolescents with CF, leading to malnutrition, inadequate growth, compromised lung function and increased risk for respiratory infections. A cross-sectional approach was deployed to examine the degree of adherence to the nutrition recommendations and diet quality among children with CF. A total of 76 children were recruited from Aghia Sophia's Children Hospital, in Athens, Greece. In their majority, participants attained their ideal body weight, met the recommendations for energy and fat intake, exceeding the goal for saturated fatty acids consumption. Carbohydrate and fiber intake were suboptimal and most participants exhibited low or mediocre adherence to the Mediterranean diet prototype. It appears that despite the optimal adherence to the energy and fat recommendations, there is still room for improvement concerning diet quality and fiber intake.

Exploring the relationship between the Mediterranean diet and weight loss maintenance: the MedWeight study.

Weight loss maintenance is crucial for obesity management, yet optimal dietary patterns for this period are not established. We aimed to explore the relationship between adherence to the Mediterranean diet and weight loss maintenance. Sample includes 565 adults (62 % women) of the MedWeight study. Eligible volunteers were those reporting intentional weight loss of ≥10 %, starting from a BMI ≥ 25 kg/m2, over 12 months prior to enrolment. Based on current weight, participants were characterised as maintainers (≤90 % maximum weight) or regainers (>95 % maximum weight). Socio-demographics and weight history were recorded. Dietary intake was assessed by two non-consecutive 24-h recalls within 10 d and analysed in energy, macronutrient and food group intakes. Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Score (MedDietScore) (range 0-55, greater scores showing higher adherence). Protein intake was higher in maintainers than in regainers (P < 0·001). When MedDietScore quartiles were considered, a linear trend for weight loss maintenance was revealed (P < 0·05). After adjustment for basic demographic characteristics, being in the third or fourth quartile of the MedDietScore (v. first) was associated with 2·30 (95 % CI 1·29, 4·09) and 1·88 (95 % CI 1·10, 3·22) increased odds of maintenance. Regarding individual MedDietScore components, only fruit intake is associated with increased odds for maintenance (1·03 (95 % CI 1·01, 1·06)). The leave-one-out approach revealed that at least six MedDietScore components were essential for the observed relationship. Higher adherence to the Mediterranean diet was associated with 2-fold increased likelihood of weight loss maintenance. Future studies should replicate these findings in non-Mediterranean populations as well.

Comparison of International Growth Standards for Assessing Nutritional Status in Cystic Fibrosis: The GreeCF Study.

OBJECTIVE: The aim of the study was to compare 3 international growth references and explore their differences in assessing growth in Greek school-aged patients with cystic fibrosis (CF). METHODS: Sample included 114 patients (50 boys, age 11.5 ±â€Š3.9 years), provided care at Aghia Sofia Children's Hospital, Greece. Anthropometrics and predicted forced expiratory volume in 1 second (FEV1%) were measured. Body mass index (BMI) and height z scores were computed according to the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and International Obesity Task Force (IOTF) references. Agreement between methods was analyzed with kappa statistics, repeated-measures analysis of variance, and Bland-Altman analysis. The relationship between FEV1% and BMI was explored with linear regression. RESULTS: Mean CDC BMI z score was the lowest (0.06 ±â€Š1.08), followed by WHO (0.17 ±â€Š1.14) and IOTF (0.35 ±â€Š1.05) (P ≤ 0.001 for all). The CDC and WHO growth references highly agreed for most weight status strata and stunting; all other comparisons produced lower agreements. Except for CDC and IOTF BMI z scores, all other comparisons produced wide levels of agreement and proportional bias. CDC reference classified more children as attaining low or normal weight, against WHO or IOTF (P ≤ 0.001 for all). Lowest prevalence of ideal and excess weight was recorded by CDC, compared to all other standards (P ≤ 0.001 for all). All BMI z scores provided moderate associations with FEV1%. CONCLUSION: Large variations across weight status classification were present when employing 3 growth standards in school-aged patients . Given than BMI z-scores from all references provided comparable associations with pulmonary function, our data indicate that no studied reference is better than others in assessing growth in CF.

Sex-Specific Physical Activity Patterns Differentiate Weight Loss Maintainers From Regainers: The MedWeight Study.

BACKGROUND: Although plenty of evidence indicates that weight loss maintainers are highly physically active, studies focusing on the sex-specific differences in activity levels between maintainers and regainers are scarce. The authors aimed to investigate sex-specific differences in activity patterns in a cohort of Mediterranean maintainers and regainers. METHODS: Sample includes 756 participants of the MedWeight registry (60.5% women), aged 18-65 years, who lost ≥10% of their initial weight, and either maintained their loss for ≥12 months or regained it. Participants completed a series of questionnaires, including demographics and weight history. Activity levels were evaluated with the International Physical Activity Questionnaire-short version. RESULTS: Maintainers of both sexes were, in total, more active than their same-sex regainers. When specific activities were considered, women maintainers spent more time walking than regainers (Padjusted = .02), whereas men maintainers spent more time in vigorous activities (Padjusted = .001) and walking than regainers (Padjusted = .001). Modest increments in activity of sex-relevant intensity were associated with increased odds for maintenance. CONCLUSIONS: Maintainers attained a more active lifestyle than their same-sex regainers, involving more walking for both sexes and more vigorous activities for men. The detected differences, according to activity intensity, support that activity patterns associated with successful weight loss are distinguishable between sexes.