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BACKGROUND: In view of the high burden of childhood overweight/obesity (OW/OB), it is important to identify targets for interventions that may have the greatest effects on preventing OW/OB in early life. Using methods of causal inference, we studied the effects of sustained behavioral interventions on the long-term risk of developing OW/OB based on a large European cohort. METHODS: Our sample comprised 10 877 children aged 2 to < 10 years at baseline who participated in the well-phenotyped IDEFICS/I.Family cohort. Children were followed from 2007/08 to 2020/21. Applying the parametric g-formula, the 13-year risk of developing OW/OB was estimated under various sustained hypothetical interventions on physical activity, screen time, dietary intake and sleep duration. Interventions imposing adherence to recommendations (e.g. maximum 2 h/day screen time) as well as interventions 'shifting' the behavior by a specified amount (e.g. decreasing screen time by 30 min/day) were compared to 'no intervention' (i.e. maintaining the usual or so-called natural behavior). Separately, the effectiveness of these interventions in vulnerable groups was assessed. RESULTS: The 13-year risk of developing OW/OB was 30.7% under no intervention and 25.4% when multiple interventions were imposed jointly. Meeting screen time and moderate-to-vigorous physical activity (MVPA) recommendations were found to be most effective, reducing the incidence of OW/OB by -2.2 [-4.4;-0.7] and -2.1 [-3.7;-0.8] percentage points (risk difference [95% confidence interval]), respectively. Meeting sleep recommendations (-0.6 [-1.1;-0.3]) had a similar effect as increasing sleep duration by 30 min/day (-0.6 [-0.9;-0.3]). The most effective intervention in children of parents with low/medium educational level was being member in a sports club; for children of mothers with OW/OB, meeting screen time recommendations and membership in a sports club had the largest effects. CONCLUSIONS: While the effects of single behavioral interventions sustained over 13 years were rather small, a joint intervention on multiple behaviors resulted in a relative reduction of the 13-year OW/OB risk by between 10 to 26%. Individually, meeting MVPA and screen time recommendations were most effective. Nevertheless, even under the joint intervention the absolute OW/OB risk remained at a high level of 25.4% suggesting that further strategies to better prevent OW/OB are required.
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Sobrepeso , Obesidad Infantil , Niño , Adolescente , Humanos , Sobrepeso/epidemiología , Sobrepeso/prevención & control , Obesidad Infantil/epidemiología , Obesidad Infantil/prevención & control , Incidencia , Terapia Conductista , EscolaridadRESUMEN
BACKGROUND AND AIMS: This study aims to examine the associations of food portion size (PS) with markers of insulin resistance (IR) and clustered of metabolic risk score in European adolescents. METHODS: A total of 495 adolescents (53.5% females) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study were included. The association between PS from food groups and homeostasis model assessment of insulin resistance (HOMA-IR) index, VO2 max, and metabolic risk score was assessed by multilinear regression analysis adjusting for several confounders. Analysis of covariance (ANCOVA) was used to determine the mean differences of food PS from food groups by HOMA-IR cutoff categories by using maternal education as a covariable. RESULTS: Larger PS from vegetables in both gender and milk, yoghurt, and milk beverages in males were associated with higher VO2 max, while larger PS from margarines and vegetable oils were associated with lower VO2 max (p < 0.05). Males who consumed larger PS from fish and fish products; meat substitutes, nuts, and pulses; cakes, pies, and biscuits; and sugar, honey, jams, and chocolate have a higher metabolic risk score (p < 0.05). Males with lower HOMA-IR cutoff values consumed larger PS from vegetables, milk, yoghurt, and milk beverages (p < 0.05). Females with lower HOMA-IR cutoff values consumed larger PS from breakfast cereals, while those with higher HOMA-IR cutoff values consumed larger PS from butter and animal fats (p = 0.018). CONCLUSION: The results show that larger PS from dairy products, cereals, and high energy dense foods are a significant determinant of IR and VO2 max, and larger PS from food with higher content of sugar were associated with higher metabolic risk score.
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Resistencia a la Insulina , Síndrome Metabólico , Productos Lácteos , Femenino , Humanos , Masculino , Tamaño de la Porción , AzúcaresRESUMEN
Research in bone health during childhood is limited and important to prevent future diseases, particularly, osteoporosis. Bone parameters using DXA and pQCT in 295 Spanish children were evaluated and we found a benefit of meeting the World Health Organization physical activity recommendations in bone composition in childhood. PURPOSE: To investigate the association between physical activity (PA) and bone health in a Spanish paediatric cohort, considering the influence of meeting/not meeting the current World Health Organization (WHO) PA recommendations and to elucidate if there are differences between boys and girls. METHODS: In a cohort of children born in the region of Aragon (Spain) in 2009, followed until the age of 7 years, bone parameters were assessed using dual-energy X-ray absorptiometry (DXA) (whole body scan) and peripheral quantitative computed tomography (pQCT) (tibia scanned at the 8% (distal) and 38% (diaphyseal) of the total tibia length) in 295 7-year-old children (154 boys) in the last evaluation performed between 2016 and 2017. PA was assessed using GT3X Actigraph accelerometers. RESULTS: Boys had significantly higher areal bone mineral density (aBMD), higher total bone mineral content (BMC) at the diaphyseal site and higher trabecular BMC and vBMD, and higher total bone area at the distal site than girls (p<0.01 for all of them). Both boys and girls complying with the WHO PA recommendations had significantly higher trabecular BMC than their inactive counterparts. CONCLUSIONS: Meeting WHO PA recommendations has a beneficial effect in bone composition in childhood both in boys and in girls.
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Densidad Ósea , Huesos , Absorciometría de Fotón/métodos , Niño , Ejercicio Físico , Femenino , Humanos , Masculino , TibiaRESUMEN
BACKGROUND: Obesity in children is one of the most severe public health challenges of the current century and Type 2 Diabetes Mellitus (T2DM) frequency is also escalating. More so, the importance of process evaluation (PE) in complex interventions is increasingly recognized. The present review, aims to identify the effectiveness in terms of body composition parameters in a generation of articles to prevent obesity and T2DM in children. We hypothesise that those studies reporting PE applying the latest implementation guidelines suggested by the researchers would potentially show positive changes in body composition compared to those not reporting it. Additionally, we will evaluate the implementation degree of PE in those articles considering it and describe the PE subcomponents. Lastly, we aim to assess the intervention target used and its results. METHODS: A literature review was performed in parallel by 2 independent reviewers. A final number of 41 studies were selected for inclusion criteria. RESULTS: Meta-analysis of BMI and zBMI found non-significant effects of the proposed interventions. Sub-group analysis revealed only a significant effect in studies which performed PE. Moreover, PE was reported in 42% effective studies and 57% non-effective studies. Fidelity and satisfaction were the most implemented PE subcomponents, although there was a generally low grade of PE use (7/41). The highest proportion of effectiveness (83%) was shown in interventions of physical activity alone while the intervention most used was 3-arm target (diet, PA and BS). CONCLUSIONS: Overall, obesity and T2DM prevention studies included in this review are not effective in terms of BMI and zBMI. Those studies performing PE reported to be effective in terms of BMI, while studies not reporting PE did not have positive results in terms of BMI and zBMI. In addition, none of the intervention studies included all PE indicators and most studies, which included PE in their interventions, did not provide full report of the PE components, according to the guidelines used for the present review. PROSPERO registration number: CRD42018093667.
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Diabetes Mellitus Tipo 2 , Obesidad Infantil , Niño , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/prevención & control , Dieta , Ejercicio Físico , Humanos , Obesidad Infantil/prevención & controlRESUMEN
In this large perspective cohort among European children and adolescents, we observed that daytime napping was positively associated with bone stiffness, while short or long sleep duration combined with poor sleep quality was associated with less bone stiffness. Our findings are important for obtaining optimal bone stiffness in childhood. INTRODUCTION: To examine the cross-sectional and longitudinal associations between sleep duration, sleep quality, and bone stiffness index (SI) in European children and adolescents. METHODS: Four thousand eight hundred seventy-one children aged 2-11 years from the IDEFICS study and 861 children aged 6-15 years from the subsequent I.Family study were included. Sleep duration (i.e., nocturnal sleep and daytime napping) and sleep quality (i.e., irregularly bedtime routine, have difficulty falling asleep and trouble getting up in the morning) were reported by self-administrated questionnaires. Nocturnal sleep duration was converted into age-specific z-scores, and total sleep duration was classified into short, adequate, and long based on the National Sleep Recommendation. Calcaneal SI of both feet were measured using quantitative ultrasound. Linear mixed-effects models with country as a random effect were used, with adjustments for sex, age, pubertal status, family socioeconomic status, physical activity, screen time, body mass index, and daylight duration. RESULTS: Nocturnal sleep duration z-scores were positively associated with SI percentiles among participants with adequate sleep duration at baseline. Moreover, the positive association between daytime napping and SI percentiles was more pronounced in participants with adequate sleep duration at baseline, while at 4-year follow-up was more pronounced in participants with short sleep duration. In addition, extreme sleep duration at baseline predicted lower SI percentiles after 4 years in participants with poor sleep quality. CONCLUSION: The positive associations between nocturnal sleep, daytime napping and SI depended on total sleep duration. Long-term detrimental effect of extreme sleep duration on SI only existed in individuals with poor sleep quality.
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Ejercicio Físico , Sueño , Adolescente , Índice de Masa Corporal , Niño , Preescolar , Estudios de Cohortes , Estudios Transversales , HumanosRESUMEN
OBJECTIVE: To report dietary free sugars consumption and their different types and food sources in European children. METHODS: The present study is based on the IDEFICS study, a European multicenter cohort study in children (2-9 years old) from eight countries, comprising 8308 children (51.4% males). Dietary intake of the previous 24 h was assessed using a computer-assisted 24-h dietary recalls (24-HDR) and the different types of sugars were assessed using the German food composition database. RESULTS: Mean total energy intake was 1720 (SD 477) kcal/d for boys and 1631 (SD 451) kcal/d for girls. Total sugars intake was 98 (SD 52) g/day for boys and 93 (SD 49) g/day for girls. Free sugars intake was 81 (SD 49) g/day for boys and 77 (SD 47) g/day for girls. Girls had significantly lower intakes of energy, total and free sugars compared with than boys but did not differ in terms of percent of energy from total (23%) or free sugars (18%). There were large variations between countries in average % energy from free sugars (ranging from 13% in Italy to 27% in Germany). Less than 20% of children were within the recommended intake of 10% of energy from free sugars. The food groups that contributed substantially to free sugars intakes were "Fruit juices", "Soft drinks", "Dairy" and "Sweets and candies". CONCLUSIONS: The contribution of free sugars to total energy intake in European children is higher than recommendations. The main food contributors to free sugars intake are sweetened beverages ("Fruit juices" and "Soft drinks"). It is especially important to reduce children's intake of free sugars, focusing in target population on certain foods and food groups.
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Encuestas sobre Dietas/métodos , Encuestas sobre Dietas/estadística & datos numéricos , Dieta/métodos , Dieta/estadística & datos numéricos , Azúcares de la Dieta/administración & dosificación , Dulces/estadística & datos numéricos , Niño , Preescolar , Estudios de Cohortes , Productos Lácteos/estadística & datos numéricos , Ingestión de Energía , Europa (Continente) , Femenino , Jugos de Frutas y Vegetales/estadística & datos numéricos , Humanos , Masculino , Ingesta Diaria Recomendada , Factores SexualesRESUMEN
BACKGROUND AND AIMS: Studies in children and adolescents suggest that higher dairy consumption may exert a protective effect on adiposity. However, only few studies examined the association between dietary calcium intake and body mass measures with conflicting results. We evaluated the association between total dietary calcium, calcium from dairy and non-dairy sources and anthropometric indices in a large European cohort of children and adolescents. METHODS AND RESULTS: As many as 6,696 children belonging to the IDEFICS study were eligible for the cross-sectional analysis (Boys = 51%; age 6.0 ± 1.8 years; mean ± SD). Of these, 2,744 were re-examined six years later (Boys = 49.6%; age = 11.7 ± 1.8 years) in the framework of the I.Family study. The exposures were the baseline energy-adjusted total, dairy and non-dairy calcium intakes measured by a validated 24-h dietary recall. Multivariable linear regression was used to determine the association between calcium intake and z-scores of anthropometric indices (body mass index, BMI; waist circumference, WC; sum of skinfolds, SS; fat mass index, FMI) at baseline, and their variation over the 6 years follow-up. The association of dietary calcium with the incidence of overweight/obesity was also assessed. At baseline, an inverse association between total calcium intake and all the adiposity indices was consistently observed in boys, while only SS and FMI were significant in girls. The prevalence of overweight/obesity decreased significantly (P < 0.0001) across tertiles of calcium intake, in both sexes. Over the follow-up, boys with higher baseline calcium intake value showed significantly lower increase in BMI, WC and FMI z-scores, while in girls only a lower increase in WC z-score was observed. Only in boys, the risk to become overweight/obese decreased significantly across tertiles of calcium intake. Similar results were observed by analyzing only dietary calcium from dairy, while no association was observed between non-dairy calcium and adiposity indices. CONCLUSIONS: We showed in a large cohort of European children and adolescents that dietary calcium intake may play a role in the modulation of body fat in developmental age. The association between dietary calcium and adiposity indices was driven by dairy calcium, while no effect was observed for non-dairy calcium intake. The existence of a sex-related difference in the association deserves further investigations.
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Adiposidad , Calcio de la Dieta/administración & dosificación , Productos Lácteos , Obesidad Infantil/prevención & control , Ingesta Diaria Recomendada , Adolescente , Factores de Edad , Niño , Preescolar , Estudios Transversales , Europa (Continente)/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Obesidad Infantil/diagnóstico , Obesidad Infantil/epidemiología , Obesidad Infantil/fisiopatología , Prevalencia , Factores Protectores , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Factores de TiempoRESUMEN
BACKGROUND: We compared differences in physical activity (PA) between pre/mid-pubertal and post-pubertal participants according to gender. METHODS: The study included a total of 1842 healthy participants aged 12.5-17.4 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Participants wore a uniaxial accelerometer (ActiGraph© GT1M, Pensacola, FL, USA) attached to their lower back for seven consecutive days to measure PA. Pubertal status was assessed by physical examination and the population was classified as pre/mid-pubertal (Tanner stages 1-3) or post-pubertal (Tanner stages 4-5). PA was compared between these groups according to gender during the whole week, on school-free days and on school days, before and after school, and during lessons and recesses. RESULTS: When comparing the pre/mid-pubertal group with the post-pubertal group, girls' total PA did not differ between groups. However, a slight difference was observed in boys, among whom PA on school-free days showed a difference of 17.6% between the pre/mid-pubertal group and the post-pubertal group (679 kcounts vs 564 kcounts, respectively; P = 0.0007) and 20% (162 kcount vs 135 kcounts; P = 0.006) for school recess. There was no difference among girls. CONCLUSIONS: A reduced level of PA in the post-pubertal groups was only observed in boys during non-organized times such as on school-free days and during school recesses, with a moderate impact on total PA.
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Conducta del Adolescente/psicología , Ejercicio Físico/psicología , Pubertad/psicología , Acelerometría/estadística & datos numéricos , Adolescente , Factores de Edad , Niño , Europa (Continente) , Femenino , Humanos , Masculino , Factores SexualesRESUMEN
Most researchers adjust bone by lean mass when comparing swimmers with controls. This adjustment is done under the assumption that lean affects bone similarly in both groups. Nonetheless, we found that the muscle-bone association is uncoupled in swimmers, and consequently, researchers should avoid this adjustment when evaluating swimmers' bone. INTRODUCTION: To examine the functional and structural muscle-bone unit in adolescent swimmers. METHODS: Sixty-five swimmers (34 girls/31 boys) and 119 controls (51 girls/68 boys) participated in the study. Muscle cross-sectional area (MCSA), bone mineral content (BMC), and polar strength-strain index (SSIPOL) were measured in the non-dominant radius by peripheral quantitative computed tomography (pQCT). Subtotal BMC and lean mass were evaluated with dual-energy X-ray absorptiometry (DXA). Handgrip and isometric knee extension (IKE) tests were performed to determine muscle force. The effect of MCSA, lean and force on SSIPOL, and BMC were tested, and the functional and structural muscle-bone ratios of swimmers and controls were compared. RESULTS: Both muscle size (MCSA and lean) and muscle force (handgrip and IKE) influenced BMC and SSIPOL in swimmers and controls similarly. Swimmers presented normal MCSA and lean values for their height, but when compared with controls, swimmers presented a higher amount of lean and MCSA for the same BMC or SSIPOL (structural muscle-bone unit). For the functional muscle-bone unit, different results were found for the lower and upper limbs, as no differences were found for the upper limbs, while for the lower limbs, swimmers presented higher muscle force for the same amount of BMC. CONCLUSIONS: The contradictory results regarding BMC in swimmers found in previous studies could partly be explained with the findings of the present study that reinforce the idea that swimming is not an effective sport to practice regarding bone mass and that the muscle-bone unit is different in swimmers than in controls.
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Densidad Ósea/fisiología , Músculo Esquelético/fisiología , Natación/fisiología , Absorciometría de Fotón/métodos , Adolescente , Algoritmos , Antropometría/métodos , Niño , Femenino , Fuerza de la Mano/fisiología , Humanos , Masculino , Fuerza Muscular/fisiología , Músculo Esquelético/anatomía & histología , Pubertad/fisiología , Caracteres SexualesRESUMEN
PURPOSE: To assess drinking occasions (volume and type) according to consumption with food in or outside meals, and location, for six countries. METHODS: A total of 10,521 participants aged 4-65 years from Argentina, Brazil, China, Indonesia, Mexico and Uruguay completed a validated 7-day fluid intake record. For each drinking event, the volume consumed, the fluid type, the location of intake, and whether the drink was accompanied by food (meal or snack) or not, was recorded. RESULTS: Similar drinking behaviors were found in Mexico and Argentina; fluid intake during meals was 48 and 45% of total fluid intake (TFI), respectively. In Brazil (55%), Indonesia (58%) and China (66%) most fluid was consumed without food. In Uruguay, 34% of TFI was with a main meal, 31% with food between meals and 35% without food. Indonesia had the highest median (25-75th percentile) TFI; 2520 (1750-3347) mL/day, and China the lowest 1138 (818-3347) mL/day. Water was consumed with meals for 37% of Chinese and 87% of Indonesian participants, while the four Latin-American American countries showed a preference for sweet drinks; 54% in Mexico, 67% in Brazil, 55% in Argentina and 59% in Uruguay. Diversity in fluid type was noted when drinking with food between meals. Apart from China, most drinking occasions (> 75%) occurred at home. CONCLUSIONS: Three distinct drinking behaviors were identified, namely, drinking with meals, drinking as a stand-alone activity, and a type of 'grazing' (i.e., frequent drinks throughout the day) behavior. Most drinking occasions occurred at home.
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Bebidas/estadística & datos numéricos , Conducta de Ingestión de Líquido , Ingestión de Líquidos , Adolescente , Adulto , Anciano , Argentina , Brasil , Niño , Preescolar , China , Estudios Transversales , Ingestión de Energía , Femenino , Humanos , Indonesia , Masculino , México , Persona de Mediana Edad , Uruguay , Adulto JovenRESUMEN
PURPOSE: To report daily total fluid intake (TFI) and fluid types in Indonesia according to age, sex, socio-economic status (SES) and geographic region, and compare TFI with the Indonesian adequate fluid intake (AI) recommendations. METHODS: Data were collected in 32 cities over nine regions from children (4-9 years, n = 388), adolescents, (10-17 years, n = 478) and adults (18-65 years, n = 2778) using a fluid intake 7-day record (Liq.In7); socio-economic status was also recorded. The 7-day mean TFIs were compared with the AI of water set by the Ministry of Health of the Republic of Indonesia. RESULTS: Total median fluid intakes for all age groups exceeded 2000 mL/day. At population level, TFI was associated with household income (P < 0.001), education (P < 0.001) and Indonesian geographical regions (P < 0.001). More than 67% of participants met the AI of water from fluids. A higher percentage of children and adolescents met the AI (78 and 80%, respectively), compared with adults (72%). Drinking water was the main contributor to TFI in all age groups (76-81%). Sugar-sweetened beverages (SSB) were consumed by 62% children, 72% adolescents and 61% of adults. An SSB intake ≥ 1 serving per day was observed for 24% children, 41% adolescents and 33% adults. CONCLUSIONS: A high percentage of the population drank enough to meet the AI of water from fluids. Water was the most frequently consumed drink; however, many participants consumed at least one serving of SSB per day. This study provides data to help direct targeted intervention programs.
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Bebidas/estadística & datos numéricos , Deshidratación/epidemiología , Ingestión de Líquidos , Encuestas Nutricionales , Adolescente , Adulto , Niño , Estudios Transversales , Deshidratación/prevención & control , Femenino , Humanos , Indonesia , Masculino , Persona de Mediana Edad , Embarazo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
PURPOSE: To describe total fluid intake (TFI) and types of fluid consumed in urban China by age, gender, regions and city socioeconomic status relative to the adequate intakes (AI) set by the Chinese Nutrition Society. METHODS: In 2016, participants aged 4-9, 10-17 and 18-55 years were recruited via a door-to-door approach in 27 cities in China. In total, 2233 participants were included. The volumes and sources of TFI were collected using the Liq.In 7 record, assisted by a photographic booklet of standard fluid containers. RESULTS: The mean daily TFI among children, adolescents and adults were 966, 1177 and 1387 mL, respectively. In each age group, TFI was significantly higher in male vs female (981 vs 949, 1240 vs 1113, 1442 vs 1332; mL). Approximately 45, 36 and 28% of children, adolescents and adults reached the AI. Although plain water was the highest contributor to TFI, the contribution of sugar sweetened beverages (SSB) was ranked in the top three together with water and milk and derivatives. Approximately 27, 48 and 47% of children, adolescents and adults consumed more than one serving of SSB per day, respectively. CONCLUSIONS: A relatively large proportion of participants did not drink enough to meet the AI in urban China. Many children, adolescents and adults consumed more than one serving of SSB per day. A majority of children, adolescents and adults in the study population do not meet both quantitative and qualitative fluid intake requirements, and signal socioeconomic disparities.
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Bebidas , Ingestión de Líquidos , Encuestas Nutricionales , Adolescente , Adulto , Animales , Niño , Preescolar , China , Estudios Transversales , Femenino , Humanos , Lactancia , Masculino , Persona de Mediana Edad , Necesidades Nutricionales , Embarazo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
PURPOSE: To report total fluid intake (TFI) and the intake of different fluid types in adults (≥ 18 years old) from Mexico, Argentina, Brazil and Uruguay. To compare intakes between countries and with recommended adequate intake (AI) of water from fluids. METHODS: Cross-sectional data were collected using a validated liquid intake 7-day record (Liq.In 7 ) in populations from Argentina (n = 1089), Brazil (n = 477), Mexico (n = 1677) and Uruguay (n = 554). Population characteristics, including age, gender, body mass index and socioeconomic level were recorded. Mean TFI was compared with the AI of water from fluids set by the USA Institute of Medicine. RESULTS: The lowest TFI was recorded in Mexican women (1748 mL/day) and the highest in Argentinean men (2318 mL/day). Median daily TFI was significantly different between countries; Uruguay and Argentina had higher values than Mexico and Brazil. In the former, plain water contributed to only 25% of TFI, the remainder being predominantly from hot beverages. Approximately, a third of adults did not drink enough fluid to meet the recommended AI. High SSB consumption was reported, which was significantly different between countries (p < 0.05), the highest being in Mexico (median 25-75th percentiles): 531 (300-895 mL/day. CONCLUSIONS: This survey highlights the need to increase water consumption and reduce SSB intake in this region to avoid potential associated health risks. These findings may be useful information in monitoring public health policy strategies.
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Bebidas/estadística & datos numéricos , Ingestión de Líquidos , Encuestas Nutricionales , Adolescente , Adulto , Argentina , Brasil , Comparación Transcultural , Estudios Transversales , Deshidratación , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Uruguay , Adulto JovenRESUMEN
PURPOSE: The primary aim of this survey was to report total fluid intake (TFI) and different fluid types for children (4-9 years) and adolescents (10-17 years) in Mexico, Brazil, Argentina and Uruguay. The second aim was to compare TFI with the adequate intake (AI) of water from fluids as recommended by the USA Institute of Medicine. METHODS: Data were collected using a validated liquid intake 7-day record (Liq.In 7 ). Participants' characteristics, including age, sex and anthropometric measurements were recorded. RESULTS: A total of 733 children and 933 adolescents were recruited. Over 75% of children in Uruguay met the IOM's recommended intake. Fewer children in Argentina (64-72%) and Brazil (41-50%) obtained AI and the lowest values were recorded in Mexico (33-44%), where 16% of boys and 14% girls drank 50% or less of the AI. More adolescents in Argentina (42%) met the AIs than other countries; the lowest was in Mexico (28%). Children and adolescents in Mexico and Argentina drank more sugar sweetened beverages than water. CONCLUSIONS: Large numbers of children and adolescents did not meet AI recommendations for TFI, raising concerns about their hydration status and potential effects on mental and physical well-being. Given the negative effects on children's health, the levels of SSB consumption are worrying.
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Bebidas/estadística & datos numéricos , Ingestión de Líquidos , Encuestas Nutricionales , Adolescente , Argentina , Brasil , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , México , UruguayRESUMEN
PURPOSE: This study aimed to identify and characterize patterns of fluid intake in children and adolescents from six countries: Argentina, Brazil, China, Indonesia, Mexico and Uruguay. METHODS: Data on fluid intake volume and type amongst children (4-9 years; N = 1400) and adolescents (10-17 years; N = 1781) were collected using the validated 7-day fluid-specific record (Liq.In7 record). To identify relatively distinct clusters of subjects based on eight fluid types (water, milk and its derivatives, hot beverages, sugar-sweetened beverages (SSB), 100% fruit juices, artificial/non-nutritive sweetened beverages, alcoholic beverages, other beverages), a cluster analysis (partitioning around k-medoids algorithm) was used. Clusters were then characterized according to their socio-demographics and lifestyle indicators. RESULTS: The six interpretable clusters identified were: low drinkers-SSB (n 523), low drinkers-water and milk (n 615), medium mixed drinkers (n 914), high drinkers-SSB (n 513), high drinkers-water (n 352) and very high drinkers-water (n 264). Country of residence was the dominant characteristic, followed by socioeconomic level, in all six patterns. CONCLUSIONS: This analysis showed that consumption of water and SSB were the primary drivers of the clusters. In addition to country, socio-demographic and lifestyle factors played a role in determining the characteristics of each cluster. This information highlights the need to target interventions in particular populations aimed at changing fluid intake behavior and improving health in children and adolescents.
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Bebidas/estadística & datos numéricos , Ingestión de Líquidos , Adolescente , Animales , Argentina , Asia , Brasil , Niño , Preescolar , China , Estudios Transversales , Ingestión de Energía , Femenino , Humanos , Indonesia , Masculino , México , Encuestas y Cuestionarios , UruguayRESUMEN
We aimed to provide evidence for an a priori hypothesis and sample size for subjectively assessing physical activity intensity and duration in paediatric population, adopting objective methods as the reference. We searched electronic databases, reference lists and author databases. Correlation coefficients were pooled as an indicator of agreement estimates. We found 183 agreement analyses (94.5% based on correlation coefficients) from 89 studies that met our inclusion criteria. We identified four physical activity parameters addressing intensity and two parameters addressing duration. The physical activity parameters focusing on intensity were measured only by questionnaires, and the best correlation was achieved by moderate-to-vigorous physical activity compared with a heart rate monitor. In addition, total physical activity duration had a stronger correlation with an accelerometer when measured by diaries or logs than when measured by questionnaires. In both cases, the correlation was moderate. Studies with sample sizes between 50 and 99 subjects showed measurements that were stable in both magnitude and interpretation. Our findings suggest that the agreement between subjective and objective methods for assessing physical activity intensity and duration is weak to moderate. Furthermore, sample sizes ranging from 50 to 99 subjects provide stable agreement estimates between methods.
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Ejercicio Físico , Proyectos de Investigación , Niño , Objetivos , Humanos , Reproducibilidad de los Resultados , Tamaño de la Muestra , Encuestas y CuestionariosRESUMEN
BACKGROUND AND AIMS: The early onset of cardio-metabolic abnormalities, known as metabolically unhealthy (MU) status, is highly associated with obesity and cardiovascular disease (CVD), as well as with increased morbidity and mortality later in life. Given the lack of a consensus MU classification for prepubertal children, we aimed to compare available MU definitions in terms of their association with CVD risk biomarkers. METHODS AND RESULTS: A total of 930 prepubertal children (622 with overweight/obesity, 462 males) aged 5-10.9 years were recruited, anthropometric measures were taken and biomarkers were analyzed. Children were classified using eight MU definitions based on different cut-offs for blood pressure, triacylglycerides, high-density lipoprotein cholesterol, glucose and homeostasis model assessment for insulin resistance (HOMA-IR). MU prevalence in children with overweight/obesity ranged between 30% and 60% across definitions. Plasma concentrations of resistin, leptin, myeloperoxidase (MPO) and total plasminogen activator inhibitor 1 (tPAI-1) were higher, and those of adiponectin were lower, in MU compared to MH children with overweight/obesity. Linear regression analyses confirmed the contribution of MPO and tPAI-1 concentrations to MU status, with most significant results derived from definitions that use age and sex-specific criteria and that account for HOMA-IR. CONCLUSION: Plasma concentrations of MPO and tPAI-1 are increased in prepubertal MU children irrespective of having normal-weight or overweight/obesity. Inclusion of age and sex-specific cut-offs for cardio-metabolic components as well as insulin resistance criteria increases the quality of MU definitions as seen by their stronger association with CVD biomarkers concentrations.
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Enfermedades Cardiovasculares/sangre , Estado de Salud , Síndrome Metabólico/sangre , Obesidad Infantil/sangre , Peroxidasa/sangre , Inhibidor 1 de Activador Plasminogénico/sangre , Terminología como Asunto , Factores de Edad , Biomarcadores/sangre , Enfermedades Cardiovasculares/clasificación , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Niño , Preescolar , Femenino , Humanos , Resistencia a la Insulina , Masculino , Síndrome Metabólico/clasificación , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/epidemiología , Obesidad Infantil/clasificación , Obesidad Infantil/diagnóstico , Obesidad Infantil/epidemiología , Valor Predictivo de las Pruebas , Prevalencia , Factores de Riesgo , Factores Sexuales , España/epidemiologíaRESUMEN
Dietary scores, rather than individual nutrients, allow exploring associations between overall diet and bone health. The aim of the present study was to assess the associations between the Mediterranean Diet Score for Adolescents (MDS-A) and the Diet Quality Index for Adolescents (DQI-A) and bone mineral content (BMC) among Spanish adolescents. Our results do not support an association between dietary scores or indices and BMC in adolescents. INTRODUCTION: To assess the associations between the MDS-A and a DQI-A with the BMC measured with dual-energy X-ray absorptiometry. METHODS: The MDS-A and the DQI-A were calculated in 179 Spanish adolescents, based on two 24-h dietary recalls from the HELENA cross-sectional study. The associations between the diet scores and the BMC outcomes [total body less head (TBLH), femoral neck (FN), lumbar spine (LS), and hip] were analyzed using logistic regression models adjusting for several confounders. RESULTS: Four hundred ninety-two models were included and only fruits and nuts and cereal and roots were found to provide significant ORs with regard to BMC. The risk of having low BMC reduced by 32% (OR 0.684; CI 0.473-0.988) for FN when following the ideal MDS-A, but this association lost significance when adjusting for lean mass and physical activity. For every 1-point increase in the cereal and root and the fruit and nut components, the risk of having low FN diminished by 56% (OR 0.442; CI 0.216-0.901) and by 67% (OR 0.332; CI 0.146-0.755), respectively. CONCLUSION: An overall dietary score or index is not associated with BMC in our adolescent Spanish sample.
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Fenómenos Fisiológicos Nutricionales de los Adolescentes/fisiología , Densidad Ósea/fisiología , Dieta Mediterránea/estadística & datos numéricos , Absorciometría de Fotón , Adolescente , Niño , Estudios Transversales , Ejercicio Físico/fisiología , Conducta Alimentaria , Femenino , Humanos , Masculino , Estado Nutricional , Factores Socioeconómicos , EspañaRESUMEN
OBJECTIVE: To report dietary sugars consumption and their different types and food sources, in European adolescents. METHODS: Food consumption data of selected groups were obtained from 1630 adolescents (45.6% males, 12.5-17.5 years) from the HELENA study using two nonconsecutive 24-h recalls. Energy intake, total sugars and free sugars were assessed using the HELENA-DIAT software. Multiple regression analyses were performed adjusting for relevant confounders. RESULTS: Total sugars intake (137.5 g/day) represented 23.6% and free sugars (110.1 g/day), 19% of energy intake. Girls had significantly lower intakes of energy, carbohydrates, total sugars and free sugars. 94% of adolescents had a consumption of free sugars above 10% of total energy intake. The main food contributor to free sugars was 'carbonated, soft and isotonic drinks,' followed by 'non-chocolate confectionary' and 'sugar, honey, jam and syrup.' Older boys and girls had significantly higher intakes of free sugars from 'cakes, pies and biscuits.' Free sugars intake was negatively associated with low socioeconomic status for 'non-chocolate confectionary' and 'sugar, honey and jam' groups; with low maternal educational level for carbonated and 'soft drinks,' 'sugar, honey and jam,' 'cakes and pies' and 'breakfast cereals' groups; and with high paternal educational level for 'carbonated and soft drinks' and 'chocolates' group. CONCLUSIONS: The majority (94%) of studied adolescents consumed free sugars above 10% of daily energy intake. Our data indicate a broad variety in foods providing free sugars. Continued efforts are required at different levels to reduce the intake of free sugars, especially in families with a low educational level.