Physical fitness reference standards for preschool children: The PREFIT project.

OBJECTIVES: Reference values are necessary for classifying children, for health screening, and for early prevention as many non-communicable diseases aggravate during growth and development. While physical fitness reference standards are available in children aged 6 and older, such information is lacking in preschool children. Therefore, the purposes of this study were (1) to provide sex-and age-specific physical fitness reference standards for Spanish preschool children; and (2) to study sex differences across this age period and to characterise fitness performance throughout the preschool period. DESIGN: Cross-sectional. METHODS: A total of 3179 preschool children (1678 boys) aged 2.8-6.4 years old from Spain were included in the present study. Physical fitness was measured using the PREFIT battery. RESULTS: Age- and sex-specific percentiles for the physical fitness components are provided. Boys performed better than girls in the cardiorespiratory fitness, muscular strength, and speed-agility tests over the whole preschool period studied and for the different percentiles. In contrast, girls performed slightly better than boys in the balance test. Older children had better performance in all fitness tests than their younger counterparts. CONCLUSIONS: Our study provides age- and sex-specific physical fitness reference standards in preschool children allowing interpretation of fitness assessment. Sexual dimorphism in fitness tests exists already at preschool age, and these differences become larger with age. These findings will help health, sport, and school professionals to identify preschool children with a high/very low fitness level, to examine changes in fitness over time, and to analyse those changes obtained due to intervention effects.

Movement behaviors and cardiometabolic risk in schoolchildren.

Growing evidence has accumulated in recent years showing that movement behaviors have important implications for health in children, especially for cardiovascular health, whose risk factors could track from childhood to adulthood. However, these findings are mixed and inconsistent in children. The aim of this study was to examine the relationship between different movement behaviors (sedentary behavior, physical activity and sleep duration) and cardiometabolic risk in schoolchildren. The study shows cross-sectional results of baseline measurement from 146 Spanish schoolchildren, aged 8-to-11 years old, participating in the MOVI-2 study. Movement behaviors were determined using accelerometry combined with self-reported sleep time. Cardiometabolic risk was assessed using a validated metabolic syndrome index. Logistic regression analysis showed that higher levels of vigorous physical activity (OR = 0.110, p = 0.004) and sleeping more than 9 hours (OR = 0.269, p = 0.015) could be protective factors against metabolic syndrome risk in children. ANCOVA analysis showed associations between vigorous physical activity and waist circumference (p < 0.001), and sleep time with insulin resistance (p = 0.017) and lipid profile (p = 0.035). No association was observed between light and moderate physical activity, sedentary behavior and metabolic syndrome (index and components). No statistically significant differences were found for blood pressure and any of the movement behaviors. Our data suggest that both the amount of vigorous physical activity accumulated and sleep duration are independently associated with higher cardiometabolic risk in children.

ASSOCIATIONS BETWEEN ENERGY AND FAT INTAKES WITH ADIPOSITY IN SCHOOLCHILDREN - THE CUENCA STUDY.

INTRODUCTION: the relationship between changes in energy intake (EI) over the last few decades and the trends towards of excess weight in children is still debated. OBJECTIVE: to examine the relationship between energy and macronutrient intakes with adipostity in children, controlling for cardiorespiratory fitness (CRF) as a surrogate measure of physical activity. METHOD: we conducted a cross-sectional study of 320 schoolchildren aged 9-11 years (54.5% girls). We collected data on socio-demographic variables, and measured weight, height, waist circumference (WC), and fat mass percentage by bioimpedance analysis. Fat mass index (FMI) was calculated as fat mass (kg) divided by height (m) squared, to adjust for body size. Energy (kcal) and macronutrient intake (percentages) were measured by two non-consecutive 24-h recalls (weekday and weekend day), using the Young Adolescents' Nutrition Assessment on Computer (YANA-C) software program; CRF was measured by the 20-m shuttle run test. RESULTS: boys in the 4th quartile of the WC distribution had lower fat intake (34.9%) than boys in the 1st (42.4%; p = 0.019) and 2nd quartiles (41.6%; p = 0.022). Children in the 1st quartile of the FMI distribution had higher daily EIs than children in the 4th quartile (1762.3 kcal vs. 1496.8 kcal; p = 0.023). All macronutrient intakes relative to weight were lower in children in the more adipose categories for weight status, WC and FMI (p < 0.001). CONCLUSION: adiposity was inversely related to energy and fat intakes. Excessive EI and high EI from fats not appears to be directly associated with the current obesity epidemic among schoolchildren living in Cuenca (Spain).

Introducción: la relación entre los cambios en la ingesta energética en las últimas décadas y el incremento en las cifras de obesidad en niños está aún en debate. Objetivo: examinar la asociación entre la ingesta energética y de macronutrientes con diferentes medidas de adiposidad en niños, controlando por resistencia cardiorrespiratoria como una medida sustituta de la actividad física. Método: se realizó un estudio observacional sobre 320 escolares de entre 9 y 11 años (54,5% niñas). Se tomó información sobre variables sociodemográficas y se midió peso, altura, perímetro de cintura y porcentaje de masa grasa a través de bioimpedancia. El índice de masa grasa fue calculado dividiendo la masa grasa (en kg) entre la altura al cuadrado (en m), para ajustar por el tamaño corporal. La ingesta energética y el porcentaje de macronutrientes fueron medidos con dos recordatorios de 24-h en días no consecutivos (entre semana y fin de semana), empleando el software Young Adolescents' Nutrition Assessment on Computer (YANA-C); el fitness cardiorrespiratorio fue medido a través del test de 20 metros de ida y vuelta. Resultados: los niños en el cuarto cuartil de perímetro de cintura tienen una ingesta de grasas menor (34,9%) que los chicos en el primer (42,4%; p = 0,019) y segundo cuartil (41,6%; p = 0,022). Los escolares en el primer cuartil de índice de masa grasa tienen mayor ingesta energética total que los escolares del cuarto cuartil (1762,3 kcal vs. 1496,8 kcal; p = 0,023). Las ingestas de macronutrientes relativas al peso son menores en los sujetos de las categorías más altas de estatus ponderal, perímetro de cintura e índice de masa corporal (p < 0,001). Conclusión: la adiposidad está inversamente asociada con las ingestas energética y de grasas. Una excesiva ingesta energética y de grasas no parece estar directamente asociada con la actual epidemia de obesidad de los escolares de Cuenca (España).

Levels and Patterns of Objectively Assessed Physical Activity and Compliance with Different Public Health Guidelines in University Students.

BACKGROUND: Physical activity (PA) is associated with health enhancement. The aim of this study was to assess: 1) levels and patterns of PA in university students by using accelerometers; and 2) the percentage of fulfilment of PA recommendations for adults, according to different public health guidelines. METHODS: Observational cross-sectional study (Cuenca's Adults Study) involving 296 (206 women) healthy Spanish university students aged 18-25 years old. Participants wore the ActiGraph GT1M accelerometer for seven consecutive days. Total PA, steps and time spent in sedentary time, light, moderate, vigorous, and moderate to vigorous PA (MVPA) was assessed, and the prevalence of sufficient PA was calculated according to various public health guidelines. RESULTS: No sex differences in total PA were found. University students were more sedentary during weekend days than weekdays (p<0.05). Only 30.3% of participants accumulated 30 min/day at least five days a week of MVPA. A total of 5.4% of students met the recommendation of 150 min/week of MVPA or 75 min/week of vigorous PA, in PA bouts of at least 10 min. using the same definition, but on five or more days a week, only 0.5% students were found to meet the recommendation. In addition, only 0.5% of students met the recommendation of 30 min/day of MVPA, at least five days a week and in bouts of at least 10 min. Finally, 28.1% of the students met the recommendation of 10,000 steps/day. CONCLUSIONS: Our study shows a high incidence of sedentary time in university students. The number of students meeting PA recommendations significantly differed depending on the recommendation proposed. Specific strategies to promote PA in this population are necessary as well as an agreement as to which PA guidelines should be used.

Associations between energy and fat intakes with adiposity in schoolchildren - the Cuenca Study / Asociación entre la ingesta energética y de grasas y la adiposidad en escolares - Estudio Cuenca

Introduction: the relationship between changes in energy intake (EI) over the last few decades and the trends towards of excess weight in children is still debated. Objective: to examine the relationship between energy and macronutrient intakes with adipostity in children, controlling for cardiorespiratory fitness (CRF) as a surrogate measure of physical activity. Method: we conducted a cross-sectional study of 320 schoolchildren aged 9-11 years (54.5% girls). We collected data on socio-demographic variables, and measured weight, height, waist circumference (WC), and fat mass percentage by bioimpedance analysis. Fat mass index (FMI) was calculated as fat mass (kg) divided by height (m) squared, to adjust for body size. Energy (kcal) and macronutrient intake (percentages) were measured by two non-consecutive 24-h recalls (weekday and weekend day), using the Young Adolescents’ Nutrition Assessment on Computer (YANA-C) software program; CRF was measured by the 20-m shuttle run test. Results: boys in the 4th quartile of the WC distribution had lower fat intake (34.9%) than boys in the 1st (42.4%; p = 0.019) and 2nd quartiles (41.6%; p = 0.022). Children in the 1st quartile of the FMI distribution had higher daily EIs than children in the 4th quartile (1762.3 kcal vs. 1496.8 kcal; p = 0.023). All macronutrient intakes relative to weight were lower in children in the more adipose categories for weight status, WC and FMI (p <0.001). Conclusion: adiposity was inversely related to energy and fat intakes. Excessive EI and high EI from fats not appears to be directly associated with the current obesity epidemic among schoolchildren living in Cuenca (Spain) (AU)

Introducción: la relación entre los cambios en la ingesta energética en las últimas décadas y el incremento en las cifras de obesidad en niños está aún en debate. Objetivo: examinar la asociación entre la ingesta energética y de macronutrientes con diferentes medidas de adiposidad en niños, controlando por resistencia cardiorrespiratoria como una medida sustituta de la actividad física. Método: se realizó un estudio observacional sobre 320 escolares de entre 9 y 11 años (54,5% niñas). Se tomó información sobre variables sociodemográficas y se midió peso, altura, perímetro de cintura y porcentaje de masa grasa a través de bioimpedancia. El índice de masa grasa fue calculado dividiendo la masa grasa (en kg) entre la altura al cuadrado (en m), para ajustar por el tamaño corporal. La ingesta energética y el porcentaje de macronutrientes fueron medidos con dos recordatorios de 24-h en días no consecutivos (entre semana y fin de semana), empleando el software Young Adolescents’ Nutrition Assessment on Computer (YANA-C); el fitness cardiorrespiratorio fue medido a través del test de 20 metros de ida y vuelta. Resultados: los niños en el cuarto cuartil de perímetro de cintura tienen una ingesta de grasas menor (34,9%) que los chicos en el primer (42,4%; p = 0,019) y segundo cuartil (41,6%; p = 0,022). Los escolares en el primer cuartil de índice de masa grasa tienen mayor ingesta energética total que los escolares del cuarto cuartil (1762,3 kcal vs. 1496,8 kcal; p = 0,023). Las ingestas de macronutrientes relativas al peso son menores en los sujetos de las categorías más altas de estatus ponderal, perímetro de cintura e índice de masa corporal (p <0.001). Conclusión: la adiposidad está inversamente asociada con las ingestas energética y de grasas. Una excesiva ingesta energética y de grasas no parece estar directamente asociada con la actual epidemia de obesidad de los escolares de Cuenca (España) (AU)

BMI as a mediator of the relationship between muscular fitness and cardiometabolic risk in children: a mediation analysis.

OBJECTIVE: Muscular fitness levels have been associated with cardiometabolic risk in children, although whether body weight acts as a confounder or as an intermediate variable in this relationship remains controversial. The aim of this study was to examine whether the association between muscular fitness and cardiometabolic risk factors is mediated by body mass index (BMI). DESIGN AND METHODS: Cross-sectional study using a sample of 1158 schoolchildren aged 8-11 years from the province of Cuenca, Spain. We measured anthropometrics and biochemical variables and we calculated a muscular fitness index as the sum of z-scores of handgrip dynamometry/weight and standing long jump, and we estimated a previously validated cardiometabolic risk index (CMRI). Linear regression models were fitted for mediation analysis to assess whether the association between muscular fitness and cardiometabolic risk was mediated by BMI. RESULTS: Children with normal weight (NW) had a better cardiometabolic risk profile than their overweight (OW) or obese (OB) peers after controlling for muscular fitness. Marginal estimated mean ± SE values for NW, OW and OB categories of CMRI were -0.75 ± 0.06 < 0.84 ± 0.10 < 2.18 ± 0.16 in boys and -0.73 ± 0.06 < 0.96 ± 0.10 < 2.71 ± 0.17 in girls, both p < 0.001. Children with higher levels of muscular fitness had a better cardiometabolic risk profile (CMRI marginal estimated mean ± SE 1.04 ± 0.13 > 0.05 ± 0.09 >-1.16 ± 0.13 for lower, middle and upper quartiles of muscular fitness in boys and 1.01 ± 0.16 > 0.10 ± 0.09 > -1.02 ± 0.15 in girls, both p < 0.001), but differences disappeared when controlling for BMI. BMI acted as a full mediator between muscular fitness and most cardiometabolic risk factors (Sobel test z = -11.44 for boys; z = -11.83 for girls; p < 0.001 in CMRI mediation model) and as a partial mediator in the case of waist circumference (Sobel test z=-14.86 for boys; z=-14.51 for girls; p<0.001). CONCLUSIONS: BMI mediates the association between muscular fitness and cardiometabolic risk in schoolchildren. Overall, good muscular fitness is associated with lower cardiometabolic risk, but particularly when accompanied by normal weight.

The relationship between beverage intake and weight status in children: the Cuenca study / Relación entre la ingesta de bebidas y el estatus ponderal en niños: estudio Cuenca

Introduction: Beverage consumption is becoming more important in current research regarding its possible association with the childhood obesity epidemic. The influence of physical activity on fluid intake has been poorly studied, and cardiorespiratory fitness (CRF) may be a reliable marker for this type of assessment. The present study analysed beverage intake related to weight, adjusted by CRF, in children aged 9 to 11 years. Methods: A cross-sectional, school-based study was conducted on 373 children, aged 9 to 11 years, from the Cuenca province in Spain. To obtain beverage consumption we averaged two 24-h recalls, collected using the YANA-C assessment tool, validated for HELENA study. CRF was assessed by the 20-m shuttle run test. Results: Fluid intake was 1483.39 mL/day, and energy ascribed to fluids was 16% of total energy intake. Beverages were 40% of total sugar intake from diet. The largest amount of fluid consumed among thinness boys came from fruit juices and milk drinks. Thinner girls consumed more diet drinks and whole milk than their normal and overweight counterparts, after adjusting for age and CRF. Conclusions: Overweight-obese boys consumed less fruit juices and milk drinks and girls ingested less diet drinks and whole milk than their normal-weight counterparts. These results suggest the importance of investigating the hydration habits of children to draw reliable conclusions about the best way to hydrate in different situations to avoid adiposity increases (AU)

Introducción: El consumo de bebidas está cobrando mayor importancia en las investigaciones actuales en relación a una posible asociación con la epidemia de obesidad infantil. La influencia de la actividad física en este consumo de fluidos ha sido escasamente estudiada y la resistencia cardiorespiratoria (RCR) puede resultar un marcador fiable para su valoración. Nuestro estudio analiza la ingesta de fluidos y su relación con el estatus ponderal ajustado por RCR en niños de 9-11 años. Métodos: Estudio transversal en el que participaron 373 niños de 9-11 años de colegios de la provincia de Cuenca (España). Para obtener la ingesta de bebidas, se realizó la media de dos recordatorios de 24 horas obtenidos mediante el programa YANA-C, validado para el estudio HELENA. La condición física cardiorrespiratoria fue evaluada a través del test de 20 metros ida y vuelta. Resultados: La ingesta media de líquidos fue de 1483,39 ml/día, y la energía proveniente de fluidos supone un 16% del aporte energético diario. Las bebidas suponen el 40% del aporte de azúcares ingeridos en la dieta. Las bebidas más consumidas en niños son los zumos naturales y las bebidas lácteas. Las niñas delgadas consumen más leches enteras y bebidas refrescantes "light" que sus homólogas con peso normal y sobrepeso-obesidad. Conclusiones: Los niños con exceso de peso consumen menos zumos naturales y bebidas lácteas, y las niñas consumen menos leches enteras y bebidas refrescantes "light" que sus compañeras en normopeso. Es de gran importancia revisar los hábitos de hidratación de los escolares para establecer conclusiones fiables sobre cuál es la mejor forma de hidratarse en diferentes situaciones para evitar ganancias ponderales (AU)

Successful intervention models for obesity prevention: the role of healthy life styles.

Children obesity is considered a serious public health problem around the world. In Spain, the prevalence of overweight/obesity is reaching alarming figures, exceeding 35% of the children. Several hypotheses suggest that the energy balance model does not fit very well when analyzing the causes of the current obesity epidemic and, although genetics seems to explain up to 30% of the likelihood to become obese in infancy, has been suggested that genetics might be influenced by environment factors including vigorous physical activity (PA). Some recent systematic reviews indicate that there is enough evidence about the effectiveness of interventions to prevent obesity in children 6-12 years old; however, the heterogeneity of the effect, and the potential selection, information and publication biases that undermine the validity of these studies, thus their results should be interpreted with caution. In Spain, an extracurricular PA program of leisuretime (MOVI) has evidenced some effectiveness on reducing the adiposity and on improving the lipid profile in schoolchildren. To overcome some weakness of MOVI program, a second edition of this study was designed. The objectives of this review are twofold: 1) to analyze latest data of the obesity epidemic in Spain; and 2) to describe the main features of MOVI-2 program, and overall of the successful interventions to prevent children obesity.

La obesidad infantil continúa siendo un serio problema de salud pública en todo el mundo. Las cifras ac - tuales en España son alarmantes, y se sitúan en torno al 35,4%. Hay varias hipótesis que apuntan a que el modelo de balance energético como causa de la obesidad infantil no se sostiene. Y aunque las razones genéticas parecen ex - plicar hasta el 30% de la probabilidad de llegar a ser obe - so, se ha sugerido que esta herencia podría ser in fluen - ciable por factores ambientales entre los que se encuentra la actividad física (AF) vigorosa. Aunque las últimas revisiones señalan que existe evidencia suficiente sobre la efectividad de las intervenciones para prevenir la obesidad en niños de 6-12 años, la heterogeneidad del efecto encontrado en los resultados y la posibilidad de sesgos de diseño y de publicación de los estudios hacen que los re sul tados deban interpretarse con cautela. En España la intervención MOVI, un programa extraescolar de AF de carácter recreativo, ha conseguido disminuir la adiposidad, y me - jo rar el perfil lipídico. Para superar potenciales limitaciones de la primera intervención, se diseñó una segunda edición. Los objetivos de esta revisión fueron: 1) analizar los últimos datos de la epidemia de la obesidad infantil en España; y 2) describir las principales características del programa MOVI-2, y en general de las intervenciones que han sido efectivas para prevenir la obesidad en niños.

Successful intervention models for obesity prevention: The role of healthy life styles / Modelos exitosos de intervención para la prevención de la obesidad: el papel de los estilos de vida saludables

Children obesity is considered a serious public health problem around the world. In Spain, the prevalence of overweight/obesity is reaching alarming figures, exceeding35% of the children. Several hypotheses suggest that the energy balance model does not fit very well when analyzing the causes of the current obesity epidemic and, although genetics seems to explain up to 30% of the likelihood to become obese in infancy, has been suggested that genetics might be influenced by environment factors including vigorous physical activity (PA). Some recent systematic reviews indicate that there is enough evidence about the effectiveness of interventions to prevent obesity in children 6-12 years old; however, the heterogeneity of the effect, and the potential selection, information and publication biases that undermine the validity of these studies, thus their results should be interpreted with caution. In Spain, an extracurricular PA program of leisure time(MOVI) has evidenced some effectiveness on reducing the adiposity and on improving the lipid profile in schoolchildren. To overcome some weakness of MOVI program, a second edition of this study was designed. The objectives of this review are twofold: 1) to analyze latest data of the obesity epidemic in Spain; and 2) to describe the main features of MOVI-2 program, and overall of the successful interventions to prevent children obesity (AU)

La obesidad infantil continúa siendo un serio problema de salud pública en todo el mundo. Las cifras actuales en España son alarmantes, y se sitúan en torno al35,4%. Hay varias hipótesis que apuntan a que el modelo de balance energético como causa de la obesidad infantil no se sostiene. Y aunque las razones genéticas parecen explicar hasta el 30% de la probabilidad de llegar a ser obeso, se ha sugerido que esta herencia podría ser in fluenciable por factores ambientales entre los que se encuentra la actividad física (AF) vigorosa. Aunque las últimas revisiones señalan que existe evidencia suficiente sobre la efectividad de las intervenciones para prevenir la obesidad en niños de 6-12 años, la heterogeneidad del efecto encontrado en los resultados y la posibilidad de sesgos de diseño y de publicación de los estudios hacen que los resultados deban interpretarse con cautela. En España la intervención MOVI, un programa extraescolar de AF de carácter recreativo, ha conseguido disminuir la adiposidad, y mejorar el perfil lipídico. Para superar potenciales limitaciones de la primera intervención, se diseñó una segunda edición. Los objetivos de esta revisión fueron: 1) analizar los últimos datos de la epidemia de la obesidad infantil en España; y 2) describir las principales características del programa MOVI-2, y en general de las intervenciones que han sido efectivas para prevenir la obesidad en niños (AU)