Relationship between perceived physical literacy and obesity-related outcomes in adolescents: the EHDLA study.

Purpose: The aim of the present study was to examine the relationship between perceived physical literacy and obesity-related outcomes among adolescents from Spain. Methods: This is a secondary cross-sectional analysis including a total sample of 845 Spanish adolescents (55.3% girls) aged 12-17 years from the Valle de Ricote (Region of Murcia) from the Eating Healthy and Daily Life Activities (EHDLA) project. Physical literacy was evaluated using the Spanish Perceived Physical Literacy Instrument for adolescents (S-PPLI). Body mass index was computed by taking the participants' body weight in kilograms and dividing it by the square of their height in meters, and body mass index (z score) and overweight/obesity and obesity were computed by the World Health Organization age- and sex-specific thresholds. Waist circumference was measured using a constant tension tape. Moreover, the waist-to-height ratio was calculated, and therefore, abdominal obesity was determined. Skinfold measurements were taken at the triceps and medial calf using calibrated steel calipers. Results: In general, the overall trend was downward (i.e., the higher the PPLI score the lower the obesity-related indicators), with the approximate significance of smooth terms being statistically significant for all models examined (p < 0.001). Adolescents with lower perceived physical literacy (PPL) showed the highest estimated marginal means of body mass index, body mass index z score, waist circumference, waist-to-height ratio, and skinfold (triceps and calf) and predictive probabilities of having excess weight, obesity, and abdominal obesity, while their counterparts with high PPL had the lowest. In addition, significant differences were observed for all the obesity-related indications between adolescents with low PPL and those with medium PPL (p-adjusted < 0.05 for all indicators), as well as with those with high PPL (p-adjusted < 0.05 for all indicators). Moreover, these significant differences were also shown for most indicators between adolescents with medium PPL and those with high PPL (except for obesity). Conclusion: Physical literacy could play a crucial role in maintaining more desirable obesity-related outcomes in adolescents. Adolescents with high perceived physical literacy showed lower obesity-related indicators (i.e., body mass index, body mass index z score, waist circumference, waist-to-height ratio, skinfolds), as well as a lower probability of having excess weight, obesity, and abdominal obesity.

Physical activity as a mediator of the association of body mass index change with anxiety/depression symptoms in Brazilian adults during COVID-19 / La actividad física como mediadora de la asociación de la alteración del índice de masa corporal con síntomas de ansiedad/depresión en adultos brasileños durante la COVID-19

Background: the COVID-19 pandemic has impacted people’s behaviors and mental health around the world. Aim: to verify the mediating role of physical activity (PA) level in the relationship between body mass index (BMI) and anxiety and depression symptoms in adults during the COVID-19 pandemic. Methods: this is a cross-sectional study with Brazilian adults aged ≥ 18 years (N = 2000, 59.6 % women) selected by the nonprobabilistic snowball method through digital means of communication (WhatsApp®, Telegram®, Facebook®, Twitter®, e-mails). Linear regression models were fitted for PA level mediation analyses in the relationship between BMI and anxiety/depression symptoms. Results: significant differences were found between the active/not overweight group and the other three groups (active/overweight, insufficiently active/not overweight and insufficiently active/overweight [p < 0.001]) for anxiety/depression after adjusting for age, sex, chronic diseases, alcohol consumption, and smoking. When testing the mediating role of daily PA in the association between BMI and anxiety/depression symptoms, BMI was negatively associated with daily PA in the first regression equation (p < 0.001); in the second, BMI was positively related to anxiety/depression symptoms (p < 0.001); and in the third, daily PA showed an inverse relationship with anxiety/depression symptoms (p < 0.001), and although BMI remained negatively associated with anxiety/depression symptoms, these associations maintained their statistical significance. Conclusions: the results suggest that the effect of BMI on anxiety and depression was partially mediated by daily PA.(AU)

Introducción: la pandemia de covid-19 ha afectado el comportamiento y la salud mental de las personas en todo el mundo. Objetivo: verificar la mediación del nivel de actividad física (af) en la relación entre el índice de masa corporal (imc) y los síntomas de ansiedad y depresión en adultos durante la pandemia covid-19. Métodos: estudio transversal, con adultos brasileños con edad ≥ 18 años (n = 2.000, 59,6 % mujeres), seleccionados por el método no probabilístico de bola de nieve, a través de medios de comunicación digitales (whatsapp®, telegram®, facebook®, twitter®, correos electrónicos).se ajustaron modelos de regresión lineal para los análisis de la mediación del nivel de actividad física en la relación entre el imc y los síntomas de ansiedad/depresión. Resultados: se encontraron diferencias significativas entre el grupo activo/sin exceso de peso y los otros tres grupos (activo/con exceso de peso, insuficientemente activo/sin exceso de peso e insuficientemente activo/con exceso de peso [p < 0,001]) para ansiedad/depresión después de ajustar por edad, sexo, enfermedades, consumo de alcohol y tabaquismo. al probar el papel mediador de la af diaria en la asociación entre el imc y los síntomas de ansiedad/depresión, en la primera ecuación de regresión, el imc se asoció negativamente con la af diaria (p < 0,001); en la segunda, el imc se relacionó positivamente con los síntomas de ansiedad/depresión (p < 0,001); y en la tercera, la af diaria mostró una relación inversa con los síntomas de ansiedad/depresión (p < 0,001), y aunque el imc mantuvo una asociación negativa con dichos síntomas, estas asociaciones conservaron su significación estadística. Conclusiones: los resultados sugieren que el efecto del imc sobre la ansiedad y la depresión estuvo parcialmente mediado por la actividad física diaria.

Exploring the link between perceived physical literacy and academic performance outcomes: insights from the EHDLA study.

Objective: The aim of this study was to verify the relationship between perceived physical literacy (PPL) and academic performance outcomes among Spanish adolescents aged 12-17 years. Methods: This cross-sectional study is a secondary examination utilizing data derived from the Eating Healthy and Daily Life Activities (EHDLA) project. The Spanish Perceived Physical Literacy Instrument for Adolescents (S-PPLI) was used to evaluate the PPL of the participants. To determine academic performance, the numerical grades for each subject were added together and then divided by the total number of subjects. Results: Overall, a positive trend in the association between S-PPLI scores and academic performance was observed. We identified two significant ranges within the S-PPLI scores. First, there was a significant range between 9 and 33 points on the S-PPLI, indicating an inverse association with academic performance. Second, another significant range was observed at scores of 34 points or higher on the S-PPLI, suggesting a positive association with academic performance. Participants with low PPL had the lowest academic performance (mean = 6.4; bias-corrected and accelerated (BCa) bootstrapped 95% confidence interval (CI): 6.2-6.6). Conversely, those adolescents with high PPL had the highest academic performance (mean = 6.9; BCa bootstrapped 95% CI: 6.6-7.1). Significant differences were found between low PPL and medium PPL (p-adjusted = 0.031) and between low PPL and high PPL (p-adjusted = 0.031). Conclusions: Increased physical literacy could be a relevant factor for achieving greater academic performance in adolescents. This study has potential implications for physical education instructors, school leaders, and healthcare practitioners.

Valoración del hábito de alimentación en el estilo de vida saludable adquirido en adultos españoles de 22 a 72 años de edad / Assessment of the eating habit in the health-related lifestyle among Spanish adults from 22 to 72 years of age

Introducción: los hábitos de alimentación constituyen uno de los factores predictores de salud principales dentro de los estilos de vida adqui-ridos. La evaluación de dichos hábitos va a ser fundamental para poder reafirmar las conductas saludables y reorientar aquellos hábitos quesupongan un riesgo.Objetivos: evaluar el hábito de alimentación dentro del estilo de vida saludable adquirido en adultos españoles de 22 a 72 años de edad.Métodos: a una muestra de 788 sujetos de edades comprendidas entre los 22 y los 72 años de edad se aplicó la Escala de Valoración delEstilo de Vida Saludable Adquirido (E-VEVSA), formada por 52 ítems y estructurada en siete dimensiones, entre las cuales se evaluó el hábitode alimentación saludable, que explicó una varianza de 8,67 % sobre el total de la escala (66,87 %) y un alfa de Cronbach de 0,794 para unalfa total de 0,894.Resultados: el 16 % de los adultos encuestados posee hábitos de alimentación saludables; el 68,3 %, tendente hacia la salud; y el 15,7 %, pocosaludables. Las pruebas de χ2 de Pearson muestran una asociación positiva y significativa de las mujeres con hábitos saludables de alimentacióny una mejora significativa con el transcurso de la edad. Los datos inferenciales (pruebas t de Student y ANOVA de un factor) confirman estasdiferencias en función del sexo y la edad.Conclusiones: es necesario promover programas preventivos para la mejora de los hábitos de alimentación en la población adulta, sobre todo,en el 15,7 % que posee un nivel poco saludable de la alimentación en su estilo de vida.(AU)

Introduction: eating habits are one of the main predictors of health within a person lifestyle. The assessment of these habits will be essentialto confirm health-related habits and orientate behaviors of risk for health.Objectives: to assess the eating habits within the health-related lifestyle among Spanish adults from 22 to 72 years of age.Methods: the Health-Related Lifestyle Assessment Scale (E-VEVSA) was applied to a sample of 788 subjects between the ages of 22 and 72.This scale is made up of 52 items and structured in seven dimensions, among which the healthy eating habit was evaluated, which explained avariance of 8.67 % of the total scale (66.87 %) and a Cronbach’s alpha of 0.794 for a total alpha of 0.894.Results: sixteen percent of the adults surveyed have healthy eating habits, 68.3 % tend towards health and 15.7 % are unhealthy. Pearson’sχ2 tests show a positive and significant association of women with healthy eating habits and a significant improvement with age. The inferentialdata (Student’s t-tests and one-factor ANOVA) confirm these differences according to gender and age.Conclusions: it is necessary to promote preventive programs to improve eating habits in the adult population, especially in the 15.7 % that havean unhealthy level of nutrition in their lifestyle.(AU)

[Assessment of the eating habit in the health-related lifestyle among Spanish adults from 22 to 72 years of age]. / Valoración del hábito de alimentación en el estilo de vida saludable adquirido en adultos españoles de 22 a 72 años de edad.

Introduction: Introduction: eating habits are one of the main predictors of health within a person lifestyle. The assessment of these habits will be essential to confirm health-related habits and orientate behaviors of risk for health. Objectives: to assess the eating habits within the health-related lifestyle among Spanish adults from 22 to 72 years of age. Methods: the Health-Related Lifestyle Assessment Scale (E-VEVSA) was applied to a sample of 788 subjects between the ages of 22 and 72. This scale is made up of 52 items and structured in seven dimensions, among which the healthy eating habit was evaluated, which explained a variance of 8.67 % of the total scale (66.87 %) and a Cronbach's alpha of 0.794 for a total alpha of 0.894. Results: sixteen percent of the adults surveyed have healthy eating habits, 68.3 % tend towards health and 15.7 % are unhealthy. Pearson's 2 tests show a positive and significant association of women with healthy eating habits and a significant improvement with age. The inferential data (Student's t-tests and one-factor ANOVA) confirm these differences according to gender and age. Conclusions: it is necessary to promote preventive programs to improve eating habits in the adult population, especially in the 15.7 % that have an unhealthy level of nutrition in their lifestyle.

Introducción: Introducción: los hábitos de alimentación constituyen uno de los factores predictores de salud principales dentro de los estilos de vida adquiridos. La evaluación de dichos hábitos va a ser fundamental para poder reafirmar las conductas saludables y reorientar aquellos hábitos que supongan un riesgo. Objetivos: evaluar el hábito de alimentación dentro del estilo de vida saludable adquirido en adultos españoles de 22 a 72 años de edad. Métodos: a una muestra de 788 sujetos de edades comprendidas entre los 22 y los 72 años de edad se aplicó la Escala de Valoración del Estilo de Vida Saludable Adquirido (E-VEVSA), formada por 52 ítems y estructurada en siete dimensiones, entre las cuales se evaluó el hábito de alimentación saludable, que explicó una varianza de 8,67 % sobre el total de la escala (66,87 %) y un alfa de Cronbach de 0,794 para un alfa total de 0,894. Resultados: el 16 % de los adultos encuestados posee hábitos de alimentación saludables; el 68,3 %, tendente hacia la salud; y el 15,7 %, poco saludables. Las pruebas de 2 de Pearson muestran una asociación positiva y significativa de las mujeres con hábitos saludables de alimentación y una mejora significativa con el transcurso de la edad. Los datos inferenciales (pruebas t de Student y ANOVA de un factor) confirman estas diferencias en función del sexo y la edad. Conclusiones: es necesario promover programas preventivos para la mejora de los hábitos de alimentación en la población adulta, sobre todo, en el 15,7 % que posee un nivel poco saludable de la alimentación en su estilo de vida.

Papel de la dieta mediterránea en la reducción de factores de riesgocardiovascular / Role of the Mediterranean diet in the reduction of cardiovascular risk factors

Introducción: Las enfermedades cardiovasculares son un grupo heterogéneo de trastornos cuya causa subyacente de desarrollo suele ser la aterosclerosis. Se estima que los factores dietéticos son responsables de la mayor contribución, entre todos los factores de riesgo conductuales, al riesgo de mortalidad por las enfermedades cardiovascularesa nivel poblacional en toda Europa. Es por ello, que un patrón dietético adecuado y ajustado individualmente a las características clínicas de cada paciente como es el de dieta mediterránea, podría ayudar a reducir las comorbilidades cardiovasculares e incluso a prevenirlas y tratarlas cuando ya existen. Objetivo: El principal objetivo de esta revisión es analizar el papel de la dieta mediterránea en la reducción de factores de riesgo cardiovascular y la morbimortalidad cardiovascular en general, centrándonos en su actuación sobre la hipertensión arterial, obesidad, dislipemia y diabetes mellitus tipo 2. Resultados: Se han realizado estudios en los que se comparan distintos tipos de dietas para la prevención y manejo de estos eventos, siendo la MedDiet la que ha demostrado un mayor beneficio. Es capaz de influir positivamente sobre comorbilidades cardiovasculares como hipertensión arterial, obesidad, dislipemia y diabetes mellitus tipo 2 si existe un nivel alto de adhesión hacia ella, que es lo más complicado ya que hoy en día existen influencias que promueven el cambio de las dietas tradicionales a dietas occidentalizadas. Conclusión: Un patrón alimentario adecuado, como la dieta mediterránea, es una de las medidas más importantes para prevenir la principal causa de muerte a nivel mundial, como son las enfermedades cardiovasculares y sus comorbilidades asociadas.(AU)

Introduction: Cardiovascular diseases (CVD) are a heterogeneous group of disorders whose underlying cause of development is usually atherosclerosis. It is estimated that dietary factors are responsible for the principal contribution, among all behavioral risk factors, to the risk of CVD mortality at the population level throughout Europe. Therefore, an appropriate dietary pattern individually adjusted to the clinical characteristics of each patient, such as the Mediterranean diet, could help to reduce cardiovascular comorbidities and even prevent and treat them when they already exist. Objective: The principal aim of this review is to analyze the role of the Mediterranean diet in reducing cardiovascular risk factors and overall cardiovascular morbidity and mortality, focusing on its impact on arterial hypertension, obesity, dyslipidemia and diabetes mellitus type 2. Results: Studies have been carried out comparing different diets for prevention and management, with the MedDiet being the one that has shown the most benefit. It can positively influence cardiovascular comorbidities such as arterial hypertension, obesity, dyslipidemia, and type 2 diabetes mellitus if there is a high level of adherence to it, which is the most complicated aspect since nowadays there are influences that promote the change from traditional diets to Westernized diets. Conclusion: An adequate dietary pattern, such as the Mediterranean diet, is one of the most important measures to prevent the leading cause of death worldwide, such as cardiovascular diseases and their associated comorbidities.(AU)

Physical activity as a mediator of the association of body mass index change with anxiety/depression symptoms in Brazilian adults during COVID-19.

BACKGROUND: the COVID-19 pandemic has impacted people's behaviors and mental health around the world. AIM: to verify the mediating role of physical activity (PA) level in the relationship between body mass index (BMI) and anxiety and depression symptoms. METHODS: this is a cross-sectional study with Brazilian adults aged ≥ 18 years (n = 2,000, 59.6 % women) selected by the nonprobabilistic snowball method through digital means of communication (WhatsApp®, Telegram®, Facebook®, Twitter®, e-mails). Linear regression models were fitted for PA level mediation analyses in the relationship between BMI and anxiety/depression symptoms. RESULTS: significant differences were found between the active/not overweight group and the other three groups (active/overweight, insufficiently active/not overweight and insufficiently active/overweight [p < 0.001]) for anxiety/depression after adjusting for age, gender, chronic diseases, alcohol consumption, and smoking. When testing the mediating role of daily PA in the association between BMI and anxiety/depression symptoms, BMI was negatively associated with daily PA in the first regression equation (p < 0.001); in the second, BMI was positively related to anxiety/depression symptoms (p < 0.001); and in the third, daily PA showed an inverse relationship with anxiety/depression symptoms (p < 0.001), and although BMI remained negatively associated with anxiety/depression symptoms, these associations maintained their statistical significance. CONCLUSIONS: the results suggest that the effect of BMI on anxiety and depression was partially mediated by daily PA.

Overall proportion of orthorexia nervosa symptoms: A systematic review and meta-analysis including 30 476 individuals from 18 countries.

Background: To date, no previous meta-analysis has determined the overall proportion of orthorexia nervosa symptoms on a global scale. The aim of the present study was 2-fold: first, to establish the overall proportion of orthorexia nervosa symptoms on a global scale, assessed with the ORTO-15 questionnaire; and second, to determine the role of sex, type of population, mean age, body mass index, and the temporal trend in relation to orthorexia nervosa symptoms. Methods: Four databases were searched (PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews) with date limits from January 2005 to June 2023. Studies assessing the proportion of orthorexia nervosa assessed using the ORTO-15 questionnaire with a cutoff of <35 or <40 points were included in this review. Results: The overall proportion of orthorexia nervosa symptoms (using the cutoff <35 points) was 27.5% (95% confidence interval (CI) = 23.5-31.6, I2 = 97.0%). In addition, no significant differences were observed between females (34.6%, 95% CI = 29.5-39.8, I2 = 96.1%) and males (32.1%, 95% CI = 26.5-38.1, I2 = 93.1%). According to the type of population, the highest overall proportion was found in people focused on sports performance or body composition (34.5%, 95% CI = 23.1-47.0, I2 = 98.0%). Notwithstanding, caution should be exercised in interpreting this result, as reverse causality could be a potential pitfall in this relationship. Conclusions: We found that approximately three out of 10 study participants showed orthorexia nervosa symptoms according to the ORTO-15 tool. This overall proportion was higher in those participants who were athletes or fitness practitioners. Over the years, the proportion of orthorexia nervosa symptoms seems to be increasing. These high percentages and their increase are worrisome from a public health perspective and highlight the need to develop psychometric instruments to aid in clinical diagnosis and treatment efficacy. Registration: PROSPERO (CRD42022350873).

Cross-Sectional Association between Perceived Physical Literacy and Mediterranean Dietary Patterns in Adolescents: The EHDLA Study.

PURPOSE: The objective of the current study was to analyze the relationship between perceived physical literacy (PPL) and adherence to the Mediterranean Diet (MedDiet) and its specific components in a sample of Spanish adolescents. METHODS: In this cross-sectional study, we examined a sample of 845 adolescents (58.1% boys) aged 12-17 years from the Valle de Ricote (Region of Murcia, Spain). PPL was assessed by the Spanish Perceived Physical Literacy Instrument for adolescents (S-PPLI). To assess adherence to the MedDiet, the Mediterranean Diet Quality Index in children and adolescents (KIDMED) was applied. RESULTS: In unadjusted analyses, adolescents with medium or high PPL were more likely to have optimal adherence to the MedDiet (medium PPL: OR = 1.69, 95% CI 1.20-2.40, p-adjusted = 0.003; high PPL: OR = 2.90, 95% CI 2.03-4.17, p-adjusted < 0.001). These findings remained significant after adjusting for sex, age, socioeconomic status, body mass index, energy intake, overall sleep duration, physical activity, and sedentary behavior (medium PPL: OR = 1.51, 95% CI 1.05-2.19, p-adjusted = 0.003; high PPL: OR = 2.27, 95% CI 1.53-3.39, p-adjusted < 0.001). CONCLUSIONS: PPL could play a relevant role in the adoption of healthy eating habits among adolescents. Adolescents with low or medium PPL were less likely to report optimal adherence to the MedDiet. Adolescents with high PPL seem to consume more fruits, vegetables, fish, pulses, nuts, and dairies (for breakfast). Conversely, these adolescents tend to skip breakfast less, as well as to consume less commercially baked goods or pastries at this meal.

Trastornos adaptativos y su manejo desde atención primaria / Adaptive disorders and their management in primary care

Introducción: El trastorno de adaptación describe una respuesta emocional y conductual desproporcionada a uno o más estresores psicosociales identificables. Existen múltiples situaciones capaces de generarnos una situación de estrés agudo. Sin embargo, uno de los requisitos necesarios para poder hablar de trastorno adaptativo es que ese o esos factores estresantes supongan un deterioro en el funcionamiento normal del individuo. Objetivos: El objetivo principal de este trabajo es analizar, mediante una revisión bibliográfica, el diagnóstico y abordaje de los trastornos adaptativos dentro del ámbito de Atención Primaria. El objetivo secundario es destacar la importancia de la detección y el tratamiento precoces, así como de la gestión multidisciplinar y la promoción de la salud mental. Resultados: Los principales factores de riesgo de los trastornos adaptativos son el desempleo, los bajos ingresos,el escaso apoyo social, las enfermedades físicas y la salud mental. La prevalencia es mayor en jóvenes,especialmente entre las mujeres, y existe un riesgo aumentado de suicidio en el subtipo de estado de ánimo depresivo. El Cuestionario Internacional de Trastornos Adaptativos es actualmente la principal herramienta diagnóstica, por establecer sus criterios diagnósticos en base a la definición teórica establecida por la CIE-11. El manejo de estos trastornos se realiza principalmente mediante terapia cognitivo-conductual. Conclusiones: Los trastornos de adaptación surgen como respuestas anormales ante ciertas situaciones estresantes. El papel de los médicos de Atención Primaria en el abordaje de este trastorno es primordial, siendo necesaria su detección y manejo precoz para disminuir los niveles de ansiedad disfuncionales que presentan los pacientes.(AU)

Introduction: Adjustment disorder describes a disproportionate emotional and behavioral response to one or more identifiable psychosocial stressors. There are multiple situations capable of generating an acute stressful situation. However, one of the requirements to be able to speak of an adaptive disorder is that the stressor(s) in question should lead to an impairment of the individual's normal functioning.Objectives: The main objective of this work is to analyze , through a literature review, the diagnosis and approach to the diagnosis and management of adaptive disorders in the Primary Care setting. The secondary objective is toemphasize the importance of early detection and treatment, as well as multidisciplinary management and mentalhealth promotion. Results: The main risk factors for adjustment disorders are unemployment, low income, low social support, physical illness, and personal history of mental health. The International Questionnaire of Adaptive Disorders is currently the principal diagnostic tool, as it establishes its diagnostic criteria based on the theoretical definition established by the ICD-11. The management of these disorders is mainly through cognitive behavioural therapy.Conclusions: Adjustment disorders arise as abnormal responses to certain stressful situations. The role of primary care physicians in dealing with this disorder is essential, and early detection and management are necessary to reduce the levels of dysfunctional anxiety that patients present.(AU)

Beneficios de la dieta mediterránea y la actividad física en adolescentes / Benefits of the Mediterranean diet and physical activity in adolescents

Introducción: Más de 340 millones de niños y adolescentes en todo el mundo presentan sobrepeso oobesidad, lo que convierte la obesidad en un problema urgente para la población mundial. Este período dela vida es crucial ya que los rápidos cambios cognitivos, físicos, psicológicos y emocionales afectan la saludy el bienestar. Participar en comportamientos de estilo de vida saludables, como la actividad física o seguiruna dieta, se asocia con un menor riesgo de sufrir enfermedades crónicas y degenerativas en la edadadulta. Objetivo: Describir la importancia de la dieta y la actividad física en adolescentes, valorar el grado deadherencia a estos patrones y resaltar los beneficios que supone participar en estilos de vida saludables. Método: Búsqueda sistemática de la literatura científica publicada en materia de dieta mediterránea yactividad física en este grupo de población. Resultados: Los niños y adolescentes se han ido alejando de estos estilos de vida saludables, generandola necesidad de aplicar estrategias de intervención que promuevan nuevos hábitos en adolescentes, entrelos que se incluya una adecuada alimentación basada en la dieta mediterránea, asociada a un programade actividad física semanal, lo aporta múltiples beneficios tanto a nivel cardio respiratorio, metabólico,musculoesquelético, como cognitivo y emocional. Conclusiones: Se puede resaltar la importancia de aplicar la dieta mediterránea y la actividad física en loshábitos de vida de los adolescentes ya que incluyen numerosos beneficios a nivel físico, cognitivo ypsicológico, necesarios para un correcto desarrollo en esta etapa del desarrollo.(AU)

Introduction: Over 340 million children and adolescents worldwide are overweight or obese, which makesobesity an urgent problem for the world's population. This period of life is crucial since rapid cognitive,physical, psychological, and emotional changes affect health and well-being. Engaging in healthy lifestylebehaviors, such as being physically active or following a diet, is associated with a lower risk of chronic anddegenerative diseases in later life. Objective: Describe the importance of diet and physical activity in adolescents, assess the degree ofadherence to these patterns, and highlight the benefits of participating in healthy lifestyles.Method: Systematic search of the published scientific literature on the Mediterranean diet and physicalactivity in this population group. Results: Children and adolescents have been moving away from these healthy lifestyles, generating theneed to apply intervention strategies that promote new habits in adolescents, including an adequate dietbased on the Mediterranean diet, associated with a program of weekly physical activity, which providesmultiple benefits both at the cardio-respiratory, metabolic, musculoskeletal, cognitive, and emotional levels. Conclusions: The importance of applying the Mediterranean diet and physical activity to the lifestyle ofadolescents can be highlighted since they include numerous benefits at physical, cognitive, andpsychological levels, which are necessary for correct development at this stage of development.(AU)

Environmental tobacco smoke exposure and 24-h movement guidelines in Spanish young people.

Background: No prior research has investigated how exposure to environmental tobacco smoke is related to the combination of 24-h movement behaviors among young populations thus far. The aim of this study was to examine the associations between exposure to secondhand smoke and the 24-h movement guidelines. Methods: This is a cross-sectional study using data from the last available wave of the Spanish National Health Survey [2017], a nationally representative survey of the Spanish children and adult population. The final sample included 4,378 (49.0% girls) Spanish young people aged 2-14 years. Results: A lower likelikood of meeting screen time (ST) and all three 24-h movement guidelines were found in those exposed to environmental tobacco smoke in unadjusted models. After adjusting for several covariates, meeting screen time [odds ratio (OR) =0.76; 95% confidence interval (CI), 0.59-0.97], sleep duration (OR =0.75; 95% CI, 0.58-0.96), and all three 24-h movement guidelines (OR =0.63; 95% CI, 0.44-0.91) reached significance after adjusting for potential confounders. Conclusions: Given the inverse associations found, environmental tobacco smoke exposure should be a relevant factor to consider when promoting 24-h behaviors in the young population. Avoiding exposure to tobacco smoke in the environment is essential, as it can potentially influence the 24-h movement behaviors of young people, and consequently, the health benefits associated with such behaviors.

A Cluster Randomized Controlled Trial of the Archena Infancia Saludable Project on 24-h Movement Behaviors and Adherence to the Mediterranean Diet among Schoolchildren: A Pilot Study Protocol.

Objective: The aim of this paper is to describe the protocol of pilot cluster randomized controlled trial (RCT) that will evaluate the effects of a lifestyle-based intervention. The Archena Infancia Saludable project will have several objectives. The primary objective of this project is to determine the 6-month effects of a lifestyle-based intervention on adherence to 24-h movement behaviors and Mediterranean diet (MedDiet) in schoolchildren. The secondary objective of this project is to test the intervention effects of this lifestyle-based intervention on a relevant set of health-related outcomes (i.e., anthropometric measurements, blood pressure, perceived physical fitness, sleep habits, and academic performance). The tertiary objective is to investigate this intervention's "halo" effect on parents'/guardians' 24-h movement behaviors and adherence to the MedDiet. Methods: The Archena Infancia Saludable trial will be a cluster RCT submitted to the Clinical Trials Registry. The protocol will be developed according to SPIRIT guidelines for RCTs and CONSORT statement extension for cluster RCTs. A total of 153 eligible parents/guardians with schoolchildren aged 6-13 years will be randomized into an intervention group or a control group. This project focuses on two fundamental pillars: 24-h movement behaviors and MedDiet. It will mainly focus on the relationship between parents/guardians and their children. Behavior change strategies for dietary and 24-h movement behaviors in schoolchildren will be based on healthy lifestyle education for parents/guardians through infographics, video recipes, brief video clips, and videos. Conclusions: Most of the current knowledge on 24-h movement behaviors and adherence to the MedDiet is based on cross-sectional or longitudinal cohort studies, warranting a need to design and conduct RCTs to obtain more robust evidence on the effect of a healthy lifestyle program to increase 24-h movement behaviors and to improve adherence to the MedDiet in schoolchildren.

Cross-cultural adaptation, reliability, and validation of the Spanish perceived physical literacy instrument for adolescents (S-PPLI).

Objective: The aim of this study was to examine the reliability and validity of the Spanish Perceived Physical Literacy Instrument (S-PPLI) questionnaire in Spanish adolescents. Method: The participants of this study were 360 Spanish adolescents (aged 12-17 years) from three secondary schools in the Region of Murcia (Spain). A cultural adaptation process of the original version of the PPLI questionnaire was developed. Confirmatory factor analysis was applied to test the three-factor structure of physical literacy. Intraclass correlation coefficients were computed to estimate the test-retest concordance. Results: Using a confirmatory factor analysis, the factor loading of all items above the standard of 0.40 ranged from 0.53 to 0.77, suggesting that the observed variables sufficiently represented the latent variables. Analyses for convergent validity showed average variance extracted values that ranged from 0.40 to 0.52 and composite reliability values higher than 0.60. All the correlations were below the recommended cutoff point of 0.85, which indicated that the three physical literacy factors achieved adequate discriminant validity. Intraclass correlation coefficients ranged from 0.62 to 0.79 (p < 0.001 for all items), which indicated moderate/good reliability. Conclusions: Our results suggest that the S-PPLI is a valid and reliable measure of physical literacy among Spanish adolescents.

Impacto de la hipertensión arterial en el desarrollo de enfermedades cardivosaculares / Impact of arterial hypertension on the development of cardiovascular diseases

Introducción: Las enfermedades cardiovasculares (ECV) son la primera causa de muerte a nivel mundial. Están fuertemente influenciadas por unos factores de riesgo (FR), algunos de ellos modificables concambios en el estilo de vida. De todos los FR, uno de los más prevalentes en la población es la hipertensiónarterial (HTA), definida por unos valores de presión arterial ≥140-90mmHg. Objetivos: Conocer la relación entre la HTA y el resto FR con el desarrollo de las distintas ECV, identificarel umbral idóneo para evitar sobrediagnósticos y sobretratamientos de la HTA, y reconocer la importanciade unos buenos hábitos de vida como prevención. Resultados y Discusión: En el estudio de FÉLIX-REDONDO et al. se demostró que el FR más influyenteen las ECV era la HTA. Sin embargo, esto puede variar según la edad, tal y como observaron VERA-REMARTÍNEZ et al. con su estudio, cuya media de edad era de 30 años, y el factor más prevalente fue eltabaco. El control de los hábitos de vida que ayuden a reducir tanto la HTA como el resto de factores, serábeneficioso para la prevención primaria y secundaria de ECV. Para evitar un tratamiento demasiadointensivo, es recomendable un enfoque gradual, comenzando con objetivos de prevención para todos lospacientes, independientemente del riesgo, siguiendo con la estratificación del riesgo de ECV y la discusiónde los beneficios potenciales del tratamiento con el paciente. Conclusiones: Las ECV, concretamente la cardiopatía isquémica y las enfermedades cerebrovasculares,son la principal causa de muerte en el mundo, por lo que es muy importante el control de aquellos FR queaceleren la aparición de estas. El más prevalente de ellos, es la presión arterial elevada.(AU)

Introduction: Cardiovascular diseases (CVD) are the leading cause of death worldwide. They are stronglyinfluenced by some risk factors (RF), some of them modifiable with changes in lifestyle. Of all the RFs, oneof the most prevalent in the population is arterial hypertension (AHT), defined by blood pressure values≥140-90mmHg. Objectives: Know the relationship between HTA and the rest RF with the development of different CVDs,identify the ideal threshold to avoid overdiagnosis and overtreatment of HTN, and recognize the importanceof good lifestyle habits as prevention. Results and Discussion: In the study by FÉLIX-REDONDO et al. it was shown that the most influential RFin CVD was AHT. However, this may vary according to age, as observed by VERA-REMARTÍNEZ et al. withhis study, whose mean age was 30 years, and the most prevalent factor was tobacco. The control of lifestylehabits that help reduce both hypertension and the rest of the factors will be beneficial for the primary andsecondary prevention of CVD. To avoid overly intensive treatment, a stepwise approach is recommended,starting with prevention goals for all patients, regardless of risk, followed by CVD risk stratification anddiscussion of the potential benefits of treatment with the patient. Conclusions: CVD, specifically ischemic heart disease and cerebrovascular diseases, are the main causeof death in the world, so it is very important to control those RFs that accelerate their appearance. The mostprevalent of them is high blood pressure.(AU)

La telemedicina en la diabetes mellitus, el nuevo camino por recorrer / Telemedicine in diabetes mellitus, the new road ahead

Introducción: La Diabetes Mellitus es una enfermedad crónica muy prevalente a nivel mundial que genera un grannúmero de procesos asistenciales y un abordaje complejo, suponiendo un importante porcentaje del gasto sanitario. Espor ello por lo que se plantea la necesidad de desarrollar un sistema que permita hacer más eficiente el manejo de estospacientes a la vez que se garantiza una asistencia continuada de calidad, resultando la telemedicina como una alternativaválida. Objetivos: Con este estudio se pretende analizar la eficacia de las intervenciones basadas en la telemedicina en elmanejo de los pacientes con Diabetes Mellitus frente a la asistencia estándar. Se compara el rendimiento de estas nuevasintervenciones en pacientes con Diabetes Mellitus tipo 1 y tipo 2, evaluando la mejoría de parámetros clínicos y analíticos,la calidad de vida y la reducción de costes gracias a su empleo. Resultados: Se realizó una revisión de los principales motores de búsqueda y bases de datos. Entre las publicacionesutilizadas se pudo encontrar una reducción significativa de los niveles de HbA1c en ambos tipos de diabetes, unincremento en el autocontrol y autoeficacia, una mejoría en la calidad de vida variable según el cuestionario y finalmente,una reducción en los costes asistenciales. Conclusión: La telemedicina se erige como una alternativa eficaz y válida a la atención habitual para estos pacientes.Es necesaria mayor investigación en el futuro para poder unificar los diferentes sistemas dando así lugar a unaherramienta universal.(AU)

Introduction: Diabetes Mellitus is a very prevalent chronic disease worldwide that generates a large number of careprocesses and a complex approach, assuming a significant percentage of health spending. That is why the need arisesto develop a system that allows for more efficient management of these patients while ensuring continuous quality care,resulting in telemedicine as a valid alternative. Objectives: This study aims to analyze the effectiveness of interventions based on telemedicine in the management ofpatients with Diabetes Mellitus compared to standard care. The performance of these new interventions in patients withtype 1 and type 2 Diabetes Mellitus is compared, evaluating the improvement of clinical and analytical parameters, qualityof life and cost reduction thanks to their use. Results: A review of the main search engines and databases was carried out. Among the publications used, it waspossible to find a significant reduction in HbA1c levels in both types of diabetes, an increase in self-control and self-efficacy, an improvement in variable quality of life according to the questionnaire, and finally, a reduction in care costs.Conclusion: Telemedicine stands as an effective and valid alternative to regular care for these patients. More researchis needed in the future to be able to unify the different systems, thus giving rise to a universal too.(AU)

Prevalence of Disordered Eating and Its Associated Factors From a Socioecological Approach Among a Sample of Spanish Adolescents: The EHDLA Study.

Objectives: The aim of this study was twofold: a) to establish the prevalence of adolescents with disordered eating and b) to determine the factors associated with this prevalence in a sample of Spanish adolescents from the Valle de Ricote (Region of Murcia, Spain). Methods: This cross-sectional study analyzed data from 730 adolescents (56.2% girls) from the EHDLA study. To determine the prevalence of disordered eating, the Sick, Control, One stone, Fat, Food (SCOFF) questionnaire was used. A socioecological approach was used to identify individual-, interpersonal-, or organizational-level factors associated with disordered eating. Results: The prevalence of disordered eating was 30.1%. This condition was associated with female sex (odds ratio [OR] = 2.60; 95% confidence interval [CI], 1.81-3.73), immigrant status (OR = 2.22; 95% CI, 1.51-3.25), or excess weight (OR = 2.74; 95% CI, 1.93-3.89). Furthermore, for each additional hour slept, lower odds of having disordered eating were found (OR = 0.81; 95% CI, 0.67-0.98). Discussion: Almost one-third of the sample of Spanish adolescents analyzed reported disordered eating. Female sex, immigrant status and excess weight are individual aspects that seem to be related to disordered eating among Spanish adolescents.

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

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

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

Mediterranean Dietary Patterns Related to Sleep Duration and Sleep-Related Problems among Adolescents: The EHDLA Study.

PURPOSE: The aim of the present study was to examine the association of adherence to the Mediterranean Diet (MD) and its specific components with both sleep duration and sleep-related disorders in a sample of adolescents from the Valle de Ricote (Region of Murcia, Spain). METHODS: This cross-sectional study included a sample of 847 Spanish adolescents (55.3% girls) aged 12-17 years. Adherence to the MD was assessed by the Mediterranean Diet Quality Index for Children and Teenagers. Sleep duration was reported by adolescents for weekdays and weekend days separately. The BEARS (Bedtime problems, Excessive daytime sleepiness, Awakenings during the night, Regularity and duration of sleep, and Sleep-disordered breathing) screening was used to evaluate issues related to sleep, which include difficulties at bedtime, excessive drowsiness during the day, waking up frequently during the night, irregularity, length of sleep, and breathing issues while sleeping. RESULTS: Adolescents who presented a high adherence to the MD were more likely to meet the sleep recommendations (OR = 1.52, 95% CI 1.12-2.06, p = 0.008) and less likely to report at least one sleep-related problem (OR = 0.56, 95% CI 0.43-0.72, p < 0.001). These findings remained significant after adjusting for sex, age, socioeconomic status, waist circumference, energy intake, physical activity, and sedentary behavior, indicating a significant association of adherence to the MD with sleep outcomes (meeting sleep recommendations: OR = 1.40, 95% CI 1.00-1.96, p = 0.050; sleep-related problems: OR = 0.68, 95% CI 0.50-0.92, p = 0.012). CONCLUSIONS: Adolescents with high adherence to the MD were more likely to report optimal sleep duration and fewer sleep-related problems. This association was more clearly observed for specific MD components, such as fruits, pulses, fish, having breakfast, dairies, sweets, and baked goods/pastries.

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

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