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Funding Acknowledgements Type of funding sources: Other. Main funding source(s): 1. SHE Foundation and "la Caixa" 2. Fondo de Investigación Sanitaria - Instituto de Salud Carlos III. Background/Introduction Adolescence is a sensitive period regarding self-esteem and body image. In particular, nutritional status could affect self-esteem levels and body image satisfaction. Purpose To evaluate the distribution of body image satisfaction by nutritional status, and to assess the relationship between body image satisfaction and self-esteem over adolescence. Methods 1315 adolescents from the SI! Program for Secondary Schools trial were assessed at baseline (12.5 (0.4) years, 48.2% girls), first follow-up (1-FU) (13.9 (0.4) years, 47.6% girls) and second follow-up (2-FU) (15.8 (0.4) years, 48.4% girls). Adolescents were classified as having underweight, normal weight or overweight/obesity according to Center for Disease Control (CDC) standards for body mass index (BMI). Body image satisfaction and self-esteem were assessed with Stunkard's figure rating scale and self-esteem domain of the Child Health and Illness Profile-Adolescent Edition (CHIP-AE) questionnaire, respectively. The association between both variables was estimated using linear and logistic mixed models. Results Overall, only 14.6% of adolescents were systematically satisfied with their body image. Most adolescents with overweight/obesity desired to lose weight (89.7% at baseline, 84.9% at 1-FU, and 83.9% at 2-FU), while most adolescents with underweight desired to gain weight (76.3% baseline, 80.0% 1-FU, 84.0% 2-FU). The percentage of girls with normal weight desiring to lose weight increased from 33.4% at ~12 years of age to 45.9% at ~16 years of age, while the desire to gain weight increased in boys with normal weight (32.3% at baseline vs 38.2% at 2-FU) (Figure 1). Satisfied adolescents consistently presented higher self-esteem over time compared to unsatisfied adolescents, especially girls (Table 1). Conclusion(s) Body image satisfaction was consistently related to nutritional status over adolescence. The desire to lose weight in girls with normal weight increased over time, while the desire to gain weight increased in boys with normal weight. Data suggests that body image satisfaction could determine self-esteem levels. These results show how gender stereotypes may affect body image and self-esteem, and therefore eating and exercise behaviors, highlighting the importance to reinforce body acceptance through school-based health promotion interventions.

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): 1. Fondo de Investigación Sanitaria - Instituto de Salud Carlos III 2. SHE Foundation and “la Caixa” Foundation. Background/Introduction The evidence for gender differences in overall cardiovascular health (CVH) score and individual health metrics over adolescence is conflicting. Purpose To study gender differences in overall CVH status and its individual metrics in a large cohort of adolescents aged 12 to 16 years in Spain. Methods This study collected longitudinal data from 1324 adolescents at baseline (48.4% girls; 12.5 (0.4) years), 1211 (47.9% girls; 13.9 (0.4) years) at first follow-up and 1095 at second follow-up (48.2% girls; 15.8 (0.4) years) attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain. Eight individual metrics (nicotine exposure, diet, physical activity (PA), sleep health, body mass index (BMI), blood glucose, non-high-density lipoprotein cholesterol, and blood pressure (BP)) were measured and scored from 0 to 100 points according to the Life’s Essential 8 (LE8) criteria established by the American Heart Association. An overall CVH score was constructed summing the metrics described above, ranging from 0 to 100 points. Low, moderate, or high overall CVH score was defined as 0-49, 50-79, or 80-100 points, respectively. Differences in CVH over time were analyzed in individuals with CVH score available at three time-points (n=1077) using generalized linear mixed adjusted models. Results At approximately 12 years of age, most individuals had a moderate or high LE8 CVH score and CVH was slightly higher (healthier) in girls than boys (77.2 vs. 76.0 points) (Figure 1). LE8 CVH score increased significantly in boys and girls between 12 and 14 years of age (1.78 and 1.95 points, respectively), without gender differences (Figure 2). LE8 CVH score decreased significantly in boys and girls between 14 and 16 years of age; however, this decline was higher in boys than in girls (-3.17 versus -1.62 points, p value=0.007). Regarding individual metrics, mean scores were lowest for the diet, and sleep health and highest for BP. The highest declines over time were observed in PA, especially in boys, and nicotine exposure, especially in girls. Conclusions Most adolescents had a moderate or high overall CVH status, although boys showed slightly unhealthier scores and greater decline over time. Gender differences in individual CVH metrics were also found. This information is helpful for tailoring health promotion programs in adolescence.

Aims Large studies linking adolescents’ objectively measured sleep duration and adiposity markers are lacking. We characterized sleep duration and its cross-sectional and longitudinal associations with adiposity markers in adolescence. Methods and results Seven-day accelerometry was performed in a cohort of adolescents enrolled in the SI! Program for Secondary Schools trial in Spain at approximately ages 12 (1216 adolescents, 49.6% girls), 14 (1026 adolescents, 51.3% girls), and 16 (872 adolescents, 51.7% girls) years. Participants were classified as very short sleepers (VSS; Conclusion Most adolescents did not meet sleep recommendations. Shorter sleep duration was independently associated with unfavourable adiposity markers, and such adverse impact was cumulative. Health promotion programmes should emphasize the importance of good sleep habits. Lay summary This study used a wearable activity tracker to analyse sleep patterns and their association with adiposity markers in a large cohort of adolescents at ages 12, 14, and 16 years. At 12 years, only 34% of adolescents met sleep recommendations (eight or more hours of sleep per day), and this percentage decreased with advancing age (23% at 14 and 19% at 16 years). Adolescents sleeping

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): 1. Fondo de Investigación Sanitaria- Instituto de Salud Carlos III2. SHE Foundation and “la Caixa” Foundation. Background There is a paucity of data on adolescents’ cardiovascular health (CVH) profiles and longitudinal trajectories. Purpose To identify CVH trajectories in a large cohort of Spanish adolescents aged 12 to 16 years and their relationship with sociodemographic variables. Methods This study collected data at approximately 12, 14 and 16 years of age from 1078 adolescents attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain [1]. The status (non-ideal = 0 points; ideal = 1 point) of each CVH individual metric (smoking status, body mass index, physical activity, dietary habits, blood pressure, total cholesterol, and blood glucose) was determined following the criteria established by the American Heart Association [2]. An overall CVH score was constructed summing the number of ideal CVH metrics (ranged thus from 0 to 7 points), and poor, intermediate, or ideal overall CVH score was defined as ≤3, 4-5, or 6-7 ideal metrics, respectively [3]. CVH trajectories were identified using latent class trajectory modeling with the Stata command traj [4]. Next, individuals were assigned to the trajectory group they were most likely to belong based on the posterior predictive probabilities of group membership. Results Among 1078 adolescents with a baseline mean (SD) age of 12.5 (0.4) years, 48.5% girls, four distinct CVH trajectory groups were identified: low-stable (56 adolescents [5.0%]), low-rise (232 [21.3%]), intermediate-decline (136 [18.2%]) and intermediate-stable (654 [55.5%]) (Figure 1). Adolescents belonging to the intermediate-stable and the low-stable trajectories showed the highest and lowest overall CVH mean (SD) scores at baseline [4.8 (0.8) and 2.6 (0.9), respectively] (Figure 2). Similar differences were observed for the analysis of overall CVH score as a categorical variable (poor, intermediate, ideal). Sociodemographic differences between CVH trajectories were identified, with the highest proportion of girls, high-income and non-migrant families within the intermediate-stable trajectory. Conclusions In a large cohort of adolescents, ~55% of adolescents showed an intermediate CVH score at baseline and did not decline over time. The characterization of distinct CVH trajectories and sociodemographic differences between them may help tailoring health promotion programs for adolescents.