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Background The purpose of this study was to objectively assess pre-school children's total physical activity ( TPA) patterns and compliance with guidelines and to examine differences relative to parental education. Methods The sample consisted on 509 healthy pre-school children, aged 3-6 years recruited from kindergartens located in the metropolitan area of Porto, Portugal. The PA was assessed for 7 consecutive days by accelerometry. For TPA, we followed the guidelines of the National Association for Sport and Physical Education ( NASPE) (children who spent at least >120 min per day in active play). For TPA, we calculated the proportion of children who spent at least >120 min per day in active play and moderate-to-vigorous physical activity (MVPA), we calculated the proportion of children who spent at least >60 min per day in active play. Parental education was analysed according to the Portuguese education system. Results Children with parents in the highest education level were less active than children from low and middle education level ( P ≤ 0.001) in all patterns of PA (week and weekend). Regarding TPA during the week we found that the majority of children from low and middle parental education meet the NASPE guidelines. On the other hand, more than half the children from high parental education did not meet these recommendations ( P ≤ 0.001) and MVPA recommendations ( P ≤ 0.05). In both recommendations, children from low parental education were twice more likely to meet the recommendations compared with children belonging to high parental education. Conclusion Parent education was negatively associated with children's daily physical activity patterns and compliance with guidelines. [ABSTRACT FROM AUTHOR]

What is already known about this subject Diet and physical activity ( PA) are recognized as important factors to prevent abdominal obesity ( AO)., Studies have found an inverse relationship between milk intake or milk products and body weight and/or body fat in children and adolescents., Evidence suggests that low levels of PA are associated with AO in youth., What this study adds Our study explored the combined association of milk intake and PA on AO in adolescents, which are most often studied in isolation., Our findings suggested that adolescents with high milk intakes, regardless of whether they were active or low active, were less likely to have AO., Our findings could have a great epidemiological interest and bring important evidence in the field of AO management among adolescents., Background Diet and physical activity ( PA) are recognized as important factors to prevent abdominal obesity ( AO), which is strongly associated with chronic diseases. Some studies have reported an inverse association between milk consumption and AO. Objective This study examined the association between milk intake, PA and AO in adolescents. Methods A cross-sectional study was conducted with 1209 adolescents, aged 15-18 from the Azorean Archipelago, Portugal in 2008. AO was defined by a waist circumference at or above the 90th percentile. Adolescent food intake was measured using a semi-quantitative food frequency questionnaire, and milk intake was categorized as 'low milk intake' (<2 servings per day) or 'high milk intake' (≥2 servings per day). PA was assessed via a self-report questionnaire, and participants were divided into active (>10 points) and low-active groups (≤10 points) on the basis of their reported PA. They were then divided into four smaller groups, according to milk intake and PA: (i) low milk intake/low active; (ii) low milk intake/active; (iii) high milk intake/low active and (iv) high milk intake/active. The association between milk intake, PA and AO was evaluated using logistic regression analysis, and the results were adjusted for demographic, body mass index, pubertal stage and dietary confounders. Results In this study, the majority of adolescents consumed semi-skimmed or skimmed milk (92.3%). The group of adolescents with high level of milk intake and active had a lower proportion of AO than did other groups (low milk intake/low active: 34.2%; low milk intake/active: 26.9%; high milk intake/low active: 25.7%; high milk intake/active: 21.9%, P = 0.008). After adjusting for confounders, low-active and active adolescents with high levels of milk intake were less likely to have AO, compared with low-active adolescents with low milk intake (high milk intake/low active, odds ratio [ OR] = 0.412, 95% confidence intervals [ CI]: 0.201-0.845; high milk intake/active adolescents, OR = 0.445, 95% CI: 0.235-0.845). Conclusion High milk intake seems to have a protective effect on AO, regardless of PA level. [ABSTRACT FROM AUTHOR]

Objective: There are no data available on overweight and obesity prevalence among Portuguese adolescents living in the Azorean Islands. Therefore, the purpose of this study was to report the prevalence of overweight and obesity in a representative sample of Azorean adolescents. Design: This study was conducted using a representative sample of 2,124 Azorean adolescents ages 15 to 18 years. Weight and height were measured and participants were classified according to the International Obesity Task Force (IOTF) and the World Health Organization (WHO) cut-offs. Results: Results showed a prevalence of overweight and obesity of 24.9% and 6.5% in girls, and 19.3% and 7.7% in boys, respectively (p = 0.008), according to the IOTF criteria, whereas the figures for the WHO criteria were 24.9% and 9.8% in girls, and 21.1% and 10.5% in boys, respectively (p = 0.123). The prevalence of overweight and obesity among Azorean adolescents is higher than that reported for Portuguese youth living in mainland Portugal, and in some age groups, these figures are doubled. Conclusion: The fact that Azorean adolescents exhibit a higher rate of obesity than their peers living in the mainland was also observed in other European countries, and therefore, strategies to promote healthy weight in this population are required. [ABSTRACT FROM AUTHOR]

A better understanding of the different domains and characteristics of children's and adolescent's physical activity (PA) could be a strategy to clarify the association of this behaviour with the early development of cardiovascular risk factors. To examine the relationship between leisure time physical activity (LTPA) and sports competition activities (SCA) with high blood pressure (HBP) levels in a sample of children and adolescents from Porto, Portugal. This is a cross-sectional study, which comprised 503 boys and 572 girls, aged 8-17 years old. LTPA and SCA were assed by self-reported. Students were assigned as active and non-active in SCA or LTPA according to their self-reported participation. Participants were classified as HBP when they are above of the last quartile for systolic and/or diastolic BP adjusted for gender and age. Do not be engaged in LTPA (OR: 1.47; 95% CI: 1.12; 1.93) and SCA (OR: 1.36; 95% CI: 1.02; 1.81) was significantly associated with the likelihood of being HBP. However, when cardiorespiratory fitness (CRF) (OR: 1.23; 95% CI: 0.91; 1.67) and body mass index (BMI) (OR: 1.31; 95% CI: 0.98; 1.75) were included on SCA model, the association between SCA with HBP did not showed significant results. Children and adolescents who are not engaged in SCA or LTPA are more likely to be classified as having HBP; however, the relationship between SCA and HBP was dependent of CRF and BMI. Further, PA strategies should take these differences on the relationship between HBP, SCA and LTPA. [ABSTRACT FROM AUTHOR]

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This study compared body mass index (BMI) and inverted BMI (iBMI) as predictors of body fatness in 177 Portuguese children (149 girls and 96 boys) aged 7-16 years. Participants undertook measures of height and body mass from which BMI (kg/m2) and iBMI (cm2/kg) were determined. Maturation was determined via self-report and fat mass index (FMI, kg/m2) via dual-energy X-ray absorptiometry. Significant relationships were evident between BMI and iBMI and FMI (both P=0.0001). BMI was not normally distributed (P=0.0001) but iBMI was (P>0.05). Analysis of covariance identified that BMI and iBMI, controlling for maturation, were both significant predictors of FMI (both P=0.0001) but that iBMI predicted a slightly greater amount of the variance (adjusted R2=0.970) compared with BMI (adjusted R2=0.968). This study suggests that iBMI is a similar proxy for body fatness compared with BMI in children. [ABSTRACT FROM AUTHOR]

Introduction: Despite being one of the oldest treatments in the field of Psychiatry, Electroconvulsive therapy (ECT) is used worldwide for various severe and treatment-resistant psychiatric disorders, establishing itself as one of the fastest and most effective treatments. Objectives:Theprimaryaimof this studywas todescribeanationwide epidemiological perspective of the use of ECT in hospitalized psychiatric patients. The secondary aims were to characterize clinical and sociodemographic trends of hospitalized patients who needed ECT. Methods:Aretrospective-observational study was conducted using an administrative database which gathered all hospitalizations registered in Portuguese public hospitals from 2008 to 2015. We selected all hospitalizations with a procedure code 94.27 - Other electroshock therapy defined by the International Classification of Diseases version-9, Clinical Modification. The variables included in the study were birth date, sex, residence address, primary and secondary diagnoses, admission date, discharge date, length of stay (LoS), discharge status from each single hospitalization episode. Results: There were a total of 879 hospitalizations with ECT during the 8-year period of the study. Most of the hospitalizations occurred in female patients (53.4 vs 46.6%), belonging to the age group of 51-70 years old, with a mean age of 50.5 years old. The median LoS was 43.0 days with an IQR of 27.0-68.0 days. The specific primary diagnosis most frequent in all hospitalizations was Major depressive disorder, recurrent episode representing 19.6% of all ECT related hospitalizations. Conclusions: In Portugal most of the patients who received ECT were women above middle age, and depressive disorders were the most common indication. [ABSTRACT FROM AUTHOR]

This study analyzed associations between physical activity (PA), sedentary behaviors (SB), sleep, and mental health indicators in young adults during the COVID-19 lockdown (15 January-19 April 2021). The participants were 549 Portuguese university students (18-30 years, 57.7% male). Mental health was assessed using the DASS-21 for depression, anxiety, stress, and DASS-21 total score (DASSt). Physical activity (vigorous, moderate, walking) was measured with the IPAQ, while SB (e.g., sitting, screen time) and sleep were evaluated using self-reported measures and the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regressions showed that sleep quality (β = 2.116), sitting time (ST; β = 0.451), vigorous PA (VPA; β = -0.005), and computer use for work/study (β = 0.444) were significantly associated with overall mental health, DASSt ( R 2 = 0.358). Sleep quality, sitting, and VPA were also linked to depression ( R 2 = 0.308), anxiety ( R 2 = 0.275), and stress ( R 2 = 0.338). Computer use for work/study was additionally associated with anxiety and stress. Overall, poor sleep quality, increased sitting, and computer use for work/study, alongside lower VPA, showed significant associations with poorer mental health outcomes. These findings highlight the importance of sleep, PA, and limiting sedentary behaviors, particularly during lockdowns, in mitigating mental health issues among Portuguese young adults.

This study examined the associations between age, adiposity, physical activity, sedentary behavior, and elevated blood pressure (BP) in 2901 Portuguese children and adolescents aged 2-18. BP, body mass index (BMI), waist-to-height ratio (WHtR), physical activity, and sedentary behavior were measured. Elevated BP was defined as a BP above the 90th percentile for age, sex, and height. Multivariable analyses assessed the prevalence ratios (PR) of elevated BP across age groups, BMI, WHtR, physical activity, and sedentary behavior. Results showed that older age, especially among middle schoolers, was associated with a 1.8 times higher risk of elevated BP than preschoolers. Participants with a higher BMI (overweight/obese) and a WHtR ≥ 0.50 had a 1.49- and 1.4-times higher risk of elevated BP, respectively. Those who did not meet the recommended 60 min of moderate-to-vigorous physical activity (MVPA) per day showed a 1.63 times higher risk of elevated BP, whereas the association between sedentary behavior and BP was not significant after adjustment. These findings highlight age, higher BMI, central obesity, and insufficient physical activity as key factors associated with elevated BP, underscoring the need for early monitoring and intervention to prevent hypertension in this population.

Objectives: Maintaining a healthy aging process is vital to combating and delaying the adverse health outcomes faced by the growing older adult population, where a key aspect to achieving healthy aging is the preservation of functional fitness. This study aims to present trends on the functional fitness of Portuguese older adults between 2008 and 2018 and build new normative reference standards for the Senior Fitness Battery Tests., Design: Cross-sectional study., Methods: Functional fitness was measured with the Senior Fitness Battery Tests in two national representative cohorts of the Portuguese older adult population (≥65 years) using the 2008 (n = 4712) and 2018 (n = 2717) surveys. Changes were assessed according to sex and age group. Sex and age-group normative fitness scores were developed., Results: Overall findings suggested that older adults' point prevalence for arm-curl, 8-ft up-and-go, and 30-s chair sit-to-stand remained stable between 2008 and 2018, with declining trends being observed for the 6-min walk and back-scratch tests. However, results for trends varied when stratified by sex and age categories., Conclusions: Our results suggest a trend toward a stabilization of most of the functional fitness tests over the past decade, but with a critical decline in the 6-min walk test. Thus, this test should be targeted by future health-care policies. Moreover, this investigation provides new and updated normative reference standards for the Senior Fitness Battery Tests that should be used as a tool to promote a healthy aging process among Portuguese older adults., Competing Interests: Declaration of interest statement None., (Copyright © 2023. Published by Elsevier Ltd.)

This investigation aimed to describe the current physical fitness (PF) status of Portuguese youth, compare secular trends from 2008 and 2018, and establish updated age- and sex-specific percentile values for distinct PF tests. In 2008 and 2018, 22 048 and 8960 children and adolescents (10-18 years) were included in two national cross-sectional investigations. PF was evaluated using the FITESCOLA® battery tests and the handgrip strength test. Independent sample t-tests and chi-squared tests were used to model the results. Weight smoothed percentile values were calculated using Cole's Lambda-Mu-Sigma (LMS) method. All analyses were weighted according to age, sex, and geographic region. In 2018, boys surpassed girls in the 20-m shuttle run, curl-ups, push-ups, standing long, and vertical jump tests, while girls performed better in the sit-and-reach (p < 0.05). The percentage of boys and girls meeting the healthy zone in the 20-min shuttle run test did not differ between 2008 and 2018 (p ≥ 0.05). In boys, a higher percentage fell in the healthy zone for the curl-up and push-up tests in 2018 compared to 2008 (85.8% vs. 83.4%, and 57.8% vs. 53.8%; p < 0.05). Girls improved their flexibility component (sit-and-reach test), with a higher percentage meeting the healthy zone in 2018 (32.6% vs. 36.9%; p < 0.05); an opposite trend was seen for boys (65.5% vs. 50.1%; p < 0.05). The present investigation provides new and updated PF percentile curves for Portuguese youth, which can be used as a general overview of the current PF state among the Portuguese young population., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: Assessment of trends in physical activity (PA) and sedentary time (ST) is important for evaluating the effectiveness of national policies and setting goals to improve population PA. This study describes changes in measured PA and ST through motion sensors of the Portuguese population from 2008 to 2018., Methods: PA and ST were measured with accelerometry from individuals (≥10 yr) participating in the 2008 ( n = 4 532) and 2018 ( n = 6 369) Portuguese PA Surveillance Systems. Changes were analyzed using generalized linear and logistic models adjusted for accelerometer wear time. A weight factor was applied to all analyses in order to achieve national representativeness of the present results., Results: In 2018, 15.4%, 71.2%, and 30.6% of Portuguese youth, adults, and older adults met the PA recommendations. Compared with 2008, the percentage meeting the PA guidelines increased in youth females (4.7% vs 7.7%, P < 0.05) and adult males (72.2% vs 79.4%, P < 0.05). A decrease in ST was observed for adult males, whereas ST increased in all youth. Male youth decreased the number of breaks in ST (BST per hour), whereas a favorable increase was found for both adult and older adult males and females., Conclusions: PA has remained fairly stable between 2008 and 2018 for all groups, except for youth females and adult males. For ST, a favorable decrease was observed for adult males; however, an inverse trend was found in youth. These results are relevant for policy makers to develop health care policies aimed at promoting PA and reducing ST across all age-groups., (Copyright © 2023 by the American College of Sports Medicine.)

We examined the construct validity and reliability of the previously developed Psychological and Social modules of the Portuguese Physical Literacy Assessment Questionnaire (PPLA-Q) using Mokken Scale Analysis in a sample of 508 Portuguese adolescents in public schools in Lisbon. We used a retest subsample ( n = 73) to calculate the Intraclass Correlation Coefficient. Eight PPLA-Q scales can be interpreted as moderate-to-strong Mokken scales (H = .47-.66) with good total-score reliability (ρ = .83-.94), and moderate-to-excellent test-retest reliability (ICC 95%CI = .51-.95); four scales had an interpretable invariant item ordering. All but the Physical Regulation scale functioned similarly across sex. Scale-scores correlated as expected, with low-to-moderate correlations across domains supporting convergent and discriminant validity. These results support the construct validity and reliability of the PPLA-Q to assess the psychological and social domains of physical literacy in Portuguese adolescents (15-18 years) enrolled in physical education.

Background: The lack of instruments to assess the level of physical activity in pregnant women, led to the development of the PPAQ (Pregnancy Physical Activity Questionnaire), a self-administered questionnaire, which has already been translated in several countries and has already been used in several studies., Aim(s): Translate and adapt the PPAQ into Portuguese and test its reliability and validity., Methods: An analytical observational study was carried out. Linguistic and semantic equivalence was performed through translation and back-translation and content validity was tested by a panel of experts. To test reliability, a test-retest was performed on a sample of 184 pregnant women, with an interval of 7 days and the ICC was used. To test the criterion validity, Pearson's correlation coefficient (r) was used between the PPAQ and the accelerometer, in a sample of 226 pregnant women., Findings: The questionnaire was considered comprehensive. The ICC values of Reliability were: total score (0.77); sedentary activities (0.87); light-intensity activities (0.76); moderate-intensity activities (0.76); vigorous-intensity activities (0.70). For criterion validity was obtained a coefficient correlation of r = -0.030, considered weak and negative, for total activity., Discussion: This study describes the translation and validation process of the PPAQ questionnaire from English to Portuguese. The final version of the PPAQ was considered as a valid instrument in terms of content to measure physical activity and was referred to as being simple to apply and easy to understand., Conclusion: The PPAQ has content validity, excellent reliability and weak criterion validity, as in the original version., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Santos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In recent years, the number of pregnant women with obesity has increased exponentially; thus, it is important to evaluate and characterize the physical activity levels of this specific group. The aim of this study is to evaluate the reliability and validity of the Portuguese version of the Physical Activity and Pregnancy Questionnaire and Pregnancy Questionnaire in pregnant women with obesity and to classify physical activity using the Physical Activity and Pregnancy Questionnaire and accelerometry. An analytical observational study was carried out between May and August of 2019 at the University Hospital Center of São João, with a sample of 31 pregnant women with obesity (30.9 ± 4.6 years 36.5 ± 4.6 kg/m 2 of BMI and 21.5 ± 9 gestational weeks). The physical activity of participants was evaluated using an accelerometer and Physical Activity and Pregnancy Questionnaire at two time points (the first visit at the moment of consultation and the second seven days after, with accelerometer retest), the interclass correlation coefficient was used to test reliability between the Physical Activity and Pregnancy Questionnaire filled out at visit1 and the Physical Activity and Pregnancy Questionnaire filled out at visit2, and Pearson's correlation was used to determine validity between the Physical Activity and Pregnancy Questionnaire and accelerometry. The interclass correlation coefficient values for total activity were 0.95, 0.97 for moderate and 0.58 for vigorous intensities. It ranged from 0.74 for sports/exercise to 0.96 for domestic activities. The Pearson's correlations showed that the Physical Activity and Pregnancy Questionnaire is moderately valid for moderate intensity (r = 0.435). A total of 67.7% of the pregnant women complied with international physical activity recommendations.

Background: Identifying muscle weakness is challenging, because the reduction of strength with aging does not depend only on sarcopenia, but also on sensorimotor deficits. Nevertheless, this identification is improved by adjusting muscle strength allometrically, by removing the influence of body size. However, the effectiveness of foreign models to normalize these (dys)functionalities is not yet tested. This study aimed to compare and apply foreign allometric exponents for normalizing isokinetic knee extension strength in Portuguese older adults to identify muscle weakness/mobility limitation. Additionally, to attest any populational difference, data of these people and Brazilian older adults were compared METHODS: This is a cross-sectional study encompassing 226 Portuguese (n = 132) and Brazilian (n = 94) older adults. Mobility limitation (six-minute walk test, at lowest quartile), lower limb strength (knee extension isokinetic strength at 60º/s), and body dimensions measures were taken. Foreign allometric exponents ( b ) were used to normalize Portuguese strength (strength/body-size variables b ). Non-normalized and normalized strength were compared (ROC) to generate the most accurate cut-point for identifying muscle weakness/mobility limitation., Results: Older Portuguese men and women had better mobility than their Brazilian counterparts. Older Portuguese women had superior muscle strength to Brazilian women. Normalization from 11 foreign models removed the influence of body size on muscle strength, with a negligible correlation (r ≤ 0.30). In contrast to the non-normalized strength, the normalized strength cut-off points were sufficiently accurate (AUC ≥ 0.70) to avoid identifying false-negative cases of weakness/mobility limitation., Conclusions: Portuguese older women were stronger and had superior functional capacity compared to Brazilian ones. Normalized foreign models improved the accuracy in identifying muscle weakness/mobility limitation in Portuguese older adults. The isokinetic knee extension muscle strength normalized, even using foreign allometric exponents, should be better than no adjustment., (© 2022. The Author(s).)

Objectives: The primary aim of this study was to describe a Portuguese nationwide epidemiological perspective on the use of electroconvulsive therapy (ECT) in hospitalized psychiatric patients. The secondary aims of the study were to characterize clinical and sociodemographic trends of hospitalized patients treated with ECT., Methods: A retrospective-observational study was conducted using an administrative database gathering every registered Portuguese public hospital hospitalizations from 2008 to 2015. We selected all hospitalizations with a procedure code 94.27 (Other electroshock therapy) defined by the International Classification of Diseases version 9, Clinical Modification. Variables included birth date, sex, address, primary and secondary diagnoses, admission/discharge date, length of stay, and discharge status from each single hospitalization episode. We also calculated Portugal's inpatient ECT prevalence rate (iP%)., Results: There were a total of 879 registered hospitalizations with ECT within the 8-year period of this study. Most occurred in female patients (53.4%), belonging to the age group of 51 to 70 years old, with a mean age of 50.5 years. The median length of stay was 43.0 days with an interquartile range of 27.0 to 68.0. The most frequent primary diagnosis was major depressive disorder, recurrent episode, representing 19.6% of all hospitalizations. The iP% for the study period was 0.71%., Conclusions: In Portugal, most of the patients who received ECT were women above middle age, and depressive disorders were the most common indication. Portugal's iP% represents a low rate when compared with other European countries, which might indicate an underutilization of ECT in Portuguese psychiatric hospitals., Competing Interests: The authors have no conflicts of interest or financial disclosures to report., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The Portuguese Physical Literacy Assessment (PPLA) is a novel tool to assess high-school students' (grade 10-12; 15-18 years) Physical Literacy (PL) in Physical Education (PE); inspired by the four domains of the Australian Physical Literacy Framework (APLF), and the Portuguese PE syllabus. This paper describes the development, content validation, and pilot testing of the PPLA-Questionnaire (PPLA-Q), one of two instruments in the PPLA, comprised of modules to assess the psychological, social, and part of the cognitive domain of PL., Methods: Development was supported by previous work, analysis of the APLF, and literature review. We iteratively gathered evidence on content validity through two rounds of qualitative and quantitative expert validation (n = 11); three rounds of cognitive interviews with high-school students (n = 12); and multiple instances of expert advisor input. A pilot study in two grade 10 classes (n = 41) assessed feasibility, preliminary reliability, item difficulty and discrimination., Results: Initial versions of the PPLA-Q gathered evidence in favor of adequate content validity at item level: most items had an Item-Content Validity Index ≥.78 and Cohen's κ ≥ .76. At module-level, S-CVI/Ave and UA were .87/.60, .98/.93 and .96/.84 for the cognitive, psychological, and social modules, respectively. Through the pilot study, we found evidence for feasibility, preliminary subscale and item reliability, difficulty, and discrimination. Items were reviewed through qualitative methods until saturation. Current PPLA-Q consists of 3 modules: cognitive (knowledge test with 10 items), psychological (46 Likert-type items) and social (43 Likert-type items)., Conclusion: Results of this study provide evidence for content validity, feasibility within PE setting and preliminary reliability of the PPLA-Q as an instrument to assess the psychological, social, and part of the cognitive domain of PL in grade 10 to 12 adolescents. Further validation and development are needed to establish construct validity and reliability, and study PPLA-Q's integration with the PPLA-Observation (an instrument in development to assess the remaining domains of PL) within the PPLA framework., (© 2021. The Author(s).)

Objectives: To analyse the prevalence and association between metabolic syndrome (MetS), clustered cardiometabolic risk (CCMR), obesity (body mass index [BMI], fat mass [FM] and waist circumference [WC]), and cardiorespiratory fitness (CRF); and to assess whether obesity (BMI, FM, and WC) acts as a mediator between CRF and MetS or CCMR., Methods: This cross-sectional study included a subsample of the AFINA-te Study (n = 209; 11.51 ± 0.72 years old). BMI, FM, and WC were assessed. The Course-Navette test was used to assess CRF. MetS was calculated following the International Diabetes Federation (IDF) definitions, and assessed using WC, triglycerides (TGs), high density lipoprotein (HD), fasting glucose (FG), and systolic and diastolic blood pressures (SBP/DBP). CCMR was calculated based on the sex and age-specific z score., Results: The prevalence of overweightness, obesity, MetS, and CCMR were 17.22, 1.44, 5.74, and 18.36%, respectively. After including BMI, FM, or WC into the model, the association between CRF and MetS was no longer significant, and the association between CRF and CCMR was only significant when it was mediated by BMI (β = -0.006; p = 0.026). The rest of the analysis of the mediation did not show a direct effect, although a significant indirect effect with a significant value for the Sobel test was observed (all p < 0.001)., Conclusions: BMI, FM, and WC act as full mediators in the association between CRF and MetS; FM and WC act as full mediators in the association between CRF and CCMR; and BMI acts as a partial mediator. The use of FM or WC as obesity variables is recommended., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Background: To examine the associations between motor competence (MC), moderate to vigorous physical activity (MVPA), and body mass index (BMI) changes over 1 year in preschoolers., Methods: Fifty-four preschoolers (24 girls; 42.4%) aged 4-5 years old from the metropolitan area of Porto, Portugal comprised the sample. Height, body mass, and BMI were calculated. MC was assessed according to the Movement Assessment Battery for Children-2. MVPA was measured by accelerometry. For each participant, changes in MVPA, MC, and BMI over a year were computed. Different levels of MC were calculated; and then data were analyzed., Results: The MVPA increased over time in all levels of MC in the follow-up. The BMI decreased over time for all levels in follow-up (P = .001). The preschoolers classified as at a high level of MC were more likely to spend more time in MVPA (in minutes) than their counterparts with low MC in follow-up. Multiple linear regression analyses, adjusted by sex and age, were fit to predict Δ% MC by Δ% MVPA and Δ% BMI. The Δ% MC was positively associated with Δ% MVPA., Conclusion: Increases in MC were positively associated with MVPA. Higher performance in MC increases due to time spent in MVPA. Improvement of MC in young children has potentially relevant policy implications related to MVPA and public health.

ABSTRACT Physical activity (PA) and sedentary behaviours (SB) influence health. Since most people engage in different combinations of both behaviours every day, understanding the socio-demographic characteristics of adults with distinct PA and sitting time (ST) patterns is important to contribute to evidence-based planning of public health strategies. Data from a national survey on diet and activity behaviours (IAN-AF, 2015/16) including 1724 adults (50.5% women, 18-64 years) from a representative sample of Portuguese adults was used in this study. Participants were interviewed face-to-face, and the International Physical Activity Questionnaire (IPAQ) was used. Logistic regression examined the associations between socio-demographic factors each of the four-low/high PA-ST groups. PA low/high categories were defined as in IPAQ, while ST low/high categories were defined according to ST tertiles (≤180 min/day, ≥360 min/day). A 'higher risk' behaviour pattern (low PA/high ST) was present in 37.3% of the adults and was likely associated with a middle household income, and with having 12 or more years of education. The 'lower risk' (high PA/low ST) represented 26.6% of the sample and was likely associated with middle-aged adults and with having a lower educational level. Being male, young and highly educated was related to being physically active and spending large amounts of time in ST. Besides adding to the body of mixed evidence on this theme, the identification of the socio-demographic factors associated with each PA/ST pattern will permit national public health authorities to define policies and tailored actions to promote PA and reduce ST.

Background and Aims: Several cross-sectional, but few prospective, studies suggest that inflammation may be involved in the development of high blood pressure. We examined markers of inflammation for their associations with blood pressure levels over a two-year period in healthy adolescents., Methods and Results: The sample comprised 406 adolescents (209 girls) aged 12-18 years in the LabMed Physical Activity Study were followed-up for 2 years. Anthropometric (weigh, height, BMI), markers of inflammation (high sensitivity C-reactive protein, complement factors C3 and C4, fibrinogen, leptin and adiponectin) and ambulatory blood pressure (BP) were collected. Socioeconomic status, pubertal development, adherence to Mediterranean diet and cardiorespiratory fitness were measured for adjustment for potential confounders. Adjusted linear regression models revealed a significant association of Leptin/Adiponectin (L/A) Ratio (baseline) with systolic BP (β = 0.120; p < 0.034) and with diastolic BP (β = 0.125; p < 0.036) at follow-up (full adjusted model). Leptin was associated with systolic BP at follow-up (β = 0.102; p < 0.038) after adjustment for systolic BP at baseline, height, pubertal stage, socioeconomic status, adherence to Mediterranean diet, cardiorespiratory fitness, however, not independently of BMI., Conclusion: L/A ratio was positively associated with systolic BP and diastolic BP even after adjusting confounding variables. Therefore, a higher misbalance between leptin and adiponectin (higher L/A ratio) early adolescence may exert a negative effect BP levels in late adolescence regardless of several confounders factors., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2020. Published by Elsevier B.V.)

Purpose: The 24-Hour Movement Guidelines (24 hMG) provide specific recommendations, including physical activity (PA), screen-time and sleep-duration, which preschoolers should achieve for a healthy day (24 h). The aim of the current study was to analyse preschooler's adherence with the 24-Hour Movement Guidelines., Methods: The sample comprised 739 preschool children. PA was accelerometer-derived. Screen time and sleep duration were parent-reported through questionnaires. Preschoolers were classified as meeting/not meeting in each guideline and as well as for the overall 24hMG., Results/findings: According to the 24hMG, we found high percentages of preschoolers that met sleep guidelines (80.6%), only around 1/3 of preschool children met PA (28.6%) and a lower proportion met screen-time guidelines (20.3%). We found that 31.7% of the children met at least 2 of the recommendations and that more than half only one (52.8%). Overall, 4.5% of preschool children complied with the 24hMG and 11.1% of the children did not comply with any of the three recommendations., Conclusions: Few preschoolers met PA and screen-time recommendations, which deeply impacts the preschooler's adherence to the 24hMG. Future work should focus on finding solutions for promoting better adherence and mainly identifying ways to reduce screen time and increase PA at these ages.

Background and Aim: This study aimed to: i) examine the differences in insulin resistance (IR) across adiposity levels; and ii) ascertain whether high levels of adiponectin attenuate the detrimental association of adiposity with IR in adolescents., Methods and Results: A total of 529 adolescents aged 12-18 years participated in this cross-sectional study (267 girls). Anthropometry and body adiposity parameters [body mass index (BMI), sum of skinfolds, body fat percentage (BF %) by bio-impedance analysis and waist circumference (WC)], were measured according to standardized procedures and categorized into age- and sex-specific quartiles. Socioeconomic status, pubertal stage and lifestyle determinants (Mediterranean diet adherence and cardiorespiratory fitness) were gathered and used as confounders. Serum adiponectin and IR (homeostasis model assessment of insulin resistance [HOMA-IR] estimated from fasting serum insulin and glucose were assessed. Analysis of covariance (ANCOVA) showed that HOMA-IR increased in a linear fashion throughout the quartiles of all adiposity measures (p < 0.001 for all), independently of age, sex, pubertal stage, socioeconomic status, adherence to the Mediterranean diet and cardiorespiratory fitness. Two-way ANCOVA showed that adolescents in the higher quartile of adiposity for BF%, BMI, WC and skinfolds sum (Q4) presented the highest adiponectin levels, and had 0.77 Standard Deviation (SD), 0.8 SD, 0.85 SD and 0.8 SD lower HOMA-IR, respectively (p < 0.01) than their low adiponectin group counterparts, after adjustments for potential confounders., Conclusion: Higher adiponectin levels may attenuate the detrimental association between adiposity and IR, particularly in subjects with higher adiposity., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest relevant to this article to disclose., (Copyright © 2020 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Objective: The purpose of this study was to examine the longitudinal associations between cardiorespiratory fitness and health-related quality of life (HRQoL) in a sample of adolescents, and to determine whether changes in cardiorespiratory fitness were associated with HRQoL over a 2-year follow-up., Methods: This is a longitudinal analysis with 571 Portuguese adolescents (274 boys and 297 girls) aged 12-18 years. HRQoL was measured with the Kidscreen-10 questionnaire; the 20 m shuttle-run was used to estimate cardiorespiratory fitness; socioeconomic status was assessed with the Family Affluence Scale; and pubertal stage was assessed with Tanner stages. Linear regression and analysis of covariance (ancovas) were used to examine the associations between cardiorespiratory fitness and HRQoL., Results: HRQoL decreased over a 2-year period both in boys and girls (P < .05). Moreover, girls at baseline and at follow-up reported significantly lower HRQoL values than boys (between subjects P < .001). After adjustments for potential confounders, regression analyses showed significant cross-sectional associations between cardiorespiratory fitness and HRQoL both at baseline (B = 0.095; P = .023) and at follow-up (B = 0.090; P = .012). ancova showed that adolescents whose cardiorespiratory fitness decreased over time exhibited lower scores of HRQoL at follow-up, compared to those with persistent high cardiorespiratory fitness; this held after adjustments for age, sex, socioeconomic status, and pubertal stage., Conclusions: Changes in cardiorespiratory fitness during adolescence were associated with HRQoL over a 2-year period. This study suggests that improving cardiorespiratory fitness could be an important strategy in improving the HRQoL of adolescents., (© 2019 Wiley Periodicals, Inc.)

Purpose: Low-grade inflammation leads to several metabolic disorders, and adherence to a Mediterranean diet (MedDiet), cardiorespiratory fitness (CRF), and muscular fitness (MF) has been considered important markers of metabolic healthy in youth. We investigated the combined association of adherence to Mediterranean diet, and muscular and cardiorespiratory fitness on high-sensitivity C-reactive protein (hs-CRP) in adolescents., Methods: This is a cross-sectional analysis with 1462 adolescents (625 girls) aged 9-18 years from Colombia and Portugal. MedDiet was assessed by Kidmed questionnaire. Shuttle run test was used to assess CRF. MF was assessed by the standing long-jump and handgrip tests. High-sensitivity assays were used to obtain the hs-CRP level., Results: Logistic regression shows that subjects with a low adherence to MedDiet and LowMF/LowCRF had a similar odds (OR = 2.3; 95% CI 1.2-4.0) as those with an optimal adherence to MedDiet and LowMF/LowCRF (OR = 2.3; 95% CI 1.2-5.0) of expressing high inflammatory profile when compared to those with an optimal adherence to MedDiet and HighMF/HighCRF. In addition, ANCOVA showed that subjects classified as high adherence to MedDiet and HighMF/HighCRF had, on average, the lowest levels of hs-CRP (F (7,1454)  = 2.051 p = 0.04)., Conclusion: The combination of optimal levels of CRF and MF and adherence to MedDiet is associated with lower hs-CRP. However, high MF and CRF seems to counteract the deleterious effect of having a low adherence to the MedDiet on hs-CRP levels.

This study aimed to investigate the association between dairy product consumption and metabolic and inflammatory biomarkers in Portuguese adolescents, and whether the association differed by weight status. A cross-sectional study was conducted during the school year 2011/2012 with 412 Portuguese adolescents (52.4% girls) in 7th and 10th grade (aged 12 to 18 years old). The World Health Organization cutoffs were used to categorize adolescents as non-overweight (NW) or overweight (OW). Blood samples were collected to analyze C-reactive protein (CRP), interleukin-6 (IL-6), leptin, and adiponectin. Dairy product intake was evaluated using a food frequency questionnaire. Participants were divided by tertiles according to the amount of dairy product consumed. The associations between dairy product consumption with metabolic and inflammatory biomarkers were evaluated using generalized linear regression models with logarithmic link and gamma distribution and adjusted for potential confounders. The majority of adolescents were NW (67.2%). NW adolescents had lower IL-6, CRP, and leptin concentration than their counterparts ( p < 0.05, for all comparisons). Higher levels of total dairy product and milk intake were inversely associated with IL-6 (P for trend <0.05, for all) in NW adolescents, but not in OW adolescents. NW adolescents in the second tertile of yogurt consumption had lower level of IL-6 compared to those in the first tertile ( p = 0.004). Our results suggest an inverse association between total dairy product and milk intake and serum concentrations of IL-6 only among NW adolescents.

Background and Aims: The long-term relations between excessive adiposity in early childhood and unfavourable cardiometabolic profiles in later ages are not yet completely understood. We aimed to assess the associations between birth weight (BW) and BMI from 6 months to 6 years of age, with biomarkers indicative of low-grade inflammation, insulin resistance and lipid profiles in adolescence., Methods and Results: Retrospective school-based study with 415 Portuguese adolescents (220 girls), mean age of 14.08 ± 1.6 years old. Anthropometric data from birth to 6 years old was extracted from individual child health book records. Actual weight and height were measured and BMI calculated. Participants were classified at each time point as normal weight or overweight according to WHO reference values. Biomarkers were obtained from venous blood samples. Linear regressions were used to explore the associations between the biomarkers and early life anthropometric indicators. From 2 years onwards, BMI associated positively with the inflammatory score and HOMA-IR in adolescence. Children who were overweight/obese from 2 to 6 years of age presented significantly higher inflammatory score and HOMA-IR later in adolescence. TC/HDL ratio was also positively associated with BMI from the age of 5 years onwards. The associations between BMI and cardiometabolic outcomes remained positive in adolescence, with overweight adolescents presenting a higher inflammatory score, HOMA-IR and TC/HDL than normal weight adolescents., Conclusion: A high BMI from an early age was consistently associated with worse inflammatory and lipid profiles and insulin resistance in adolescence. No associations were found between BW and the same studied outcomes., (Copyright © 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. All rights reserved.)

Objective: The main aim of the present study was to examine the association between the Dietary Inflammatory Index (DII®) and academic performance in children., Design: School-based cross-sectional study. The DII was calculated based on dietary information obtained from a single 24h dietary recall. Academic performance was assessed by school records provided by the administrative services (i.e. Maths and Language)., Setting: Porto area (Portugal)., Subjects: A total of 524 children (277 girls) aged 11·56 (sd 0·86) years., Results: The DII was associated with academic indicators (standardized β values ranging from -0·121 to -0·087; all P<0·05). Significant differences were found between quartiles of the DII (P<0·05); children in the fourth quartile had significantly lower scores in all academic indicators compared with children in the first quartile (score differences ranging from -0·377 to -0·292) after adjustment for potential confounders., Conclusions: The inflammatory potential of diet may negatively influence academic performance. Children should avoid the consumption of a pro-inflammatory diet and adhere to a more anti-inflammatory diet to achieve academic benefits.

Background and Aims: The associations between fruit and vegetable consumption and high blood pressure among adults are well studied. Nonetheless, data on the influence of a low consumption of fruit and vegetables on cardiovascular disease risk, particularly blood pressure, among healthy adolescents are scarce. Therefore, we aim to analyse the associations between fruit and/or vegetable intake and blood pressure over a two-year period in healthy adolescents., Methods and Results: As part of a cohort, 606 adolescents from the LabMed Physical Activity study were evaluated in 2011 (baseline) and 2013 (follow-up). Blood pressure was measured according to standardized procedures and fruit and vegetable consumption was assessed with a food frequency questionnaire. Anthropometric variables, socioeconomic status, pubertal stage and lifestyle determinants were gathered and used as confounders. Prospective associations between fruit and/or vegetable intake and blood pressure were examined using generalized linear models. Girls who consumed more fruit at baseline had a significant decrease in diastolic blood pressure at follow-up [unstandardized beta: -0.005 mmHg (95%CI: -0.01; -0.0002) (p = 0.038)]., Conclusion: In apparently healthy adolescents, fruit intake may already start to have an effect in blood pressure. Girls who consumed more fruit exhibited lower levels of diastolic blood pressure., (Copyright © 2018 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Purpose: The dietary guidelines for the consumption of a variety of fruits and vegetables have been recognized as an important factor for achieving healthy eating patterns to reduce the risk of chronic disease throughout the lifespan. Our aim is to assess the association between fruit and vegetable variety and low-grade inflammation in adolescents., Methods: This cross-sectional analysis was conducted with 412 adolescents (ages 14.4 ± 1.7 years; 52% girls). The consumption of a variety of fruits and vegetables was assessed with a food-frequency questionnaire, considering the number of individual/category of fruit or vegetable intake at least once month, and categorized into tertiles. Blood samples were collected to determine C-reactive protein (CRP), interleukin-6 (IL-6), complement component 3 (C3), and 4 (C4). We created categories of lower or higher (inflammatory state) for each biomarker, considering sex- and age-adjusted median values. Then, we computed an overall inflammatory score, by adding all points awarded wherein one point was assigned if biomarker was higher or zero if lower, and created categories of 0-1 or 2-4 biomarkers above the median. The odds ratio (OR) and 95% interval confidence (95% CI) were calculated from binary logistic regression to estimate the magnitude of association between fruit and vegetable variety and inflammatory biomarkers., Results: Adolescents with a greater variety of vegetable consumption (≥13 categories/month) had lower odds of having a higher CRP (OR 0.31, 95% CI 0.15-0.64, p trend  = 0.004) when compared to those with lower variety consumption (≤6 categories/month), independent of vegetable quantity intake. However, a greater variety of fruit consumption (≥12 categories/month) had higher odds of having a higher IL-6 (OR 4.41, 95% CI 1.67-11.71, p trend  = 0.012), C3 (OR 3.30, 95% CI 1.23-8.86, p trend  = 0.047), and inflammatory score (OR 4.90, 95% CI 1.62-14.86, p trend  = 0.017), when compared to those with lower variety consumption (≤9 categories/month), independent of fruit quantity intake, only for girls., Conclusions: The consumption of a variety of vegetables is inversely associated with lower CRP. This finding supports the current dietary guidelines regarding the consumption of a variety of vegetables. The role of fruit variety in low-grade inflammation should be further studied.

Background: Physical fitness (PF) and adherence to the Mediterranean diet are important indicators of healthy lifestyles. The purpose of this study is to analyze the independent and combined associations between PF and adherence to Mediterranean diet with health-related quality of life (HRQoL) in adolescents., Methods: This is a cross-sectional analysis with 956 Portuguese adolescents aged 12-18 years. HRQoL was measured with the Kidscreen-10 questionnaire. PF was assessed with the ALPHA health-related fitness battery. The 20-m shuttle run test was used for the estimation of cardiorespiratory fitness; handgrip strength and standing long jump tests were applied for the assessment of muscular fitness and the 4 × 10 m shuttle run test for the assessment of motor fitness (speed and agility). The results of the PF tests (cardiorespiratory fitness, muscular fitness and motor fitness) were transformed into standardized values (Z-scores) by age and sex. Adherence to the Mediterranean diet was assessed with the KIDMED index. Regression analysis and analysis of covariance were performed., Results: PF (B = 0.228; P < 0.05) and adherence to the Mediterranean diet (B = 0.259; P < 0.05) were positively associated with HRQoL, after controlling for several variables. Participants classified as high PF and high adherence to Mediterranean diet had on average the highest HRQoL score compared with those with low PF and low adherence to Mediterranean diet (F(3, 939) = 4.270; P = 0.005), after adjustments for potential confounders., Conclusions: The combination of high PF levels and optimal adherence to Mediterranean diet is positively associated with HRQoL.

Purposes: To examine the association between sedentary time (ST) and light physical activity (LPA), moderate- to vigorous-intensity physical activity (MVPA), and body mass index (BMI), and to track these behaviors over a 3-year follow-up in young schoolchildren., Methods: The final sample was 64 children (female: n = 36 or 56.3%), enrolled in schools in Porto, Portugal. Height and mass of children were measured by standard methods, and BMI was then calculated. ST, LPA, and MVPA were measured by accelerometer. Changes (Δ) and relative changes (Δ%) between 2009/2010 and 2012/2013 of ST, LPA, MVPA, and BMI were computed. Multiple linear regression analyses were fit to predict Δ%ST (outcome variable), by Δ%LPA, Δ%MVPA, and Δ%BMI (exposure variables)., Results: ST increased and LPA decreased significantly for whole sample (both Ps < .05). No statistically significant difference was found for MVPA over time. There were no differences for ΔST, ΔLPA, ΔMVPA, and ΔBMI between boys and girls. The Δ%LPA and Δ%MVPA were negatively associated with Δ%ST, whereas Δ%BMI was positively associated. Tracking coefficients varied from moderate to strong., Conclusions: Time spent in ST increases due to displacement of time in LPA. This reinforces public health measures and suggests the need for interventions focusing on offsetting the decline ST and increasing MVPA during childhood.

The aims of this study were to examine the longitudinal association between muscular fitness (MF) and blood pressure (BP) 2 years later, and to determine whether changes in MF over a 2-year period were associated with BP at follow-up, in adolescents. The sample comprised 734 youths (349 girls) aged from 12 to 18 years. MF was assessed with the standing long jump and handgrip tests. Socioeconomic status, pubertal stage, waist circumference, resting BP, and cardiorespiratory fitness were measured according to standard procedures. Regression analyses showed a significant inverse association between MF at baseline and systolic BP (β = - 0.072; p = 0.032) and rate pressure product (β = - 0.124; p < 0.001) at follow-up, after adjustments for age, sex, height, pubertal stage, and socioeconomic status. However, when analyses were further adjusted for waist circumference and cardiorespiratory fitness, these associations did not remain significant. Adolescents with persistently high and increasing MF exhibited the lowest levels of diastolic BP (F (3, 721)  = 3.814, p = 0.018) and systolic BP (F (3, 721)  = 3.908, p = 0.014) when compared to those with persistent low MF after adjustment for age, sex, height, socioeconomic status, cardiorespiratory fitness, and waist circumference.Conclusion: This study suggests that persistent greater and increasing MF in youth are associated with lower levels of BP across the adolescence. What is Known: • Currently, there is a growing interest on the health benefits of muscular fitness. • Cross-sectional studies have identified an association between muscular fitness and blood pressure in adolescents. What is New: • Changes in muscular fitness during adolescence were associated with systolic and diastolic BP over a 2-year period. • Adolescents with persistently low muscular fitness exhibited the highest levels of diastolic and systolic BP.

Purpose: Then objective of this study was to evaluate the ability of several nontraditional cardiometabolic and inflammatory biomarkers in identifying high cardiometabolic risk in adolescents., Methods: A cross-sectional study was conducted with 529 Portuguese adolescents (267 girls) aged 14.3 ± 1.7 years. A clustered cardiometabolic risk score (body fat percentage, systolic blood pressure, ratio of total cholesterol to high-density lipoprotein cholesterol, triglycerides, homeostatic model assessment of insulin resistance, and negative values of cardiorespiratory fitness) was computed. The nontraditional cardiometabolic biomarkers assessed were complement factors (C3 and C4), C-reactive protein (CRP), fibrinogen, leptin, white blood cells (WBCs), albumin, interleukin-6, and a clustered score of inflammatory biomarkers (InflaScore) (C3, C4, CRP, fibrinogen, and leptin)., Results: Receiver operating characteristic curves analyses showed that C3, C4, CRP, fibrinogen, leptin, and the InflaScore were able to present discriminatory ability in identifying an unfavorable cardiometabolic profile in both girls and boys (p <.01 for all). Logistic regression analyses showed that C3, C4, CRP, fibrinogen, leptin, the InflaScore (in both sexes), and WBC (boys) were associated with high cardiometabolic risk, independent of age, pubertal stage, socioeconomic status, or adherence to a Mediterranean diet (p <.05 for all)., Conclusions: C3, C4, CRP, fibrinogen, and leptin were associated with high cardiometabolic risk in both sexes and WBC in boys. In addition, the clustered inflammatory biomarkers seem to have a better diagnostic accuracy in identifying an unfavorable cardiometabolic profile than single biomarkers. Such biomarkers may have utility in motivating health professionals, public health workers, and adolescents' families toward lifestyle changes, improving prevention efforts early in life., (Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

BackgroundObesity is often associated with iron deficiency in children and adolescents. We aimed to study the effect of an 8-month physical exercise (PE) intervention on hepcidin and other markers of inflammation and on iron status in overweight/obese children and adolescents.MethodsSeventy-three overweight/obese children and adolescents participated in the 8-month-long longitudinal study. They were divided into two groups according to their participation in an after-school PE program: the PE group (n=44) and the control group (n=29). Hepcidin, interleukin (IL)-6, C-reactive protein (CRP), iron, ferritin, transferrin, and soluble transferrin receptor (sTfR) were evaluated.ResultsAt baseline, IL-6 correlated positively with hepcidin and negatively with iron and transferrin saturation, suggesting that increasing adiposity associates with increasing IL-6 and hepcidin synthesis, reducing iron availability. After 8 months, the PE group showed a decrease in BMI z-score (P=0.003), body fat mass (P=0.012), CRP (P=0.002), IL-6 (P=0.048), ferritin (P=0.013), hepcidin (P=0.040), and sTfR (P=0.010), and an increase in iron concentration (P=0.002). Moreover, the PE group, when compared with the control group, showed lower weight (P=0.026), BMI (P=0.040), waist circumference (P=0.010), and waist-to-height ratio (P=0.046).ConclusionWe showed that an 8-month-long intervention at school allowed a reduction in BMI z-score and an improvement in inflammation, reducing hepcidin levels and the disturbances in iron status.

Background and Aim: Muscular fitness and an adherence to the Southern European Atlantic Diet (SEADiet) have been inversely associated with cardiometabolic risk. Our aim was to assess the independent and combined associations of muscular fitness and adherence to the SEADiet on cardiometabolic risk in adolescents., Methods and Results: A total of 467 Portuguese adolescents (275 girls) participated in this cross-sectional study. Sum of the Z-Scores of Curl-Up and Push-Up tests was used to create a muscular fitness score. Adherence to SEADiet was obtained using a food frequency questionnaire. A cardiometabolic risk score was computed from sum of Z-score of triglycerides, systolic blood pressure, total cholesterol/HDL ratio, HOMA-IR and waist circumference. Adolescents with low muscular fitness and low adherence to the SEADiet had the poorest cardiovascular profile F (5, 452)  = 5.074 (p < 0.001) and the highest odds of having a high cardiometabolic risk score (OR = 4.5; 95% CI: 2.1-14) when compared to those with High muscular fitness/High adherence to the SEADiet after adjustments for age, sex, pubertal stage, socioeconomic status, total energy intake, low-energy reporter and cardiorespiratory fitness., Conclusions: Our findings seem suggest that improving muscular fitness as well as an adherence to the SEADiet could be an important strategy to reduce clustered cardiometabolic risk in youth., (Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Objective: To examine the combined effects of physical activity and weight status on blood pressure (BP) in preschool-aged children., Study Design: The sample included 733 preschool-aged children (49% female). Physical activity was objectively assessed on 7 consecutive days by accelerometry. Children were categorized as sufficiently active if they met the recommendation of at least 60 minutes daily of moderate-to-vigorous physical activity (MVPA). Body mass index was used to categorize children as nonoverweight or overweight/obese, according to the International Obesity Task Force benchmarks. BP was measured using an automated BP monitor and categorized as elevated or normal using BP percentile-based cut-points for age, sex, and height., Results: The prevalence of elevated systolic BP (SBP) and diastolic BP was 7.7% and 3.0%, respectively. The prevalence of overweight/obese was 32%, and about 15% of children did not accomplish the recommended 60 minutes of daily MVPA. After controlling for age and sex, overweight/obese children who did not meet the daily MVPA recommendation were 3 times more likely (OR 3.8; CI 1.6-8.6) to have elevated SBP than nonoverweight children who met the daily MVPA recommendation., Conclusions: Overweight or obese preschool-aged children with insufficient levels of MVPA are at significantly greater risk for elevated SBP than their nonoverweight and sufficiently active counterparts., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: This study examined the utility of the Ruiz et al. cut-points when examining body mass index (BMI) and resting blood pressure in young people., Methods: Two hundred fifty-six children (154 girls and 102 boys) aged 7-16 years underwent assessment of BMI, physical maturation, resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) and cardiorespiratory fitness using breath by breath gas analysis during treadmill testing to exhaustion., Results: Results from a series of 2 (fit vs. unfit) × 2 (gender) ways analysis of covariance, controlling for maturation indicated higher SBP in the unfit group compared to the fit group (P = 0.001), higher DBP in the unfit group compared to the fit group (P = 0.04) and higher BMI (in unfit) than fit children (P = 0.0001). Males had significantly higher BMI than females (P = 0.04). Maturation as a covariate was significantly and positively associated with SBP (P = 0.003), DBP (P = 0.004), and BMI (P = 0.001)., Conclusions: This study suggests that the Ruiz et al. cut-points are valid in distinguishing between children with higher and lower BMI and resting BP values., (© 2014 Wiley Periodicals, Inc.)

Objective: Public health organizations recommend that preschool-aged children accumulate at least 3h of physical activity (PA) daily. Objective monitoring using pedometers offers an opportunity to measure preschooler's PA and assess compliance with this recommendation. The purpose of this study was to derive step-based recommendations consistent with the 3h PA recommendation for preschool-aged children., Method: The study sample comprised 916 preschool-aged children, aged 3 to 6years (mean age=5.0±0.8years). Children were recruited from kindergartens located in Portugal, between 2009 and 2013. Children wore an ActiGraph GT1M accelerometer that measured PA intensity and steps per day simultaneously over a 7-day monitoring period. Receiver operating characteristic (ROC) curve analysis was used to identify the daily step count threshold associated with meeting the daily 3hour PA recommendation., Results: A significant correlation was observed between minutes of total PA and steps per day (r=0.76, p<0.001). The optimal step count for ≥3h of total PA was 9099 steps per day (sensitivity (90%) and specificity (66%)) with area under the ROC curve=0.86 (95% CI: 0.84 to 0.88)., Conclusion: Preschool-aged children who accumulate less than 9000 steps per day may be considered Insufficiently Active., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: The positive impacts of active travel on health markers still require further research, especially in youth populations with higher risk of obesity. The present study aimed to analyze the associations between blood pressure and adiposity risk (BPAR) and active travel to school in children., Methods: The sample comprised 665 Portuguese children (345 boys) aged 7-9 years. Data on height, weight, and skinfold thickness were collected by a trained fieldworker as well as data on BPAR between March 2009 and January 2010 (data were analyzed in 2012-2013). Information on mode and duration of travel to school (i.e. exposure) was gathered by questionnaire. Outcome variables were statistically normalized and expressed as Z scores. A BPAR score was computed as the mean of the Z scores. Multiple linear regression, with adjustments for confounders, was used., Results: Active commuting was inversely associated with BPAR after adjustment for several potential confounders. After adjusting for BMI, the strength of the relationship between BPAR and active commuting was significantly improved (p≤0.01)., Conclusions: Findings showed an independent association between the clustered BPAR and active commuting in children aged 7-9 years., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Few studies have reported associations between clustering metabolic risk factors and socioeconomic status (SES) in youth. This study aimed to analyze the association between clustering metabolic risk factors and SES in adolescents. It was hypothesized that SES is inversely related to clustering metabolic risk factors. This 2009 cross-sectional school-based study investigated 517 Portuguese adolescents ages 15-18 years. The study considered the age- and sex-adjusted z-scores for the ratio of total cholesterol/high-density lipoprotein, homeostasis model, triglycerides, and systolic blood pressure, and a metabolic risk score was constructed by summing all the z-scores (≥1 standard deviation was considered high risk). Cardiorespiratory fitness was estimated by the 20 m shuttle-run test and dietary intake by a food frequency questionnaire. The best of parental education was used as a proxy measure of SES. The results showed that adolescents with low SES were more likely to have a high metabolic risk score (odds ratio [OR], 1.96; p < 0.020) regardless of cardiorespiratory fitness, adherence to the Mediterranean diet, or pubertal stage. In conclusion, a lower SES was associated with increased risk for a high metabolic risk score among Azorean adolescents after adjustment for pubertal stage, adherence to the Mediterranean diet, and cardiorespiratory fitness. Future health-promotion strategies among Azorean adolescents should consider the impact of SES on their health.

Objective: The aim of this study was to investigate the association between self-efficacy, enjoyment, and volitional control with active commuting, as well as to analyze the impact of social support from parents, friends, and teachers with active commuting to school., Methods: Participants in this cross-sectional study were 625 students (male: 46.3%) aged 10 to 15years from Porto, Portugal (2010/2011). A questionnaire was used to assess active commuting to/from school (walk/cycle), self-efficacy, enjoyment, volitional control and social support. Binary logistic regression was performed to identify significant associations between targeted variables and active commuting., Results: The results show positive associations in crude analyses for all variables, except for enjoyment for walk/cycle to school. In the adjusted model, higher likelihood of active commuting was found among students who reported having higher self-efficacy (OR=2.10; CI95%: 1.07; 4.11) to walk/cycle to school as well as among adolescents who reported being encouraged by their parents (OR=3.66; CI95%: 1.55; 8.69), and having the partnership of friends in active journeys (OR=4.31; CI95%: 1.79; 10.37)., Conclusion: Self-efficacy, encouragement from parents and companionship from friends were important indicators of active commuting to school among Portuguese adolescents. These findings provide support for further research to identify and understand factors that predict and explain the active commuting., (Copyright © 2014 Elsevier Inc. All rights reserved.)

This cross-sectional study was designed to develop normative functional fitness standards for the Portuguese older adults, to analyze age and gender patterns of decline, to compare the fitness level of Portuguese older adults with that of older adults in other countries, and to evaluate the fitness level of Portuguese older adults relative to recently published criterion fitness standards associated with maintaining physical independence. A sample of 4,712 independent-living older adults, age 65-103 yr, was evaluated using the Senior Fitness Test battery. Age-group normative fitness scores are reported for the 10th, 25th, 50th, 75th, and 90th percentiles. Results indicate that both women and men experience age-related losses in all components of functional fitness, with their rate of decline being greater than that observed in other populations, a trend which may cause Portuguese older adults to be at greater risk for loss of independence in later years. These newly established normative standards make it possible to assess individual fitness level and provide a basis for implementing population-wide health strategies to counteract early loss of independence.

This study aimed to produce age- and sex-specific physical fitness reference data for Portuguese youth; to report the prevalence of youth in the healthy zone of physical fitness according to the FITNESSGRAM(®) criteria; to verify the agreement between the Portuguese physical fitness percentiles and the FITNESSGRAM(®) healthy zones. In 2008, 22,048 Portuguese children and adolescents (10-18 years) were evaluated. Physical fitness (curl-ups, push-ups, 20-m shuttle run and modified-back-saver-sit-and-reach tests) was evaluated using the FITNESSGRAM(®) Test Battery 8.0. Smoothed percentile curves were estimated using Cole's LMS method. Boys consistently outperformed girls in every physical fitness test, except for the modified-back-saver-sit-and-reach tests. In both sexes and for all physical fitness tests, higher percentile values were observed at older ages. The 50th percentile of all physical fitness tests had the highest accuracy to discriminate between under healthy zone and healthy zone of the FITNESSGRAM(®). Portuguese schools and physical education teachers may considerer the 50th percentile for age and sex or the FITNESSGRAM(®) criteria for classifying participants in the healthy zone as acceptable cut-offs, above which youth should be considered fit. These reference values can be used as normative data and for baseline values for subsequent surveillance of the physical fitness of Portuguese youth.

Objectives: To examine the efficacy of aerobic fitness thresholds in predicting weight status and cardiovascular disease risk (CVD) in young people., Methods: A cross-sectional school-based study was conducted on 414 Portuguese young people (235 girls and 179 boys) aged 10-16 years (Mean age ± SD = 13.6 ± 1. 8 years). Height and mass were assessed to determine body mass index (BMI). The 20 m multistage shuttle-fitness test (MSFT) was used as an estimate of aerobic fitness. Capillary blood sampling was used to determine: total cholesterol, triglycerides, high-, and low-density lipoprotein. These were combined with measures of systolic blood pressure as z-scores and summed to create a CVD risk score., Results: Analysis of covariance, controlling for sexual maturation, indicated a significant main effect for BMI as a result of fitness category (P = 0.0001). When applied to CVD risk data, there was no difference between "fit" and "unfit" groups (P = 0.136). Subsequent receiver operating curve (ROC) analysis indicated significant diagnostic accuracy of 20 mMSFT performance for boys and girls (both P = 0.0001) with subsequent cut-offs of estimated VO2 peak of 49.5 ml kg(-1) min(-1) for girls and 47.7 ml kg(-1) min(-1) for boys. When applied to BMI and CVD risk data, there was a significant main effect as a result of fitness category for BMI (P = 0.0001) and CVD risk score (P = 0.0001)., Conclusions: Recently established cut-points proposed by Boddy et al. (Boddy et al. [2012]: PLoS One 7(9): e45755) show validity in distinguishing between weight status but not CVD risk in Portuguese young people. Alternative ROC generated cut points significantly predicted BMI and CVD risk in this sample., (Copyright © 2013 Wiley Periodicals, Inc.)

Aim: The benefits of promoting physical activity (PA) in counteracting the high prevalence of childhood obesity have become increasingly important in the past decade. The aim of this study was to examine the association between compliance of daily PA recommendations and the risk of being overweight or obese in preschool-aged children., Methods: The sample comprised 607 children aged 4-6 years, recruited from kindergartens located in the metropolitan area of Porto, Portugal. Preschooler's body mass index was classified according to International Obesity Task Force. PA was assessed during 7 consecutive days by accelerometer. Children were classified as meeting or not meeting PA recommendations based on two guidelines: (i) at least 3 h per day of total PA (TPA); and (ii) at least 1 h per day of moderate to vigorous PA (MVPA)., Results: The prevalence of overweight and obesity was 23.5 and 10.6% in girls and 17.2 and 8.9% in boys. In all, 90.2 and 97.3% of girls met the ≥ 1 h MVPA and ≥ 3 h TPA recommendations, respectively. In all, 96.2 and 99.4% boys met the ≥ 1 h MVPA and 3 h TPA recommendations, respectively. Boys were significantly more likely to achieve the ≥ 1 h MVPA and ≥ 3 h TPA recommendations than girls (P ≤ 0.001). Not meeting the ≥ 1 h MVPA guideline was associated with obesity status (OR: 3.8; IC: 1.3-10.4), in girls, but not boys. No other statistically significant associations were found., Discussion: These findings suggest that over 90% of children met the recommended guidelines. There is an association with low levels of MVPA and higher obesity status among preschool girls. Further, longitudinal studies are needed to confirm these data.

Background: There is clear evidence that environmental factors play an important role regarding physical activity (PA) and sedentary behaviour (SB) in youth. This short report highlights seasonal differences in the amount and intensities of PA and SB, in Portuguese youth., Methods: Three hundred and eighty-seven participants (aged 14.7 ± 1.9 years), 220 girls, used the Actigraph GT1M accelerometer for 7 days (15-second epochs), between January and June in 2008. PA and SB differences were assessed using an ANCOVA., Results: Boys had significantly higher values of PA, with the exception of Light intensity. Girls were significantly more sedentary. PA intensities and SB changed significantly according to gender and month of assessment. SB (Gender F = 16.32, p < 0.001; Month F = 2.95, p < 0.013), Light PA (Gender F = 9.30, p = 0.002; Month F = 8.37, p < 0.001; Gender*Month F = 2.24, p = 0.050), Moderate PA (Gender F = 40.04, p < 0.001), Vigorous PA (Gender F = 32.89, p < 0.001; Month F = 2.56, p = 0.027). Both genders increased PA from winter to summer months and SB decreased., Conclusions: Seasonality in PA intensities and SB suggest that interventions to promote PA and decrease SB must be tailored to take into consideration the month of the year they are going to be implemented and also gender characteristics.

Background: Elevated blood pressure (BP) in childhood and adolescence is associated with overweight and obesity. Recently a body shape index (ABSI) has been suggested as superior to body mass index (BMI, kg/m(2)) and waist circumference (WC) as a measure of disease risk., Objective: To examine the association between ABSI, BMI, WC and BP in Portuguese adolescents and to consider the role of ABSI, BMI and WC when examining this issue in adolescents., Methods and Procedures: Height, body mass, WC and resting blood pressure were assessed in 445 Portuguese adolescents (252 girls and 193 boys) aged 10-17 years., Results: ABSI, BMI and WC were all significantly related to both SBP and DBP (all p = 0.001 or better). ABSI, BMI and WC were all significant predictors of SBP and DBP for the whole sample and when analysed in separate gender groups (p = 0.001 or better in all cases). However, in all cases ABSI was a better predictor of BP than BMI or WC., Conclusions: Although BMI and WC significantly predict resting BP in adolescents, the use of ABSI explained a greater amount of the variance in BP in this population. When examining the effect of weight status on BP, researchers should consider use of ABSI alongside BMI.

The aim of this study was to examine any differences in cardiovascular disease (CVD) risk in Portuguese children split by parental educational level. A cross-sectional school-based study was conducted in 2011 on 359 Portuguese children (202 girls and 157 boys) aged 10 to 17 years (mean age ± SD = 13.9 ± 1.98 years). Height and body mass were assessed to determine body mass index (BMI). Parental education level (PEL) was used as a surrogate for socioeconomic status (SES). Capillary blood sampling was used to determine: Total Cholesterol (TC), Triglycerides (TG), Fasting Glucos (GLUC), High and Low Density Lipoprotein (HDL/LDL). These measurements were combined with measures of systolic blood pressure and cardiorespiratory fitness as z-scores. CVD risk was constructed by summing the z-scores. Analysis of covariance, controlling for BMI, indicated that CVD risk was significantly different across PEL groups (p = 0.01), with CVD risk score being significantly lower in low (p = 0.04) and middle (p = 0.008) PEL groups, compared to high PEL. Moreover, the covariate, BMI was also significant (p = 0.0001, β = 0.023), evidencing a significant positive association between BMI and CVD risk, with higher BMI associated with greater CVD risk. In Portuguese children, significantly greater CVD risk was found for children of high PEL, while higher BMI was associated with greater CVD risk.