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Background: This study aimed to analyze the relationship between socioeconomic status (SES), poverty rate, and the prevalence of overweight/obesity or obesity in children and adolescents aged 2–14. Methods: Parents or guardians reported the weight and height of participants, used to calculate body mass index (BMI) and BMI z-scores according to the International Obesity Task Force standards. Participants were categorized into "overweight/obesity" and "no overweight/obesity" and further into "obesity" and "no obesity". The rate of poverty rate was determined using data from the National Statistics Institute of Spain, defining it as the percentage of people with income below 60% of the national median. SES was based on the head of household's occupation and categorized into low, medium, and high levels. Results: Adjusted multilevel models showed participants with medium or high SES had lower odds of overweight/obesity compared to those with low SES (medium SES: odds ratio [OR]: 0.63, 95% confidence interval [CI]: 0.54–0.73; high SES: OR: 0.59, 95% CI: 0.49–0.70). Participants in the high-poverty group had higher odds of having overweight/obesity (OR: 1.40, 95% CI: 1.13–1.74) compared to the low-poverty group. Conclusions: The study highlights significant socioeconomic disparities in childhood overweight/obesity, emphasizing the potential impact of SES and poverty on health outcomes in Spanish children and adolescents. [ABSTRACT FROM AUTHOR]

Background: We investigated the association between body mass index (BMI) and obesity‐related cancer risk among individuals with/without incident hypertension (HTN), type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD) and the joint associations of overweight/obesity (BMI ≥25 kg/m2) and each cardiometabolic condition with obesity‐related cancer risk Methods: We conducted a population‐based cohort (n = 1,774,904 individuals aged ≥40 years and free of cancer and cardiometabolic conditions at baseline) study between 2010 and 2018 with electronic health records from Spain. Our main outcome measures were hazard ratios (HRs) for incident obesity‐related cancers and relative excess risk due to interaction (RERI). Results: A total of 38,082 individuals developed obesity‐related cancers after a median of 8 years of follow‐up. The positive association between BMI and obesity‐related cancer risk was similar among individuals free of cardiometabolic conditions (hazard ratio, HR per 5 kg/m2: 1.08, 95% confidence interval, CI: 1.06–1.10) and with incident HTN (1.05, 1.01–1.08). The association among those with incident T2DM was null (0.98, 0.93–1.03). There was a positive additive interaction between overweight/obesity and CVD (relative excess risk due to interaction [RERI]: 0.19 [0.09, 0.30]), meaning that the combined association was 0.19 more than the sum of the individual associations. In contrast, a RERI of −0.24 (−0.28, −0.20) was observed for the combined association between overweight/obesity and T2DM. Conclusions: Public health strategies to reduce overweight can help prevent cancer cases among the general population and individuals with incident HTN/CVD. Further, weight‐loss interventions seem to lead to a greater cancer risk reduction among individuals with CVD. [ABSTRACT FROM AUTHOR]

The presence of visceral adipose tissue implies a higher risk of cardiovascular diseases than subcutaneous adiposity, the most dangerous heart fat. Epicardial adipose tissue (EAT) could have great potential as a detection indicator of cardiovascular diseases, although it has seldom been studied in Spanish children., Objective: The objective of the current research was to describe the values of EAT in a Spanish pediatric population and to investigate the associations between EAT and anthropometric measures, blood pressure, lipid and glucose profiles, and metabolic syndrome., Method: An analytical cross-sectional study of elementary and high school students (aged 6 to 17) measured anthropometrics, blood pressure, lipid and glycemic profiles, and echocardiographic fat thickness. The analysis was based on regression and discriminant analysis., Results: The results of this study (N = 227) showed that the body mass index (BMI) was 20.29 ± 4.54, with an overweight set of 49.77%, and the percentage for metabolic syndrome was 5.3%. EAT was linked to being male, BMI percentile, waist circumference, waist-to-height ratio ( p < 0.001), hypertension, higher low-density lipoprotein (LDL) levels, and metabolic syndrome ( p < 0.05)., Conclusions: This paper argues that in children with higher elevated EAT thickness values, this correlates with cardiovascular risk factors including high blood pressure, elevated LDL levels, and metabolic syndrome.

Background: A high body mass index (BMI) has been associated with increased risk of several cancers; however, whether BMI is related to a larger number of cancers than currently recognized is unclear. Moreover, whether waist circumference (WC) is more strongly associated with specific cancers than BMI is not well established. We aimed to investigate the associations between BMI and 26 cancers accounting for non-linearity and residual confounding by smoking status as well as to compare cancer risk estimates between BMI and WC.Methods: Prospective cohort study with population-based electronic health records from Catalonia, Spain. We included 3,658,417 adults aged ≥ 18 years and free of cancer at baseline between 2006 and 2017. Our main outcome measures were cause-specific hazard ratios (HRs) with 99% confidence intervals (CIs) for incident cancer at 26 anatomical sites.Results: After a median follow-up time of 8.3 years, 202,837 participants were diagnosed with cancer. A higher BMI was positively associated with risk of nine cancers (corpus uteri, kidney, gallbladder, thyroid, colorectal, breast post-menopausal, multiple myeloma, leukemia, non-Hodgkin lymphoma) and was positively associated with three additional cancers among never smokers (head and neck, brain and central nervous system, Hodgkin lymphoma). The respective HRs (per 5 kg/m2 increment) ranged from 1.04 (99%CI 1.01 to 1.08) for non-Hodgkin lymphoma to 1.49 (1.45 to 1.53) for corpus uteri cancer. While BMI was negatively associated to five cancer types in the linear analyses of the overall population, accounting for non-linearity revealed that BMI was associated to prostate cancer in a U-shaped manner and to head and neck, esophagus, larynx, and trachea, bronchus and lung cancers in an L-shaped fashion, suggesting that low BMIs are an approximation of heavy smoking. Of the 291,305 participants with a WC measurement, 27,837 were diagnosed with cancer. The 99%CIs of the BMI and WC point estimates (per 1 standard deviation increment) overlapped for all cancers.Conclusions: In this large Southern European study, a higher BMI was associated with increased risk of twelve cancers, including four hematological and head and neck (only among never smokers) cancers. Furthermore, BMI and WC showed comparable estimates of cancer risk associated with adiposity. [ABSTRACT FROM AUTHOR]

Background Although overweight and obesity are assumed to arise from an energy imbalance, evidence has shown that the frequency and timing of meals are also potential risk factors for obesity. However, the lack of a consistent approach to define eating patterns relative to internal circadian rhythms limits the extent of these findings. Objectives The objective of this study was to investigate the association of the circadian pattern of energy intake with adiposity and with internal circadian rhythms. Methods A total of 260 Spanish adults (aged 20–30 y; 78.1% women) were included in a 6-d cross-sectional study. Participants documented sleep and dietary intake within the study period. From these data, we evaluated the chronotype, eating patterns (meal timing, eating duration, and eating frequency), and we obtained the daily profile of energy intake. In addition, we evaluated the circadian pattern of wrist temperature (internal circadian rhythm marker). Circadian patterns of energy intake and wrist temperature were analyzed, and their association among them and with anthropometric variables and diet quality was studied. Results The greater fragmentation of the circadian pattern of energy intake was associated with lower BMI (in kg/m2; −10.55; 95% CI: −16.96, −4.13; P  = 0.001). In addition, a greater eating frequency (≥5 eating occasions/d) was significantly associated with lower BMI (−1.88; 95% CI: −3.27, −0.48) and higher energy intake after 20:00 (4.14% of kcal; 95% CI: 1.67, 7.16). Furthermore, a greater eating frequency was associated with lower fragmentation (P  = 0.042) and greater stability of the circadian pattern of wrist temperature (P  = 0.016). Conclusions The daily pattern of energy intake is associated with adiposity and robust circadian rhythms. Our results shed light on the relevance of eating frequency as a potential zeitgeber for the circadian system. Although more evidence is needed, eating frequency could be considered for future chrono-nutritional recommendations for the prevention of circadian misalignment and obesity. [ABSTRACT FROM AUTHOR]

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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Domínguez-Martín, Tárraga-López and López-Gil.)

Aim: Physical activity (PA) has traditionally been measured wearing accelerometers on the hip, but they are increasingly being worn on the wrist. We compared hip and wrist accelerometers with regard to their acceptability and any associations between PA and fatness and fitness.Methods: This cross-sectional study comprised 103 children aged 8-12 years (62% boys) who participated in the ActiveBrains trial by the University of Granada, Spain, in 2014-2016. The children wore both ActiGraph GT3X+ hip and wrist accelerometers round the clock for 7 days. The acceptability of both placements was evaluated by a questionnaire, while the children's fat mass index, waist circumference and cardiorespiratory fitness (CRF) were assessed.Results: Wearing wrist accelerometers caused less disturbance, mainly because hip accelerometers caused more issues during the night. The measurements from both placements showed that lower PA levels were associated with fatness and that higher PA levels were associated with better CRF.Conclusion: Both placements showed consistent results with regard to measuring associations between PA levels and fatness and fitness. However, wearing them on the wrist caused less discomfort at night. Future studies are needed to confirm the best placement for accelerometers during PA studies. [ABSTRACT FROM AUTHOR]

The aims of the present study were: i) to examine the associations of total accelerometer-based sedentary time (ST) and specific-domain self-reported ST (i.e., screen-based, educational-based, social-based, and other-based ST) with adiposity and physical fitness in youth; and ii) to analyse the mediation effect of physical activity (PA) on associations. This study was conducted with 415 children (9.1 ± 0.4 years) and 853 adolescents (13.6 ± 1.6 years) in Spain during 2011-2012. Total ST and PA were assessed by accelerometry. Leisure-time spent in twelve sedentary behaviours was self-reported. Adiposity and physical fitness was measured following the ALPHA battery for youth. Total accelerometer-based ST was positively associated with global adiposity score in children, and negatively associated with global physical fitness score in children and adolescents; but relationships were not independent of PA. PA mediated all associations of accelerometer-based and self-reported ST with adiposity or physical fitness in children. Conversely, screen-, educational-, social-, and other-based ST were negatively related to physical fitness in adolescents, independently of PA. These findings give an impetus to developing effective strategies for specifically promoting PA in children and for increasing PA while reducing ST in adolescents in order to produce improvements on adiposity and physical fitness. [ABSTRACT FROM AUTHOR]

BACKGROUND Walking and bicycling (active commuting) to school may be a useful strategy to increase the daily amount of physical activity, and, potentially, improve children's health. However, it is unclear whether active commuting to school (ACS) has the potential to improve physical health and cognitive performance in children. Our aim was to examine the relationship between ACS with adiposity indicators, physical fitness, and cognitive performance in 4‐ to 7‐year‐old children. METHODS: We conducted a cross‐sectional study with 1159 children from the provinces of Cuenca and Ciudad Real, Spain. ACS was self‐reported by parents. Adiposity (body mass index, waist circumference, body fat mass, and triceps skinfold thickness) and physical fitness (cardiorespiratory and muscular fitness) were measured by standard procedures. Cognitive performance was assessed using the Battery of General and Differential Aptitudes. Data analysis included analysis of covariance. RESULTS: We found no differences in adiposity, physical fitness, and cognitive performance between active commuters and nonactive commuters. CONCLUSIONS: Walking to school had no positive impact on adiposity, physical fitness, and cognition in 4‐ to 7‐year‐old children. Future studies should examine the intensity and duration of walking to school needed to provide benefits in health and cognitive performance. [ABSTRACT FROM AUTHOR]

Background: Several unhealthy lifestyle behaviors in adolescence are often linked to overweight/obesity. Some of them may be present simultaneously, leading to combined effects on health. Therefore, the clustering of several unhealthy behaviors in adolescents might be associated with adiposity excess., Purpose: To identify lifestyle patterns and analyze their association with adiposity in early adolescents., Methods: A cross-sectional cluster analysis was performed in 1183 adolescents (50.5% girls) with a mean age of 12.5 (0.4) years included in the SI! Program for Secondary Schools in Spain to identify lifestyle patterns based on healthy diet, step counts, sleep time, and leisure screen time. Generalized mixed models were applied to estimate the association between lifestyle patterns and adiposity indices., Results: Four lifestyle patterns were derived: Cluster 1-higher screen time and poorer diet (n = 213), Cluster 2-lower activity and longer sleepers (n = 388), Cluster 3-active and shorter sleepers (n = 280), and Cluster 4-healthiest (n = 302). Except for the number of steps (12,008 (2357) day), the lifestyle behaviors in our sample presented levels far below the recommendations, especially for sleep duration. Cluster 4 included the largest proportion of adolescents from high socioeconomic status families (47.7%) and the lowest prevalence of overweight/obesity (23.1%). Compared to Cluster 4-healthiest, adolescents in the remaining clusters presented a higher prevalence of overweight/obesity and central obesity, showing Cluster 3 the highest prevalences (PR:1.31 [95%CI: 1.31, 1.31] and PR:1.40 [95%CI: 1.33, 1.47])., Conclusions: Clustering of lifestyle patterns in early adolescence allows the identification of individuals with excess adiposity, in whom health promotion strategies should be stressed, especially in socioeconomically disadvantaged groups., Trial Registration: Clinical Trial Registry, NCT03504059. Registered 20/04/2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03504059 ., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: To compare infant growth and adiposity pattern up to 2 years of age in Spanish infants, depending on maternal origin and anthropometric standards.Methods: Longitudinal study of a representative cohort of infants born at term in Aragon (Spain) (n = 1.430). Mean z-scores of weight, length, body mass index, triceps and subscapular skinfolds were calculated until 24 months of age using World Health Organization (WHO), Euro-Growth and Spanish growth standards and categorized by maternal origin (Spanish vs. immigrant).Results: Infants of immigrant mothers had higher weight, length, body mass index, triceps and subscapular skinfolds than Spanish maternal origin infants during the first months of life. Mean z-scores significantly varied depending on growth standards used. At 18 months of age, all anthropometric differences between both groups disappeared, but only when using WHO growth standards. Mean triceps and subscapular skinfold z-scores substantially and progressively increased from 3 months to 24 months of age in both groups compared to WHO standards. At 24 months, the prevalence of infants at risk of overweight and overweight were similar in both groups (Spanish: 15.1% and 3.8%; immigrant: 14.7% and 4.9%, respectively).Conclusions: Infant growth, adiposity patterns and prevalence of overweight depend on maternal origin, showing initial differences which progressively disappeared at 24 months of life when WHO growth standards were used. Differences in infant mean anthropometric measurements depend on anthropometric standard used. [ABSTRACT FROM AUTHOR]

We aimed to examine (a) the construct validity and reliability of the International Fitness Scale ( IFIS) in children; and (b) the association of both self-reported and measured fitness with cardiometabolic risk. Cross-sectional study in 1145 Spanish children (9-12 years). We measured body fat, waist circumference, blood pressure, lipids, insulin, and fitness level (reported and measured). A validated cardiometabolic syndrome index was used. An age- and sex-matched sample of 245 children originally not included in the study sample fulfilled IFIS twice for reliability purposes. IFIS was able to correctly classify children according to their measured fitness levels (analysis of covariance, adjusted for sex and age was used). Test-retest reliability of IFIS items was also good, i.e., average weighted Kappa = 0.70. Our data also suggest that both measured and reported cardiorespiratory, and speed and agility fitness were associated with cardiometabolic risk factors, such as adiposity and a cardiometabolic syndrome risk score. The associations for muscular fitness (both reported and measured) differed depending on how it was expressed (i.e., absolute vs relative terms). Our findings suggest that self-reported fitness, as assessed by IFIS, is a valid, reliable, and health-related measure, and it can be a good alternative at population level when physical fitness cannot be measured. [ABSTRACT FROM AUTHOR]

The present study assesses the impact of beverage consumption pattern on diet quality and anthropometric proxy measures for abdominal adiposity in Spanish adolescents. Data were obtained from a representative national sample of 1,149 Spanish adolescents aged 10-18 years. Height, weight, and waist circumferences were measured. Dietary assessment was performed with a 24-h recall. Beverage patterns were identified by cluster analysis. Adherence to the Mediterranean diet was measured by the KIDMED index. Three beverage clusters were identified for boys-'whole milk' (62.5 %), 'low-fat milk' (17.5 %) and 'soft drinks' (20.1 %)-and for girls-whole milk' (57.8 %), 'low-fat milk' (20.8 %) and juice (21.4 %), accounting for 8.3, 9.6, 13.9, 8.6, 11.5 and 12.9 % of total energy intake, respectively. Each unit of increase in the KIDMED index was associated with a 14.0 % higher ( p = 0.004) and 11.0 % lower ( p = 0.048) probability of membership in the 'low-fat milk' and 'soft drinks' cluster in girls and boys, respectively, compared with the 'whole milk' cluster. Boys in the 'soft drinks' cluster had a higher risk of 1-unit increase in BMI z score (29.0 %, p = 0.040), 1-cm increase in waist circumference regressed on height and age (3.0 %, p = 0.027) and 0.1-unit increase in waist/height ratio (21.4 %, p = 0.031) compared with the 'whole milk' cluster. Conclusion: A caloric beverage pattern dominated by intake of 'soft drinks' is related to general and abdominal adiposity and diet quality in Spanish male adolescents. [ABSTRACT FROM AUTHOR]

ObjectiveTo analyse the association between waist-to-height ratio (WtHR) and body fat and to develop predictive adiposity equations that will simplify the diagnosis of obesity in the paediatric age group.DesignCross-sectional study conducted in Spain during 2007 and 2008. Anthropometric dimensions were taken according to the International Biology Program. The children were classified as underweight, normal weight, overweight or obese according to national standards of percentage body fat (%BF). WtHR differences among nutritional status categories were evaluated using ANOVA. Correlation analysis and regression analysis were carried out using WtHR as a predictor variable for %BF. A t test was applied to the results obtained by the regression model and by the Siri equation. The degree of agreement between both methods was evaluated by estimating the intra-class correlation coefficient.SettingElementary and secondary schools in Madrid (Spain).SubjectsGirls (n 1158) and boys (n 1161) from 6 to 14 years old.ResultsWtHR differed significantly (P < 0·001) depending on nutritional status category. This index was correlated (P < 0·001) with all adiposity indicators. The mean %BF values estimated by the regression model (boys: %BF = 106·50 × WtHR – 28·36; girls: %BF = 89·73 × WtHR – 15·40) did not differ from those obtained by the Siri equation. The intra-class correlation coefficient (0·85 in boys, 0·79 in girls) showed a high degree of concordance between both methods.ConclusionsWtHR proved to be an effective method for predicting relative adiposity in 6–14-year-olds. The developed equations can help to simplify the diagnosis of obesity in schoolchildren. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To objectively assess physical activity (PA) levels in a cohort of Spanish cancer survivors.Design: Descriptive, cross-sectional.Setting: The Hospital Universitario de Fuenlabrada and two healthcare centers in Madrid, Spain.Sample: 204 cancer survivors and 115 adults with no history of cancer.Methods: Participants wore a triaxial accelerometer for seven or more consecutive days to assess PA levels. Body mass index (BMI), indirect indicators of adiposity (waist circumference, waist-to-hip ratio), and cardiorespiratory fitness also were determined.Main Research Variables: Light, moderate, vigorous, and total PA (sum of the former).Findings: Most (94%) of the cancer survivors met international recommendations for moderate PA, but very few (3%) fulfilled those (75 minutes or more per week) for vigorous PA. Except for lower total (minute per day, p = 0.048) and vigorous PA levels (p < 0.001 for both minute per day and minute per week) recorded in the cancer survivors group, no between-group differences were detected (p > 0.05). A high percentage of the survivors (33%) were obese (BMI greater than 30 kg/m2), and many also showed poor cardiorespiratory fitness (45% were below the 8 metabolic equivalent threshold).Conclusions: Although cancer survivors overall met international PA recommendations for a healthy lifestyle, their BMI and cardiorespiratory profiles were not within the healthy range.Implications for Nursing: Cancer survivors need to be informed about healthy lifestyle habits and should be regularly monitored. [ABSTRACT FROM AUTHOR]

ObjectiveTo examine the trends in BMI and adiposity among schoolchildren from Cuenca, Spain, during 2004–2010.DesignTwo methodologically comparable surveys were carried out in 2004 and 2010.SettingPrimary schools in Cuenca, a province in the middle of Spain.SubjectsAll schoolchildren aged 8–11 years, belonging to 4th and 5th grades from twenty schools in the Province of Cuenca, were invited to participate in both cross-sectional studies. Weight, height and body fat percentage (BF%) from bioelectrical impedance were measured with standardized procedures.ResultsThe study included 550 boys and 539 girls in 2004, and 569 boys and 531 girls in 2010. In 2010, 8·1 % of children were underweight, 25·9 % overweight and 9·5 % obese. From 2004 to 2010, the prevalence of overweight rose from 21·6 % to 28·0 % (P = 0·004) and BF % increased from 22·6 % to 24·0 % (P = 0·001) among boys. No change was observed in overweight and BF % in girls, or in underweight and obesity in either sex. In boys, most of the distribution of BMI and BF % shifted to the right; in contrast, among girls no substantial change was apparent in the distribution of BMI and BF %.ConclusionsFrom 2004 to 2010 the prevalence of overweight and adiposity has continued to increase among boys. However, the obesity epidemic may have levelled off in girls. Given that the prevalence of childhood excess weight is still very high, the current evidence-based efforts to halt the obesity epidemic in Spain should be strengthened. [ABSTRACT FROM PUBLISHER]

Abstract: Introduction: Obesity, defined as an excess of total body fat, is a matter of concern all over the world, and its prevalence is still increasing among elderly people. Objectives: To examine whether sedentary behaviour (hours sitting per day) is associated with higher risk of central obesity, overweight-obesity and overfat in a representative sample of non-institutionalized Spanish elderly population and if so, whether hours walking per day modified this association. Study design: A cross-sectional study in a sample of 3136 people ≥65 years of age. Main outcomes measures: Anthropometric measurements were obtained using standardized techniques and equipment. Active and sedentary behaviours were recorded by questionnaire. Results: For both men and women, the higher prevalence of overweight-obesity, central obesity and overfat was found in those who spent sitting more than 4h per day and walk less than 1h, compared with those who spent sitting less than 4h per day and walk more than 1h (all p <0.001, except for central obesity in women). In men, more than 4h sitting per day was associated with 1.7-fold higher odds of having central obesity compared with those sitting less than 4h per day (p <0.01). In women, this sedentary behaviour increased the risk of overweight-obesity and overfat by 1.5 and 1.4, respectively (p <0.01). Age or time spent walking did not significantly change these results. Conclusion: Sitting time increases the risk of overweight-obesity and overfat in women and the risk of central obesity in men, independently of walking time. [Copyright &y& Elsevier]

Summary [ABSTRACT FROM AUTHOR]

Background: It is well established that variation of soft-tissue traits is less influenced by the genetic component than skeletal traits. However, it is still unclear whether heritabilities ( h2) of obesity-related phenotypes present a common pattern across populations. Aim: To estimate familial resemblance and heritability of body size, shape and composition phenotypes and to compare these results with those from other populations. Subjects and methods: The subject group consisted of 533 nuclear families living in Greater Bilbao and included 1702 individuals aged 2--61 years. Familial correlations and h2 were estimated for 29 anthropometric phenotypes (19 simple measures, three derived factors, four obesity indices and the three Heath-Carter somatotype components) using MAN and SOLAR programmes. Results: All phenotypes were influenced by additive genetic factors with narrow sense heritabilities ranging from 0.28--0.69. In general, skeletal traits exhibited the highest h2, whereas phenotypes defining the amount of adipose tissue, particularly central fat, were less determined by genetic factors. Conclusions: Familial correlations and heritability estimates of body morphology and composition from the Greater Bilbao sample were within the range observed in other studies. The lower heritability detected for central fat has also been found in some other populations, but further investigations in different populations using the same anthropometric traits and estimation methods are needed in order to obtain more robust conclusions. [ABSTRACT FROM AUTHOR]

Objective. To determine, through the use of a structural equation model, the relationships that exist between physical activity, body fat, perceived physical ability, and three indicators of psychological well-being, in a sample of Spanish university students. Methods. A descriptive cross-sectional study of 639 students 18-29 years of age representative of the universities of Valencia, Spain, during the 2005-2006 term. Physical exercise was rated by taking an inventory of healthy behaviors among students. The following scales were applied: self-perceived physical ability, self-esteem, satisfaction with life, and subjective vitality. Body fat was expressed as the percentage of fat mass (PFM). A theoretical model was devised using six measured variables. Results. The participants' level of physical activity was moderate; they perceived themselves to be physically competent; had high self-esteem; were satisfied with life; and had high vitality. Physical activity was negatively correlated with PFM in men and women alike; and negatively associated with perceived physical ability; while perceived physical ability was positively associated with self-esteem, life satisfaction, and subjective vitality. The effect of physical activity on perceived competence was mediated in part by PFM in men. In women, exercise was directly correlated to PFM, as well as perceived ability, without PFM mediation. Conclusions. Increased physical activity is of great value to public health because, in addition to helping to reduce body fat, it improves psychological well-being and self-image. [ABSTRACT FROM AUTHOR]

Objectives:To examine the association of objectively assessed physical activity (PA) with markers of total and central body fat in adolescents, and to determine whether meeting the current PA recommendations (60 min day−1 of at least moderate intensity PA) is associated with reduced levels of total and central body fat.Subjects/Methods:A total of 365 Spanish adolescents aged 12.5–17.5 years participated in this cross-sectional study. PA was assessed by accelerometry and expressed as average PA (counts per minute), and min day−1 of light, moderate, moderate to vigorous (MVPA) and vigorous PA. MVPA was dichotomized into <60 min day−1 and 60. Total body fat was measured by DXA, BodPod and the sum of six skinfolds. Central body fat was measured by DXA at three regions (R1, R2 and R3), and waist circumference.Results:All markers of central body fat were negatively associated with vigorous PA (P<0.01) after controlling for sex, age and pubertal status. Abdominal adiposity measured at R1, R2 and R3 was also negatively associated with MVPA (P0.001), and with average PA (P<0.01). All markers of total body fat were negatively associated with vigorous PA (P<0.01), MVPA (P<0.01) and average PA (P<0.05). Adolescents engaged on at least 60 min day−1 MVPA presented lower levels of total (P<0.05) and central body fat (P0.01).Conclusions:The results suggest that vigorous PA may have a greater effect on preventing obesity in adolescents than does PA of lower intensity, whereas both average PA and at least moderate PA may have an impact on total and central body fat in youth. [ABSTRACT FROM AUTHOR]

Objective:To assess the impact of a physical activity program on obesity in primary school children.Design:Cluster-randomized controlled trial with 10 intervention and 10 control schools.Participants:A total of 1044 children, mean age 9.4 years (s.d.=0.7) at baseline, of the Province of Cuenca, Spain.Intervention:Recreational, non-competitive physical activity program conducted after school hours on school premises. The program consisted of three 90-min sessions per week, for 24 weeks.Main outcome measures:Body mass index (BMI), triceps skin-fold thickness (TST) and percentage body fat. Secondary measures were blood lipids and blood pressure. Measurements were made at the beginning (September 2004) and at the end of the program (June 2005). Since schools rather than children were randomized, mixed regression models were used to adjust for individual-level covariates under cluster randomization.Results:There were no differences in BMI between the intervention and control groups. Compared with controls, intervention children showed a decrease in TST in both boys (−1.14 mm; 95% confidence interval (CI) −1.71 to −057; P<0.001) and girls (−1.55 mm; 95% CI −2.38 to −0.73; P<0.001), as well as a reduction in the percentage of body fat in girls (−0.58%; 95% CI −1.04 to −0.11; P=0.02). Furthermore, the intervention boys exhibited a decrease in apolipoprotein (apo) B levels (−4.59; 95% CI −8.81 to −0.37; P=0.03) and an increase in apo A-I levels (13.57; 95% CI 7.95–19.20; P<0.001). Blood lipid results in girls were very similar. No changes in total cholesterol, triglycerides or blood pressure were associated with the intervention in either sex, except for an increase in diastolic blood pressure (1.55 mm Hg; 95% CI 0.19–2.91; P=0.03) in the intervention versus control boys.Conclusion:An after-school program of recreational physical activity reduced adiposity, increased apo A-I and decreased apo B in primary school children.International Journal of Obesity (2008) 32, 12–22; doi:10.1038/sj.ijo.0803738; published online 25 September 2007 [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effect of physical performance and extracurricular organized physical activities (EOPA) in normal- and overweight children. Methods: A random sample of 1,068 schoolchildren (7–12 years old) representative of the region of Aragon (Spain) was selected and divided into normal-, overweight and obese groups based on previously published body mass index reference standards. Physical performance was assessed by the European physical test battery. EOPA were estimated when children performed at least 3 h per week during the previous year in addition to school physical education. Results: Overweight and obese subjects had lower performances on all tests requiring propulsion or lifting of the body mass (standing-broad jump, sit-ups, bent-arm hangs, speed shuttle run and endurance shuttle run) when compared with normal-weight counterparts (p < 0.001). The overweight and obese children showed greater hand grip strength measures than the normal-weight ones (p < 0.001). Plate tapping and sit reach test scores were similar in both groups. The participation in EOPA was similar in normal- and overweight or obese groups; however, a significant increase with age was observed (p < 0.01). Conclusion: In this age group, overweight was not related to EOPA participation. Overweight children had poorer results on weight-bearing tasks. The good results in static strength, coordination and speed of limb movements in overweight children should be considered in the promotion of physical activity programs for overweight children. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Considering that the prevalence of overweight and obesity in Southeast of Spain is high, the aim of this work was to analyze the relation between the adherence to a personalized diet and the effectiveness of changes in the body composition in overweight and obese adults in this region. This quasi-experimental study presents the following selection criteria: attendance at the consultation between 2006 and 2012, subjects ≥ 19 years of age with overweight or obesity. In total, 591 overweight or obese individuals were involved in this study, attending 4091 clinic consultations in total. Most of the sample consisted of subjects who attended >3 consultations (>1.5 months), and were females aged 19–64 years who obtained clinically significant changes in fat mass (FM, ≥5%) and recommended changes in fat-free mass (FFM, ≥0%). Based on the results obtained and the experience gained from this research, the following recommendations are established: (i) record fat mass and fat-free mass index as a complement to body mass index; (ii) use FM and FFM to evaluate effectiveness of interventions with the aim of obtaining body composition changes; (iii) use personalized diet to achieve significant changes in FM and avoid non-recommended changes in FFM. [ABSTRACT FROM AUTHOR]

Obesity is declared as a chronic multifaceted health problem, and young adults may be particularly vulnerable to weight gain. This study aims to identify the role of dietary calcium intake and the muscle strength index in handling excess of fat mass in young adults and to examine if the relationship between dietary calcium intake and fat mass percentage is mediated by muscle strength. A cross-sectional study including 355 Spanish college students (aged 21.05 ± 3.11) was performed during the 2017-2018 academic year. Pearson correlation coefficients were estimated to determine the relationship between dietary calcium intake, fat mass percentage, body mass index, muscle strength components, and total energy intake. ANCOVA models were used to analyze the differences in the muscle strength index by total dietary calcium intake categories, as well as the differences in % fat mass by total dietary calcium intake and muscle strength index categories, controlling for different sets of confounders. A mediator analysis was conducted to test if the relationship between dietary calcium intake and fat mass percentage was explained by muscle strength. Data on the fat mass percentage, dietary calcium intake, and muscle strength index as the sum of the standardized z-score of the standing long jump and z-score of handgrip/weight were collected. The muscle strength index was significantly better in young adults with higher dietary calcium intake. Moreover, the fat mass percentage was significantly lower in those with a higher dietary calcium intake and a better muscle strength index. Finally, the relationship between dietary calcium intake and fat mass percentage was fully mediated by muscle strength (z = -1.90; p < 0.05), explaining 33.33% of this relationship. This study suggests that both a major dietary calcium intake and muscle strength are associated with fat mass percentage. Moreover, muscle strength mediates the link between dietary calcium intake and fat mass percentage. Therefore, both high dietary calcium intake and exercise activities aimed at improving muscle strength levels may help to prevent the cardiometabolic risk associated with an excess of fat mass in young people.

Background: During the great lockdown in Spain due to SARS-CoV-2, in between the months of March and June 2020, dietary and physical activity habits were modified in children. The aim of the study was to determine the impact of the lockdown on anthropometric parameters in children aged 11/12 years., Methods: Fifty Spanish children aged 11/12 years (M = 11.40; SD = 0.50) participated: 33 (66%) boys and 17 (34%) girls. For data collection, we used an anthropometry kit; the Alpha-Fitness Battery, a validated instrument to assess dietary intake, habits and practices; and an ad hoc survey to collect sociodemographic and other data under investigation., Results: There were significant differences in the anthropometric parameters measured and in the results obtained for Body Mass Index (BMI) and body fat percentage pre- and post-lockdown in both boys and girls ( p < 0.05). No significant differences were found in waist-circumference measurements ( p > 0.05)., Conclusions: There is evidence of a significant impact of the SARS-CoV-2 lockdown on anthropometric parameters in boys and girls aged 11/12 years.

Context: A comprehensive understanding of the association between body mass index (BMI) and coronavirus disease 2019 (COVID-19) is still lacking., Objective: To investigate associations between BMI and risk of COVID-19 diagnosis, hospitalization with COVID-19, and death after a COVID-19 diagnosis or hospitalization (subsequent death), accounting for potential effect modification by age and sex., Design: Population-based cohort study., Setting: Primary care records covering >80% of the Catalan population, linked to regionwide testing, hospital, and mortality records from March to May 2020., Participants: Adults (≥18 years) with at least 1 measurement of weight and height., Main Outcome Measures: Hazard ratios (HR) for each outcome., Results: We included 2 524 926 participants. After 67 days of follow-up, 57 443 individuals were diagnosed with COVID-19, 10 862 were hospitalized with COVID-19, and 2467 had a subsequent death. BMI was positively associated with being diagnosed and hospitalized with COVID-19. Compared to a BMI of 22 kg/m2, the HR (95% CI) of a BMI of 31 kg/m2 was 1.22 (1.19-1.24) for diagnosis and 1.88 (1.75-2.03) and 2.01 (1.86-2.18) for hospitalization without and with a prior outpatient diagnosis, respectively. The association between BMI and subsequent death was J-shaped, with a modestly higher risk of death among individuals with BMIs ≤ 19 kg/m2 and a more pronounced increasing risk for BMIs ≥ 40 kg/m2. The increase in risk for COVID-19 outcomes was particularly pronounced among younger patients., Conclusions: There is a monotonic association between BMI and COVID-19 diagnosis and hospitalization risks but a J-shaped relationship with mortality. More research is needed to unravel the mechanisms underlying these relationships., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society.)

Rates of non-communicable diseases (NCDs), such as obesity, diabetes, cardiovascular events and cancer, continue to rise worldwide, which require objective instruments for preventive and management actions. Diverse anthropometric and biochemical markers have been used to qualitatively evaluate degrees of disease, metabolic traits and evolution of nutritional status. The aim of this study was to integrate and assess the interactions between an anthropometric measurement, such as waist circumference (WC), and biochemical data, such as the triglyceride glucose index (TyG), in order to individually characterize metabolic syndrome (MetS) features considering the hypertriglyceridemic waist phenotype as a marker. An ancillary cross-sectional study was conducted using anthropometric measurements, such as weight, height, waist and hip circumferences, as well as fasting biochemical data of 314 participants. Different indices based on WC (WC, WC*TG and WC*TyG) were estimated to compute MetS components and accompanying comorbidities. ROC curves were fitted to define the strength of the analyses and the validity of the relationships. Associations were confirmed between anthropometric, biochemical and combined indices with some chronic disease manifestations, including hyperglycemia, hypertension and dyslipidemia. Both WC*TG and WC*TyG indices showed similar performance in diagnosing MetS (area under the ROC curve = 0.81). Interestingly, when participants were categorized according to a reference value of the WC*TyG index (842.7 cm*mg/dl), our results evidenced that subjects classified over this limit presented statistically higher prevalence of MetS and accompanying individual components with clinical relevance for interventions. These results revealed that WC*TyG mirrors the hypertriglyceridemic phenotype, which suggests may serve as a good indicator to define the metabolic syndrome phenotype and a suitable, sensitive, and simple proxy to complement others. A reference point was proposed with a good clinical performance and maximized sensitivity and specificity values., (© 2021. The Author(s).)

Background: Physical fitness levels and the amount of accumulated adipose tissue (fatness) relate to current and future individuals' heath status. Nevertheless, the interrelationships of their combined patterns with polypharmacy and the types of medications consumed have not been sufficiently investigated., Methods: This cross-sectional study was carried out in six Spanish regions between 2008 and 2009 with a sample of older community-dwelling adults (≥65 years old) without dementia or cancer. Fitness was measured with one-leg balance and senior fitness tests, as well as by measuring weight and fat mass with a bioelectrical impedance analyzer. Polypharmacy was defined as the use of five or more medications. An analysis of variance was performed for comparisons between the physical fitness and fatness patterns and the medication consumed., Results: A total of 1709 elders were included in the study (72.1 ± 5.2 years). The two unfit patterns were those with the highest drug consumption. The High-Fat-Unfit pattern was the one that had the most significant consumption and had the highest percentage of polymedicated subjects. The Low-Fat-Fit pattern had a significantly lower percentage of people that did not consume any medications. The highest percentages of drug consumption in 7 of the 10 groups that were included were concentrated in the two unfit patterns., Conclusions: This study highlights the importance of fitness in older adults, as it is at least as important as the avoidance of accumulation of excess fat with respect to the consumption of a smaller number of medicines.

Background & Aims: Ultra-processed food and drink products (UPF) consumption has been associated with obesity and its-related comorbidities. Excess of visceral fat, which appears with increasing age, has been considered as the culprit contributing to adiposity-associated adverse health outcomes. However, none of previous studies elucidated the link between UPF and directly quantified adiposity and its distribution. We aimed to prospectively investigate the association between concurrent changes in UPF consumption and objectively assessed adiposity distribution., Methods: A subsample of 1485 PREDIMED-Plus participants (Spanish men and women aged 55-75 years with overweight/obesity and metabolic syndrome) underwent body composition measurements. Consumption of UPF at baseline, 6 and 12 months was evaluated using a validated 143-item semi-quantitative Food Frequency Questionnaire. Food items (g/day) were categorized according to their degree of processing using NOVA system. Regional adiposity (visceral fat (in g) and android-to-gynoid fat ratio) and total fat mass (in g) at three time points were measured with dual-energy X-ray absorptiometry (DXA) and were normalized using sex-specific z-scores. The association of changes in UPF consumption, expressed as the percentage of total daily intake (daily g of UPF/total daily g of food and beverage intake∗100), with adiposity changes was evaluated using linear mixed-effects models., Results: On average, the consumption of UPF accounted for 8.11% (SD 7.41%) of total daily intake (in grams) at baseline. In multivariable-adjusted model, 10% daily increment in consumption of UPF was associated with significantly (all p-values <0.05) greater accumulation of visceral fat (β 0.09 z-scores, 95% CI 0.05; 0.13), android-to-gynoid fat ratio (0.05, 0.00; 0.09) and total fat (0.09, 0.06; 0.13)., Conclusion: A higher consumption of UPF was associated with greater age-related visceral and overall adiposity accumulation. Further studies are warranted to confirm these results in other populations and settings., Trial Registration: The trial was registered at the International Standard Randomized Controlled Trial (ISRCTN: http://www.isrctn.com/ISRCTN89898870) with number 89898870 and registration date of 24 July 2014, retrospectively registered., Competing Interests: Conflicts of interest E.R. reports outside the submitted work: serving on the advisory board and receiving financial support other than grants or personal fees from Cerveza y Salud, Spain; personal fees from Brewers of Europe, Belgium; personal fees from Fundación Cerveza y Salud, Spain; financial support from Instituto Cervantes, Albuquerque, USA; personal fees from Instituto Cervantes, Milan, Italy; personal fees from Instituto Cervantes, Tokyo, Japan; non-financial support from Fundación Bosch i Gimpera, Spain; grants from Spanish Institute of Health “Carlos III”; personal fees from Pernaud Richart, Mexico; personal fees from Fundación Dieta Mediterranea, Barcelona, Spain; non-financial support from ERAB, Belgium; non-financial support from Sociedad Española de Nutrición (SEN); non-financial support from Wine and Culinary International Forum; grant from Grant–Fountain Laboratories, Spain; and grant from Uriach Laboratories. The rest of the authors, JK, MM, IA, MB-R, MR-C, JVioque, SG-P, LD, JS-S(,) MF, VM, RE, JVidal, MAM-G, SC, AJJ, TF-V, RC, RO, PB-C, NB, HS, JAM, and DR, declare that they have no potential conflicts of interests., (Copyright © 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

The fat but fit paradox has suggested that obese individuals with good fitness levels have lower cardiometabolic risk compared to individuals with normal weight but lower fitness levels. This paradigm has not been explored in the context of bone health. The aim of this study was to test whether categories of fat but fit paradigm assessed by body fat percentage and handgrip strength holds up in young adults and to analyze the relationship between fat but fit categories and bone outcomes. Cluster cross-sectional analyses of data from 499 young adults aged 18 to 30 from Toledo and Cuenca, Spain were conducted. Body fat percentage, handgrip strength, bone mineral content (BMC), bone mineral density (BMD), and dietary nutrients such as, proteins, magnesium, calcium, phosphorus, potassium, and vitamin D were assessed. Cluster analysis of body fat percentage and handgrip z scores resulted in a classification of four clusters that could be interpreted according to Fat Unfit (FU), Unfat Unfit (UU), Fat Fit (FF) and Unfat Fit (UF) categories. ANCOVA models showed that young adults in clusters with higher handgrip strength levels (FF, UF) and with higher key bone nutrients levels (UF) had significantly higher total BMC values than their peers in the UU and FU cluster categories, after controlling for sex, age and height. This study provides two novel conclusions in relation to the fat but fit paradigm: first, it confirms the construct of the four clusters of body fat percentage and handgrip strength, and second, it reinforces the predictive validity of the fat but fit paradigm categories, indicating the positive effect, although it may not just be a causal relationship, of muscular strength and key bone nutrients on counteracting the negative effect of obesity on bone health.

The aim of this study was to analyze the anthropometric characteristics and sport supplement (SS) consumption patterns of heavyweight and lightweight international rowers. Methods: The 13 heavyweights (11 males) and seven lightweights (five males) of the Spanish National Rowing Team were recruited for the study. Body composition was measured by bio-impedance analysis, and the questionnaire used in this investigation was previously validated to assess SS consumption. According to anthropometrics parameters, it was reported that male heavyweight rowers were heavier ( p < 0.001) and taller ( p < 0.001), but no statistical differences were reported for % body fat ( p = 0.104) or % lean body mass ( p = 0.161). All rowers reported consumption of at least one SS. Based on the Australian Institute of Sport's classification, higher medical supplement consumption was observed when comparing heavyweight rowers to lightweight rowers (2.5 ± 1.1 vs. 1.7 ± 0.5, p = 0.040). There were no differences in the totals of group A (strong scientific evidence for sports scenarios, p = 0.069), group B (emerging scientific support, deserving of further research, p = 0.776), or group C (scientific evidence not supportive of benefit and/or security amongst athletes, p = 0.484). The six most consumed SSs were iron (85%), caffeine (85%), β-alanine (85%), energy bars (85%), vitamin supplements (80%), and isotonic drinks (80%), with no statistical differences between heavyweight and lightweight rowers ( p > 0.05). These results suggest that the absence of differences in body composition (expressed as a percentage) do not represent anthropometric disadvantages for heavyweight rowers. In addition, SS consumption was similar between rowers, reporting only higher medical supplement consumption in heavyweight rowers.

Background: Dietary factors seem to influence telomere length. Moreover, associations between changes in adiposity indices and telomere length (TL) have been found in intervention studies., Objective: We evaluated changes in two diet quality indices and their association with TL in children with abdominal obesity in a 12-month lifestyle intervention., Methods: Eighty-seven participants (7-16 years old) were assigned to the intervention (moderate hypocaloric Mediterranean diet) or usual care group (standard paediatric recommendations) for a 2-month intensive phase and a subsequent 10-month follow-up. Diet quality was assessed using the Diet Quality Index for Adolescents (DQI-A) and the Healthy Lifestyle Diet Index (HLD-I). TL was measured by monochrome multiplex real-time quantitative PCR. The intra-class correlation coefficient for TL was 0.793 (95% CI 0.707, 0.857)., Results: After a 12-month lifestyle intervention, a significant reduction in BMI-SDS (-0.57 and -0.49 for the intervention and usual care groups, respectively) and fat mass was observed in all subjects without differences between groups. Changes in DQI-A (+12.36% vs +5.53%, P = .005) and HLD-I (+4.43 vs +1.09, P < .001) were higher in the intervention subjects compared with usual care subjects after 2 months. Interestingly, we observed a positive change in TL between 2 and 12 months (P = .025), which was associated with higher scores on the DQI-A (β = 0.008, R 2 = 0.088, P = .010) and HLD-I (β = 0.022, R 2 = 0.198, P = .015), in the intervention group after the 2-month intensive phase., Conclusion: Favourable changes in diet quality indices could contribute to telomere integrity in children with abdominal obesity enrolled in an intensive lifestyle intervention., (© 2020 World Obesity Federation.)

Introduction: Introduction: body mass index (BMI) does not allow to discriminate the composition of the different body compartments. The aim of this study was to develop reference values for the fat mass index (FMI) and fat-free mass index (FFMI) in healthy adolescents using anthropometric techniques in order to provide reference standards for daily clinical practice. Methods: a cross-sectional study in 1,040 healthy Caucasian adolescents (470 boys and 570 girls) aged 10.1 to 14.9 years. Weight, height, and skinfold thickness were recorded, and BMI, percentage of total body fat, FMI and FFMI, and FMI and FFMI percentiles were calculated. Results: FFMI and FMI percentiles for healthy adolescents (both sexes) categorized by age are displayed. In boys a significant increase in FFMI is observed, and both the percentage of total body fat and FMI significantly decreased. In contrast, in girls the percentage of body fat mass, FMI, and FFMI significantly increased. Except at 10 years of age, FMI was higher (p < 0.05) in girls at all ages. FFMI was higher (p < 0.05) in boys at all ages. Conclusions: reference values of FMI and FFMI would be a very useful instrument in clinical practice for the diagnosis and, especially, the analysis of body composition changes during the treatment of childhood obesity.

The university stage is a critical developmental period for young adults, where lifestyles can determine future health. A cross-sectional study including 481 college students was conducted, with the following objectives: 1) to examine the prevalence of risk of developing eating disorders in college students, 2) to assess differences in obesity and physical fitness in those with and without risk of eating disorders, and 3) to determine whether cardiorespiratory fitness, muscular fitness or fat mass were associated with the risk of eating disorders. We measured fat mass percentage (by densitometry), risk of feeding or eating disorders (by SCOFF questionnaire), cardiorespiratory fitness levels and a muscular fitness index. The prevalence of risk of eating disorders in women (32.4%) was higher than in men (17.4%) (p<0.001). In both sexes, higher obesity indicator mean values were observed among those who were at risk of eating disorders. Men participants without risk had higher cardiorespiratory fitness means than their at-risk peers [39.4 (8.3) vs. 32.4 (5.5), p<0.001)], and women showed differences only in the dynamometry/weight variable. In college students, it is necessary to promote healthy habits, including good levels of physical fitness, and to prevent excess body fat to effectively prevent eating disorders., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Objective: studies have been published in Europe comparing the mean macronutrient and micronutrient intake values of the general population with those of the vegan population, but none has been conducted in a country that mainly follows the Mediterranean diet. Therefore, the aim of this study was to carry out this comparison in Spain. Methods: a cross-sectional study of a sample of Spanish vegans was designed in 2015. To compare the distribution of nutrients with those of the general population, we used data from the Spanish Agency for Food Safety and Nutrition, which was considered to be normally distributed as it was a large population with biological parameters. All participants were asked about their dietary intake for the previous day (24 hour reminder) and the nutrients were calculated using specialized software. The distributions were compared using the Kolmogorov-Smirnov test. Results: The sample comprised 102 vegans, 67 of whom were women. The vegan population consumed more carbohydrates and fiber, less total fat (women only), fewer saturated fatty acids, and more polyunsaturated fatty acids. They had much lower cholesterol intake, lower calcium and iodine intake, higher iron and folic acid intake, and much lower intake of vitamins B12 and D. Conclusions: Spanish vegans had nutritional deficiencies compared to the general population and should therefore ensure their diet includes the necessary supplements.

Purpose: The aim of this research was to describe, examine, and compare the level of physical fitness, physical activity, and sedentary behaviour in pupils aged 6-13 in the Region of Murcia, Spain, in accordance with weight status. Methods: A total of 370 children (166 girls and 204 boys) aged 6-13 (M = 8.7; DT = 1.8) from the Region of Murcia participated in this descriptive and cross-sectional study. Some anthropometric parameters such as body mass index, waist circumference, as well as skinfold measurements were determined. ALPHA-FIT Test Battery was used to evaluate physical fitness. Krece Plus Short Test was used to measure physical activity level and sedentary behaviour. Results: 52.4% of the children presented excess weight (according to the World Health Organization growth references). Regarding boys, statistically significant differences were found for cardiorespiratory fitness ( p < 0.001), relative handgrip strength ( p < 0.001), lower muscular strength ( p < 0.001), speed-agility ( p < 0.001), as well as sport activities hours ( p = 0.001) among the three weight status groups (normal weight, overweight, and obesity). As for girls, statistically significant differences were found for cardiorespiratory fitness ( p = 0.004), relative handgrip strength ( p < 0.001), lower muscular strength ( p < 0.001), sport activities hours ( p = 0.005), as well as physical activity level (assessed by Krece Plus Test) ( p = 0.017). A negative statistically significant correlation was found between body mass index and cardiorespiratory fitness ( rho = -0.389), lower muscular strength, ( rho = -0.340), and relative handgrip strength ( rho = -0.547). At the same time, a positive statistically significant relationship between body mass index and the time spent in speed-agility ( rho = 0.263) was shown. Regarding waist circumference and body fat percentage, similar relationships were identified. Moreover, a greater probability of having higher cardiorespiratory fitness (OR = 1.58; CI 95% = 1.38-1.82), relative handgrip strength (OR = 1.25; CI 95% = 1.19-1.31), more hours of sport activities (OR = 1.40; CI 95% = 1.19-1.66), and physical activity level (assessed by Krece Plus Test) (OR = 1.23; CI 95% = 1.07-1.42) was noted in the normal weight group. Conclusions: Children that presented normal weight achieved higher results for health-related physical fitness and physical activity than those with excess weight; this was, however, not found to be the case for sedentary behaviour. The authors emphasise the need for changes in public policies and school-based intervention programmes to develop higher levels of both PF and PA in overweight and obese children.

Background: We aimed to evaluate the relationships between obesity metrics including Body Mass Index (BMI), waist to height ratio (WtHR) and fat mass percentage, and disease activity, damage accrual, inflammation markers and traditional cardiovascular risk factors in SLE patients., Methods: A cross-sectional study was conducted on a sample of 275 patients (90.5% females; mean age 46.37±13.85 years). Disease activity was assessed with the SLE disease activity index (SLEDAI-2K), and disease-related organ damage was assessed using the SLICC/ACR damage index (SDI). Biochemical variables of lipids profile, high-sensitivity C-reactive protein (hs-CRP), homocysteine (Hcy), anti-dsDNA titers and complement components C3 and C4 serum levels were measured. Blood pressure and ankle-brachial index (ABI) were also calculated., Results: Significant differences were observed between normal-weight, overweight and obese patients in SLEDAI (2.60±2.48 vs. 2.71±2.65 vs. 3.84±3.02; P=0.004), SDI (0.76±1.10 vs. 1.09±1.24 vs. 1.57±1.54; P=0.002), hsCRP (2.15±2.93 vs. 3.24±3.63 vs. 5.30±5.63 mg/dL; P<0.001), complement C3 level (99.92±24.45 vs. 111.38±27.41 vs. 123.16±28.96 mg/dL; P<0.001), triglycerides serum levels (85.99±41.68 vs. 102.35±50.88 vs. 129.12±61.59 mg/dL; P<0.001) and systolic blood pressure (112.28±16.35 vs. 124.25±17.94 vs. 132.78±16.71 mmHg; P=0.001) after adjusting for age and sex., Conclusions: Patients with SLE who are obese have worse disease activity and damage accrual, higher levels of inflammation markers hs-CRP and C3 complement, increased triglycerides serum levels and systolic blood pressure levels in comparison with overweight or normal weight SLE patients, supporting that optimizing weight in SLE patients should be a potential target to improve SLE outcomes.

Objective: To determine the body composition profile of forest firefighters. Data were collected from 701 forest firefighters., Methods: We have carried out this analysis using a bioimpedance scale BC-601 of the brand Tanita ISO 9001 Certified., Results: Obtained values of body mass index 24.85 in women and 27.83 in men. The visceral fat index was 5 in women and 9 in men. In both cases, taking as reference the values proposed by the WHO, women are within a low-moderate risk of cardiovascular or metabolic diseases. Men are at a moderate-high risk., Conclusions: The values obtained in the analysis show that forest firefighters have a moderate risk of cardiovascular and metabolic diseases in the future. It is effective to propose future works that elaborate specific physical activity plans to improve their health profile.

Introduction: Paired cohort investigations assessing the evolution of anthropometric indices are scarce. Here we assessed the 10-year evolution of BMI, total body fat, and lean body mass in 50,019 participants aged 18-90 years at the time of first assessment. Material and Methods: A retrospective cohort study using an electronic database that contains anonymized, longitudinal data from Primary Care medical records covering the 2007-2008 and 2017-2018 periods. Total body fat was estimated using the Clínica Universidad de Navarra-Body Adiposity Estimator formula, and the Hume formula was applied to estimate lean body mass. Results: The mean BMI of participants <60 years old in the 2007-2008 period increased significantly, from 27.5 to 28.3 kg/m 2 ( p < 0.001). However, the BMI of older subjects decreased during the next decade, from 28.9 to 28.3 kg/m 2 ( p < 0.001). The estimated total body fat showed a continuous progressive increase over all ages. Finally, lean body mass showed a progressive increase until the 40s, with a plateau between 40-45 years old and an uninterrupted decrease until older ages. Also, subjects who increased their BMI by 2 kg/m 2 during the 10-year period were mainly women and younger at baseline, with a lower initial BMI and total body fat in comparison with those who experienced a BMI decrease of ≥2.0 kg/m 2 . Conclusion: The evolutions of BMI and the estimated body compositions reported here confirm that the adverse decrease in lean body mass begins in middle age. The proportion of older subjects is important when evaluating overweight and obesity prevalence in cross-sectional studies., (Copyright © 2020 Santos, Buti, López-Cano, Sánchez, Vidal, Hernández, Lafarga, Gutiérrez-Carrasquilla, Rius, Bueno and Lecube.)

Background and Aims: In lifestyle intervention studies, we demonstrated that changes in telomere length (TL) were associated with changes in anthropometric indices. Therefore, our new hypothesis is that TL could be a predictor of changes in anthropometric or metabolic measures in children with abdominal obesity. The aim of the study was to evaluate the association between anthropometric and biochemical measurements with TL before and after an 8-week lifestyle intervention in children with abdominal obesity (7-16 years old)., Methods and Results: We assessed anthropometric and biochemical outcomes at baseline and after 8-week lifestyle intervention in 106 children with abdominal obesity (11.30 ± 2.49 years old, 63% girls). TL was measured by monochrome multiplex real-time quantitative PCR. After the lifestyle intervention, anthropometric parameters and glucose metabolism indicators significantly improved in the participants. TL did not change after the intervention in participants. Significant negative correlations between baseline TL and anthropometric measures (BMI, body weight and waist circumference) were observed. Furthermore, baseline TL was a predictor for changes in blood glucose levels after the lifestyle intervention., Conclusions: An inverse correlation between TL and obesity traits was observed in children with abdominal obesity. Interestingly, we found that baseline TL could predict changes in blood glucose levels., Clinical Trial: NCT03147261. Registered 10 May 2017., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (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. Published by Elsevier B.V. All rights reserved.)

Background: Longitudinal changes in child and adolescent active school transport (AST), and the mediating role of different intensities of daily physical activity (PA) levels in relation to AST and physical fitness and adiposity indicators is unclear. This study aimed to: 1) describe longitudinal changes in AST, light PA (LPA), moderate- to vigorous-intensity PA (MVPA), physical fitness and adiposity indicators over three time-points; and 2) investigate the mediating role of LPA and MVPA levels on associations between AST and physical fitness and adiposity indicators over three time-points among children and adolescents., Methods: This longitudinal study comprised 1646 Spanish children and adolescents (48.8% girls, mean age 12.5 years ±2.5) at baseline, recruited from schools in Cádiz and Madrid. Mode of commuting to school was self-reported at baseline (T0, 2011-12), 1-year (T1) and 2-year follow-up (T2). PA was assessed using accelerometers. Handgrip strength, standing long jump and cardiorespiratory fitness (CRF) assessed physical fitness. Height, weight, body mass index, waist circumference, and triceps and subscapular skinfold thickness were measured. Multilevel linear regression analyses assessed changes in AST, PA levels, physical fitness and adiposity indicators over three time-points (T0-T1-T2). Additionally, longitudinal path analysis (n = 453; mean age [years] 12.6 ± 2.4) was used to test the mediating effects of LPA and MVPA levels on the association between AST and physical fitness and adiposity indicators., Results: Multilevel analyses observed decreases in LPA between T0-T1 (β = - 11.27; p < 0.001) and T0-T2 (β = - 16.27; p < 0.001) and decreases in MVPA between T0-T2 (β = - 4.51; p = 0.011). Moreover, changes over time showed increases in handgrip between T0-T1 (β = 0.78; p = 0.028) and T0-T2 (β = 0.81; p = 0.046). Path analyses showed that AST was directly positively associated with MVPA at T1 (all, β ≈ 0.33; p < 0.001). MVPA at T1 mediated associations between AST and CRF at T2 (β = 0.20; p = 0.040), but not the other outcomes. LPA did not mediate any associations., Conclusions: Results from longitudinal path analysis suggest that participation in more AST may help attenuate declines in MVPA that typically occur with age and improve CRF. Therefore, we encourage health authorities to promote AST, as a way to increase MVPA levels and CRF among youth.

Background: The prevalence of childhood hypertension (HT) is growing exponentially, influenced by environmental factors such as foods with high salt content, sedentary lifestyles, and poor-quality food. The incidence of HT is about 10.4% in well-nourished children, but when associated with obesity or overweight, this can rise to 38% and 68%, respectively. To assess the influence of physical activity on the blood pressure (BP) of children who are overweight or obese., Methods: This randomized clinical trial was carried out in Granada (Spain), from October 2015 to June 2016. The sample consisted of 98 children, all of whom were overweight or obese. The intervention group (IG) (n = 49) practised physical activity and received nutritional advice, while the control group (n = 49) only received theoretical-practical sessions on nutrition. Body composition was measured, a nutritional assessment was made and BP was determined (in percentiles, to avoid the misclassification of children who are located at the extremes of normal growth)., Results: Before the physical activity intervention, 85.7% of the children in the IG (with overweight/obesity) were in the 95th or higher percentile for BP, a situation representative of high BP (HT). However, by the end of the study period, this value had decreased significantly (P = 0.001), to 16.13%., Conclusions: Childhood obesity is a risk factor for HT. Physical activity, together with nutritional advice, effectively reduces BP in children who are overweight or obese. The use of percentiles, according to age, weight, and height, is an effective means of measuring BP., Clinical Trials Registration: This study is registered at https://www.clinicaltrials.gov (identifier NCT02779647)., (© American Journal of Hypertension, Ltd 2019. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Introduction: Background: survivors of childhood acute leukemia are at risk for obesity. The purpose was to evaluate the different clinical measurements of body composition and to compare with body mass index (BMI). Methods: cross-sectional study of 39 survivors with more than ten years of survivorship since diagnosis. Anthropometry and body composition accuracy measurements were determined and also obesity risk factors. Results: obesity prevalence by body fat percentage were: 38.5% for BMI; 46.1% for waist circumference; 51.3% for skinfolds and 56.4% for bioelectrical impedance analysis (BIA). There was a good correlation among the measurements, but BMI underestimated the percent body fat among childhood leukemia survivors in comparison with: waist circumference (-1.03 ± 2.01), skinfolds (-2.95 ± 5.78) and BIA (-3.78 ± 7.4), and this bias appears to be more variable with increasing percent of body fat > 30%. Three patients showed sarcopenia and only one sarcopenic obesity. Waist circumference fat mass was the better predictor of cardiovascular risk factors (LDL-cholesterol: r = 0.703; HDL-cholesterol: r = -0.612; p < 0.05 and hypertension: OR 4.17; IC 95%: 1.012-19.3). Obesity risk factors were: female sex, high-risk tumor, radiotherapy and stem cell transplantation. Conclusions: BMI underestimates obese childhood leukemia survivors in comparison with waist circumference, skinfolds and bioelectrial impedance analysis. BMI use could misclassify obese survivors as non-obese. Female sex, high tumoral risk and coadyuvant treatments (radiotherapy and stem cell transplant) are risk factors for adiposity.

Background: Childhood obesity has become a major health problem in children under the age of 5 years. Providing reference standards would help paediatricians to detect and/or prevent health problems related to both low and high levels of body mass and to central adiposity later in life. Therefore, the aim of this study was to examine the prevalence of different weight status categories and to provide sex- and age-specific anthropometry reference standards for Spanish preschool children., Methods: A total of 3178 preschool children (4.59±0.87 years old) participated in this study. Prevalence of different degrees of obesity (mild, severe, and morbid) and other weight status categories were determined., Results: Reference standards were obtained. Prevalence of overweight and obese preschool children in the Spanish population ranged from 21.4 to 34.8%. Specifically, the obesity prevalence was 3.5, 1.2, and 1.3% of these subjects were categorized as mild, severe, and morbid obese. Sex- and age-specific reference standards for anthropometric parameters are provided for every 0.25 years (i.e. every trimester of life)., Conclusion: Our results show a high prevalence of overweight/obese preschoolers. The provided sex- and age-specific anthropometric reference standards could help paediatricians to track and monitor anthropometric changes at this early stage in order to prevent overweight/obesity.

Full-fat dairy has been traditionally associated with obesity and cardiovascular disease (CVD); however, recent evidence shows that the amount of dairy intake might have a beneficial effect over these pathologies, regardless of their fat content. The aim of this study was to examine the association between the intake of dairy products (including milk with different fat contents) with both adiposity and serum lipid concentration, adjusted by cardiorespiratory fitness (CRF), in Spanish schoolchildren. A cross-sectional study of 1088 children, aged 8 to 11 years, was conducted in which anthropometric variables (body mass index (BMI), waist circumference (WC), fat mass percentage (FM%) and fat mass index (FMI)), blood lipid profile, and dairy intake (using a food frequency questionnaire), and CRF (through a 20-m shuttle run test) were measured. Results showed that children with lower BMI, WC, FM%, and FMI had higher whole-fat milk intake and lower skimmed and semi-skimmed milk intake than children with higher BMI, WC, FM%, and FMI. Children with normal levels of triglycerides and high density lipoproteins (HLD) cholesterol consumed more whole-fat milk and less reduced-fat milk than children with dyslipidemic patterns. These relationships persisted after adjustment for CRF. Our findings suggest that full-fat milk intake should be promoted in children without obesity or high cardiometabolic risk., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Background: Although physical activity (PA) integrated in schools' classrooms have shown a positive effect on children's behaviors, its effectiveness on cognitive functions, PA levels and other health variables remains unclear. This article outlines the rationale and methods of two classroom-based PA interventions (MOVI-da10!) on improving adiposity, executive function and motor competence in preschool children.Methods: A three-arm cluster-randomized controlled trial (RCT) was carried out including eight schools (rural and urban areas) from Cuenca province, Spain. The schools were allocated to one of three groups: MOVI-da10-Enriched! intervention (n = 3), MOVI-da10-Standard! intervention, (n = 2), and the control group (n = 3). Around 900 children aged 4 to 6 years old were assesed at baseline (September 2017) and at the end (June 2018) of the intervention. The primary outcomes were changes in body fat by bioimpedance, executive function and motor competence. During a school year (from October 2017 to May 2018), children belonging to the MOVI-da10-Enriched! group performed enriched PA integrated into the academic curriculum including two active breaks lasting 10 min, 5 days/week. The children belonging to the MOVI-da10-Standard! group performed PA breaks (with low cognitive demand, where curricular contents were not reinforced) including two active breaks lasting 10 min, 5 days/week. In the control group, regular PA continued.Discussion: To our knowledge, MOVI-da10! is the first RCT to examine the effectiveness of two programs (enriched PA integrated into the academic curriculum and PA breaks only) versus a control group on improving adiposity, executive function and motor competence in preschool children.Trial Registration: NCT03236363 (clinicaltrials.gov), 31st July 2017. [ABSTRACT FROM AUTHOR]

: The preservation of muscle mass and muscle function after weight loss therapy is currently a considerable challenge in the fight against obesity. Muscle mass secretes proteins called myokines that have relevant functions in the regulation of metabolism and health. This study was aimed to evaluate whether a very low-calorie ketogenic (VLCK) diet may modulate myokine levels, in addition to changes in body composition, compared to a standard, balanced low-calorie (LC) diet or bariatric surgery in patients with obesity. Body composition, ketosis, insulin sensitivity and myokines were evaluated in 79 patients with overweight/obesity after a therapy to lose weight with a VLCK diet, a LC diet or bariatric surgery. The follow-up was 6 months. The weight loss therapies induced changes in myokine levels in association with changes in body composition and biochemical parameters. The effects on circulating myokine levels compared to those at baseline were stronger after the VLCK diet than LC diet or bariatric surgery. Differences reached statistical significance for IL-8, MMP2 and irisin. In conclusion, nutritional interventions or bariatric surgery to lose weight induces changes in circulating myokine levels, being this effect potentially most notable after following a VLCK diet., Competing Interests: A.B.C. and F.F.C. received advisory board fees and/or research grants from Pronokal Protein Supplies, Spain. I.S. is the Medical Director of Pronokal, Spain..

Background : Central obesity, due to the accumulation of visceral fat(VF), is one of the main risk factors for venous thrombosis. The aim of this study was to determine if VF may be a risk factor for development of portal vein thrombosis(PVT) in cirrhotic patients. Methods : A total of 214 cirrhotic patients at the outpatient clinic were consecutively included, undergoing an anthropometric evaluation, blood tests and bioimpedance. Results : Median MELDscore was10. Prior liver decompensation occurred in 44.9% of patients and 35.6% of patients had large esophageal varices. Mean body mass index was 28.7 Kg/m2 (39.3%were obese) and mean waist circumference(WC) was 103.8 cm. A 7.5% of patients had PVT at the time of inclusion. PVT was more frequent in males(93.8 vs. 68.2%, p = 0.03). Patients with PVT had a higher WC(111.9 vs. 103.2 cm, p = 0.02) and VF (17.1 vs. 14.5, p = 0.04). PVT was also more frequent in patients with prior decompensation (81.3 vs. 41.9%, p < 0.01) and with large esophageal varices(62.5 vs. 33.3%, p = 0.02). In the simplified multivariate analysis, PVT was independently associated with the presence of portal hypertension(OR 13, 95%CI 1.6-108.3, p = 0.02) and VF(OR 1.2, 95%CI 1.03-1.3, p = 0.01). Conclusion : VF was independently associated with PVT in cirrhotic patients. VF may be more reliable than conventional anthropometric measurements for cirrhotic patients.

Introduction and Objectives: In epidemiological studies, excess body fat (BF) has been associated with cardiometabolic risk factors, some types of cancer, and other causes of death. A new anthropometric method has been defined: The CUN-BAE index (University of Navarra Clinic-Body Fat Estimator), which is based on BMI, sex, and age. BMI and CUN-BAE index were used to assess their contribution to mortality risk from any cause in the Asturias Study cohort., Material and Methods: The Asturias study is a cohort study including 1.034 individuals aged 30-75years who participated in the first study phase (1998-1999). The study included a clinical survey, physical examination, and an oral glucose tolerance test. Vital status was determined in the cohort after 18years of follow-up., Results: Two hundred and four subjects died: 93 females and 111 males (16.6% and 23.5% respectively men). Baseline values of both BMI and %BF suggesting obesity (BMI>30kg/m 2 and CUN-BAE >25% in males and >35% in females) were found in most subjects. After adjusting for T2DM, HBP, CVD, and tobacco, the risk of all-cause and cardiovascular mortality was significantly higher as CUN-BAE increased, especially in females., Conclusions: The CUN-BAE equation is a useful tool, especially in females, to detect those who will have a greater risk of mortality, regardless of cardiovascular risk factors., (Copyright © 2019 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)