European fitness landscape for children and adolescents: updated reference values, fitness maps and country rankings based on nearly 8 million test results from 34 countries gathered by the FitBack network.

OBJECTIVES: (1) To develop reference values for health-related fitness in European children and adolescents aged 6-18 years that are the foundation for the web-based, open-access and multilanguage fitness platform (FitBack); (2) to provide comparisons across European countries. METHODS: This study builds on a previous large fitness reference study in European youth by (1) widening the age demographic, (2) identifying the most recent and representative country-level data and (3) including national data from existing fitness surveillance and monitoring systems. We used the Assessing Levels of PHysical Activity and fitness at population level (ALPHA) test battery as it comprises tests with the highest test-retest reliability, criterion/construct validity and health-related predictive validity: the 20 m shuttle run (cardiorespiratory fitness); handgrip strength and standing long jump (muscular strength); and body height, body mass, body mass index and waist circumference (anthropometry). Percentile values were obtained using the generalised additive models for location, scale and shape method. RESULTS: A total of 7 966 693 test results from 34 countries (106 datasets) were used to develop sex-specific and age-specific percentile values. In addition, country-level rankings based on mean percentiles are provided for each fitness test, as well as an overall fitness ranking. Finally, an interactive fitness platform, including individual and group reporting and European fitness maps, is provided and freely available online (www.fitbackeurope.eu). CONCLUSION: This study discusses the major implications of fitness assessment in youth from health, educational and sport perspectives, and how the FitBack reference values and interactive web-based platform contribute to it. Fitness testing can be conducted in school and/or sport settings, and the interpreted results be integrated in the healthcare systems across Europe.

CHANGES IN PHYSICAL ACTIVITY LEVELS IN PATIENTS WITH ACUTE CORONARY SYNDROME BETWEEN THE FIRST AND THIRD DECADES OF THE 21st CENTURY.

Sedentary lifestyle and obesity increase the risk of coronary disease (CAD). The aims of this prospective study were to estimate the trends in physical activity (PA) level, accuracy of the Baecke's/LRC-PA questionnaires, and trends in obesity parameters (body mass index-BMI/waist-to-hip ratio-WHR) in patients with acute coronary syndrome (ACS) in the last two decades. We grouped 209 patients with ACS (UAP-unstable angina, STEMI-ST-elevation myocardial infarction, NSTEMI-non STEMI) by year of admission (Group 2002-05/Group 2017) and compared them by the levels of PA (Baecke's/LRC-PA questionnaires) and obesity parameters (BMI, WHR). Group 2017 had higher WHR (1.02 vs. 0.97) and leisure PA index (LI) (3.00 vs. 2.50), as well as less high and very low activity patients (P<0.05). Patients with UAP/STEMI had higher WHR in 2017 (1.02 vs. 0.96, 1.02 vs. 0.99, respectively) (P<0.05) and had lower LI in 2002-05 (2.50 vs. 3.25, 2.75 vs. 3.50, respectively) (P<0.05). In conclusion, leisure PA and WHR was increased in the study period both in patients with ACS and in the general population. We emphasize the usage of more precise methods for evaluation of PA and obesity (Baecke's/Four-point LRC-PA questionnaires, WHR), and that only increased PA with dietary changes leads to reduction of central obesity and risk of ACS.

Agreement between the SHAPES Questionnaire and a Multiple-Sensor Monitor in Assessing Physical Activity of Adolescents Using Categorial Approach: A Cross-Sectional Study.

This study aimed to evaluate the agreement between a 7-day recall questionnaire and multiple-sensor monitor in identifying sufficiently active adolescents. A total of 282 students involved in the CRO-PALS study were randomly selected for a device-based measurement of physical activity (PA) using the SenseWear Armband device (SWA) no more than three weeks before or after having fulfilled the SHAPES questionnaire. Valid data was obtained from 150 participants (61 boys; 89 girls) and included in the analysis. In boys, SHAPES exhibited high specificity (92.3%), overall percent agreement (85.0%), and significant agreement (κ = 0.32, p = 0.014) with the SWA in recognising sufficiently active individuals. Conversely, no agreement was detected for quartiles of PA, although boys that were classified in the first and in the fourth quartile by SHAPES differed in device-based measured duration of MVPA (134 [95%CI: 109-160] vs. 87 [95%CI: 65-108], p = 0.032); and VPA (39 [95%CI: 23-56] vs. 14 [95%CI: 6-22], p = 0.011). In girls, no significant agreement between the two methods was found in any of the analyses. It appears that the SHAPES questionnaire is effective to identify individuals that comply with PA recommendations and to distinguish between the most active and the least active individuals for adolescent boys, but not for girls.

Can Injuries Be Predicted by Functional Movement Screen in Adolescents? The Application of Machine Learning.

ABSTRACT: Karuc, J, Misigoj-Durakovic, M, Sarlija, M, Markovic, G, Hadzic, V, Trost-Bobic, T, and Soric, M. Can injuries be predicted by functional movement screen in adolescents? The application of machine learning. J Strength Cond Res 35(4): 910-919, 2021-This study used machine learning (ML) to predict injuries among adolescents by functional movement testing. This research is a part of the CRO-PALS study conducted in a representative sample of adolescents and analyses for this study are based on nonathletic (n = 364) and athletic (n = 192) subgroups of the cohort (16-17 years). Sex, age, body mass index (BMI), body fatness, moderate-to-vigorous physical activity (MVPA), training hours per week, Functional Movement Screen (FMS), and socioeconomic status were assessed at baseline. A year later, data on injury occurrence were collected. The optimal cut-point of the total FMS score for predicting injury was calculated using receiver operating characteristic curve. These predictors were included in ML analyses with calculated metrics: area under the curve (AUC), sensitivity, specificity, and odds ratio (95% confidence interval [CI]). Receiver operating characteristic curve analyses with associated criterium of total FMS score >12 showed AUC of 0.54 (95% CI: 0.48-0.59) and 0.56 (95% CI: 0.47-0.63), for the nonathletic and athletic youth, respectively. However, in the nonathletic subgroup, ML showed that the Naïve Bayes exhibited highest AUC (0.58), whereas in the athletic group, logistic regression was demonstrated as the model with the best predictive accuracy (AUC: 0.62). In both subgroups, with given predictors: sex, age, BMI, body fat percentage, MVPA, training hours per week, socioeconomic status, and total FMS score, ML can give a more accurate prediction then FMS alone. Results indicate that nonathletic boys who have lower-body fat could be more prone to suffer from injury incidence, whereas among athletic subjects, boys who spend more time training are at a higher risk of being injured. Conclusively, total FMS cut-off scores for each subgroup did not successfully discriminate those who suffered from those who did not suffer from injury, and, therefore, our research does not support FMS as an injury prediction tool.

THE ROLE OF ANTHROPOMETRIC PARAMETERS AND PHYSICAL ACTIVITY LEVEL IN PATIENTS WITH ACUTE CORONARY SYNDROME ADMITTED TO THE INTENSIVE CARDIAC CARE UNIT.

Anthropometric parameters have a role in diagnosing obesity, which increases the risk of acute coronary syndrome (ACS). The aim of the study was to assess the impact of obesity and physical activity level on the severity and long-term prognosis of ACS. A total of 116 patients with ACS were analyzed according to baseline (demography, medical history, anthropometry), severity (clinical presentation, in-hospital complications, laboratory, echocardiography, coronary angiography) and prognostic parameters (major adverse cardiovascular events during a six-year period). The levels of obesity and physical activity (Baecke/Lipid Research Clinics physical activity questionnaires) were compared with a sample of the Croatian general population. Study results showed the subjects with a higher number of narrowed coronary arteries (CAs) to have higher body mass index (BMI) and waist circumference (WC); those with stenosed left anterior descending artery and anterior myocardial infarction (MI) had higher BMI; waist-to-hip ratio (WHR) positively correlated with creatine kinase and negatively with left ventricle ejection fraction (p<0.05). Inactive patients more often had multi-vessel coronary disease and anterior MI; patients with a higher leisure physical activity index had a lower number of affected CAs, lower rate of stent implantations and lower stent length, while those with a higher work physical activity index had a lower rate of anterior MI (p<0.05). During the follow-up, inactive patients had more strokes and deaths (p<0.05). Our patients had higher body weight, WC and WHR, as well as lower leisure time and total physical activity indices than the general population (p<0.05). In conclusion, ACS is less severe and has better long-term prognosis in less obese patients with a higher level of physical activity. Patients with ACS are more obese and have lower total, as well as leisure time physical activity indices than the general population.

Heart Rate-Corrected QT and JT Intervals in Electrocardiograms in Physically Fit Students and Student Athletes.

In literature, data on the prevalence of prolonged and shortened corrected QT (QTc) have shown considerable variability. The aim of the study was to compare QTc and JTc intervals of competitive student athletes and noncompetitive sport participants to QTc cutoff points used in athletes. A group of 485 physically fit candidates for the study of kinesiology (139 female and 346 male candidates) aged 18-20 participated in the study. Basic anthropometry, field fitness test, cardiovascular, electrocardiograms measurements, and blood sampling for lipid profile were conducted. The prolonged QTc according to European Society of Cardiology criteria was found in 2.9% of female and 4.3% of male students. When the "Seattle criteria" were used, the proportion of prolonged QTc was 1.44% in female and 0.29% in male students. The shortened QTc according to the Seattle cutoff points was presented in 0.7% of female and 2.0% of male students. The JTc over 400 ms was found in 0.72% of female and 0.29% of male students. The JTc shorter than 320 ms was presented in 0.7% of female and 1.1% of male students. No significant differences were found between students involved in competitive sport and those involved in recreational sporting activities. Female students had lower body mass index and blood pressure values, better blood lipid profile, and lower uric acid concentrations. In conclusion, the Seattle criteria markedly decreased the proportion of prolonged QTc in student athletes, particularly in male students. It seems that the JTc interval could be a better parameter than the QTc interval for the estimation of specific repolarization time in physically fit university students.

The Role of Anthropometry in Acute St-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention.

The aim of this study was to investigate the controversial influence of anthropometry on clinical severity and prognosis of acute ST-elevation myocardial infarction (STEMI). We prospectively analyzed 250 patients with acute STEMI treated with primary percutaneous coronary intervention (September 2011 ­ September 2012). They were grouped according to the following anthropometric parameters: body mass index (BMI) (<25.0, 25.0-29.9, ≥30.0 kg/m²), waist circumference (WC) (<102/88, ≥102/88 cm), waist-to-hip ratio (WHR) (<0.90/0.85, ≥0.90/0.85) and waist-to-height ratio (WHtR) (<53/49, 53/49-62/57, ≥63/58). The groups were analyzed by baseline, as well as severity (clinical, laboratory, echocardiography, coronary angiography, in-hospital complications) and prognostic parameters (major adverse cardiovascular events and sick leave duration during 12-month follow up). Patients with BMI <25.0 kg/m2 had the highest rates of dyspnea and those with BMI ≥30.0 kg/m² had the longest hospitalization and widest stents; patients with WHR ≥0.90/0.85 had higher rates of significantly stenosed proximal/middle coronary segments, while those with WHtR ≥63/58 had the highest rates of heart failure and total in-hospital complications (p<0.05). BMI <25.0 kg/m2 increased (odds ratio (OR) 2.00, confidence interval (CI) [1.09-3.68], p=0.026) and BMI 25.0-29.9 kg/m2 reduced (OR 0.52, CI [0.30-0.91], p=0.022) the risk of dyspnea; WHR≥0.90/0.85 increased the risk of significant proximal/middle coronary segment stenosis (OR 3.34, CI [1.13-9.86], p=0.029) and WHtR ≥63/58 the risk of heart failure (OR 2.05, CI [1.13-3.71], p=0.017) and total in-hospital complications (OR 1.94, CI [1.13-3.33], p=0.017) (p<0.05). In conclusion, WHR and WHtR are better anthropometric parameters than BMI in predicting acute STEMI severity, while WC has no influence on it. Anthropometry has no influence on prognosis.

School day and weekend patterns of physical activity in urban 11-year-olds: a cross-cultural comparison.

OBJECTIVES: This multi-center study was conducted to objectively evaluate energy expenditure and physical activity (PA) patterns on school days and weekends in urban 11-year-olds. METHODS: The sample consisted of 241 children from three cities: Zagreb, Ljubljana (both in Central Europe) and Ann Arbor (United States). Energy expenditure and PA were assessed during two school days and two weekend days using a multiple-sensor body monitor. RESULTS: Differences between the cities were observed for all PA variables. The highest level of moderate to vigorous PA (MVPA) was noted in Ljubljana boys [284 (98) min/day] and the lowest in Zagreb girls [179 (95) min/day]. In Zagreb and Ljubljana, boys were more physically active than girls, while in Ann Arbor the opposite was observed. In contrast, no gender difference in sedentary behavior was observed in any of the cities. A decline in PA from school days to weekends was noted in all city groups in both genders. However, the magnitude of the reduction in daily energy expenditure differed between the cities, with the largest differences being observed in Ljubljana and the smallest in Ann Arbor. In all three city groups, the great majority of boys and girls achieved current recommendations of 60 min of MVPA either during school days or weekends. CONCLUSIONS: Weekends seem to be an appropriate target when promoting PA in 11-year-olds in all the cities included in the study. Increasing vigorous activity on weekends seems to be of particular importance in Zagreb and Ljubljana.

Associations of objectively assessed sleep and physical activity in 11-year old children.

AIM: Objective methods were used to evaluate children's sleep and physical activity over several days in order to test the hypotheses that: (1) low average sleep duration and/or sleep efficiency are linked to a low amount of physical activity; and (2) a reduction in sleep quantity and/or sleep efficiency during the night is followed by a decrease in physical activity the following day. METHODS: This is a multi-centre, observational study involving 276 children, aged 10.5-12 years, from diverse urban settings in Croatia, Slovenia and the US. Sleep and activity were monitored for 2-6 days (median = 4) using the Sensewear Armband™ multi-sensor body monitor. RESULTS: While average sleep duration and efficiency were unrelated to physical activity, within-subjects associations revealed that an extra hour spent in bed during the night was followed by a 16-minute decrease in moderate-to-vigorous physical activity (p < 0.001). This was accompanied by a 4.5 kJ/kg and 5.9 kJ/kg lower total daily energy expenditure in boys and girls, respectively (p < 0.001). CONCLUSIONS: This study found no evidence for a link between short sleep and low or reduced physical activity.

Tracking of BMI, fatness and cardiorespiratory fitness from adolescence to middle adulthood: the Zagreb Growth and Development Longitudinal Study.

BACKGROUND: Effective intervention strategies aiming to improve cardiorespiratory fitness and to decrease body fatness are needed. However, long-term stability of these traits is not well understood. AIM: To assess long-term tracking of cardiorespiratory fitness and body fatness from late adolescence to middle adulthood. SUBJECTS AND METHODS: The sample consisted of 50 participants (31 boys) from the Zagreb Growth and Development Longitudinal Study who were followed up in adulthood (median age = 43). Fatness was evaluated through BMI and skin-folds, while cardiorespiratory fitness was assessed using a cardiopulmonary exercise test. Inter-age partial correlation coefficients were calculated to evaluate tracking. RESULTS: Body mass index and skin-folds showed moderate tracking from age 15 years to middle adulthood (partial r = 0.55, p < 0.001 and partial r = 0.52, p < 0.001, respectively), while tracking of subcutaneous fat distribution was somewhat lower (partial r = 0.38, p < 0.01). At the same time, the observed tracking of peak oxygen uptake was low-to-moderate (partial r = 0.30, p = 0.03), while ventilatory aerobic and anaerobic thresholds did not show significant tracking. CONCLUSIONS: The results of this study indicate that preventive efforts aiming to increase cardiorespiratory fitness should include all adolescents, irrespective of their cardiorespiratory fitness status. Conversely, strategies aiming at obesity prevention should focus on high-risk groups of adolescents.

Correction: Radman et al. Prevalence of Key Modifiable Cardiovascular Risk Factors among Urban Adolescents: The CRO-PALS Study. Int. J. Environ. Res. Public Health 2020, 17, 3162.

The authors regret to acknowledge that a mistake has been made in the original article [...].

Assessment of Nutrient Intake and Diet Quality in Adolescent Dietary Supplement Users vs. Non-Users: The CRO-PALS Longitudinal Study.

Dietary supplement users tend to have a better diet quality and overall prudent lifestyle. The main goals of this research were to report the prevalence and type of dietary supplements among Croatian adolescents and to examine the differences in the diet quality among dietary supplement users vs. non-users at the beginning (15/16 y) and at the end of high school education (18/19 y). This research is based on results of the longitudinal CRO-PALS study in which 607 adolescents participated, who had complete dietary, anthropometric, and physical activity data at the beginning (15/16 y) and at the end of their high school education (18/19 y). The dietary assessment method used was a single multi-pass 24 h recall. Dietary supplement users were divided into two groups for the purposes of statistical analysis-users of vitamin and multivitamin preparations (VMV) and users of mineral and multivitamin preparations (MMV). As they aged, there was an increase in the consumption of dietary supplements, and the most frequently used preparation in both age groups was vitamin C (23.7% of users). Dietary supplement users had a higher intake of non-carbonated sweetened drinks and a lower intake of fruits and vegetables in both genders and both age groups. Fast food intake was higher among dietary supplement girl users and boys who were not dietary supplements users in both age groups. Dietary supplement users had a higher achieved average intake of most micronutrients (values obtained only from food) in both genders and both age groups (with exceptions for certain vitamins and minerals). By observing other parameters for assessing the diet quality in this research, we can conclude that girls who do not use dietary supplements have a better diet quality in both age groups.

Physical Activity of Children and Adolescents in Croatia: A Global Matrix 4.0 Systematic Review of Its Prevalence and Associated Personal, Social, Environmental, and Policy Factors.

BACKGROUND: The previous review of physical activity (PA) among Croatian children and adolescents was conducted a decade ago. Therefore, the aim of this study was to summarize recent evidence on PA of Croatian children and adolescents and associated personal, social, environmental, and policy factors. METHODS: Eighteen experts reviewed the available evidence and provided ratings (from the lowest grade "F" to the highest grade "A+") for the 10 Global Matrix indicators. A systematic search with 100 keywords was conducted in Hrcak, PubMed/MEDLINE, Scopus, SPORTDiscus, and Web of Science for documents published from January 01, 2012, to April 15, 2022. We also conducted internet searches and secondary analyses of data (relative frequencies) from 6 studies. RESULTS: After assessing 7562 references, we included 90 publications in the review and 18 studies (83.3% of medium-to-good quality) in evidence synthesis. We found a high prevalence of insufficient PA (especially among girls) and excessive screen time (especially among boys). PA participation of children and adolescents in Croatia has declined over time. The following grades were assigned to the indicators for Croatia: B- for overall PA, C- for organized sport and PA, C for active play, C- for active transportation, D+ for sedentary behavior, inconclusive for physical fitness, D+ for family and peers, B- for school, B- for community and environment, and D+ for government. CONCLUSIONS: Coordinated actions are needed across sectors to improve PA promotion, with a focus on increasing PA among girls, reducing sedentary screen time among boys, improving parental support for PA, and further development of national PA policies.

Validation of the Sensewear Armband during recreational in-line skating.

Multi-sensor body monitors that combine accelerometry with other physiological data are designed to overcome drawbacks of accelerometers in assessing activities with little or no vertical movement. One of such devices is the Sensewear Armband (SWA) which has been extensively validated during various activities. However, very few of the validation studies included activities other than walking and running. The aim of this investigation was to assess the validity of the SWA during recreational in-line skating. Nineteen participants (11 females and 8 males), 28 (±6) years of age, performed in-line skating exercise on a circular track at a self-selected pace. Energy expenditure was measured with the SWA and the Cosmed K4b(2) breath-by-breath portable metabolic unit. The mean (SD) energy expenditure during in-line skating estimated by the SWA [25.5 (5.8) kJ/min] was significantly lower compared with indirect calorimetry [44.2 (9.7) kJ/min, P < 0.001]. Similarly, the mean (SD) MET values recorded by the SWA were also lower compared with IC [5.3 (1.0) METs vs. 9.1 (1.6) METs, P < 0.001]. The ratio limits of agreement suggest that in 95% of cases the SWA will underestimate the energy expenditure and MET values during in-line skating by as much as 24-56% compared with indirect calorimetry. In conclusion, the results of the present study indicate that the SWA is not able to overcome the drawbacks of accelerometry in assessing activities with limited vertical movement.

Does time of the day matter? Temporal associations between physical activity and quality and quantity of subsequent sleep in adolescents.

Temporal associations between moderate-to-vigorous physical activity (MVPA) at four different multi-hour intervals during the day and the following indicators of sleep quality and sleep quantity in adolescents were examined. This research is a part of the CRO-PALS study, including 129 adolescents (48 boys, 81 girls; mean age ± SD = 15.6 ± 0.4 years) having complete data on sleep and MVPA measured by the SenseWear Pro3 Armband monitor. As data had a hierarchical structure, repeated measures multilevel modelling was used to assess the associations between PA and sleep. During school nights, in girls, morning MVPA was not related to following indicators of sleep quality and sleep quantity. At the same time, evening MVPA was linked with longer sleep onset latency (ß = 0.064; 95%CI = 0.025 to 0.103) and higher wake after sleep onset (ß = 0.156; 95%CI = 0.0482 to 0.2638). Moreover, during weekend nights, morning MVPA was not associated with sleep, while evening MVPA was accompanied by longer sleep onset latency (ß = 0.058; 95%CI = 0.023 to 0.093), higher wake after sleep onset (ß = 0.104; 95%CI = 0.012 to 0.20), and negatively with sleep efficiency (ß = -0.019; 95%CI = -0.037 to -0.001). In boys the specific multi-hour interval of performing physical activity was not associated with any of indicators of sleep quality. In conclusion, while no strong relations between MVPA and sleep were seen among boys, in girls morning hours MVPA resulted in better sleep patterns over school nights, while afternoon MVPA was followed with slight worsening of some indicators of sleep quality across the whole week.

Incidence of cardiovascular events when watching intense football matches - sex differences.

INTRODUCTION: FIFA World Cup represent one of the world's greatest phenomena. The spectators watch the matches of national teams with great emotional involvement. It is well documented fact that emotional stress can be a trigger of unwanted cardiovascular (CV) event. AIM: The aim of this retrospective study was to determine whether there had been an increase in the number of the emergency admissions for CVD in the Emergency Room and Clinic for Cardiovascular Diseases of the Sestre milosrdnice University Hospital Centre during and after the matches that the Croatian national team played in the FIFA World Cup 2018. METHODS: The hospital's database was examined for the dates when Croatia played its matches, plus two more days after each match. An unexposed period that included the same dates in 2017 and 2019 was formed. RESULTS: 1093 cases were assessed. The incidence of CV admissions during the exposed period was 1.15 (95% confidence interval [CI]; 1.02 to 1.31) times higher than during the unexposed period. There was a 1.30 (95% CI; 1.1 to 1.54) times higher incidence in women compared to the unexposed period. Arrhythmias and angina pectoris were the CVDs that occurred more frequently in the exposed period. CONCLUSION: This study showed that watching Croatian national team's matches and cheering represented an additional risk for a CV incident, especially in women.

Suppurative tonsillitis and sudden cardiac death due to physical training in a young soccer player.

A teenager aged 17 was a professional soccer player, and was without symptoms. He died suddenly during physical exercise at the field. All reanimation efforts were unsuccessfull. At the forensic autopsy he had suppurative bacterial tonsillitis, subacute diffuse myopericarditis and narrowing of the ascending aorta of 10 mm. In Croatia the death rate among athletes reached 0.15/100,000, in athletes suffered of acute respiratory tract infections 0.34/100,000, in males who practice exercise recreatively 0.75/100,000 (p = 0.0014), in school children 1.0/100,000 (p = 0.0010). Physical exercise is contraindicated in acute respiratory tract infections. Every such case has to be treated by physician. When to start with physical training after suppurative-bacterial tonsillitis depends on disappearing of clinical signs, normalization of erythrocite sedimentation rate; of white cell count and serum level of C-reactive protein. Physical exercise is contraindicated in patients suffering of myopericarditis for at least 6 months. When to start exercise depends on disappearing of subjective symptoms and normalization of clinical and laboratory findings.

Prevalence of Key Modifiable Cardiovascular Risk Factors among Urban Adolescents: The CRO-PALS Study.

The occurrence of chronic diseases in youth has become a serious global issue requiring early prevention. Due to the specific environment in large cities, urban youth are especially exposed to risky lifestyle patterns. OBJECTIVE: This survey aimed to determine the prevalence of key modifiable cardiovascular risk factors in the adolescent population of the Croatian capital Zagreb. METHODS: A clustered two-stage random sample design was employed to select a representative group of 903 adolescents (girls n = 444; boys n = 459; age 15.6 ± 0.4) starting their secondary education. Participants were invited to fulfil an electronic questionnaire meant to collect data on daily physical activity, screen time and tobacco use. In addition, anthropometric and blood pressure measurements were taken by medically trained personnel. Data that were not originally categorical were dichotomized based on internationally accepted cut-off values for each risk factor, summarized for females and males, and presented as percentages and 95% confidence intervals. RESULTS: The outcomes suggest that that more than one half did not meet the recommended daily physical activity (girls 59.4%; boys 45.5%), while about one quarter exceeded 2 hours of screen time per day and had high blood pressure (girls 26.6% and 21.6%; boys 27.0% and 27.0%, respectively). Moreover, the results indicated nearly one fifth of adolescents had excess weight (girls 16.1%; boys 22.2%) and a similar proportion smoked tobacco (girls 20.8%; boys 17.0%). CONCLUSIONS: Local and regional health stakeholders should make additional efforts to promote healthy lifestyles in urban teenagers. Special emphasis should be placed on promoting physical activity.

Indicators of nutritional status and physical activity level as factors associated with the onset of menarche of ten year old girls from Zadar county, Croatia.

OBJECTIVES: The aim is to determine the differences in nutritional status and level of physical activity (PA) of ten year old menstruating and non-menstruating girls. METHODS: On the sample of 208 girls, fourth graders of elementary schools in Croatia, the indicators of nutritional status were measured: body mass index(BMI), body fat % and waist to hip ratio(WHR), while the PA was assessed using PAQ-C questionnaire. Welch´s t-test was applied to establish the differences and multivariate regression analysis was applied to establish the relationships. RESULTS: Menstruating girls have significantly higher body mass (43.42 kg±8.31 vs. 38.64 kg±8.33), waist circumference (68.10 cm ± 9.86 vs. 62.22 cm ± 7.16), hip circumference (80.81 cm ± 7.24 vs. 76.63 cm ± 7.7), BMI (19.70 ± 3.42 vs. 17.74 ± 3.10), body fat % (28.05 ± 7.54 vs. 21.98 ± 7.67) and WHR (0.84 ± 0.06 vs. 0.81 ± 0.05) in comparison to non-menstruating girls, while non-menstruating girls have significantly higher PA level (2.93 ± 0.57 vs. 2.68 ± 0.57). The regression analysis have shown a significant relationship between body fat % and the onset of menarche (ß=-0.23, SEß=0.07, p<0.01). CONCLUSIONS: Results show differences in the indicators of nutritional status of girls with regard to the status of maturity. Increased nutritional status and body fat % may be indicators of the accelerated developmental tempo and a determinant for the earlier onset of menarche.

Eveningness in Energy Intake among Adolescents with Implication on Anthropometric Indicators of Nutritional Status: The CRO-PALS Longitudinal Study.

Shifting of energy intake towards a later time in the day is associated with an increased risk of obesity in adults. However, there is a lack of data for adolescents. The aim of this study was to investigate adolescents eveningness in energy intake (EV) and its association with anthropometric indicators of nutritional status. This investigation was based on results from the Croatian physical activity in adolescence longitudinal study (CRO-PALS). The cohort included 607 adolescents (50.25% females and 49.75% males) who were assessed at the age of 15/16 and 18/19. A single multi-pass 24-h recall was used as a dietary assessment method, while anthropometric indicators of nutritional status included body mass index (BMI), waist to hip ratio (WHR) and the sum of four skinfolds. The School Health Action, Planning and Evaluation System (SHAPES) questionnaire was used to assess active daily energy expenditure and sedentary behaviors. EV was significantly higher at 18/19 years compared to 15/16 years in whole population (p < 0.01), among male adolescents (p < 0.01), but not among female adolescents (p > 0.05). Although a significant correlation between EV and WHR was found in females at the age of 15/16 (p < 0.01), the results of this study suggest that EV has no or a minor effect on anthropometric indicators of nutritional status in adolescence.