Direct and indirect effects of physiological, psychological and cognitive variables on academic achievement in children.

BACKGROUND: Associations between cardiorespiratory fitness (CRF), screen time, psychological well-being, executive functions, and academic achievement have been reported, however, few studies have analysed models considering the effect of all these variables on academic achievement. This study aims to analyse the direct and indirect associations of mothers' education level, CRF, screen time, psychological well-being, executive functions, with academic achievement in schoolchildren, by sex. METHODS: This was a cross-sectional analysis of MOVI-daFit! study including 519 schoolchildren (49.52% girls) aged 9-11 years old. Executive functions were assessed with the NIH Toolbox, CRF with the 20-m shuttle run test, academic achievement through the final academic grades in language and mathematics and mother's education level, screen time and well-being by questionnaires. RESULTS: Structural equation modelling revealed that in boys cognitive flexibility had a significant direct effect on academic achievement and screen time a total significant effect on academic achievement. In girls, CRF was associated with inhibition and psychological well-being, and this was associated with academic achievement. CONCLUSIONS: Physiological, psychological, and behavioural variables act together to impact academic achievement, and that differences by sex might exist. Thus, strategies to enhance academic achievement in schoolchildren should consider psychological well-being, CRF, screen time, and sex differences. IMPACT: Physiological, psychological, and behavioural variables, such as cardiorespiratory fitness, screen time, psychological well-being, and cognition all together have an impact on academic achievement, with differences by sex. Previous studies have demonstrated the separate effect of these variables, however, to date, this is the first study that analyses all together in the same model their impact on academic achievement, by sex. This study shows that in boys cognitive flexibility and screen time impact academic achievement. In girls, cardiorespiratory fitness is highly associated with psychological well-being, and this, in turn, was associated with academic achievement.

Adherence to the Mediterranean diet and depressive, anxiety, and stress symptoms in Spanish adolescents: results from the EHDLA study.

Depression and anxiety are prevalent and disabling conditions among adolescents. The aim of this study was to examine the relationship between adherence to the Mediterranean diet (MD) and depressive, anxiety, and stress symptoms in adolescents. This cross-sectional study included a sample of 698 adolescent students from a region of Spain (mean age of 13.9 ± 1.5 years; 56.2% girls). Adherence to the MD was evaluated with the Mediterranean Diet Quality Index in children and adolescents (KIDMED). Mental health symptoms were measured with the Depression, Anxiety, and Stress Scale (DASS-21). Logistic regression models were performed, including a wide range of potential confounders. Compared to individuals with low adherence to the MD, those with moderate and high adherence had lower odds of experiencing depressive symptoms (odds ratio [OR] = 0.40, 95% confidence interval [CI] 0.24-0.65 and OR = 0.33, 95% CI 0.20-0.55, respectively), which were statistically significant even after adjustment. No significant associations were found regarding anxiety or stress symptoms. Therefore, according to our results, higher adherence to the MD is inversely related to having depressive symptoms among adolescents, regardless of socioeconomic, anthropometric, and lifestyle factors. Considering the deleterious effects of mental health problems in youths, further research on the role of nonpharmacological strategies for the prevention and treatment of depressive symptoms in adolescence is essential.

Can different types of tree nuts and peanuts induce varied effects on specific blood lipid parameters? A systematic review and network meta-analysis.

Tree nuts and peanuts have shown cardioprotective effects through the modulation of blood lipid levels. Despite the abundance of scientific evidence available, it remains uncertain whether the type of nut consumed influences these changes. The objective of this study was to evaluate and rank the effects of six types of nuts on total cholesterol (total-c), low-density lipoprotein (LDL-c), triglyceride (TG) and high-density lipoprotein (HDL-c) levels through a systematic search of randomized controlled trials (RCTs), a frequentist network meta-analysis (NMA), and the estimation of SUCRA values. A total of 76 RCTs were ultimately analyzed. The total c for pistachios, almond, and walnuts; LDL-c for cashews, walnuts, and almond; and TG for hazelnuts and walnuts significantly decreased, while only peanuts exhibited a significant increase in HDL-c levels. According to the rankings, the most effective type of nut for reducing total cholesterol was pistachio, cashew for LDL-c, hazelnut for TG, and peanut for increasing HDL-c levels. It should be noted that every type of nut analyzed exhibited a significant positive impact on some parameters, and specific types demonstrated enhanced advantages for particular blood lipids. These results endorse the use of personalized nutritional strategies to address and prevent dyslipidemia.Registration: PROSPERO database CRD42021270779.

Global prevalence of intellectual developmental disorder in dystrophinopathies: A systematic review and meta-analysis.

AIM: To estimate the global prevalence of intellectual developmental disorder (IDD) and the IDD prevalence-genotype association in Becker muscular dystrophy (BMD) or Duchenne muscular dystrophy (DMD) according to the affected isoforms of the DMD gene: Dp427, Dp140, Dp71. METHOD: Systematic searches in MEDLINE, Scopus, Web of Science, and the Cochrane Library were conducted from inception of each database to March 2022. Observational studies that determined the prevalence of IDD in the population with BMD or DMD were included. Meta-analyses of IDD prevalence and prevalence ratios of the IDD-genotype association were conducted. RESULTS: Forty-nine studies were included. The prevalence of IDD in BMD was 8.0% (95% confidence interval 5.0-11.0), and in DMD it was 22.0% (18.0-27.0). Meta-analyses of IDD-genotype association showed a deleterious association between IDD and the number of isoforms affected in DMD, with a prevalence ratio = 0.43 (0.28-0.64) and 0.17 (0.09-0.34) for Dp140+ /Dp71+ versus Dp140- /Dp71+ and Dp140+ /Dp71+ versus Dp140- /Dp71- comparisons respectively. However, in BMD, there was no association for Dp140+ /Dp71+ versus Dp140- /Dp71+ . INTERPRETATION: There is a high prevalence of IDD in BMD and DMD. Moreover, the number of isoforms affected is strongly and negatively associated with the prevalence of IDD in DMD. WHAT THIS PAPER ADDS: The global prevalence of intellectual developmental disorder (IDD) was 8% in Becker muscular dystrophy and 22% in Duchenne muscular dystrophy (DMD). The global prevalence of IDD in DMD was 12%, 29%, and 84% in participants with Dp427- /Dp140+ /Dp71+ , Dp427- /Dp140- /Dp71+ , and Dp427- /Dp140- /Dp71- genotypes respectively. In DMD, 12% and 22% of participants had abnormal performance IQ and verbal IQ values respectively.

Clustering of Mediterranean dietary patterns linked with health-related quality of life in adolescents: the EHDLA study.

The aim of this cross-sectional study was to analyze the association between adherence to the Mediterranean diet (MedDiet) and its dietary components and health-related quality of life (HRQoL) in a sample of Spanish adolescents. A total sample of 634 adolescents was included (mean age: 13.96 ± 1.54 years; 56.9% girls). The Mediterranean Diet Quality Index in children and adolescents (KIDMED) and the KIDSCREEN-10 were used to assess adherence to the MedDiet and its components and HRQoL, respectively. Linear regression was applied to estimate the association between overall adherence to the MedDiet and HRQoL. Cluster analysis was used to establish subgroups according to different patterns of MedDiet component consumption. Higher overall adherence to the MedDiet was significantly associated with greater HRQoL (unstandardized beta coefficient [ß] = 0.329; 95% CI: 0.108, 0.550; p = 0.004), even after adjustment for sociodemographic, physical and lifestyle covariates (ß = 0.228; 95% CI: 0.007, 0.449; p = 0.043). When different clusters were established according to similar features of MedDiet component consumption, the cluster with a higher percentage of individuals who skipped breakfast had significantly lower scores on the HRQoL scale (p < 0.05)  Conclusions: Our findings highlight the relevance of considering the specific patterns of food group consumption and MedDiet-related behaviors and not just the overall measure of MedDiet adherence for promoting HRQoL in adolescents. What is Known: • Previous studies have shown that some lifestyle behaviors, such as dietary habits, could be associated with health-related quality of life. • According to our results, higher adherence to the Mediterranean diet pattern was associated with greater health-related quality of life in adolescents. What is New: • Skipping breakfast seems to have a crucial role in health-related quality of life among adolescents. • These results could lead to the development of more specific dietary strategies for increasing health-related quality of life in adolescents.

A replication study of JTC bias, genetic liability for psychosis and delusional ideation.

BACKGROUND: This study attempted to replicate whether a bias in probabilistic reasoning, or 'jumping to conclusions'(JTC) bias is associated with being a sibling of a patient with schizophrenia spectrum disorder; and if so, whether this association is contingent on subthreshold delusional ideation. METHODS: Data were derived from the EUGEI project, a 25-centre, 15-country effort to study psychosis spectrum disorder. The current analyses included 1261 patients with schizophrenia spectrum disorder, 1282 siblings of patients and 1525 healthy comparison subjects, recruited in Spain (five centres), Turkey (three centres) and Serbia (one centre). The beads task was used to assess JTC bias. Lifetime experience of delusional ideation and hallucinatory experiences was assessed using the Community Assessment of Psychic Experiences. General cognitive abilities were taken into account in the analyses. RESULTS: JTC bias was positively associated not only with patient status but also with sibling status [adjusted relative risk (aRR) ratio : 4.23 CI 95% 3.46-5.17 for siblings and aRR: 5.07 CI 95% 4.13-6.23 for patients]. The association between JTC bias and sibling status was stronger in those with higher levels of delusional ideation (aRR interaction in siblings: 3.77 CI 95% 1.67-8.51, and in patients: 2.15 CI 95% 0.94-4.92). The association between JTC bias and sibling status was not stronger in those with higher levels of hallucinatory experiences. CONCLUSIONS: These findings replicate earlier findings that JTC bias is associated with familial liability for psychosis and that this is contingent on the degree of delusional ideation but not hallucinations.

Evidence, and replication thereof, that molecular-genetic and environmental risks for psychosis impact through an affective pathway.

BACKGROUND: There is evidence that environmental and genetic risk factors for schizophrenia spectrum disorders are transdiagnostic and mediated in part through a generic pathway of affective dysregulation. METHODS: We analysed to what degree the impact of schizophrenia polygenic risk (PRS-SZ) and childhood adversity (CA) on psychosis outcomes was contingent on co-presence of affective dysregulation, defined as significant depressive symptoms, in (i) NEMESIS-2 (n = 6646), a representative general population sample, interviewed four times over nine years and (ii) EUGEI (n = 4068) a sample of patients with schizophrenia spectrum disorder, the siblings of these patients and controls. RESULTS: The impact of PRS-SZ on psychosis showed significant dependence on co-presence of affective dysregulation in NEMESIS-2 [relative excess risk due to interaction (RERI): 1.01, p = 0.037] and in EUGEI (RERI = 3.39, p = 0.048). This was particularly evident for delusional ideation (NEMESIS-2: RERI = 1.74, p = 0.003; EUGEI: RERI = 4.16, p = 0.019) and not for hallucinatory experiences (NEMESIS-2: RERI = 0.65, p = 0.284; EUGEI: -0.37, p = 0.547). A similar and stronger pattern of results was evident for CA (RERI delusions and hallucinations: NEMESIS-2: 3.02, p < 0.001; EUGEI: 6.44, p < 0.001; RERI delusional ideation: NEMESIS-2: 3.79, p < 0.001; EUGEI: 5.43, p = 0.001; RERI hallucinatory experiences: NEMESIS-2: 2.46, p < 0.001; EUGEI: 0.54, p = 0.465). CONCLUSIONS: The results, and internal replication, suggest that the effects of known genetic and non-genetic risk factors for psychosis are mediated in part through an affective pathway, from which early states of delusional meaning may arise.

Cognitive functioning throughout adulthood and illness stages in individuals with psychotic disorders and their unaffected siblings.

Important questions remain about the profile of cognitive impairment in psychotic disorders across adulthood and illness stages. The age-associated profile of familial impairments also remains unclear, as well as the effect of factors, such as symptoms, functioning, and medication. Using cross-sectional data from the EU-GEI and GROUP studies, comprising 8455 participants aged 18 to 65, we examined cognitive functioning across adulthood in patients with psychotic disorders (n = 2883), and their unaffected siblings (n = 2271), compared to controls (n = 3301). An abbreviated WAIS-III measured verbal knowledge, working memory, visuospatial processing, processing speed, and IQ. Patients showed medium to large deficits across all functions (ES range = -0.45 to -0.73, p < 0.001), while siblings showed small deficits on IQ, verbal knowledge, and working memory (ES = -0.14 to -0.33, p < 0.001). Magnitude of impairment was not associated with participant age, such that the size of impairment in older and younger patients did not significantly differ. However, first-episode patients performed worse than prodromal patients (ES range = -0.88 to -0.60, p < 0.001). Adjusting for cannabis use, symptom severity, and global functioning attenuated impairments in siblings, while deficits in patients remained statistically significant, albeit reduced by half (ES range = -0.13 to -0.38, p < 0.01). Antipsychotic medication also accounted for around half of the impairment in patients (ES range = -0.21 to -0.43, p < 0.01). Deficits in verbal knowledge, and working memory may specifically index familial, i.e., shared genetic and/or shared environmental, liability for psychotic disorders. Nevertheless, potentially modifiable illness-related factors account for a significant portion of the cognitive impairment in psychotic disorders.

The role of daytime napping on salivary cortisol in children aged 0-5 years: a systematic review and meta-analysis.

Cortisol levels are implicated in emotional and cognitive development in children. However, it is not clear whether daytime napping influences cortisol levels in early childhood. This systematic review and meta-analysis aimed to synthesize the available evidence regarding the association between daytime napping and salivary cortisol in early childhood. The Medline, Embase, Web of Science, PsycINFO, and Cochrane Collaboration databases were searched for observational and experimental studies reporting data about napping behavior and salivary cortisol in children 0-5 years of age. Salivary cortisol levels were analyzed in three situations: CAR, cortisol awakening response from nap awakening; PRE-POST, before and after a daytime nap; and DIURNAL, from morning awakening to bedtime. Five studies showed a significant CAR after napping (mean difference, MD: 0.11µg/mL; 95% confidence interval, CI: 0.04, 0.18). In the PRE-POST analysis, a small decrease was observed for at-home naps (MD: -0.05 µg/mL; 95% CI: - 0.09, - 0.02) but not for at-childcare naps (MD: 0.04 µg/mL; 95% CI: - 0.01, 0.09). A similar pattern of DIURNAL salivary cortisol decrease was observed when children took a nap (MD: - 0.34 µg/mL; 95% CI: - 0.41, - 0.28) and when they did not sleep during the day (MD: - 0.28 µg/mL; 95% CI: - 0.38, - 0.19). CONCLUSIONS: Daytime napping plays a minor role in the fluctuation of salivary cortisol levels during the day. The conditions of the home or the childcare environment under which napping occurs might have a greater influence on cortisol levels than daytime napping itself in early childhood. PROSPERO Identifier: CRD42020212249. WHAT IS KNOWN: • The regulation of sleep involves circadian rhythmicity of cortisol secretion via activation of the HPA axis and a subsequent release of cortisol upon morning awakening followed by a decline throughout the day. WHAT IS NEW: • The available evidence supports the occurrence of a cortisol awakening response after a daytime nap. • A small decrease in cortisol after napping was observed when the nap occurred at home but not at childcare. • The conditions of the home or childcare environment under which the nap occurs and the activities before and after napping may have a greater influence on cortisol levels than napping itself.

Napping and cognitive decline: a systematic review and meta-analysis of observational studies.

BACKGROUND: No clear evidence is available for the influence of napping on cognitive function in older adults. This systematic review and meta-analysis aimed to elucidate the cross-sectional and longitudinal relationships between napping and cognitive function (global cognition and memory) and to explore whether some individual characteristics and sleep characteristics can modify this relationship. METHODS: We systematically searched Medline (via PubMed), Web of Science, and Scopus. DerSimonian and Lair and Hartung-Knapp-Sidik-Jonkman random effects methods were used to compute pooled estimates of odds ratios (ORs) and their respective 95% confidence intervals (95% CIs) for the association of global cognition and memory with napping. The mean age, the night sleep time (hours), and the percentage of women, no nappers, and people in the less night-time sleep duration category were used for meta-regressions. RESULTS: Twenty-five studies were included in this systematic review and meta-analysis, 18 cross-sectional and seven longitudinal studies, including 95,719 participants older than 60 years. The pooled ORs from the cross-sectional analyses were 1.03 (95% CI: 1.01 to 1.06) for global cognition and 1.06 (95%: 0.90 to 1.26) for memory. The pooled ORs from the longitudinal analyses were 1.00 (95% 0.85 to 1.18) for global cognition and 1.08 (95% 0.98 to 1.19) for memory. These associations were not modified by individual or sleep characteristics. CONCLUSION: Our data confirm the absence of association between napping and global cognition and memory regardless of the characteristics of the population. This information might be considered when providing lifestyle recommendations to adults with and without cognitive complaints.

A Cluster Mediation Analysis Confirms the Validity of the "Fat but Fit" Paradigm in Children's Cognitive Function and Academic Achievement.

OBJECTIVE: To evaluate the fat but fit conceptual model, testing whether this paradigm for body mass index (BMI) and maximum rate of oxygen consumption (VO2max) exists in schoolchildren and whether executive functions mediate the relationship between fat but fit categories and academic achievement. STUDY DESIGN: Cluster cross-sectional analyses of data from 554 children aged 9-11 from Cuenca, Spain. BMI, VO2max, core executive functions (inhibition, working memory, and cognitive flexibility) and academic achievement (language and mathematics). RESULTS: Cluster analysis of BMI and VO2max z-scores resulted in a 4-cluster solution that could be interpreted according to fat unfit, unfat unfit, fat fit, and unfat fit categories. ANCOVA models confirmed an increasing trend by cluster category in terms of VO2max levels and, conversely, a decreasing trend in terms of adiposity variables. These models also confirmed that children in the fat fit and unfat fit categories scored higher than their peers in the fat unfit and unfat unfit categories. Mediation analyses using fat but fit clusters as multicategory independent variable, executive functions as mediators, and academic achievement as outcome variable showed that the positive association between the BMI-VO2max clusters and academic achievement was mediated by inhibition levels in fat fit and unfat fit individuals, by working memory levels only in those classified as fat fit, and by cognitive flexibility only in unfat fit individuals. CONCLUSIONS: This study confirms the validity of the 4-cluster conceptual model regarding BMI and VO2max and reinforces the predictive validity, proving that fitness levels are able to counteract the detrimental effect of obesity on academic achievement.

Effect of retirement on cognitive function: a systematic review and meta-analysis.

The study aimed to determine the longitudinal association between retirement and cognitive function, including global cognition and memory-related skills. This is a systematic review of longitudinal studies on the association between retirement and cognitive function, using Medline (via PubMed), Scopus, Web of Science and PsycINFO databases from inception to April 2020 and longitudinal studies on the association between retirement and cognitive function. The Newcastle-Ottawa Scale was used to assess risk of bias of included studies. Effect size (ES) and 95% CI were calculated using Cohen's d index. Meta-regressions were calculated on the basis of sample characteristics: percentage of women, years of follow-up and age at baseline. A total of 23 longitudinal studies were included in this systematic review. The pooled ES for the association of retirement with global cognition and memory-related skills was -0.01 (95% CI -0.02 to 0.00; I2: 0.0%) and -0.09 (95% CI -0.16 to 0.01; I2: 93%), respectively. Meta-regression analyses showed that length of follow-up, percentage of women in the sample and mean age at baseline did not influence the longitudinal association between retirement and adults' memory-related skills. The results of this study indicate that retirement has no negative effects on adults' global cognition and slightly adversely influences memory-related skills. Moreover, this association does not seem to be influenced by some demographic and study characteristics.

Replicated evidence that endophenotypic expression of schizophrenia polygenic risk is greater in healthy siblings of patients compared to controls, suggesting gene-environment interaction. The EUGEI study.

BACKGROUND: First-degree relatives of patients with psychotic disorder have higher levels of polygenic risk (PRS) for schizophrenia and higher levels of intermediate phenotypes. METHODS: We conducted, using two different samples for discovery (n = 336 controls and 649 siblings of patients with psychotic disorder) and replication (n = 1208 controls and 1106 siblings), an analysis of association between PRS on the one hand and psychopathological and cognitive intermediate phenotypes of schizophrenia on the other in a sample at average genetic risk (healthy controls) and a sample at higher than average risk (healthy siblings of patients). Two subthreshold psychosis phenotypes, as well as a standardised measure of cognitive ability, based on a short version of the WAIS-III short form, were used. In addition, a measure of jumping to conclusion bias (replication sample only) was tested for association with PRS. RESULTS: In both discovery and replication sample, evidence for an association between PRS and subthreshold psychosis phenotypes was observed in the relatives of patients, whereas in the controls no association was observed. Jumping to conclusion bias was similarly only associated with PRS in the sibling group. Cognitive ability was weakly negatively and non-significantly associated with PRS in both the sibling and the control group. CONCLUSIONS: The degree of endophenotypic expression of schizophrenia polygenic risk depends on having a sibling with psychotic disorder, suggestive of underlying gene-environment interaction. Cognitive biases may better index genetic risk of disorder than traditional measures of neurocognition, which instead may reflect the population distribution of cognitive ability impacting the prognosis of psychotic disorder.

Relation between physical fitness and executive function variables in a preschool sample.

BACKGROUND: This study examined the association between key components of physical fitness with inhibition and cognitive flexibility in preschoolers. METHODS: This was a cross-sectional study of 362 Spanish preschoolers. The key components of physical fitness and executive functioning were measured. RESULTS: The partial correlation controlling for body mass index and family socioeconomic status showed that inhibition was positively related to cardiorespiratory fitness. No association was found between muscular strength (i.e., standing long jump and dynamometry) and speed/agility with inhibition or between physical fitness components and cognitive flexibility. The inhibition mean scores were significantly higher in preschoolers with higher cardiorespiratory than in their peers who were in lower categories, after adjustments were made for confounders. Additionally, the results showed that cardiorespiratory fitness was a significant predictor of inhibition, but for cognitive flexibility, age was the only significant predictor. CONCLUSIONS: Our data suggest that cardiorespiratory fitness is associated with inhibition in preschoolers. Likewise, our results also suggest that cognitive flexibility is an executive function that is more dependent on changes associated with age at this development stage. These findings are important for supporting initiatives that aimed at stimulating healthy brain development, and promote the improvement of cardiorespiratory fitness at early ages.

Progression of the functional deficit in a group of patients with bipolar disorder: a cluster analysis based on longitudinal data.

We aimed to examine the trajectory of psychosocial functioning in a sample of euthymic patients with bipolar disorder (BD) throughout a 5-year follow-up. Ninety-nine euthymic bipolar patients and 40 healthy controls (HC) were included. A neurocognitive assessment (17 neurocognitive measures grouped in 6 domains) was carried out at baseline. The split version of the Global Assessment of Functioning scale (GAF-F) and the Functioning Assessment Short Test (FAST) were used to examine psychosocial functioning at baseline (T1), and after a 5-year follow-up (T2). The statistical analysis was performed through repeated measures ANOVA and hierarchical cluster analysis based on the GAF-F and the FAST scores at T1 and T2. Eighty-seven patients (87.9%) were evaluated at T2. The cluster analysis identified two groups of patients. The first group included 44 patients (50.6%) who did not show a progression of the functional impairment (BD-NPI). The second cluster, which included 43 patients (49.4%), was characterized by a progression of the functional impairment (BD-PI). The BD-PI had a higher number of relapses and a higher number of hospitalizations during the follow-up period, as well as worse neurocognitive functioning than the BD-NPI. The repeated measures ANOVA confirmed that the psychosocial performance of BD-NPI is stable while there was a progression of the functional deterioration in BD-PI. The trajectory of the psychosocial functioning of patients with BD is not homogeneous. Our results suggest that in at least one subset of patients with BD, which might account for half of the patients, the disease has a progressive course.

Impact of number of episodes on neurocognitive trajectory in bipolar disorder patients: a 5-year follow-up study.

BACKGROUND: The neurocognitive trajectory in bipolar disorder (BD) is variable, with controversial findings, and most evidence come from cross-sectional studies. We aimed to examine the course of neurocognitive functioning in a sample of euthymic BD patients in comparison with a control group during a 5-year follow-up. METHODS: Ninety-nine euthymic bipolar patients and 40 healthy controls were assessed using a comprehensive neurocognitive battery (six neurocognitive domains) at baseline (T1) and then at 5-year follow-up (T2) in a longitudinal study. RESULTS: No evidence of a progression in neurocognitive dysfunction was found either in cognitive composite index or in any of the neurocognitive domains for the whole cohort. However, there was a negative correlation between number of manic episodes and hospitalisations due to manic episodes and change in neurocognitive composite index (NCI) during the follow-up. Moreover, patients with higher number of manic and hypomanic episodes have a greater decrease in NCI, working memory and visual memory. History of psychotic symptoms was not related to the trajectory of neurocognitive impairment. CONCLUSIONS: Our results suggest that, although the progression of cognitive decline is not a general rule in BD, BD patients who have a greater number of manic or hypomanic episodes may constitute a subgroup characterised by the progression of neurocognitive impairment. Prevention of manic and hypomanic episodes could have a positive impact on the trajectory of cognitive function.

Rationale and methods of the MOVI-da10! Study -a cluster-randomized controlled trial of the impact of classroom-based physical activity programs on children's adiposity, cognition and motor competence.

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.

Family Meals and Social Eating Behavior and Their Association with Disordered Eating among Spanish Adolescents: The EHDLA Study.

PURPOSE: The aim of this study was to examine the association of family meals and social eating behavior with disordered eating behavior in Spanish adolescents. METHODS: This was a cross-sectional study that included 706 adolescents (43.9% boys) from the Eating Habits and Daily Life Activities (EHDLA) study (aged 12 to 17) from Valle de Ricote, Region of Murcia, Spain. The frequency of family meals was assessed by asking participants to report how often their family, or most household members, had shared meals in the past week. Social eating behavior was evaluated using three statements: "I enjoy sitting down with family or friends for a meal", "Having at least one meal a day with others (family or friends) is important to me", and "I usually have dinner with others". To evaluate disordered eating, two psychologists administered the Sick, Control, One, Fat and Food (SCOFF) questionnaire. RESULTS: After adjusting for several covariates, for each additional family meal, the likelihood of having disordered eating behavior was lower (odds ratio (OR) = 0.96; 95% confidence interval (CI) 0.93 to 0.9997, p = 0.049). On the other hand, a lower likelihood of having disordered eating behavior was observed for each additional point in the social eating behavior scale (OR = 0.85; 95% CI 0.77 to 0.93, p = 0.001). The likelihood of having disordered eating behavior was 0.7% lower for each additional family meal (95% CI 0.01% to 1.4%, p = 0.046). Furthermore, for each additional point in the social eating behavior scale, a lower probability of having disordered eating behavior was observed (3.2%; 95% CI 1.4% to 5.0%, p < 0.001). CONCLUSIONS: While disordered eating behavior is complex and can be shaped by various factors, both family meals and social eating behavior emerge as significant factors inversely associated with this condition among adolescents. Promoting regular engagement in family meals and fostering positive social eating experiences could serve as effective strategies in public health initiatives aimed at mitigating the incidence of disordered eating behavior among the young population.

Food insecurity and academic performance in Spanish adolescents: Results from the EHDLA study.

Introduction: Food insecurity is a growing global issue that affects both developed and developing nations, and mounting evidence suggests that decreased consumption of healthy foods has been linked to lower academic performance in adolescents. The present study aimed to examine the relationship between food insecurity and academic performance in a sample of Spanish adolescents aged 12-17 years from the Valle de Ricote (Region of Murcia, Spain). Methods: The present study analyzed data from the Eating Healthy and Daily Life Activities study, which included a sample of 777 adolescents (55.3 % girls). The Spanish Child Food Security Survey Module was used to assess food insecurity, and academic performance was evaluated using school records provided by the schools. Linear regression models (fitted by robust methods) were used to compare the relationships between food insecurity status and academic performance-related indicators. Results: Adolescents with the highest levels of food insecurity reported the lowest academic performance in language (mean [M] = 4.7; 95 % confidence interval [CI] 3.6 to 5.7), math (M = 4.6; 95 % CI 3.5 to 5.8), foreign language (M = 4.8; 95 % CI 3.8 to 5.8), and grade point average (M = 5.7; 95 % CI 4.9 to 6.5). Conversely, adolescents with the lowest levels of food insecurity reported the highest academic performance in language (M = 6.2; 95 % CI 6.0 to 6.5), math (M = 5.9; 95 % CI 5.5 to 6.2), foreign language (M = 6.2; 95 % CI 5.9 to 6.4), and grade point average (M = 6.7; 95 % CI 6.5 to 6.9) compared to those with higher food security. Conclusions: Living in a more food-insecure household could explain the lower academic performance of adolescents. Food insecurity should always be on the agenda of public policies. The availability of quality basic food essentials must be ensured in permanently satisfactory quantities without compromising access to other fundamental needs.

The impact of the Mediterranean diet on alleviating depressive symptoms in adults: a systematic review and meta-analysis of randomized controlled trials.

CONTEXT: High adherence to the Mediterranean diet (MD) has been associated with a reduced risk of depression in prospective cohort studies, but whether MD interventions are effective among adults with depression is uncertain. OBJECTIVE: This study aimed to synthesize findings on the effects of MD interventions on the severity of depressive symptoms in adults with depression. DATA SOURCES: PubMed, Cochrane CENTRAL, PsycINFO, Scopus, and Web of Science were systematically searched from database inception to March 2023. The Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and the Cochrane recommendations were followed. We included randomized controlled trials (RCTs) comparing outcomes after MD interventions with outcomes for control conditions in adults with depressive disorders or depressive symptoms. DATA EXTRACTION: Two authors extracted the data independently. The Sidik-Jonkman estimator, the I2 metric, and the prediction interval were used to estimate between-study heterogeneity. To determine the risk of bias and the certainty of evidence from RCTs, we used the Cochrane Collaboration's Risk of Bias 2 and Grades of Recommendation, Assessment, Development, and Evaluation tools, respectively. DATA ANALYSIS: In total, 1507 participants (mean age range: 22.0 years-53.3 years) with depression were initially included in the 5 RCTs of this review. Compared with control conditions, MD interventions significantly reduced depressive symptoms among young and middle-aged adults with major depression or mild to moderate depressive symptoms (standardized mean difference: -0.53; 95% confidence interval: -0.90 to -0.16; I2 = 87.1%). The prediction interval ranged from -1.86 to 0.81. The overall risk of bias was within the range of "some concerns" to "high," while the certainty of evidence was low. CONCLUSION: MD interventions appear to have substantial potential for alleviating depressive symptoms in people experiencing major or mild depression. However, to establish robust recommendations, there remains a need for high-quality, large-scale, and long-term RCTs. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42022341895.