Calcium and vitamin D for increasing bone mineral density in premenopausal women.

BACKGROUND: Osteoporosis is a condition where bones become fragile due to low bone density and impaired bone quality. This results in fractures that lead to higher morbidity and reduced quality of life. Osteoporosis is considered a major public health concern worldwide. For this reason, preventive measurements need to be addressed throughout the life course. Exercise and a healthy diet are among the lifestyle factors that can help prevent the disease, the latter including intake of key micronutrients for bone, such as calcium and vitamin D. The evidence on whether supplementation with calcium and vitamin D improves bone mineral density (BMD) in premenopausal women is still inconclusive. In this age group, bone accrual is considered to be the goal of supplementation, so BMD is relevant for the future stages of life. OBJECTIVES: To evaluate the benefits and harms of calcium and vitamin D supplementation, alone or in combination, to increase the BMD, reduce fractures, and report the potential adverse events in healthy premenopausal women compared to placebo. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search was 12 April 2022. SELECTION CRITERIA: We included randomised controlled trials in healthy premenopausal women (with or without calcium or vitamin D deficiency) comparing supplementation of calcium or vitamin D (or both) at any dose and by any route of administration versus placebo for at least three months. Vitamin D could have been administered as cholecalciferol (vitamin D3) or ergocalciferol (vitamin D2). DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Outcomes included total hip bone mineral density (BMD), lumbar spine BMD, quality of life, new symptomatic vertebral fractures, new symptomatic non-vertebral fractures, withdrawals due to adverse events, serious adverse events, all reported adverse events and additional withdrawals for any reason. MAIN RESULTS: We included seven RCTs with 941 participants, of whom 138 were randomised to calcium supplementation, 110 to vitamin D supplementation, 271 to vitamin D plus calcium supplementation, and 422 to placebo. Mean age ranged from 18.1 to 42.1 years. Studies reported results for total hip or lumbar spine BMD (or both) and withdrawals for various reasons, but none reported fractures or withdrawals for adverse events or serious adverse events. Results for the reported outcomes are presented for the three comparisons: calcium versus placebo, vitamin D versus placebo, and calcium plus vitamin D versus placebo. In all comparisons, there was no clinical difference in outcomes, and the certainty of the evidence was moderate to low. Most studies were at risk of selection, performance, detection, and reporting biases. Calcium versus placebo Four studies compared calcium versus placebo (138 participants in the calcium group and 123 in the placebo group) with mean ages from 18.0 to 47.3 years. Calcium supplementation may have little to no effect on total hip or lumbar spine BMD after 12 months in three studies and after six months in one study (total hip BMD: mean difference (MD) -0.04 g/cm2, 95% confidence interval (CI) -0.11 to 0.03; I2 = 71%; 3 studies, 174 participants; low-certainty evidence; lumbar spine BMD: MD 0 g/cm2, 95% CI -0.06 to 0.06; I2 = 71%; 4 studies, 202 participants; low-certainty evidence). Calcium alone supplementation does not reduce or increase the withdrawals in the trials (risk ratio (RR) 0.78, 95% CI 0.52 to 1.16; I2 = 0%; 4 studies, 261 participants: moderate-certainty evidence). Vitamin D versus placebo Two studies compared vitamin D versus placebo (110 participants in the vitamin D group and 79 in the placebo group), with mean ages from 18.0 to 32.7 years. These studies reported lumbar spine BMD as a mixture of MDs and percent of change and we were unable to pool the results. In the original studies, there were no differences in lumbar BMD between groups. Vitamin D alone supplementation does not reduce or increase withdrawals for any reason between groups (RR 0.74, 95% CI 0.46 to 1.19; moderate-certainty evidence). Calcium plus vitamin D versus placebo Two studies compared calcium plus vitamin D versus placebo (271 participants in the calcium plus vitamin D group and 270 in the placebo group; 220 participants from Woo 2007 and 50 participants from Islam 2010). The mean age range was 18.0 to 36 years. These studies measured different anatomic areas, one study reported total hip BMD and the other study reported lumbar spine BMD; therefore, data were not pooled for this outcome. The individual studies found no difference between groups in percent of change on total hip BMD (-0.03, 95% CI -0.06 to 0; moderate-certainty evidence), and lumbar spine BMD (MD 0.01, 95% CI -0.01 to 0.03; moderate-certainty evidence). Calcium plus vitamin D supplementation may not reduce or increase withdrawals for any reason (RR 0.82, 95% CI 0.29 to 2.35; I2 = 72%; 2 studies, 541 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: Our results do not support the isolated or combined use of calcium and vitamin D supplementation in healthy premenopausal women as a public health intervention to improve BMD in the total hip or lumbar spine, and therefore it is unlikely to have a benefit for the prevention of fractures (vertebral and non-vertebral). The evidence found suggests that there is no need for future studies in the general population of premenopausal women; however, studies focused on populations with a predisposition to diseases related to bone metabolism, or with low bone mass or osteoporosis diagnosed BMD would be useful.

Early-life adversity is associated with poor iron status in infancy.

Exposure to early-life adversity (ELA) and iron deficiency early in life are known risk factors for suboptimal brain and socioemotional development. Iron deficiency may arise from and co-occur with ELA, which could negatively affect development. In the present study, we investigated whether ELA is associated with iron deficiency in infants receiving no iron supplementation. This study is a secondary analysis of extant data collected in the 1990s; participants were healthy infants from working-class communities in Santiago, Chile (N = 534, 45.5% female). We measured stressful life events, maternal depression, and low home support for child development during infancy and assessed iron status when the infant was 12 months old. Slightly more than half of the infants were iron-deficient (51%), and 25.8% were iron-deficient anemic at 12 months. Results indicated that ELA was associated with lower iron levels and iron deficiency at 12 months. The findings are consistent with animal and human prenatal models of stress and iron status and provide evidence of the association between postnatal ELA and iron status in humans. The findings also highlight a nutritional pathway by which ELA may impact development and present a nutritionally-focused avenue for future research on ELA and psychopathology.

Adjusting Ferritin Concentrations for Nonclinical Inflammation in Adolescents with Overweight or Obesity.

OBJECTIVE: To compare approaches for adjusting serum ferritin concentrations for inflammation in Chilean adolescents with overweight and obesity. STUDY DESIGN: Cross-sectional data from 518 adolescents (aged 16-17 years; 48% females) from Santiago, Chile were analyzed. Several approaches were compared for estimating the prevalence of depleted iron stores (defined as serum ferritin <15 µg/L), including unadjusted prevalence and higher cutoffs for various subgroups (excluding participants with inflammation), correction factors, and regression corrections. A "reference" prevalence estimate was calculated as the prevalence of serum ferritin <15 µg/L in normal weight individuals without inflammation. Each adjustment approach was compared with this reference prevalence. RESULTS: The sample comprised 61.2% normal weight, 23.7% overweight, and 15.1% obese individuals. The prevalence of inflammation (marked by C-reactive protein level >5.0 mg/L) was 6.3%, 8.1%, and 14.1% in the 3 groups, respectively. The correction factor approaches produced adjusted estimates closest to the reference estimate (24.1%-24.7% vs 22.9%), followed by the regression corrections (24.7%-25.1% vs 22.9%). Applying a higher serum ferritin cutoff (30 µg/L) to all participants or to participants with overweight/obesity produced adjusted estimates farthest from the reference (59.5% and 35.3%, respectively). CONCLUSIONS: Adjusting serum ferritin concentration may be necessary when assessing iron status in populations with high rates of overweight/obesity. After reviewing 6 approaches for adjusting for the influence of inflammation, this study suggests that using correction factors may be the most appropriate approach for adjusting serum ferritin in Chilean adolescents. Further research is needed to determine the optimal approach for adjusting serum ferritin concentrations for weight-related inflammation in broader populations.

Dynamic relationships between body fat and circulating adipokine levels from adolescence to young adulthood: The Santiago Longitudinal Study.

BACKGROUND AND AIMS: Adipose tissue secretes adipokines such as adiponectin and leptin, playing important roles in energy metabolism. The longitudinal associations between such adipokines and body fat accumulation have not been established, especially during adolescence and young adulthood and in diverse populations. The study aims to assess the longitudinal association between body fat measured with dual X-ray absorptiometry and plasma adipokines from adolescence to young adulthood. METHODS AND RESULTS: Among Hispanic/Latino participants (N = 537) aged 16.8 (SD: 0.3) years of the Santiago Longitudinal Study, we implemented structural equation modeling to estimate the sex-specific associations between adiposity (body fat percent (BF%) and proportion of trunk fat (PTF)) and adipokines (adiponectin and leptin levels) during adolescence (16 y) and these values after 6 years of follow-up (22 y). In addition, we further investigated whether the associations differed by baseline insulin resistance (IR) status. We found evidence for associations between 16 y BF% and 22 y leptin levels (ß (SE): 0.58 (0.06) for females; 0.53 (0.05) for males), between 16 y PTF and 22 y adiponectin levels (ß (SE): -0.31 (0.06) for females; -0.18 (0.06) for males) and between 16 y adiponectin levels and 22 y BF% (ß (SE): 0.12 (0.04) for both females and males). CONCLUSION: We observed dynamic relationships between adiposity and adipokines levels from late adolescence to young adulthood in a Hispanic/Latino population further demonstrating the importance of this period of the life course in the development of obesity.

Obesity and impairment of pancreatic ß-cell function in early adulthood, independent of obesity age of onset: The Santiago Longitudinal Study.

AIM: We investigated the relation of time of onset and length of obesity with biomarkers of ß-cell function in early adulthood in an infancy cohort. MATERIAL AND METHODS: In 1039 23-year-olds, body-mass index (BMI) was measured at multiple time-points from enrollment. BMI trajectories were interpolated with cubic polynomials. Fasting glucose, insulin and adiponectin were measured at 23 years. Homeostatic model assessment-insulin resistance (HOMA-IR), HOMA-S, HOMA-ß, HOMA-adiponectin (AD) and disposition index (DI) were estimated. IR and non-alcoholic fatty liver (NAFL) were diagnosed. According to the BMI trajectory, five groups were defined: participants who were never obese (NOB); participants with obesity starting in adolescence and remained obese into adulthood (recent-onset obesity, ROB); participants who were obese in early childhood but transitioned to non-obesity as preadolescents (former obesity, FOB); participants who were obese in early childhood and remained obese into adulthood (persistent obesity, POB); participants with obesity starting in preadolescence and transitioned to non-obesity as adolescents (transient obesity; TOB). RESULTS: Obesity was present in 47% of participants during at least one time-point. ROBs and POBs had higher insulin, HOMA-IR and HOMA-ß, lower HOMA-S and DI, and higher prevalence of IR and NAFL at 23 years than NOBs, TOBs and FOBs. No differences were found in the ß-cell functionality of NOBs, TOBs and FOBs. CONCLUSIONS: Persistent and recent obesity are both related to IR, NAFL and a decline of ß-cell function in emerging adulthood. Defeating obesity in childhood or adolescence allows reaching emerging adulthood with ß-cell functioning similar to that of subjects who were NOB.

Eating behavior and body composition in Chilean young adults.

BACKGROUND: Notable weight gain is observed during young adulthood, compared to other adult age groups, yet the relation between eating behavior and body composition at this stage remains poorly understood. OBJECTIVE: The aim of this cross-sectional study was to assess the association between eating behavior scores (cognitive restraint, uncontrolled eating, and emotional eating), and body composition in a sample of Chilean young adults. METHODS: Logistic and linear regression models assessed the independent associations between cognitive restraint, uncontrolled eating, and emotional eating, derived from the Three Factor Eating Questionnaire-R18, and body mass index (BMI), percent body fat by dual-energy X-ray absorptiometry, and central obesity, accounting for demographic covariates, stratified by sex, in a sample of 555 participants of the Santiago Longitudinal Study (mean age 22.6 years [SD 0.4]). RESULTS: Cognitive restraint was positively associated with obesity, defined by BMI, % body fat, and central obesity. Emotional eating was related to obesity, defined by % body fat and central obesity in men and women and to obesity, defined by BMI, in women. Cognitive restraint was related to BMI in men and % body fat in women. Uncontrolled eating was not associated with adiposity in men or women. CONCLUSIONS: In Chilean young adults, cognitive restraint and emotional eating scores were associated with higher BMI, elevated percent body fat, and greater central obesity.

Pathways to inflammation in adolescence through early adversity, childhood depressive symptoms, and body mass index: A prospective longitudinal study of Chilean infants.

Early adversity, depression, and obesity are associated with increases in low-grade inflammation. However, there are few prospective and longitudinal studies to elucidate how these associations unfold in children. The present study used latent growth curve models to examine pathways between family adversity in infancy, depressive symptoms in childhood, body mass index (BMI) in childhood, and inflammation in adolescence (age = 16-18). The study is an adolescent follow-up of infants from working-class communities around Santiago, Chile, who participated in a preventive trial of iron supplementation at 6 months of age. Anthropometrics, stressful life events, maternal depression, socioeconomic status, and developmental assessments were measured at 12 months, 5 years, 10 years, and adolescence. In adolescence, participants provided blood samples for high-sensitivity C-reactive protein (hsCRP) assessment. Greater exposure to early adversity in the form of interpersonal conflict stress in infancy indirectly associated with increased hsCRP through its association to increased intercept and slope of childhood BMI. Depressive symptoms at any time were not directly or indirectly associated with increased hsCRP. These findings contribute to our understanding of how early family adversity and its associations with obesity and depressive symptoms across childhood are linked to low-grade, chronic inflammation in adolescence. The model identified as best capturing the data supported the pivotal role of childhood BMI in explaining how early-life adversity is associated with inflammation in adolescence.

Sensitive periods for psychosocial risk in childhood and adolescence and cardiometabolic outcomes in young adulthood.

Greater psychosocial risk in childhood and adolescence predicts poorer cardiometabolic outcomes in adulthood. We assessed whether the timing of psychosocial risk from infancy through adolescence predicts cardiometabolic outcomes in young adulthood. Young adults and their mothers participated in a longitudinal study beginning in infancy in Santiago, Chile (N = 1040). At infancy, 5 years, 10 years, and adolescence, mothers reported on depressive symptoms, stressful experiences, support for child development in the home, father absence, parental education, and socioeconomic status (SES) to create a psychosocial risk composite at each time point. Young adults (52.1% female; 21-27 years) provided fasting serum samples and participated in anthropometric and blood pressure (BP) assessments, including a dual-energy X-ray absorptiometry (DXA) scan for measuring body fat. Greater infant psychosocial risk was associated with a greater young adult metabolic syndrome score (ß = 0.07, 95% confidence intervals (CI): 0.01 to 0.13, p = 0.02), a higher body mass index and waist circumference composite (ß = 0.08, 95% CI: 0.03 to 0.13, p = 0.002), and a higher body fat (DXA) composite (ß = 0.07, 95% CI: 0.01 to 0.12, p = 0.02). No psychosocial risk measure from any time point was associated with BP. Infant psychosocial risk predicted cardiometabolic outcomes in young adulthood better than psychosocial risk at 5 years, 10 years, or adolescence, mean of psychosocial risk from infancy through adolescence, and maximum of psychosocial risk at any one time. Consistent with the Developmental Origins of Health and Disease model, findings suggest that infancy is a sensitive period for psychosocial risk leading to poorer cardiometabolic outcomes in young adulthood.

A waist-to-height ratio of 0.54 is a good predictor of metabolic syndrome in 16-year-old male and female adolescents.

BACKGROUND: We aimed to determine the sensitivity and specificity of selected anthropometric indicators as predictors of cardiovascular risk in adolescents. METHODS: Cross-sectional study in 678 adolescents (16.8 y ± 0.3) from an infancy cohort. Weight, height, waist circumference (WC), and hip circumference were measured. Body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were estimated. MetS was diagnosed with IDF/AHA/NHLBI. Optimal cutoffs of BMI, WC, WHR, and WHtR for diagnosing MetS were determined using ROC analysis. RESULTS: In males, WHtR (0.96) had the greatest area under the ROC curve, followed by WC (0.95) and BMI (0.93). In females, BMI (0.84) had the greatest area under the ROC curve (0.84), followed by WHtR (0.83) and WC (0.83). In both sexes, the optimal WHtR cutoff for MetS diagnosis was 0.54. A BMI of 26.9 in males and 26.3 in females were the optimal cutoffs for diagnosing MetS. Finally, WC values of 92 and 81.6 cm in males and females, respectively, were the optimal cutoffs for MetS diagnosis. CONCLUSIONS: In both sexes, a WHtR value of 0.54 was a good predictor of MetS. In males and females, the optimal cutoff of BMI for Mets diagnosis was below the values for diagnosing obesity.

Long-term vs. recent-onset obesity: their contribution to cardiometabolic risk in adolescence.

BACKGROUND: The contribution of long-term vs. recent-onset obesity to cardiometabolic risk in adolescence remains controversial. Here, we aimed to investigate the association of time of onset and length of obesity with the cardiometabolic profile of adolescence. METHODS: Prospective study in 678 16-year-olds. BMI was measured at birth-1-5-10-16 years and BMI trajectories were interpolated using cubic splines. BMI > 2 SD at <6 years was defined as early obesity. Waist circumference (WC), blood pressure, lipid and glucose profiles were measured at 16 years. A cardiometabolic risk score was computed (MetS_score). According to the BMI trajectory, four groups were defined: participants who were never obese (NOB), participants with obesity during adolescence (recent-onset obese (ROB)), participants who were obese in early childhood but transitioned to normal/overweight as preadolescents (formerly obese (FOB)), and participants who were obese in early childhood and remained obese (persistently obese (POB)). RESULTS: ROBs and POBs had significantly unhealthier cardiometabolic profile than NOBs. No differences were observed in the cardiometabolic profile of ROBs compared to POBs. Although FOBs had higher WC and MetS_score than NOBs, no differences were found in other biomarkers. FOBs were in healthier cardiometabolic condition than ROBs and POBs. CONCLUSIONS: Both long-term and recent-onset obesity increase the cardiometabolic risk in adolescents.

Physically active Chilean school kids perform better in language and mathematics.

We examined the association between the engagement in regular physical activity (PA) and the academic performance (AP) of school-age children from Santiago Metropolitan Region. In a random sample of 1271 students (13.3 ± 2.3 years old) we measured regular PA, accounting for hours of weekly scheduled exercise, and AP, using national standardized tests scores in Language and Mathematics. Bivariate and multivariate regression analyses were used to model the relation between academic and health-related behaviors. Two outcomes were considered: (i) sufficiency according to the Ministry of Education and (ii) discretionary sufficiency (tests z-scores ≥50th percentile). About 80% of students were poorly engaged in scheduled exercise (<2 h per week). Devoting more than 4 h per week to scheduled exercise significantly increased the odds of reaching the official and discretionary sufficiency in both Language and Mathematics. Moderate engagement (2-4 h per week) just improved the odds of reaching the discretionary sufficiency standard. These results confirm the poor engagement in regular exercise at the school level. School kids with the highest allocation of time to scheduled exercise have better AP in Language and Mathematics. Our findings support the notion that academic and health-related behaviors are linked and, similarly, that school health programs may have positive effects on educational outcomes.

Nutritional quality of diet and academic performance in Chilean students.

OBJECTIVE: To explore associations between the nutritional quality of diet at age 16 years and academic performance in students from Santiago, Chile. METHODS: We assessed the nutritional quality of diet, using a validated food frequency questionnaire, in 395 students aged 16.8 ± 0.5 years. Depending on the amount of saturated fat, fibre, sugar and salt in the foods, diet was categorized as unhealthy, fair or healthy. Academic performance was assessed using high school grade-point average (GPA) and tests for college admission in language and mathematics. Academic results on or above the 75th percentile in our sample were considered good academic performance. We tested associations between nutritional quality of diet and good academic performance using logistic regression models. We considered sociodemographic, educational and body-mass index (BMI) factors as potential confounders. FINDINGS: After controlling for potential confounding factors, an unhealthy diet at age 16 years was associated with reduced academic performance. Compared to participants with healthy diets, those with unhealthy diets were significantly less likely to perform well based on language tests (odds ratio, OR: 0.42; 95% confidence interval, CI: 0.18-0.98) mathematics tests (OR: 0.35; 95% CI: 0.15-0.82) or GPA (OR: 0.22; 95% CI: 0.09-0.56). CONCLUSION: In our sample, excessive consumption of energy-dense, low-fibre, high-fat foods at age 16 years was associated with reduced academic performance.

High cardiometabolic risk in healthy Chilean adolescents: associations with anthropometric, biological and lifestyle factors.

OBJECTIVE: To analyse the prevalence of cardiovascular risk factors in healthy adolescents of low to middle socio-economic status and to study the influence of anthropometric, biological and lifestyle factors on the risk of metabolic syndrome (MetS). DESIGN: Cross-sectional study. BMI, waist circumference, blood pressure, fat and lean mass (by dual-energy X-ray absorptiometry), TAG, HDL-cholesterol, glucose, insulin, homeostatic model assessment-insulin resistance index (HOMA-IR), food intake and physical activity were measured. Cardiovascular risk factors were defined using the International Diabetes Federation criteria and insulin resistance using HOMA-IR ≥2.6. Bivariate and multivariate regressions examined the associations between MetS and anthropometric, biological and lifestyle factors. SETTING: Observational cohort study including Chilean adolescents, who were part of a follow-up study beginning in infancy. SUBJECTS: Adolescents aged 16-17 years (n 667). RESULTS: In the sample, 16.2% had obesity and 9.5% had MetS. Low HDL-cholesterol (69.9%), abdominal obesity (33.3%) and fasting hyperglycaemia (8.7%) were the most prevalent cardiovascular risk factors. In males, obesity (OR=3.7; 95% CI 1.2, 10.8), insulin resistance (OR=3.0; 95% CI 1.1, 8.2), physical inactivity (OR=2.9; 95% CI 1.1, 7.7) and sarcopenia (OR=21.2; 95% CI 4.2, 107.5) significantly increased the risk of MetS. In females, insulin resistance (OR=4.9; 95% CI 1.9, 12.6) and sarcopenia (OR=3.6; 95% CI 1.1, 11.9) were significantly associated with MetS. CONCLUSIONS: High prevalences of obesity, abdominal obesity, dyslipidaemia, fasting hyperglycaemia and MetS were found in healthy adolescents. In both sexes, sarcopenia and insulin resistance were important risk factors of MetS. Promotion of active lifestyles at the school level and regulation of the sale of energy-dense foods are needed.

The relationship between unhealthy snacking at school and academic outcomes: a population study in Chilean schoolchildren.

OBJECTIVE: We examined the association between unhealthy snacking at school and academic outcomes in students from the Santiago Metropolitan Region (Chile). DESIGN: Cross-sectional population-based study. SETTING: We measured the nutritional quality of snacks at school using an FFQ, and accounting for the amounts of saturated fat, fibre, sugar and salt in the foods, and academic outcomes using national standardized test scores in Language and Mathematics. Multivariate regression analyses modelled the relationship between unhealthy snacking at school (exposure), potential confounders and performance in Mathematics and Language (outcomes). SUBJECTS: Random sample of 1073 students (13.1 (SD 2.3) years old) attending public, partially subsidized and private schools. RESULTS: Fifty-six per cent of students ate items at snack time that were high in fat, sugar, salt and energy, and thus were considered to have unhealthy snaking. Thirty-six per cent and 8% were considered to have poor-to-fair and healthy snacking, respectively. Unhealthy snacking significantly lowered the odds of good academic performance in both domains. Students having unhealthy snacks were 56% less likely to pass in Language (fully adjusted OR = 0.44; 95% CI 0.23, 0.85) and 66% less likely to pass in Mathematics (fully adjusted OR = 0.34; 95% CI 0.19, 0.64) compared with students having healthy snack items. CONCLUSIONS: Schoolchildren eating unhealthy foods at snack time had worse academic performance in Language and Mathematics, as measured by a standardized test. Although association does not imply causation, these findings support the notion that academic and health-related behaviours are linked. More research is needed on the effect of school health programmes on educational outcomes.

Achievement in mathematics and language is linked to regular physical activity: a population study in Chilean youth.

We examined the association between the allocation of time to regular physical activity (PA) and achievement in mathematics and language in Chilean adolescents after controlling for confounders. In a random sample of 620 ninth graders (15.6 ± 0.7 years old), we measured regular PA, including physical education and sports extracurricular activities, and academic performance, using national standardised tests. Bivariate and multivariate regression analyses modelled the relation between academic and health-related behaviours. Sufficiency and proficiency in mathematics and language were used as outcome variables. Only 18% of adolescents had >4 h·week(-1) of regular PA. Devoting >4 h · week(-1) to regular PA significantly increased the odds of sufficiency and proficiency in both domains. After full adjustment, the odds of sufficiency and proficiency in mathematics increased by 1.9 (95% CI: 1.1-3.5) and 2.7 (95% CI: 1.7-4.3), respectively. Similarly, the odds of sufficiency and proficiency in language increased by 3.3 (95% CI: 1.7-9.7) and 2.6 (95% CI: 1.6-4.1), respectively. Adolescents with the highest allocation of time to regular PA performed much better in mathematics and language than inactive students. The academic benefits associated with PA can help to promote sustained behaviour changes regarding lifestyles. They can be more easily perceived as gains than health benefits alone.

Associations between Adolescent Alcohol Use and Neurocognitive Functioning in Young Adulthood.

This study examined the associations between excessive alcohol intake during adolescence and neurocognitive functioning in young adulthood and whether these relations varied by sex. Participants were working-class Chilean adolescents (N = 692; Mage 16.0 years; 54.5% female) who provided frequency of past 30-day bingeing and past-year intoxication. Neurocognitive measures were completed in young adulthood (Mage 21.2 years). Illicit substance users were excluded a priori and other substance use was controlled. When males and females were considered simultaneously, no main effects of intoxication or bingeing were found. However, several sex-specific effects emerged for intoxication, such that more frequent intoxication was associated with poorer visual memory, attention, processing speed, response inhibition, and cognitive flexibility in females, while frequent intoxication related to better attention and processing speed in males. In general, effect sizes were small. No relations emerged for verbal memory, working memory, or spatial learning. Possible factors that contribute to divergent sex effects are discussed.

A Single-Point Insulin Sensitivity Estimator (SPISE) of 5.4 is a good predictor of both metabolic syndrome and insulin resistance in adolescents with obesity.

Background: The Single-Point Insulin Sensitivity Estimator (SPISE) is a biomarker of insulin sensitivity estimated using BMI and triglycerides and high-density lipoprotein cholesterol. We assessed the accuracy of SPISE to screen obesity-related cardiometabolic risk in children and adolescents. Method: Cross-sectional validation study for a screening test in a sample of n=725 children and adolescents from an obesity clinic. Weight, height, waist circumference, blood arterial pressure, lipid profile, glucose, insulin and Tanner stage were measured. BMI, BMI for-age-and sex (BAZ), and HOMA-IR were estimated. HOMA-IR values ≥2.1 and ≥3.3 were considered IR in Tanner I-II, ≥3.3 for Tanner III-IV and ≥2.6 for Tanner V, respectively. Metabolic Syndrome (MetS) was diagnosed with the Cook phenotype. SPISE was estimated according to the following algorithm: [600* HDL^0.185/(TG^0.2* BMI^1.338)]. The optimal SPISE cut points for IR and MetS prediction were determined by ROC curve analysis. Results: In prepubertal obese patients (9.2 ± 2.1y; 18.4% males), the prevalence of IR and MetS was 28.2% y 46.9%, respectively; 58% had severe obesity (BAZ ≥4 SD). In pubertal obese patients (12.6 ± 1.8y; 57% males), the prevalence of IR and MetS was 34.1% and 55.3%, respectively; 34% had severe obesity. In prepubertal children, a SPISE of 6.3 showed the highest sensitivity (73.2%) and specificity (80%) to screen individuals with IR (AUC: 0.80; LR +: 3.3). Likewise, a SPISE of 5.7 got the highest sensitivity (82.6%) and specificity (86.1%) to screen patients with MetS (AUC: 0.87; LR +: 5.4). In pubertal patients, a SPISE of 5.4 showed the highest sensitivity and specificity to screen children and adolescents with both IR (Sn: 76.1%; Sp: 77.5%; AUC: 0.8; LR +: 3.1) and MetS (Sn: 90.4%; Sp: 76.1%; AUC: 0.90; LR +: 3.5). Conclusion: In children and adolescents with obesity, SPISE has good or very good performance in predicting IR and MetS. SPISE may be considered a relatively simple and low-cost diagnosis tool that can be helpful to identify patients with greater biological risk. In adolescents with obesity, the same cut point allows identification of those at higher risk of both IR and MetS.

Breastfeeding Duration and Timing of Bottle Supplementation: Associations with Body Mass Index from Childhood to Young-Adulthood.

Evidence for the association between breastfeeding (BF) duration and later body mass index (BMI) is inconsistent. We explored how BF duration and BF type (exclusive or partial) related to BMI from childhood to young adulthood in a Chilean cohort. Infants were recruited at 6 months between 1994 and 1996 in Santiago, Chile (n = 821). Mothers reported date of first bottle and last BF; anthropometry was measured at 1, 5, 10, 16, and 23 years. We tested whether: (1) type of BF at 6 months (none, partial, exclusive) and (2) duration of exclusive BF (<1 month, 1 to <3 months, 3 to <6 months, and ≥6 months) related to BMI. At 6 months, 35% received both breastmilk and formula ("partial BF") and 38% were exclusively breastfed. We found some evidence of an association between longer BF and lower BMI z-scores at young ages but observed null effects for later BMI. Specifically, BF for 3 to <6 months compared to <1 month related to lower BMI z-scores at 1 and 5 years (both p < 0.05). Our results are in partial accordance with others who have not found a protective effect of longer BF for lower BMI.

Resolving early obesity leads to a cardiometabolic profile within normal ranges at 23 years old in a two-decade prospective follow-up study.

Obesity is the most important predisposing factor for cardiovascular disease and type-2 diabetes. We explored the relationship between the age at onset of obesity and selected cardiometabolic parameters in young adults. Longitudinal study of n = 1,039 participants (48% males) in their early twenties. BMI was measured at birth, 1-5-10-12-14-16-23 years. BMI trajectories were interpolated. Five groups were identified: never obese (never-OB); early childhood obesity transitioning to non-obesity before adolescence (former-OB); obesity starting in preadolescence transitioning to non-obesity as adolescents (transient-OB); obesity from adolescence into early adulthood (recent-onset-OB); participants who were obese in early childhood and remained obese into adulthood (persistent-OB). Waist circumference (WC), blood pressure, lipids, glucose, and insulin were measured at 23 years. HOMA-IR and the Metabolic Syndrome Risk Z-Score were estimated. In the sample, 47% were obese during at least one time-point. Mean obesity duration was 20.7 years, 8.5 years, 6.2 years, and 3.3 years in persistent-OBs, recent-onset-OBs, former-OBs, and transient-OBs, respectively. The cardiometabolic profile was more adverse in recent-onset-OBs (12%) and persistent-OBs (15%) compared to never-OB participants (53%). Although former-OBs (15%) and transient-OBs (4%) had higher WC values than never-OBs, no differences were seen in other biomarkers. Both persistent and recent-onset obesity led to a cardiometabolic profile of risk in early adulthood, as suggested by values of WC, HOMA-IR, and hs-CRP above normal limits and HDL-chol values below normal limits. Participants who had obesity in early childhood or preadolescence but transitioned to a non-obesity status had a cardiometabolic profile similar to participants who were never obese and within normal limits. Obesity leads to risky values in a number of cardiometabolic biomarkers in young adulthood independent of age at obesity onset. Likewise, overcoming obesity during the pediatric age leads to a cardiometabolic profile within normal ranges at 23 years of age.

Validity assessment of the single-point insulin sensitivity estimator (spise) for diagnosis of cardiometabolic risk in post-pubertal hispanic adolescents.

Insulin measurements are not advised for cardiometabolic risk screening in large groups. Here we assessed the accuracy of the single-point insulin sensitivity estimator (SPISE) to diagnose cardiometabolic risk in Chilean adolescents. In 678 post-pubertal adolescents (52% males, M(SD) age = 16.8 (0.2) years), height, weight, waist circumference, blood lipids, glucose, insulin, and blood pressure were measured. BMI, HOMA-IR, and SPISE were estimated; HOMA-IR values ≥ 2.6 were considered insulin resistance (IR). Metabolic syndrome (MetS) was defined with the joint IDF/AHA/NHBLI standard. Using receiver operating characteristic curves, we obtained optimal SPISE cutpoints for IR and MetS diagnosis. The prevalence of MetS and IR was 8.2% and 17.1%, respectively. In males, the optimal cutoff for MetS diagnosis was 5.0 (sensitivity: 97%; specificity: 82%), and the optimal cutoff for IR diagnosis was 5.9 (sensitivity: 71%; specificity: 83%). In females, a SPISE of 6.0 had the highest sensitivity (90%) and specificity (74%) for MetS diagnosis. A SPISE of 6.4 was the optimal cutoff for IR diagnosis; however, sensitivity and specificity were 61% and 75%. In males and female post-pubertal adolescents, SPISE had a very good and good diagnostic performance, respectively, in predicting MetS. It was an accurate diagnostic tool for IR prediction in males, but not necessarily in females.